Smoking Characteristics and Comorbidities in the Power To Quit Randomized Clinical Trial for Homeless Smokers

Okuyemi, Kolawole S.; Goldade, Kate; Whembolua, Guy-Lucien; Thomas, Janet L.; Eischen, Sara; Guo, Hongbo; Connett, John E.; Grant, Jon E.; Ahluwalia, Jasjit S.; Resnicow, Ken; Owen, Greg; Gelberg, Lillian; Jarlais, Don Des

doi:10.1093/ntr/nts030

Cited by 37 publications

(54 citation statements)

References 36 publications

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“…Smoking cessation interventions for homeless adults have focused on behavioral counseling and pharmacotherapy [3]. Although such therapy has been shown to have increased effectiveness when combined with smoke-free policies [4], no interventions have targeted smoke-free policies in homeless service settings.…”

Section: Introductionmentioning

confidence: 99%

Interest in Smoking Cessation Related to a Smoke-Free Policy Among Homeless Adults

Vijayaraghavan,

Pierce

2015

J Community Health

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Homeless adults have among the highest rates of cigarette smoking. Few studies have explored the potential of smoke-free policies as facilitators of smoking cessation or harm reduction among sheltered homeless adults. We focused on clients of a homeless shelter in San Diego, California. The facility prohibited smoking indoors and outdoors within five blocks of the building, and permitted smoking during four smoking breaks during the day in designated smoking zones away from the building. Current and former smokers who were residents of the facility were interviewed on smoking behaviors and attitudes toward these policies. Of the 170 ever smokers, 75.3 % were current smokers. The average daily cigarette consumption was 6.6 cigarettes per day (SD 4.3). More than half of the participants (57.8 %) attempted to quit smoking in the past year. Of the current smokers, threefourths agreed that the facility policies were associated with their reduced consumption, and about half agreed that the policies were associated with either making a quit attempt or getting ready to quit completely. Sixty percent agreed that further restrictions on smoking, beyond the current policies, would be associated with increased interest in quitting smoking completely. Less than 10 % agreed that they were unhappy to stay in the facility because of the policies. Findings suggest that smoke-free policies may not influence occupancy rates in shelters serving clientele with high rates of cigarette smoking. Smoke-free policies in homeless service settings present an important and un-tapped opportunity to reduce smoking behaviors among homeless adults.

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Section: Introductionmentioning

confidence: 99%

Interest in Smoking Cessation Related to a Smoke-Free Policy Among Homeless Adults

Vijayaraghavan,

Pierce

2015

J Community Health

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“…33 Given these findings, there is mounting evidence for the integration of treatment for nicotine dependence with that of substance use treatment. 1,12,31,34 A meta-analysis showed that treating nicotine addiction during substance use treatment may enhance short-term smoking cessation and lead to prolonged abstinence from alcohol and other illicit substances. 34 Lower cigarette consumption and prior quit attempts were associated with increased likelihood of a subsequent quit attempt at Percentage represents column percentage among those who had made a quit attempt in the past 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…Prior research on tobacco use in the homeless population has focused on younger adults, where the average age of study participants in previous studies was less than 44 years. 1,2,12,13 The high prevalence of tobacco use and the increased burden of tobacco-related chronic diseases with aging underscore a need for studies that characterize tobacco use and cessation behaviors among older homeless adults in order to develop tobacco control interventions that address the unique needs of this population.…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesized a priori that current smoking would be associated with symptoms of depression, substance use disorders, history of incarceration, and history of staying in shelters. 1,2,12,13 We also hypothesized that persons who reported smoking heavily or having symptoms of depression at enrollment would be less likely to make a quit attempt at follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Tobacco Cessation Behaviors Among Older Homeless Adults: Results From the HOPE HOME Study

