Cost of Smoking among Homeless Adults

2011

To assess prevalence rates of tobacco use and dependence in a sample of homeless individuals and to investigate trends for demographic and clinical characteristics across different levels of nicotine dependence (nonsmokers vs. lowly dependent smokers vs. highly dependent smokers). A cross-sectional study of 489 homeless men and women in 3 Canadian cities. Each subject was assessed using structured clinical interviews and the Fagerström Test for Nicotine Dependence (FTND). Cochran-Armitage trend tests were applied to determine unadjusted trends in sociodemographic and clinical variables across levels of nicotine dependence. A generalized logit model was computed to adjust for potential confounding. The mean age was 37.9 years; 39.2% of the participants were women. About 80.8% were current smokers; the mean FTND score was 5.0. Although no significant differences were found between nonsmokers and smokers with low nicotine dependence, smokers with high nicotine dependence were only half as likely as nonsmokers to be Aboriginal, were 2.39 times more likely to have ever been incarcerated, and 2.44 times more likely to have current drug dependence. There were significant trends for the use of cocaine, opioids, and alcohol, with nonsmokers having the lowest and highly dependent smokers having the highest rates of using these substances. Available public health smoking cessation treatment opportunities should be made available within health care services for the homeless. There is also a need for developing and implementing tobacco dependence treatment programs, which are accessible and tailored to meet the needs of this specific population, accounting for polysubstance use and concurrent substance dependence and mental health disorders.

2015

Results: Seventy-three percent of adult homeless male respondents were current smokers, and 44% homeless male smokers smoked their first cigarette within five minutes of waking up. Smokers were significantly more likely to be African American than persons of white or other race. Analysis of the Fagerström Tests for Nicotine Dependence (FTND) revealed 41% homeless male smokers to be in the high nicotine dependence category. A majority of smokers displayed low motivation to quit and were either in the pre-contemplation (56.9%) or contemplation (16.3%) stage of change. Among homeless smokers, about 33% actively tried to limit smoking due to health concerns, and 16% were planning to quit in the next six months.

Tobacco Induced Diseases, 2018

BMC Public Health

Background Cigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among youth experiencing homelessness who use combustible tobacco in a Midwestern city to inform smoking cessation intervention. Methods This study included 96 youth (ages 14–24 years; 52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana, other product use characteristics (e.g., frequency, brand and flavor), and psychosocial predictors of more frequent (i.e., daily) use of combustible tobacco and marijuana. Results Most youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (n = 85, 88.5%), cigars (n = 89, 92.7%), and marijuana (n = 82, 85....

Journal of General Internal Medicine, 2002

This cross-sectional study sought to determine the prevalence of smoking, readiness to quit, and preferences for smoking cessation treatments among a sample of 236 homeless adults attending 9 sites serving homeless persons (mean age 41.8 years; 73% male). Two thirds (69%) were current smokers, of whom 37% reported readiness to quit smoking within the next 6 months. In bivariate analyses, persons were significantly (P < < < < < .05) more likely to be ready to quit if they had tried to quit in the past and if they had social support to quit smoking. Nicotine replacement was the most commonly preferred assistance method (44%), and self-efficacy to quit (10-point scale) was significantly greater if assistance was available (7.3 vs 4.9; P < < < < < .001). The findings suggest an urgent need to develop and implement smoking cessation programs for homeless persons.

Research in Social and Administrative Pharmacy, 2014

Introduction: The prevalence of smoking remains high among the medically underserved and could be related to disparities in access to and use of smoking cessation treatments. Methods: This study implemented and tracked providers' use of the 5 A's intervention for tobacco use (Ask, Assess, Advise, Assist, Arrange) with homeless (n ¼ 260) and housed (n ¼ 226) adults attending a free medical clinic, including referrals to and use of an on-site pharmacist-led smoking cessation service. Results: Among patients whose tobacco use was Asked about and Assessed (97%), homeless (vs. housed) patients were more likely to smoke (59% vs. 39%; P ¼ 0.008). Among current smokers, there were no homeless-housed disparities in receipt of Advice to quit smoking (84% vs. 78%; P ¼ 0.22) or Arrangement of treatment (36% vs. 31%; P ¼ 0.46). Overall, among patients for whom treatment was Arranged, homeless patients were less likely than housed patients to attend the smoking cessation program (25% vs. 48%; P ¼ 0.04). However, among those that attended any treatment (i.e., were Assisted to quit), homeless and housed patients attended similar numbers of sessions and used pharmacotherapy at similar rates. Conclusions: Providers may reduce homeless-housed disparities in smoking by offering special Assist(ance) to homeless smokers that reduces barriers to initially accessing treatment services.

