Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-19T14:55:58.394Z Has data issue: false hasContentIssue false
  • English
  • Français

Smoking amongst adults experiencing homelessness: a systematic review of prevalence rates, interventions and the barriers and facilitators to quitting and staying quit

Published online by Cambridge University Press:  23 March 2020

Kirstie Soar ,
Lynne Dawkins ,
Deborah Robson  and
Sharon Cox Open the ORCID record for Sharon Cox [Opens in a new window]
Kirstie Soar
Affiliation:
Schoolof Psychology, University of East London, Water Lane, London, E15 4LZ, UK
Lynne Dawkins
Affiliation:
Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA, UK
Deborah Robson
Affiliation:
Addictions Department & CLAHRC South London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, LondonSE5 8BB, UK
Sharon Cox*
Affiliation:
Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA, UK
*
Author for correspondence: Sharon Cox, E-mail: coxs15@lsbu.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

To date, there has been no review of the research evidence examining smoking cessation among homeless adults. The current review aimed to: (i) estimate smoking prevalence in homeless populations; (ii) explore the efficacy of smoking cessation and smoking reduction interventions for homeless individuals; and (iii) describe the barriers and facilitators to smoking cessation and smoking reduction.

Method

Systematic review of peer-reviewed research. Data sources included electronic academic databases. Search terms: ‘smoking’ AND ‘homeless’ AND ‘tobacco’, including adult (18+ years) smokers accessing homeless support services.

Results

Fifty-three studies met the inclusion criteria (n = 46 USA). Data could not be meta-analysed due to large methodological inconsistencies and the lack of randomised controlled trials. Smoking prevalence ranged from 57% to 82%. Although there was no clear evidence on which cessation methods work best, layered approaches with additions to usual care seemed to offer modest enhancements in quit rates. Key barriers to cessation exist around the priority of smoking, beliefs around negative impact on mental health and substance use, and environmental influences.

Conclusions

Homeless smokers will benefit from layered interventions which support many of their competing needs. To best understand what works, future recommendations include the need for consensus on the reporting of cessation outcomes.

