Homelessness and smoking cessation: Insights from focus groups

Abstract

Smoking prevalence among homeless persons is approximately 70%, yet little is known about tobacco use patterns or smoking cessation practices in this population. We assessed smoking attitudes and behaviors, psychosocial and environmental influences on smoking, barriers to and interest in quitting, and preferred methods for cessation among some homeless smokers. Six 90-min focus groups of current smokers (N = 62) were conducted at homeless service facilities. Participants had a mean age of 41.5 years (SD = 9.3), were predominantly male (69.4%) and African American (59%), and smoked an average of 18.3 cigarettes/day. Although most reported that they were motivated to quit, a number of barriers to quitting were identified. Participants reported that the pervasiveness and social acceptance of tobacco use in homeless settings contributed to smoking more cigarettes per day, adopting alternative smoking behaviors such as smoking cigarette butts and making their own cigarettes, and experiencing difficulty in quitting. High levels of boredom and stress also were cited as reasons for continued smoking. Smoking frequently occurred in combination with alcohol or illicit drug use or to achieve a substitute "high." Most participants (76%) reported that they planned to quit smoking in the next 6 months. Many were interested in using pharmacotherapy in combination with behavioral treatments. Results suggest that, although motivated to quit smoking, homeless smokers are faced with unique social and environmental barriers that make quitting more difficult. Interventions must be flexible and innovative to address the unique needs of homeless smokers. Smoking restrictions at homeless service facilities and funding for smoking cessation assistance in this underserved population may help to reduce prevalence.

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

“…The majority of current and former smokers were supportive of the restrictions on smoking, with almost all participants agreeing that the smoke-free policies promoted a healthy living environment. Consistent with previous studies [13,14], our findings demonstrate that homeless adults are engaged in smoking cessation behaviors. Smoked in an area where smoking was prohibited in the past month Homeless service settings have the reputation of being permissive toward smoking [15].…”

Predicting Quit Attempts Among Homeless Smokers Seeking Cessation Treatment: An Ecological Momentary Assessment Study

“…Over the past five decades, the prevalence of smoking has declined to 18.1% among U.S. adults yet over 70% of homeless individuals continue to smoke (Baggett & Rigotti, 2010; Centers for Disease Control and Prevention, 2014; Lee et al, 2005;SachsEricsson, Wise, Debrody, & Paniucki, 1999). Approximately 75% of homeless smokers report a desire to quit smoking (Butler et al, 2002;Okuyemi et al, 2006), and they undertake comparable numbers of cessation attempts compared to nonhomeless smokers (Businelle, Cuate, Kesh, Poonawalla, & Kendzor, 2013;Butler et al, 2002). However, homeless smokers have considerable difficulty quitting smoking and maintaining long-term abstinence following a quit attempt (Bonevski, Baker, Twyman, Paul, & Bryant, 2012;Businelle et al, 2014;Okuyemi et al, 2013;Shelley et al, 2010;Spector, Alpert, & Karam-Hage, 2007).…”

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

“…[1][2][3][4] Aside from the inherent risks of life on the streets, this smoking discrepancy represents an additional health disparity for the homeless. Although most homeless individuals view smoking as a relatively harmless coping mechanism, many engage in unique risky smoking behaviors that potentially increase the harms associated with smoking.…”