The role of alternative reinforcers in smoking outcomes among people with and without HIV.

Abstract

Objective: People with HIV (PWH) smoke at higher rates than people without HIV (PWOH). Alternative reinforcers, or behaviors that replace (substitute reinforcers) or maintain (complementary reinforcers) smoking, are associated with smoking outcomes but have not been studied among PWH. This observational study assessed whether alternative reinforcers changed during a quit attempt among PWH and PWOH and whether the associations differed between groups.

Method: The parent study included 274 participants (93 PWH and 181 PWOH) who sought treatment for smoking cessation in a 12-week program. The present analyses were limited to 173 (73 PWH and 100 PWOH) study completers. The primary outcomes were changes in substitute and complementary reinforcers at the end of treatment (EOT; week 12) measured using the Pleasant Events Schedule. We performed linear regressions in the overall sample and then stratified by HIV status for each alternative reinforcer. The time (baseline; week 0 vs. EOT) by smoking status at EOT (abstinent vs. nonabstinent) interaction was tested.

Results: Self-reported substitute reinforcers increased significantly over time, but this was not associated with smoking or HIV status (ps > .05). Self-reported complementary reinforcers decreased over time, and this decline was greater among abstinent compared to nonabstinent PWH (b = -13.15, z = -2.04, 95% confidence interval [-25.77, -0.53], p = .04).

Conclusions: Declines in complementary reinforcers were associated with smoking cessation outcomes among PWH. These findings partially support results from prior literature, suggesting that addressing complementary reinforcers during smoking cessation treatment may be crucial in improving quit rates among PWH. (PsycInfo Database Record (c) 2025 APA, all rights reserved).