Keywords

Homelesshomelessnesssmokingsmoking cessationtobacco
Type
Review Article
Information
Journal of Smoking Cessation , Volume 15 , Issue 2 , June 2020 , pp. 94 - 108
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aldridge, R. W., Story, A., Hwang, S. W., Nordentoft, M., Luchenski, S. A., Hartwell, G., … Hayward, A. C. (2018). Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: A systematic review and meta-analysis. The Lancet, 391(10117), 241–250.CrossRefGoogle ScholarPubMed
Arangua, L., McCarthy, W. J., Moskowitz, R., Gelberg, L., & Kuo, T. (2007). Are homeless transitional shelters receptive to environmental tobacco control interventions? Tobacco Control, 16(2), 143–144.CrossRefGoogle ScholarPubMed
Baggett, T. P., Campbell, E. G., Chang, Y., & Rigotti, N. A. (2016). Other tobacco product and electronic cigarette use among homeless cigarette smokers. Addictive Behaviors, 60, 124–130.CrossRefGoogle ScholarPubMed
Baggett, T. P., Chang, Y., Yaqubi, A., McGlave, C., Higgins, S. T., & Rigotti, N. A. (2017). Financial incentives for smoking abstinence in homeless smokers: A pilot randomized controlled trial. Nicotine and Tobacco Research, 20(12), 1442–1450.CrossRefGoogle Scholar
Baggett, TP, Chang, Y, Yaqubi, A, Mcglave, C, & Higgins, ST. (2018 a). Financial incentives for smoking abstinence in homeless smokers: a pilot randomized controlled trial. Nicotine and Tobacco Research, 20, 1442–1450.CrossRefGoogle ScholarPubMed
Baggett, T. P., Lebrun-Harris, L. A., & Rigotti, N. A. (2013). Homelessness, cigarette smoking and desire to quit: Results from a US national study. Addiction, 108(11), 2009–2018.CrossRefGoogle ScholarPubMed
Baggett, T. P., McGlave, C., Kruse, G. R., Yaqubi, A., Chang, Y., & Rigotti, N. A. (2019). SmokefreeTXT for homeless smokers: Pilot randomized controlled trial. JMIR mHealth and uHealth, 7(6), e13162.CrossRefGoogle ScholarPubMed
Baggett, T. P., & Rigotti, N. A. (2010). Cigarette smoking and advice to quit in a national sample of homeless adults. American Journal of Preventive Medicine, 39(2), 164–172.CrossRefGoogle Scholar
Baggett, T. P., Tobey, M. L., & Rigotti, N. A. (2013). Tobacco use among homeless people – addressing the neglected addiction. New England Journal of Medicine, 369(3), 201–204.CrossRefGoogle ScholarPubMed
Beard, E., West, R. (2012). Use of nicotine replacement therapy for smoking reduction and temporary abstinence: An update of Beard et al., (2011). Addiction, 107(6), 1186–1187.CrossRefGoogle Scholar
Bilano, V., Gilmour, S., Moffiet, T., d'Espaignet, E. T., Stevens, G. A., Commar, A., … Shibuya, K. (2015). Global trends and projections for tobacco use, 1990–2025: An analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control. The Lancet, 385(9972), 966–976.CrossRefGoogle ScholarPubMed
Bonevski, B., Baker, A., Twyman, L., Paul, C., & Bryant, J. (2012). Addressing smoking and other health risk behaviours using a novel telephone-delivered intervention for homeless people: A proof-of-concept study. Drug and Alcohol Review, 31(5), 709–713.CrossRefGoogle ScholarPubMed
Booth, B. M., Sullivan, G., Koegel, P., & Burnam, A. (2002). Vulnerability factors for homelessness associated with substance dependence in a community sample of homeless adults. The American Journal of Drug and Alcohol Abuse, 28(3), 429–452.CrossRefGoogle Scholar
Buckley, K., Tsu, L., Hormann, S., Giang, K., Bills, A., Early, N., & Jackowski, R. (2017). A health sciences student-run smoking cessation clinic experience within a homeless population. Journal of the American Pharmacists Association, 57(1), 109–115.CrossRefGoogle ScholarPubMed
Businelle, M. S., Cuate, E. L., Kesh, A., Poonawalla, I. B., & Kendzor, D. E. (2013). Comparing homeless smokers to economically disadvantaged domiciled smokers. American Journal of Public Health, 103(S2), S218–S220.CrossRefGoogle ScholarPubMed
Businelle, M. S., Kendzor, D. E., Kesh, A., Cuate, E. L., Poonawalla, I. B., Reitzel, L. R., … Wetter, D. W. (2014a). Small financial incentives increase smoking cessation in homeless smokers: A pilot study. Addictive Behaviors, 39(3), 717–720.CrossRefGoogle Scholar
Businelle, M. S., Ma, P., Kendzor, D. E., Reitzel, L. R., Chen, M., Lam, C. Y., … Wetter, D. W. (2014b). Predicting quit attempts among homeless smokers seeking cessation treatment: An ecological momentary assessment study. Nicotine & Tobacco Research, 16(10), 1371–1378.CrossRefGoogle Scholar
Businelle, M. S., Poonawalla, I. B., Kendzor, D. E., Rios, D. M., Cuate, E. L., Savoy, E. J., … Reitzel, L. R. (2015). Smoking policy change at a homeless shelter: Attitudes and effects. Addictive Behaviors, 40, 51–56.CrossRefGoogle Scholar
