Carolyn Springer

Tobacco Use and Readiness to Quit Smoking in Low-Income HIV-Infected Persons

The study aim was to identify covariates of smoking status and readiness to quit that encompassed key sociodemographic and health status variables, health-related quality of life, drug use and unprotected sex, and tobacco use variables in a cohort of low-income persons living with HIV. We also examined the impact of HIV diagnosis on smoking cessation. The sample (N = 428) was mostly male (59%) and Black (53%) or Hispanic (30%), and had a high school education or less (87%). Mean age was 40 years. Two-thirds of participants were current smokers, 19% former smokers, and 16% never smokers. Current smokers smoked a mean of 16 cigarettes/day for 22 years; 42% were in the precontemplation stage of readiness to quit smoking, 40% were contemplators, and 18% were in preparation. Most current smokers (81%) reported receiving medical advice to quit smoking. Multivariate logistic regression analyses indicated that current smokers, compared with former smokers, were more likely to use illicit drugs, perceive a lower health risk for continued smoking, and report less pain. Current smokers, compared with nonsmokers (former and never smokers), were more likely to report greater illicit drug use in their lifetime, current illicit drug use, and less pain. A multiple linear regression indicated that greater current illicit drug use, greater emotional distress, and a lower number of quit attempts were associated with lower stage of readiness to quit smoking. These findings confirm a high prevalence of smoking among HIV-infected persons and suggest a complex interplay among drug use, pain, and emotional distress that impact smoking status and, among smokers, readiness to quit. Tobacco control programs for HIV-infected persons should build motivation to quit smoking and address salient barriers to cessation--such as comorbid drug use, emotional distress, pain, and access to and coverage for treatment--and should educate smokers regarding the HIV-specific health benefits of cessation.

Housing Status and Health Care Service Utilization Among Low-income Persons with HIV/AIDS

AbstractOBJECTIVE: To examine the impact of housing status on health service utilization patterns in low-income HIV-infected adults. DESIGN: A survey of 1,445 HIV-infected Medicaid recipients in New York State between April 1996 and March 1997. MAIN RESULTS: Six percent of study participants were homeless, 24.5% were “doubled-up,” and 69.5% were stably housed. Compared with the stably housed, doubled-up and homeless participants were less likely to be seeing a physician regularly (P=.0001), and if seeing a physician, they were likely to have been doing so for a significantly shorter time (P=.02). The homeless were also less likely than either stably housed or doubled-up individuals to see the same physician or group of physicians at each ambulatory visit (P=.007). In addition, a higher proportion of the homeless had made one or more hospital visits over the prior 3 months than the nonhomeless. After multivariate adjustment, doubled-up participants were found to make more emergency room visits, the homeless were less likely to be taking prophylaxis for Pneumocystis carinii pneumonia, and both the doubled-up and the homeless were shown to use slightly more outpatient care than the stably housed. CONCLUSION: Our study documents differences in health care utilization patterns across stably housed, doubled-up, and homeless HIV-infected persons after controlling for health insurance coverage. These differences, especially those pertaining to outpatient services, suggest that the unstably housed may be receiving less adequate health care than the stably housed, and hence may be more likely to experience adverse clinical outcomes.

The relationship between perceptions of caregiving and carer contributions in an interview situation with a partner with aphasia

Background: Caregiving places an emotional burden on the carer of the person with aphasia as the carer is likely not prepared psychologically, emotionally, or financially for caring for someone post stroke. The carer plays a major role in the recovery process of individuals with aphasia. There is limited research examining the carer’s communicative contributions in an interview situation as it relates to their perceptions of caregiving as well as the relationship to the functional communication skills of the person with aphasia. Aims: The aim of this study was to examine the carer’s perception of caregiving as it relates to their communication style and interaction with the person with aphasia in an interview situation. The functional communication skills of persons with aphasia were also examined in relationship to the carer’s communicative contributions. Methods & Procedures: Nine persons with aphasia and their carers participated in this study. Participants were administered a variety of measures including the Communication Activities of Daily Living-2 (CADL-2) to assess functional communication skills, a Spousal Intake Form to obtain participant history and other pertinent information, a Spousal Rating Scale to evaluate the person with aphasia’s current level of performance in certain areas, and The Carers of Older People in Europe index to explore carer’s perceptions of caregiving. Participants were interviewed and discussed their opinion on 6–8 issues (e.g., healthcare system, divorce, technology, poverty). All interviews were transcribed and coded for specific communication behaviours as outlined in a previous study. Outcomes & Results: The contributions most often used by carers in the interview situations were “speaking for,” revision and correction behaviours. Within this sample, repair of the interviewer’s turn, acknowledging difficulty, rejection, and ambivalent reaction, was not observed. When looking at carers’ perceptions, carers with higher perceived quality of support and used less assistance with word-finding contributions. Conclusions: There is a relationship between the carer’s communication style and perceptions of caregiving and the functional communication skills of persons with aphasia as evidenced by their raw scores on the CADL-2. In general, our results revealed that carers of persons with aphasia are active contributors in an interview situation when the person with aphasia is attempting to communicate. Also, the carer’s perceptions of caregiving impact the way in which they communicate with the person with aphasia.