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“I Thought Cancer was a Tobacco Issue”: Perspectives of Veterans with and without HIV on Cancer and Other Health Risks Associated with Alcohol and Tobacco/Nicotine Use

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Abstract

U.S. Veterans and people living with HIV (PWH) experience higher rates of unhealthy alcohol and tobacco/nicotine use than non-Veterans and people without HIV (PWoH). Both groups are susceptible to adverse health outcomes associated with alcohol and tobacco/nicotine use. We explored awareness of alcohol- and tobacco/nicotine-related cancer and immune health risks among Veterans Health Administration (VA) patients with and without HIV. Among a sample of 41 (46% PWH; 73% male; 39% Black) purposively-selected VA patients receiving care 2020–2021 we conducted semi-structured interviews via telephone; interviews were recorded, transcribed and analyzed using a Rapid Assessment Process. Purposive selection was based on HIV status, alcohol and/or tobacco/nicotine use, and demographics. Among participants, 66% reported current smoking, and most screened positive for unhealthy alcohol use. Participants had high awareness of cancer and other health risks related to smoking but low awareness of synergistic risks and cancer risks associated with alcohol use despite awareness of a range of other alcohol-related risks. Awareness of alcohol and/or tobacco/nicotine’s impacts on the immune system was variable. Findings did not distinctly differ between PWH and PWoH. Low awareness of alcohol-related cancer risk, risks of co-occurring use, and varying awareness of the impacts of alcohol and tobacco/nicotine on the immune system suggest a need for improved messaging regarding substance use-related cancer and immune risk. This may be especially important among PWH, for whom the prevalence and adverse effects of alcohol and tobacco use, and immune dysfunction are higher.

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Data Availability

The data are not publicly available to protect confidentiality. Requests to access the data should be sent to authors ESB and ECW.

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Acknowledgements

This research is supported by the National Cancer Institute (NCI, R01CA243907; Crothers, Catz & McClure, Multiple PI’s). The authors thank the Veterans who participated in the interviews.

Funding

This research is supported by the National Cancer Institute (NCI, R01CA243907; Crothers, Catz & McClure, Multiple PI’s).

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Authors and Affiliations

  1. Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 3980 15th Ave NE, Seattle, WA, 98105, USA

    Elsa S. Briggs, Rachel M. Thomas, Madeline C. Frost, Olivia V. Fletcher, Kristina Crothers, Clementine K. Chalal, Shahida F. Shahrir & Emily C. Williams

  2. Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA

    Elsa S. Briggs, Madeline C. Frost & Emily C. Williams

  3. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Kristina Crothers & Shahida F. Shahrir

  4. Center for Health Workforce Studies, Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Shahida F. Shahrir

  5. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Jennifer B. McClure

  6. Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA

    Jennifer B. McClure

  7. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA

    Sheryl L. Catz

Authors
  1. Elsa S. Briggs
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  2. Rachel M. Thomas
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  3. Madeline C. Frost
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  4. Olivia V. Fletcher
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  6. Clementine K. Chalal
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  7. Shahida F. Shahrir
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  8. Jennifer B. McClure
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  10. Emily C. Williams
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Contributions

ECW and SLC led study conception and design with contributions from KC and JBM. Material preparation, data collection and analysis were performed by ESB, RMT, MCF, OVF and CKC with supervision from ECW. The first draft of the manuscript was written by ESB and ECW and all authors commented on previous versions of the manuscript. The manuscript was finalized by ECW. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Elsa S. Briggs.

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Ethics Approval

All research activities were reviewed and approved by the VA Puget Sound Institutional Review Board.

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All participants provided verbal consent prior to enrollment.

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Briggs, E.S., Thomas, R.M., Frost, M.C. et al. “I Thought Cancer was a Tobacco Issue”: Perspectives of Veterans with and without HIV on Cancer and Other Health Risks Associated with Alcohol and Tobacco/Nicotine Use. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04363-6

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