Carpenter, V. L., Hertzberg, J. S., Kirby, A. C., Calhoun, P. S., Moore, S. D., Dennis, M. F., … Beckham, J. C. (2015). Multi-component smoking cessation treatment including mobile contingency management for smoking cessation in homeless veteran smokers. The Journal of Clinical Psychiatry, 76(7), 959.CrossRefGoogle Scholar
Chen, J. S., Nguyen, A. H., Malesker, M. A., & Morrow, L. E. (2016). High-risk smoking behaviors and barriers to smoking cessation among homeless individuals. Respiratory Care, 61(5), 640–645.CrossRefGoogle ScholarPubMed
Collins, S. E., Orfaly, V. E., Wu, T., Chang, S., Hardy, R. V., Nash, A., … Clifasefi, S. L. (2018). Content analysis of homeless smokers’ perspectives on established and alternative smoking interventions. International Journal of Drug Policy, 51, 10–17.CrossRefGoogle ScholarPubMed
Connor, S. E., Cook, R. L., Herbert, M. I., Neal, S. M., & Williams, J. T. (2002). Smoking cessation in a homeless population: There is a will, but is there a way? Journal of General Internal Medicine, 17(5), 369–372.Google Scholar
Connor, S. E., Scharf, D. M., Jonkman, L. J., & Herbert, M. I. (2014). Focusing on the five A's: A comparison of homeless and housed patients’ access to and use of pharmacist-provided smoking cessation treatment. Research in Social and Administrative Pharmacy, 10(2), 369–377.CrossRefGoogle ScholarPubMed
Dawkins, L., Ford, A., Bauld, L., Balaban, S., Tyler, A., & Cox, S. (2019). A cross sectional survey of smoking characteristics and quitting behaviour from a sample of homeless adults in Great Britain. Addictive Behaviors, 95, 35–40.CrossRefGoogle ScholarPubMed
de Leon, J., & Diaz, F. J. (2005). A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophrenia Research, 76(2–3), 135–157.CrossRefGoogle ScholarPubMed
Department of Health. (2017). Towards a Smokefree Generation: A Tobacco Control Plan for England. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/630217/Towards_a_Smoke_free_Generation_-_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf. Accessed on 18 September 2019.Google Scholar
Garner, L., & Ratschen, E. (2013). Tobacco smoking, associated risk behaviours, and experience with quitting: A qualitative study with homeless smokers addicted to drugs and alcohol. BMC Public Health, 13(1), 951.CrossRefGoogle ScholarPubMed
Gilbody, S., Peckham, E., Bailey, D., Arundel, C., Heron, P., Crosland, S., … Bradshaw, T. (2019). Smoking cessation for people with severe mental illness (SCIMITAR+): A pragmatic randomised controlled trial. The Lancet Psychiatry, 6(5), 379–390.CrossRefGoogle ScholarPubMed
Godtfredsen, N. S., Holst, C., Prescott, E., Vestbo, J., & Osler, M. (2002). Smoking reduction, smoking cessation, and mortality: A 16-year follow-up of 19,732 men and women from The Copenhagen Centre for Prospective Population Studies. American Journal of Epidemiology, 156(11), 994–1001.CrossRefGoogle Scholar
Goldade, K., Jarlais, D. D., Everson-Rose, S. A., Guo, H., Thomas, J., Gelberg, L., … Okuyemi, K. S. (2013). Knowing quitters predicts smoking cessation in a homeless population. American Journal of Health Behavior, 37(4), 517–524.CrossRefGoogle Scholar
Goldade, K., Whembolua, G. L., Thomas, J., Eischen, S., Guo, H., Connett, J., … Grant, J. (2011). Designing a smoking cessation intervention for the unique needs of homeless persons: A community-based randomized clinical trial. Clinical Trials, 8(6), 744–754.CrossRefGoogle ScholarPubMed
Guydish, J., Passalacqua, E., Pagano, A., Martínez, C., Le, T., Chun, J., … Delucchi, K. (2016). An international systematic review of smoking prevalence in addiction treatment. Addiction, 111(2), 220–230.CrossRefGoogle ScholarPubMed
Hammett, P., Fu, S. S., Lando, H. A., Owen, G., & Okuyemi, K. S. (2015). The association of military discharge variables with smoking status among homeless veterans. Preventive Medicine, 81, 275–280.CrossRefGoogle ScholarPubMed
Higgins, J. P., & Green, S. (2011) The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions, 4(6).Google Scholar
Homeless Link. (2019, September 19). Health needs audit-explore the data. Homeless. Retrieved from https://www.homeless.org.uk/facts/homelessness-in-numbers/health-needs-audit-explore-data.Google Scholar
Husk, K., Lovell, R., Cooper, C., Stahl-Timmins, W., & Garside, R. (2016). Participation in environmental enhancement and conservation activities for health and well-being in adults: A review of quantitative and qualitative evidence. Cochrane Database of Systematic Reviews, (5), 1465–1858.Google Scholar
Hwang, S. W. (2001). Homelessness and health. Canadian Medical Association Journal, 164(2), 229–233.Google ScholarPubMed
