Building Tobacco Cessation Capacity in Homeless Shelters: A Pilot Study

Abstract

Tobacco use is common among homeless adults, yet few homeless shelters offer tobacco dependence treatment. Using a pre-intervention and post-intervention study design, we pilot tested the feasibility of a capacity building intervention that consisted of a 3.5-h training for shelter staff to provide cessation counseling. Staff (n = 12) and homeless clients (n = 46) completed questionnaires at pre-intervention, post-intervention (6 weeks), and at 12-weeks follow-up. Staff completed a questionnaire on tobacco-related knowledge, attitudes toward and practices around treating tobacco dependence, and self-efficacy in providing cessation counseling (score range 1-5). Clients completed a questionnaire on tobacco-related knowledge, attitudes toward tobacco dependence, and receipt of tobacco-related services from the program (score range 1-5). We used repeated measures linear regression analysis to examine change in scores over time. From pre-intervention to post-intervention, staff knowledge (b coefficient 0.4, 95 % CI 0.1-0.8) and efficacy (b coefficient 0.4, 95 % CI 0.2-0.7) in treating tobacco dependence increased. Client receipt of tobacco-related program services increased significantly from post-intervention to follow-up (b coefficient 0.3, 95 % CI 0.1-0.5). A brief capacity building intervention has the potential to increase tobaccorelated interventions among clients in homeless shelters.

A community-based tobacco cessation program for individuals experiencing homelessness

“…The training for the shelter staff was developed by the PI and adapted from prior capacity building interventions to increase shelters' and permanent supportive housing's capacity to provide smoking cessation services. (Durazo et al, 2020;Vijayaraghavan, Guydish, & Pierce, 2016) The training focused on how to provide cessation counseling, relying on the clinical practice guidelines for smoking cessation. (Fiore, Baker, & Use, 2008, 2008 Topics included tobacco use among PEH, nicotine addiction, tobacco cessation counseling using the ask, advise, and refer model as well as the 5A's for smoking cessation, (Fiore andBaker, .2008, 2008) a brief introduction to tobacco cessation medications, local cessation resources and tobacco policy initiatives.…”

Evaluation of Tobacco Control Policies in San Francisco Homeless Housing Programs

“…In addition, administrators identified specific features of existing smoking cessation programs that they believed were ineffective for their client population, such as asking clients to appear at weekly sessions at a specific time and place. This finding provides insight into why recent pilot efforts to build the capacity to offer smoking cessation services on-site at shelters may have been successful (Vijayaraghavan, Guydish, & Pierce, 2016). It also suggests that attempting to increase referrals to outside programs could have limited effectiveness.…”

Guest Support for Outdoor Smoke-Free Policies within a Homeless Shelter

“…For maximal effectiveness, a partial outdoor smoking ban should at the very least ensure that there is no tobacco use and ambient smoke/vape exposure in proximity to entrances and exits of the shelter grounds for nonsmokers and guests trying to cut down or quit tobacco use. Moreover, and especially given the high prevalence of concurrent tobacco product use amongst smokers experiencing homelessness [ 35 , 36 , 37 ], policies should make mention of all tobacco products, including smokeless tobacco and e-cigarettes. Ensuring the inclusion of all tobacco products in policies can help to prevent the use of an alternative form of tobacco to address cravings, which can hamper intended health promotion efforts [ 32 , 35 ].…”

“…There is a plethora of resources available to guide the implementation of tobacco-free policies in organizational or residential settings (e.g., public housing complexes), e.g., [ 36 , 37 ]. Generally, this guidance suggests the importance of clear communication with guest stakeholders about the policy, setting a designated policy implementation date that offers time for resident preparation, conducting townhalls or other meetings whereby guests can voice their thoughts regarding the impending changes, and making available interventions to address tobacco use dependence [ 38 ].…”