Vijayaraghavan¹,

Tieu²,

Ponath³

et al. 2016

NICTOB

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Introduction: Tobacco-attributable deaths contribute significantly to the increased mortality observed among homeless adults aged 50 years or more. Little is known about the epidemiology of tobacco use among older homeless individuals. This longitudinal cohort study examines smoking behaviors and factors associated with smoking cessation among homeless individuals aged 50 years or more. Methods: We recruited a prospective cohort of 350 homeless individuals sampled from the community in Oakland, California. At 6 months follow-up, participants reported their cigarette quit attempts and 30-day abstinence. We used multivariable logistic regression to examine factors associated with making a quit attempt at follow-up, hypothesizing that heavier smokers would be less likely to make a quit attempt. Results: Of the 272 ever-smokers, 229 (84.2%) were current smokers (quit ratio 15.8). Among current smokers at enrollment who had a follow-up interview at 6 months, 43.6% (n = 71) reported making a quit attempt during the follow-up. Of those who reported making a quit attempt, 14.3% (n = 10) reported 30-day abstinence at follow-up. Among those who had reported making a quit attempt at follow-up, 22.5% had used nicotine replacement therapy (NRT). Staying in shelters (adjusted odds ratio [AOR] = 2.5, 95% confidence interval [CI] = 1.0-5.8) was associated with higher odds of making a quit attempt at follow-up. Higher cigarette consumption was associated with lower odds of making a quit attempt (AOR = 0.9, 95% CI = 0.8-0.9). Conclusions: In this study of tobacco use in older homeless adults, rates of quit attempts were similar to that observed in the general population, but successful quitting was lower. Implications: The current study is among the first studies to focus specifically on tobacco use and cessation behaviors among older homeless adults. The high prevalence of smoking and the low rates of successful quitting highlight numerous opportunities to intervene to increase quitting rates among this population. Among these, increasing access to smoke-free living environments and identifying effective cessation therapies will be critical to reducing tobacco-related disease burden among older homeless adults.

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“…40 To gauge the social aspects of smoking, we asked participants how many of their five closest associates smoke cigarettes 41 and how many times they are offered a cigarette during a typical day. 42 …”

Section: Tobacco Usementioning

confidence: 99%

Posttraumatic Stress Symptoms and Their Association With Smoking Outcome Expectancies Among Homeless Smokers in Boston

Baggett

Campbell

Chang

et al. 2015

NICTOB

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Introduction: Cigarette smoking and traumatic life experiences are each common among homeless adults, but the prevalence and correlates of posttraumatic stress disorder (PTSD) symptoms among homeless smokers are not known. We assessed symptoms of PTSD and their association with smoking outcome expectancies in a sample of homeless smokers in Boston. Methods: We used time-location sampling to conduct an in-person survey of homeless adult smokers using Boston Health Care for the Homeless Program clinical services. We assessed symptoms of PTSD with the PTSD Checklist-Civilian version and considered scores at least 14 as positive. We used the Smoking Effects Questionnaire to assess positive and negative smoking outcome expectancies. We modeled the associations between PTSD screening status and smoking expectancies using design-adjusted linear regression. Results: Eighty-six percent of eligible individuals participated (N = 306). Sixty-eight percent of participants screened positive for PTSD. Screen-positive respondents were younger (P = .001), more likely to report fair/poor health (P = .01), chronic obstructive pulmonary disease (P = .02), and past-month hallucinations (P = .004), and had greater drug (P < .001) and alcohol (P < .001) use severity and cigarette dependence (P = .002). In analyses controlling for these confounders, PTSD screen-positive participants more strongly endorsed smoking to reduce negative affect (P = .01), smoking for social benefits (P = .002), and smoking for weight control (P = .03). Exploratory analyses suggested that these associations were driven by avoidance/numbing and re-experiencing symptoms. Conclusions: Symptoms of posttraumatic stress are common among homeless smokers and strongly associated with positive smoking outcome expectancies. Tobacco cessation programs for this population should consider screening for PTSD and fostering a trauma-sensitive treatment environment. Implications: In this study of homeless cigarette smokers in Boston, over two-thirds of participants screened positive for PTSD. PTSD screen-positive respondents more strongly endorsed multiple positive smoking outcome expectancies than screen-negative individuals. These findings suggest

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Smoking Characteristics and Comorbidities in the Power To Quit Randomized Clinical Trial for Homeless Smokers

Cited by 37 publications

References 36 publications

Interest in Smoking Cessation Related to a Smoke-Free Policy Among Homeless Adults

Interest in Smoking Cessation Related to a Smoke-Free Policy Among Homeless Adults

Tobacco Cessation Behaviors Among Older Homeless Adults: Results From the HOPE HOME Study

Posttraumatic Stress Symptoms and Their Association With Smoking Outcome Expectancies Among Homeless Smokers in Boston

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