Short communicationSmoking behavior and interest in quitting among homeless smokers☆
Introduction
Homeless persons have strikingly elevated rates of physical and mental disorders, including substance abuse. The prevalence of nonnicotine substance abuse disorders among the homeless is 50% Cousineau, 1997, Salit et al., 1998, and the prevalence of smoking is 60–75% Connor et al., 2002, Sachs-Ericsson et al., 1998. Although many physical disorders common among the homeless are caused or exacerbated by tobacco use, little attention has been paid to reducing tobacco use among the homeless. Because homeless persons have high rates of death due to treatable or preventable causes Barrow et al., 1999, Hwang et al., 1997, smoking cessation has the potential to reduce morbidity and mortality substantially in this vulnerable population.
Recent studies have estimated the prevalence of smoking among drug and alcohol users to be at least 75% and have further found that persons seeking treatment for drug or alcohol dependence are interested in quitting and believe that quitting smoking will not have a negative impact on their sobriety Lemon et al., 2003, McClure et al., 2002. Among homeless substance abusers attending one inpatient treatment program, over 75% wanted to quit smoking and nearly two thirds reported that the best time to quit was during inpatient drug or alcohol treatment (Irving, Seidner, Burling, Thomas, & Brenner, 1994). Another recent survey of homeless smokers found that 37% were ready to quit smoking but did not collect detailed data on drug or alcohol abuse (Connor et al., 2002). Studies to date have not examined the impact of drug and alcohol abuse on readiness to quit among the homeless. The goals of this study were to describe smoking behavior in homeless persons and to examine the impact of tobacco-related health problems and drug and alcohol abuse on readiness to quit and interest in counseling.
Section snippets
Methods
Data were collected over 1 year (3/96–3/97) from adult patients at a large Boston teaching hospital who self-identified as homeless and as current smokers (smoked at least one cigarette within the past month). Participants provided informed consent and completed a structured interview including homelessness history, drug and alcohol use, past medical and psychiatric history, smoking-related symptoms, and smoking behavior, including number of pack years, nicotine dependence (Fagerstrom &
Results
We enrolled 98 current smokers, including 53 clinic outpatients and 45 hospital inpatients. Participants were predominantly White, unmarried, unemployed or disabled, and male, with at least a high school education and a substantial duration of homelessness (median—2.75 years). Despite a mean age of 44 years, there was a significant degree of medical morbidity, including coronary, vascular, and pulmonary diseases. As in other homeless populations, mental illness and nonnicotine substance abuse
Discussion
Among homeless smokers recruited from a large urban teaching hospital, we found that having an illness that a smoker believes is tobacco-related, having greater confidence in one's ability to quit (self-efficacy), and having more social support for quitting were associated with readiness to quit and interest in smoking cessation counseling. The importance of smoking-related illness to readiness to quit in this population has not previously been described, despite a high prevalence of
Acknowledgements
Funding: At the time this study was performed, Dr. Arnsten was a fellow of the Harvard General Internal Medicine Fellowship Program, U.S. Department of Health and Human Services National Research Services Award Grant (T32-PE11001). Dr. Arnsten is currently supported by the National Institute on Drug Abuse (R01-DA11869, R25 DA15302) and by a Robert Wood Johnson Generalist Physician Faculty Scholar Award. Dr. Rigotti is currently supported by the National Heart Lung and Blood Institute
References (17)
- et al.
Issues related to smoking cessation among substance abusers
Journal of Substance Abuse
(1997) - et al.
Drug and alcohol abuse inpatients' attitudes about smoking cessation
Journal of Substance Abuse
(1994) - et al.
The impact of smoking cessation on drug abuse treatment outcome
Addictive Behaviors
(2003) - et al.
The relation between alcohol consumption and smoking abstinence: Results from the working well trial
Addictive Behaviors
(2002) - et al.
Tailoring nicotine addiction treatments for chemical dependency patients
Journal of Substance Abuse Treatment
(1993) - et al.
Predictors of participation in a smoking cessation intervention group among low-income women
Addictive Behaviors
(1998) - et al.
Distribution of smokers by stage in three representative samples
Preventive Medicine
(1995) - et al.
Smokers hospitalized in an urban, public hospital: Addiction, stages of change, and self-efficacy
Preventive Medicine
(1999)
Cited by (71)
Alternative flavored and unflavored tobacco product use and cigarette quit attempts among current smokers experiencing homelessness
2020, Addictive Behaviors ReportsResilience is associated with importance of quitting in homeless adult smokers
2020, Addictive BehaviorsIncome associations with cigarette purchasing behaviors and quit attempts among people experiencing homelessness
2019, Addictive BehaviorsCitation Excerpt :Baggett, Chang, Singer, et al., 2015) Tobacco use is also associated with a substantial financial burden: homeless adults spend a third of their monthly income on tobacco use.( Arnsten, Reid, Bierer, & Rigotti, 2004; Baggett, Rigotti, & Campbell, 2016; Wrighting, Businelle, Kendzor, LeBlanc, & Reitzel, 2017) Smokers experiencing homelessness with high nicotine dependence face substantial subsistence challenges, including difficulty finding shelter and food.( Baggett et al., 2016) Smoking cessation could substantially reduce financial burden in this population.
Cardiovascular Disease and Homelessness
2018, Journal of the American College of CardiologyCitation Excerpt :To the greatest extent possible, we follow evidence-based guidelines for treating smoking, diabetes, hypertension, and dyslipidemia. Most homeless smokers want to quit smoking (39,52,142–145), but quit rates in this population are one-fifth of the national average (51). Although several studies have examined smoking cessation interventions for homeless smokers, the negative results (146) or pilot nature (147–151) of these studies means that the optimal approach to addressing tobacco use in this population is uncertain.
- ☆
Portions of this paper were presented at the American Public Health Association 124th Annual Meeting, New York, NY, November 1996, and at the Society for General Internal Medicine 20th Annual Meeting, Washington, DC, May 1997.