{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T20:38:09Z","timestamp":1783024689057,"version":"3.54.6"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA240481"],"award-info":[{"award-number":["R01CA240481"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA240481"],"award-info":[{"award-number":["R01CA240481"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Tobacco use among people living with HIV (PWH) is 2\u20133 times higher than among HIV-negative individuals. In Viet Nam, over 50% of men living with HIV use tobacco. Reducing smoking is important to improving disparities among PWH who smoke including their higher exposure to chronic disease. However, data on tobacco spending as well as the potential impact of tobacco policies, such as taxation, is limited among PWH. Viet Nam has one of the lowest taxes on tobacco in the world, thus underutilizing this tool. Our study aims to understand tobacco spending among PWH who smoke as well as examine the financial burden of tobacco use, and their perceptions about the affordability of tobacco products.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted qualitative interviews (n\u2009=\u200924) that explored smoking behavior and perceptions about the cost of tobacco, alongside cross-sectional quantitative surveys (n\u2009=\u200975) that assessed daily tobacco expenditures and the proportion of income spent on tobacco. We applied convergent parallel design to these two independent samples taken from the same study population of PWH enrolled in a tobacco use treatment study at HIV clinics in Ha Noi, Viet Nam.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Participants spent 7.47% of their annual income on tobacco products. Tobacco dependence was positively associated with higher daily expenditure on tobacco. Qualitatively, participants did not describe tobacco-related spending as a financial burden and did not consider the price of cigarettes as a motivation to quit. However, participants acknowledged that smoking is still a costly expenditure and indicated that quitting would yield financial savings which could be redirected to other household needs.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Despite spending a considerable percentage of their income spent on tobacco, most participants perceived cigarettes as affordable. This may reflect our sample\u2019s strong socioeconomic resources as well as the low price of cigarettes in Viet Nam, which may be too low to cause financial hardship and thus reduce motivation to quitting.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0327490","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T17:49:13Z","timestamp":1751478553000},"page":"e0327490","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tobacco spending and the perceived cost of tobacco among smokers living with HIV and receiving treatment at outpatient clinics in Viet Nam: A mixed methods study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4939-9695","authenticated-orcid":true,"given":"Gloria","family":"Guevara 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Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test","volume":"158","author":"K Bush","year":"1998","journal-title":"Arch Intern Med"},{"issue":"9","key":"pone.0327490.ref041","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"H-F Hsieh","year":"2005","journal-title":"Qual Health Res"},{"issue":"11","key":"pone.0327490.ref042","article-title":"Comparing machine learning with case-control models to identify confirmed dengue cases","volume":"14","author":"T-S Ho","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0327490.ref043","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science","volume":"4","author":"LJ Damschroder","year":"2009","journal-title":"Implement Sci"},{"issue":"1","key":"pone.0327490.ref044","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s13012-016-0534-z","article-title":"Combined use of the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF): a systematic review","volume":"12","author":"SA Birken","year":"2017","journal-title":"Implement Sci"},{"issue":"7","key":"pone.0327490.ref045","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1037\/0003-066X.32.7.513","article-title":"Toward an experimental ecology of human development","volume":"32","author":"U Bronfenbrenner","year":"1977","journal-title":"American Psychologist"},{"issue":"1","key":"pone.0327490.ref046","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13012-017-0605-9","article-title":"A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems","volume":"12","author":"L Atkins","year":"2017","journal-title":"Implement Sci"},{"key":"pone.0327490.ref047","volume-title":"Multilevel barriers and facilitators to smoking cessation in people living with HIV in Vietnam: A qualitative analysis","author":"TH-L Hoang","year":"2024"},{"key":"pone.0327490.ref048","volume-title":"ATLAS.ti (version 8.4). 8.4 ed. 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