Addressing Tobacco Use in Homeless Populations: A Survey of Health Care Professionals

Abstract

Cigarette smoking is common among homeless individuals, but little is known about health care providers' practices and attitudes in addressing tobacco use in this vulnerable population. We surveyed members of the Health Care for the Homeless Clinicians' Network, a nationwide multidisciplinary organization, to assess their tobacco screening practices, attitudes toward addressing tobacco use, and experience providing tobacco products to homeless individuals. Of 231 clinicians who completed the survey, 86.5% reported routinely screening for tobacco use. Although 74.4% of respondents viewed tobacco use as one of the most important health issues among homeless people, rates of agreement with this and other attitudes toward tobacco use in the setting of homelessness varied significantly by clinical discipline. Overall, 15.3% of respondents reported having ever given patients tobacco to build trust or promote adherence to care. Addressing providers' attitudinal variations and tobacco distribution practices may foster a more consistent anti-smoking message for this population.

Sniping and other high-risk smoking practices among homeless youth

“…Although it can be challenging to engage homeless individuals in services (Gelberg et al, 2000;Rabinovitz et al, 2010;Thompson et al, 2006), most homeless adults (Baggett et al, 2013a) and homeless youth (Tucker et al, in press) who smoke are interested in quitting. Further, there is growing recognition of the importance of addressing tobacco use among the providers of services to homeless individuals (Baggett et al, 2012), particularly with less intensive program that can be delivered by existing agency staff . Results from this study provide important new information that can inform future efforts to reduce smoking, including particularly high-risk smoking practices, among homeless youth.…”

Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults?

“…Smoking is under-addressed among the homeless (9), and the extent to which smoking cessation might engender an escalation in comorbid substance use could be a concern prohibiting cessation treatment provision and smokers’ engagement in treatment (2, 15). Results from the current study indicate that smoking abstinence 26 weeks following an aided quit attempt was not significantly associated with an increase in the number of drinking days, the number of drinks consumed on drinking days, the number of binge drinking days, the odds of heavy drinking, or the number of days of cocaine, marijuana/hashish, heroin, or any drug use over the course of the parent smoking cessation intervention trial.…”

“…The perception of comorbid substance use as a barrier to quitting is echoed among healthcare professionals as well. For example, in a nationwide study conducted among 231 clinicians who serve the homeless, the majority of practitioners (86.9%) cited comorbid substance abuse as an important or very important barrier to smoking cessation among the homeless (2). Moreover, comorbid use of alcohol, one of the most common non-nicotine substances consumed among smokers, has been empirically linked with reduced odds of cessation (16) and a greater likelihood of smoking relapse (albiet among domiciled [i.e., not homeless] smokers)(17).…”

Impact of group motivational interviewing on enhancing treatment engagement for homeless Veterans with nicotine dependence and other substance use disorders: A pilot investigation

“…Other reasons may involve health-care provider behaviors and attitudes toward tobacco use among homeless persons, perpetuating erroneous assumptions that homeless smokers lack interest in smoking cessation. 8–9 However, contrary to myths that homeless individuals lack interest in smoking cessation, recent studies demonstrate that when provided opportunities to do so, homeless smokers will enroll in smoking cessation programs as well as exhibit high levels of motivation to quit smoking. 10 For example, in a recent survey of 350 homeless adults aged 50 or older, smoking quit attempt rates were similar to the general population; although, successful quitting was lower.…”

“…19 Despite the efficacy of MI for enhancing smoking abstinence, scant research has investigated MI with homeless individuals 20 and less so with Veterans, particularly as mental illness and alcohol use disorder serves as the primary competing issue for addressing tobacco use among this population. 8 Despite recommendations for concurrent treatment of substance abuse with tobacco cessation, 21 substance abuse treatment has traditionally emphasized treatment of “harder” drugs, such as alcohol, cocaine, and opioids, while largely ignoring the treatment of tobacco use. Additionally, the one-to-one format in which MI is typically provided is time and resource intensive.…”