Cochrane Database of Systematic Reviews, 2019

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess whether interventions designed to improve access to smoking cessation interventions for adults experiencing homelessness and interventions designed to help adults experiencing homelessness to quit smoking lead to increased engagement and tobacco abstinence. To also assess whether smoking cessation interventions for adults experiencing homelessness affect substance use and mental health.

Nicotine &amp; Tobacco Research, 2012

in emergency shelters; nearly half had been homeless for more than a year. Nearly all the participants were daily smokers who smoked an average of 20 cigarettes/day. Nearly 40% had patient health questionnaire-9 depression scores in the moderate or worse range, and more than 80% screened positive for lifetime history of drug abuse or dependence. Conclusions: This study demonstrates the feasibility of enrolling a diverse sample of homeless smokers into a smoking cessation clinical trial. The uniqueness of the study sample enables investigators to examine the infl uence of nicotine dependence as well as psychiatric and substance abuse comorbidities on smoking cessation outcomes.

Trials, 2015

Background: Despite progress in reducing cigarette smoking in the general U.S. population, smoking rates, cancer morbidity and related heart disease remain strikingly high among the poor and underserved. Homeless individuals' cigarette smoking rate remains an alarming 70 % or greater, and this population is generally untreated with smoking cessation interventions. Furthermore, the majority of homeless smokers also abuse alcohol and other drugs, which makes quitting more difficult and magnifies the health consequences of tobacco use. Methods/Design: Participants will be randomized to one of three groups, including (1) an integrated intensive smoking plus alcohol intervention using cognitive behavioral therapy (CBT), (2) intensive smoking intervention using CBT or (3) usual care (i.e., brief smoking cessation and brief alcohol counseling). All participants will receive 12-week treatment with a nicotine patch plus nicotine gum or lozenge. Counseling will include weekly individual sessions for 3 months, followed by monthly booster group sessions for 3 months. The primary smoking outcome is cotinine-verified 7-day smoking abstinence at follow-up week 52, and the primary alcohol outcome will be breathalyzer-verified 90-day alcohol abstinence at week 52.

Drug and Alcohol Dependence, 2015

Introduction: Homeless individuals smoke at disproportionately high rates and quit at disproportionately low rates relative to domiciled smokers. Targeted research is needed to inform future interventions. Socio-demographic characteristics of homeless adults suggest that light smoking may be prevalent, and the relation between smoking level and treatment-related preferences/needs is unknown. The current study addressed these gaps in a sample of homeless smokers. Methods: Participants (N = 237) were homeless adult daily light (1-10 cigarettes per day) and moderate/heavy (>10 cigarettes per day) smokers recruited from a single shelter that offered cessation treatment. Survey items assessed perceived treatment effectiveness, pharmacological intervention preferences, and barriers to quitting smoking. Logistic regressions were used to assess differences in treatment-related factors by smoking level. Results: The prevalence of light smoking (44.7%) was higher than in previously studied samples of domiciled smokers. Relative to moderate/heavy smokers, light smokers smoked for fewer years, had more quit attempts in the last year, and were more likely to smoke menthol cigarettes. They were less likely to believe that medications would give them the greatest chance of quitting and more likely to believe that group counseling would be helpful. Light smokers did not differ from moderate/heavy smokers on specific pharmacological intervention preferences or on perceived barriers to quitting smoking, including craving. Conclusions: The promotion of pharmacotherapy to address cravings may be necessary for light smokers, who represent a sizeable proportion of homeless smokers and who may make apt intervention targets given their higher rates of purposeful quit attempts relative to heavier smoking counterparts.