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

Abstract

Roughly 70–80% of adults experiencing homelessness smoke cigarettes. Smoke-free living/workplace policies are an empirically-supported tobacco control intervention. However, homeless shelters may be reluctant to implement smoke-free policies due to fears of it discouraging current/potential shelter guests from taking refuge there. The current study was meant to characterize guest support for on-property smoke-free policies within a homeless shelter with an extant indoor tobacco use ban amongst never smokers, former smokers, and current smokers to provide data on this point. Participants comprised a convenience sample of adult guests of a homeless shelter in Texas (N = 394, 28.2% women; 10.2% former; and 75.9% current smokers). Participant sociodemographics, smoking status, behavioral health diagnoses, and support for two versions of an on-property outdoor courtyard smoke-free policy (one partial, one complete) were assessed. Data were collected in two waves in a repeated cross-sectional design. Overall, 64.0% of participants supported a partial, and 32.0% a full smoking ban. Logistic regressions, controlling for wave of data collection, age, sex, and any additional significant predictors from a semi-adjusted model, examined associations between participant characteristics and policy support. Older participants (OR = 1.024, CI0.95 = 1.005–1.044), non-veterans (OR = 2.523, CI0.95 = 1.156–5.506), former smokers (OR = 2.730, CI0.95 = 1.191–6.258), and those without severe mental illness (OR = 1.731, CI0.95 = 1.061–2.824) had significantly greater odds of supporting a partial smoking ban. Relative to current smokers, never smokers (OR = 3.902, CI0.95 = 2.133–7.137) and former smokers (OR = 8.257, CI0.95 = 3.951–17.258) had significantly greater odds of supporting a complete smoking ban. The implementation of smoke-free living/workplace policies in homeless shelters may enjoy more support from guests—specifically, non-smokers—than anticipated by shelter administrators. Aside from reducing ambient smoke exposure for never and former smokers, these policies can help to reduce ubiquitous smoking cues for those who may want to quit, are undergoing a quit attempt, or are trying to maintain abstinence. Interventionists might partner with shelter guests, particularly smokers, to inform the roll-out of such policies for maximal acceptance and adoption.

Enablers and Inhibitors to Implementing Tobacco Cessation Interventions within Homeless-Serving Agencies: A Qualitative Analysis of Program Partners’ Experiences

“…However, all 3 agencies declined to provide us with permission to interview their clients, a decision which we respected. Given that those experiencing homelessness are subject to high rates of victimization and violence, and subsequently, trauma, it is understandable that many agencies serving these populations adopt very protective attitudes toward those they serve [ 22 , 65 ]. Each participant was compensated with a $40 e-gift card for Amazon.…”

“…Many agencies serving those who are unhoused, although dedicated to helping them, have not implemented a tobacco-free workplace (TFW) policy that disallows tobacco use on-site or limits it to designated areas [ 20 , 21 ]. This is despite the fact that prior work supports sizeable client interest (32–64%) in having smoke-free policies in these settings [ 22 , 23 ]. While agency administrators’ reluctance to implement even partial TFW policies can stem from valid concerns that doing so will keep those experiencing homelessness from seeking services, research does not support a lowering of occupancy rates following policy adoption [ 24 ].…”