Tobacco Cessation |

High-Risk Tobacco Behaviors and Barriers to Smoking Cessation Among Homeless Individuals FREE TO VIEW

Joseph Chen; Austin Nguyen; Shantyl Wilson, MSW; Mark Malesker; Lee Morrow, MS
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Pulmonary and Critical Care, Creighton University, Omaha, NE

Chest. 2014;146(4_MeetingAbstracts):966A. doi:10.1378/chest.1992401
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SESSION TITLE: Tobacco Cessation and Prevention Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Although the epidemiology of tobacco smoking and barriers to cessation are well described in the general population, such data are limited regarding homeless individuals. Given the financial and social stressors unique to the homeless population, we attempted to describe high-risk tobacco use behaviors and barriers to smoking cessation in these individuals.

METHODS: Homeless volunteers who identified themselves as current smokers completed an anonymous survey at a centralized shelter in Omaha, Nebraska. The survey instrument was a modified version of a previously validated tool. Simple descriptive statistics were used to summarize high-risk tobacco practices and barriers to smoking cessation.

RESULTS: Fifty individuals completed surveys: 84% were men; mean age was 47.3±10.3 years; racial distribution was 58% Caucasian, 36% African American, 4% Hispanic and 2% Native American; average daily cigarette consumption was 1.5 packs; and average duration of homelessness was 15.5 months. High-risk smoking behaviors were remarkably common in the homeless population with 86% reporting at least one of the behaviors included in the survey. The most common practices included sharing of cigarettes (72%), remaking cigarettes from discarded tobacco products (42%), smoking discarded cigarette remnants (34%), and adding drugs/chemicals to cigarettes (32%). While 78% of subjects reported previous counseling to quit smoking, only 46% had attempted to quit in the past year. Of these, 56.5% utilized some form of assistance. The most common self-reported barriers to smoking cessation were high levels of stress (48%) and concurrent drug abuse (36%).

CONCLUSIONS: Reported high-risk smoking behaviors varied markedly but were surprisingly common in the homeless population. The self-reported rate of attempted cessation (46%) was markedly lower than that reported for the overall population (80%). This discrepancy appears to be driven by factors inherent to homelessness, particularly social stress and substance abuse.

CLINICAL IMPLICATIONS: While the adverse health consequences of “usual” tobacco use are well described, the attributable harms conferred by high-risk behaviors practiced by the homeless are unknown but likely substantial. Although such consequences could be ameliorated through smoking cessation, homelessness presents unique barriers to long-term abstinence. A better understanding of these complex factors is needed to minimize the attendant individual and societal burdens.

DISCLOSURE: The following authors have nothing to disclose: Joseph Chen, Austin Nguyen, Shantyl Wilson, Mark Malesker, Lee Morrow

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