Food Insecurity Impacts Smoking Cessation and Tobacco Dependence in HIV Smokers

Purpose: Quitting smoking is critical for improving the survival of people living with HIV (PWH) including reducing cancer risk, yet HIV+ smokers face many challenges to cessation. Food insecurity may exacerbate tobacco dependence and readiness to quit, thereby complicating cessation efforts among PWH. However, the overlap between food insecurity and tobacco use, including cessation, among PWH is understudied. This study examines the relationship between food security and cessation outcomes, and key variables critical to cessation—tobacco dependence and readiness to quit—among PWH who smoke. Methods: We surveyed HIV+ smokers enrolled in tobacco use treatment at 5 HIV clinics in Hanoi, Vietnam between November 2021 and June 2022. We assessed food security status using the Household Food Insecurity Access Scale (HFIAS). Smoking cessation was evaluated using self-reported 7-day abstinence at 6-months post-intervention, which was confirmed biochemically by expired-air carbon monoxide (CO) measurements (<10 ppm) from all participants who self-reported quitting. We used a longitudinal survey design to test associations between baseline food security status, tobacco dependence and readiness to quit, and baseline food insecurity and 6-month cessation status. Results: Of 182 PWH who smoke, 25 (13.7%) experienced food insecurity. Food insecure participants were more likely to have high dependence (76% vs. 41%; RR = 1.86; 95% CI: 1.40–2.49) and less likely to be ready to quit (28% vs. 62%; RR = 0.45; 95% CI: 0.24–0.86). Participants with food insecurity were less likely to achieve abstinence from smoking at 6 months (4% vs. 17%; RR = 0.24; 95% CI: 0.03–1.70), although this difference was not statistically significant (p = 0.133 by Fisher’s Exact test). Conclusion: This study highlights the potential impact of food insecurity on two key factors important for smoking cessation: tobacco dependence and readiness to quit. Although the small sample size of the group reporting food insecurity limits statistical power, particularly for the cessation outcome, the data are compatible with strong negative effects of food insecurity on cessation success. Understanding how food insecurity interacts with these factors can help identify barriers to cessation and guide adaptations to tobacco use treatment for food-insecure PWH, addressing this common three-way burden in low- and middle-income countries. Citation Format: Gloria Guevara, Reet Kapur, Trang Nugyen, Nam Nugyen, Yesim Tozan, Lloyd Goldsamt, Charles Cleland, Mari Armstrong-Hough, Niyati Parekh, Donna Shelley. Impact of Food Insecurity on Smoking Cessation–Related Factors of Tobacco Dependence and Readiness to Quit Among HIV+ Smokers in Vietnam: An Exploratory Analysis [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 80.