Access Type

Open Access Dissertation

Date of Award

January 2016

Degree Type


Degree Name




First Advisor

Paul A. Toro


The rate of cigarette smoking is three-fold higher among adults living with Human Immunodeficiency Virus (HIV)/Autoimmune Deficiency Syndrome (AIDS) than in the general population (Centers for Disease Control and Prevention, 2015). Relative to non-smoking HIV-positive adults, HIV-positive cigarette smokers have even higher mortality rates, more physical health problems, greater tobacco-related health disparities, lower quality of life, and more barriers to treatment. These barriers are often interrelated with the significantly higher rate of trauma and violence exposure reported in both cigarette smokers and persons living with HIV/AIDS (PLWHA; CDC). Violence exposure not only predicts emotional distress and substance use, but also mediates between victimization and cigarette use (e.g., Feldner, Babson, & Zvolensky, 2007). Psychological and physical trauma additionally impact both short and long-term substance use treatment outcomes, independent of treatment modality (e.g., Ford et al., 2007). Though social support is consistently linked to both smoking behaviors, and mental and behavioral outcomes for PLWHA, few studies have examined the role of social support in smoking treatment among this population. Additionally, no studies have explored social and individual-level protective and risk factors in the context of a contingency management smoking cessation treatment design. The aim of this study was to examine how different risk and protective factors affect cessation outcomes among PLWHA undergoing contingency-based treatment for cigarette smoking. Specifically, this study explored how different components of violence (community and interpersonal partner violence), distress, life satisfaction, and social support affect cigarette use and cessation success. Study findings showed that intimate partner violence predicted increased initial change in cigarette use, while community violence predicted reduced initial motivations for quitting smoking. Increased depression scores predicted both initial and total treatment change in withdrawal experience. Findings have implications for the assessment of and therapeutic approaches to smoking cessation for smokers living with HIV/AIDS.