Identifying Novel Motivation Phase-Specific Cessation Targets for Youth Experiencing Homelessness in the United States

Abstract

Introduction Of youth experiencing homelessness (YEH; 14-24 years old), 70%+ smoke combusted, commercial tobacco. Though many have tried to quit, most use ineffective methods. Drop-in centers for YEH are opportune places to link YEH to evidence-based treatment. Using the Phase-Based Model (PBM) to Cessation Research, the aim of this study was to identify “Motivation” phase-specific challenges impacting YEH’s willingness to make a quit attempt—the goal of this cessation phase. Methods Surveys were interview-administered with 96 past-week combusted tobacco users accessing drop-in services. Regression models were fit to confirm hypothesized challenges impacting YEH’s willingness to quit. Results Moderate nicotine dependence was noted—a key Motivation phase cessation mechanism targeted—and was associated with population challenges including, but not limited to, replacing food with tobacco, accidental oxygen-deprivation events, and smoking to socialize. While 67.1% of participants made a past-year quit attempt, 45.8% expressed 30-day quit interest. Dimensions of coping with housing were associated with quit attempts and quit interest. Quit attempts were also associated with nicotine dependence, working, and smoking to socialize. Whereas, quit interest was associated with less endorsement of smoking to regulate affect and more endorsement to avoid danger. Conclusions Though common challenges targeted in Motivation phase cessation exist among YEH, other challenges may also need to be addressed to promote quitting. Implications Future research in optimizing evidence-based cessation access for YEH through drop-in centers may consider addressing the challenges of housing, food security, social context, violence, and neurotrauma sequela to bolster YEH willingness to make a quit attempt.