Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Dr. Karen S. Ingersoll

Second Advisor

Dr. Sandra E. Gramling


Hepatitis C is the most common chronic blood-borne infection in the United States. Research has focused on contributing factors to the development and progression of liver disease, but few studies have considered nicotine use as a potential prognostic factor with CHC. Research has commonly found that CHC patients report with a diminished quality of life. Several factors have been proposed to account for a decrease in QOL; however, the mechanisms underlying the impairment in QOL have not yet been elicited. 76 CHC patients completed self-report measures on a variety of psychosocial variables and biochemical data for determining the patient's liver disease severity was obtained. The findings revealed strong support for the deleterious effects of smoking cigarettes on liver disease symptomatology and its progression. Smokers endorsed experiencing significantly more severe symptoms of fatigue, poor appetite, and headaches. The CHC smokers tended to present with higher scores on the Aspartate Arninotransferase to platelet ratio index (APRI). The smokers' mean score is above the cut-off value of 1.50 that indicates a .88 predictive value for the presence of hepatic fibrosis. The level of cigarette consumption could also be a factor in the progression of liver disease. Individuals smoking more than one pack per day tended to report more severe symptoms of fatigue and a poorer appetite. Heavy smokers presented with an APRI mean score above the cut-off value of 2.00 that indicates a .93 negative predictive value for the presence of cirrhosis below the cut-off value.General active coping moderated the relationship between liver disease severity and QOL. The results revealed that patients using more avoidant coping reported lower levels of QOL on the physical and mental component of the SF-36. Tobacco use moderated the relationship between liver disease severity and QOL. Interestingly, smokers reported a higher level of QOL compared to nonsmokers when experiencing more severe liver disease. CHC patients with higher levels of psychological distress reported lower QOL on both physical and mental functioning. Individuals smoking marijuana also tended to report lower levels of QOL on mental functioning. Information garnered from this study is aimed to help slow the progression of advanced liver disease in CHC patients in addition to improving their QOL.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Psychology Commons