Perceived Disease Risk of Smoking, Barriers to Quitting, and Cessation Intervention Preferences by Sex Amongst Homeless Adult Concurrent Tobacco Product Users and Conventional Cigarette-Only Users

Abstract

Adults experiencing homelessness smoke conventional cigarettes and engage in concurrent tobacco product use at very high rates; however, little is known about how use patterns, perceived disease risk, barriers to quitting smoking, and smoking cessation intervention preferences differ by sex in this group. Participants comprised a convenience sample of 626 adult conventional cigarette smokers experiencing homelessness. Participants self-reported their sex, smoking history, mental health and substance use diagnosis history, other concurrent tobacco product use (CU), disease risk perceptions, perceived barriers to quitting smoking, and preferences regarding tobacco cessation interventions via a computer-administered survey. CU rates were 58.1% amongst men and 45.3% amongst women smokers. In both sexes, CUs started smoking earlier (p-values < 0.001) and were more likely to have been diagnosed with a non-nicotine substance use disorder (p-values < 0.014) relative to cigarette-only users. Among men only, CUs were younger, smoked more cigarettes per day and were more likely to identify as non-Hispanic White (p-values < 0.003) than cigarette-only users. Additionally, male CUs reported a greater risk of developing ≥1 smoking-related disease if they did not quit for good; were more likely to endorse craving cigarettes, being around other smokers, habit, stress/mood swings, and coping with life stress as barriers for quitting smoking; and were less likely to prefer medications to quit smoking relative to male cigarette-only users (p-values < 0.04). On the other hand, female CUs reported a greater risk of developing ≥1 smoking-related disease even if they quit for good; were more likely to endorse stress/mood swings and coping with life stress as barriers for quitting smoking relative to female cigarette-only users (p-values < 0.05); and did not differentially prefer one cessation medication over another. Overall, findings confirm high rates of CU among both sexes, characterize those who may be more likely to be CUs, and reveal opportunities to educate men and women experiencing homeless on the benefits of evidence-based interventions for smoking cessation.

Tobacco use behaviors and views on engaging in clinical trials for tobacco cessation among individuals who experience homelessness

“…Consistent with prior studies [ 4 ], most participants in our study had attempted to quit smoking but were unsuccessful and relapsed to smoking. In a recent study of individuals experiencing homelessness, the majority preferred to “quit cold turkey” rather than using supportive smoking cessation medications, findings that were consistent with participants in this study [ 31 ]. These findings highlight the need for interventions that increase engagement in cessation treatment to increase efficacy of quit attempts.…”

“Cigarettes play the equalizer”: discrimination experiences and readiness to quit cigarette smoking among African Americans experiencing homelessness: a qualitative analysis

“…Regarding cigarette use, it is possible that our participants smoke cigarettes more often in social settings than alone in an effort to connect with others. In a study which sampled 626 men and women experiencing homelessness who were smokers, findings revealed that men who were actively smoking tobacco endorsed craving cigarettes and being around other cigarette smokers as the main barriers to quitting cigarette smoking, while women endorsed stress/mood swings, and coping with stress as the main barriers [ 11 ]. Indeed, designated cigarette smoking areas in one’s home environment coupled with an individual’s own ability to manage stress may endorse continued cigarette smoking.…”

Evaluation of a Pharmacist-Linked Smoking Cessation Intervention for Adults Experiencing Homelessness

“…Tobacco cessation can prevent or partially reverse smoking-related diseases. Over 60% of people experiencing homelessness attempt to quit smoking yearly, a rate similar to the general population (Brown et al, 2022). However, they are less likely to quit successfully (9% to 13% quit ratio vs. 61.7%) (Creamer et al, 2019;Vijayaraghavan et al, 2013;2016) and most quit attempts are unassisted (Vijayaraghavan et al, 2016); highlighting the need to increase access to treatment (Vijayaraghavan et al, 2017).…”