Technology Access, Pattern of Use, Interest in Digital Health, and Barriers to Tobacco Treatment Among HIV-Infected Smokers From Under-Resourced Communities: A Cross-Sectional Study.

Abstract

Background: Cigarette smoking remains a major public health concern among people living with HIV (PLWH), particularly those from under-resourced communities. Digital health may improve access to cessation support, yet its potential among this population remains understudied.

Objective: This study explored barriers to quitting smoking and evaluated the potential of digital health for tobacco treatment among PWLH smokers.

Methods: We surveyed 205 PLWH who smoked cigarettes (45.4% female; mean age 51.2 years; response rate 92.3%) to examine smoking behaviors, cessation barriers, technology access, use pattern, and interest in digital health for tobacco treatment. Multivariable logistic regression models were employed to assess how demographics and smoking behaviors influence interest in using digital health (phone calls, text messages, smartphone applications, or combinations) for tobacco treatment.

Results: Participants were primarily racial and ethnic minorities, including 55.1% non-Hispanic Black and 34.2% Hispanic individuals, with 74.4% earning less than $10,000 annually. Most participants reported previous quit attempts (76.5%). Common barriers to quitting included difficulty managing cravings (45.4%), cost of treatment (28.8%), and limited access to care (25.9%), while depression (58.9%) and risky alcohol use (39.6%) were also prevalent. Access to technology was high: 91.7% owned a cell phone, 61.0% owned a smartphone, and 63.9% reported internet access. Among smartphone owners, 74.0% used mobile applications. Phone calls were the most preferred single digital health modality for tobacco treatment (51.7%), followed by text messaging (43.9%), smartphone applications (39.0%), and video conferencing (38.5%). Preferred intervention methods included mindfulness strategies (73.0%), nicotine replacement therapy (71.1%), and counseling (63-65%). Non-Hispanic Black and non-heterosexual participants showed significantly higher interest in digital health for tobacco treatment, with aOR 5.49 (1.44 - 20.90) and 6.02 (1.46 - 24.82), respectively.

Practice implications: Despite barriers, PLWH smokers are interested in digital health for tobacco treatment. Incorporating digital tools could improve access and reduce disparities in this population.