High-Risk Smoking Behaviors and Barriers to Smoking Cessation Among Homeless Individuals

Abstract

BACKGROUND: Although tobacco practices and the effects of tobacco use among the general American population are well described, minimal data exist regarding tobacco use and barriers to smoking cessation among homeless individuals. METHODS: Anonymous, voluntary surveys based on a previously implemented instrument were completed by 100 smoking individuals residing at a homeless shelter. These surveys assessed high-risk smoking behaviors and respondents' perceived barriers to long-term smoking cessation. RESULTS: Ninety percent of study participants reported engaging in at least one of the high-risk tobacco practices. Nicotine replacement therapy was perceived by respondents to be the most desired form of smoking cessation aid. Excessive stress with use of tobacco smoking to alleviate stress and anxiety was the most significant self-perceived barrier to smoking cessation. CONCLUSIONS: High-risk tobacco practices are remarkably common among smoking homeless individuals. Despite literature consistently showing that non-nicotine tobacco cessation pharmacotherapies (varenicline, buproprion) have higher smoking cessation rates, nicotine replacement monotherapy was perceived as more valuable by survey respondents. Although lack of financial resources was expected to be the biggest barrier to successful cessation, social stressors and the use of smoking to cope with homelessness were perceived as a greater obstacle in this cohort. Given the paucity of data on the long-term effects of the high-risk tobacco behaviors reported by these homeless smokers, this study highlights the need for further investigations regarding tobacco use and tobacco cessation in this vulnerable population.

A text message intervention for quitting cigarette smoking among young adults experiencing homelessness: study protocol for a pilot randomized controlled trial

“…Nearly half of young homeless cigarette smokers report rolling their own cigarettes, which may be filled with used tobacco obtained from discarded butts [12]. These practices may heighten their exposure to toxins and susceptibility to highly infectious diseases such as influenza, infectious hepatitis A, and tuberculosis [13,14]. The health of homeless young people is adversely affected by unsafe living environments, nutritional deficiencies, mental health problems, problematic substance use, and insufficient access to health services [8,[15][16][17][18].…”

A cross sectional survey of smoking characteristics and quitting behaviour from a sample of homeless adults in Great Britain

“…These factors, in addition to very low or no income, are exacerbated by smoking (Frankish, Hwang & Quantz, 2009;Baggett, et al, 2015). Homeless adults are known to also engage in 'risky smoking practices', in which the acquisition of cigarettes leads to further health risks through cigarette sharing and smoking discarded butts (Aloot, Vredevoe & Brech, 1993;Chen Nguyen, Malesker, & Morrow, 2016;Garner & Ratschen, 2013;Tucker Shadel, Golinelli, Mullins, & Ewing, 2015). There are a number of known individual-psychological and structural-social barriers, which many vulnerable groups encounter during quit attempts (Twyman, Bonevski, Paul & Bryant, 2014).…”

“…There are a number of known individual-psychological and structural-social barriers, which many vulnerable groups encounter during quit attempts (Twyman, Bonevski, Paul & Bryant, 2014). Stress, social pressure and coping with mental health symptoms are key reasons for smoking relapse amongst homeless smokers (Businelle et al, 2013;Chen et al, 2016). Desire to quit is high (Baggett, Cambell, Chang & Rigotti, 2016;Maddox & Segan, 2017), but quit attempts are often unaided (Garner & Ratschen, 2013).…”

“…At a structural and social level, as is the case for many vulnerable groups, smoking is not viewed as a primary concern. High levels of social acceptance coupled with staff concerns over the client's mental wellbeing and fragility can act as major barriers to cessation support (Chen et al, 2016;Twyman, et al, 2014). There is further evidence that in some cases, professionals actively discourage smoking cessation amongst the homeless (Garner & Ratschen, 2013;Maddox & Segan, 2017;Porter et al, 2017).…”

Addressing Smoking in Supported Residential Facilities for People with Severe Mental Illness: Has Any Progress Been Achieved?

“…In a recent New South Wales study with 144 male smokers who were homeless, for example, 66.2% reported having a diagnosed mental illness and three-quarters of these reported smoking to alleviate symptoms of their mental illness [16]. Chen et al undertook an anonymous voluntary survey with 100 smoking individuals residing at a homeless shelter, assessing high-risk smoking behaviours and respondents’ perceived barriers to long-term smoking cessation [37]. They found 90% reported engaging in at least one high-risk tobacco practice.…”