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Background <p>Smoking is more prevalent among people living with HIV (PLHIV) than in the general population, yet evidence on how electronic and conventional cigarette use relates to perceived stress among Filipino PLHIV remains limited. This study examined the association between electronic cigarette (EC) and/or conventional cigarette (CC) use and perceived stress levels (PSLs) among Filipino PLHIV receiving care in Metro Manila, Philippines.</p> Methods <p>We conducted a cross-sectional study among 220 Filipino male adults receiving HIV treatment at a community-led treatment hub in Metro Manila. Participants were categorized as never, CC only, EC only, or dual users, then dichotomized as never versus ever EC or CC use for regression analyses due to small cell counts. Perceived stress level (PSL) was assessed using the Perceived Stress Scale and summarized as low, moderate, or high. For regression analyses, we combined low and moderate stress and modeled high stress versus low-to-moderate stress due to the limited sample size. We estimated crude and adjusted prevalence ratios (PRs) for high PSLs using generalized linear models with Poisson distribution, log link function, and robust variance estimator. Adjusted models controlled for age, sexual orientation, relationship status, education, monthly income, history of respiratory illness, and diabetic and hypertensive status. Sensitivity to unmeasured confounding was assessed using E-values.</p> Results <p>Participants’ PSLs were low (15.5%), moderate (70.9%), and high (13.6%). Most participants were never EC/CC users (55.9%). In crude analyses, never EC/CC users had a higher prevalence of high PSLs than ever users (cPR 3.2; 95% CI 1.3–7.4). After adjustment for confounders, never users remained more likely to experience high PSLs (aPR 4.36; 95% CI 1.95–9.74). The E-value for the adjusted association was 8.19, indicating that an unmeasured confounder would need to be strongly associated with both smoking status and high PSLs to fully explain away the observed association.</p> Conclusions <p>Among Filipino PLHIV in this community-led treatment hub, never-users of EC/CC was associated with substantially higher perceived stress. These findings highlight the importance of strengthening stress-reduction and mental health supports, particularly for never-users, within HIV care settings, alongside comprehensive prevention and control strategies for tobacco and emerging nicotine products.</p>

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Association between electronic and conventional cigarette use and perceived stress levels among Filipino people living with HIV in a community-led treatment hub in Metro Manila, Philippines

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  • 发表日期：

    2026年5月24日

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  • Daniel B. Quizon,
  • Zypher Jude G. Regencia,
  • Emmanuel S. Baja

摘要

Background

Smoking is more prevalent among people living with HIV (PLHIV) than in the general population, yet evidence on how electronic and conventional cigarette use relates to perceived stress among Filipino PLHIV remains limited. This study examined the association between electronic cigarette (EC) and/or conventional cigarette (CC) use and perceived stress levels (PSLs) among Filipino PLHIV receiving care in Metro Manila, Philippines.

Methods

We conducted a cross-sectional study among 220 Filipino male adults receiving HIV treatment at a community-led treatment hub in Metro Manila. Participants were categorized as never, CC only, EC only, or dual users, then dichotomized as never versus ever EC or CC use for regression analyses due to small cell counts. Perceived stress level (PSL) was assessed using the Perceived Stress Scale and summarized as low, moderate, or high. For regression analyses, we combined low and moderate stress and modeled high stress versus low-to-moderate stress due to the limited sample size. We estimated crude and adjusted prevalence ratios (PRs) for high PSLs using generalized linear models with Poisson distribution, log link function, and robust variance estimator. Adjusted models controlled for age, sexual orientation, relationship status, education, monthly income, history of respiratory illness, and diabetic and hypertensive status. Sensitivity to unmeasured confounding was assessed using E-values.

Results

Participants’ PSLs were low (15.5%), moderate (70.9%), and high (13.6%). Most participants were never EC/CC users (55.9%). In crude analyses, never EC/CC users had a higher prevalence of high PSLs than ever users (cPR 3.2; 95% CI 1.3–7.4). After adjustment for confounders, never users remained more likely to experience high PSLs (aPR 4.36; 95% CI 1.95–9.74). The E-value for the adjusted association was 8.19, indicating that an unmeasured confounder would need to be strongly associated with both smoking status and high PSLs to fully explain away the observed association.

Conclusions

Among Filipino PLHIV in this community-led treatment hub, never-users of EC/CC was associated with substantially higher perceived stress. These findings highlight the importance of strengthening stress-reduction and mental health supports, particularly for never-users, within HIV care settings, alongside comprehensive prevention and control strategies for tobacco and emerging nicotine products.