Jackson, S. E., Smith, C., Cheeseman, H., West, R., & Brown, J. (2019). Finding smoking hot-spots: A cross-sectional survey of smoking patterns by housing tenure in England. Addiction, 114(5), 889–895.CrossRefGoogle ScholarPubMed
Jha, P., Peto, R., Zatonski, W., Boreham, J., Jarvis, M. J., & Lopez, A. D. (2006). Social inequalities in male mortality, and in male mortality from smoking: Indirect estimation from national death rates in England and Wales. Poland, and North America. The Lancet, 368(9533), 367–370.CrossRefGoogle ScholarPubMed
Maddox, S., & Segan, C. (2017). Underestimation of homeless clients’ interest in quitting smoking: A case for routine tobacco assessment. Health Promotion Journal of Australia, 28(2), 160–164.CrossRefGoogle ScholarPubMed
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., … Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence. (2014, October). Developing the NICE guidelines: the manual. Process and methods [PMG20]. NICE. Retrieved from https://www.nice.org.uk/process/pmg20/chapter/reviewing-research-evidence.Google Scholar
National Institute for Health and Clinical Excellence (Great Britain). (2015). Developing the NICE guidelines: the manual. Retrieved from http://www.nice.org.uk/process/pmg20/chapter/reviewingresearchevidence. Accessed on 20/08/19.Google Scholar
Nguyen, M. A. H., Reitzel, L. R., Kendzor, D. E., & Businelle, M. S. (2015). Perceived cessation treatment effectiveness, medication preferences, and barriers to quitting among light and moderate/heavy homeless smokers. Drug and Alcohol Dependence, 153, 341–345.CrossRefGoogle ScholarPubMed
Office for National Statistics. (2019, July 2). Adult smoking habits in the UK: 2018. Ons. Retrieved from https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2018.Google Scholar
Okuyemi, K. S., Goldade, K., Whembolua, G. L., Thomas, J. L., Eischen, S., Sewali, B., … Resnicow, K. (2013). Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: A randomized controlled trial. Addiction, 108(6), 1136–1144.CrossRefGoogle ScholarPubMed
Okuyemi, K. S., Thomas, J. L., Hall, S., Nollen, N. L., Richter, K. P., Jeffries, S. K., … Ahluwalia, J. S. (2006). Smoking cessation in homeless populations: A pilot clinical trial. Nicotine & Tobacco Research, 8(5), 689–699.CrossRefGoogle ScholarPubMed
Porter, M, Harvey, J, Gavin, JK, Carpenter, MJ, Cummings, KM, Pope, C, & Diaz, VA. (2017). A qualitative study to assess factors supporting tobacco use in a homeless population. AIMS Medical Science, 4, 83–98.CrossRefGoogle Scholar
Porter, J., Houston, L., Anderson, R. H., & Maryman, K. (2011). Addressing tobacco use in homeless populations: Recommendations of an expert panel. Health Promotion Practice, 12(6_suppl_2), 144S–151S.CrossRefGoogle ScholarPubMed
Power, J., Mallat, C., Bonevski, B., & Nielssen, O. (2015). An audit of assessment and outcome of intervention at a quit smoking clinic in a homeless hostel. Australasian Psychiatry, 23(5), 528–530.CrossRefGoogle Scholar
Reitzel, L. R., Kendzor, D. E., Cao, Y., & Businelle, M. S. (2014a). Subjective social status predicts quit-day abstinence among homeless smokers. American Journal of Health Promotion, 29(1), 43–45.CrossRefGoogle Scholar
Reitzel, L. R., Nguyen, N., Eischen, S., Thomas, J., & Okuyemi, K. S. (2014b). Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults? Addiction, 109(12), 2098–2104.CrossRefGoogle Scholar
Richardson, S., McNeill, A., & Brose, L. S. (2019). Smoking and quitting behaviours by mental health conditions in Great Britain (1993–2014). Addictive Behaviors, 90, 14–19.CrossRefGoogle Scholar
Robinson, C. D., Rogers, C. R., & Okuyemi, K. S. (2016). Depression symptoms among homeless smokers: Effect of motivational interviewing. Substance Use & Misuse, 51(10), 1393–1397.CrossRefGoogle ScholarPubMed
Robson, D., & McNeill, A. (2019). Cutting edge smoking cessation support: SCIMITAR+. The Lancet Psychiatry, 6(5), 358–359.CrossRefGoogle ScholarPubMed
Santa Ana, E. J., LaRowe, S. D., Armeson, K., Lamb, K. E., & Hartwell, K. (2016). Impact of group motivational interviewing on enhancing treatment engagement for homeless Veterans with nicotine dependence and other substance use disorders: A pilot investigation. The American Journal on Addictions, 25(7), 533–541.CrossRefGoogle ScholarPubMed
Segan, C. J., Maddox, S., & Borland, R. (2015). Homeless clients benefit from smoking cessation treatment delivered by a homeless persons’ program. Nicotine & Tobacco Research, 17(8), 996–1001.CrossRefGoogle ScholarPubMed
Shelley, D., Cantrell, J., Wong, S., & Warn, D. (2010). Smoking cessation among sheltered homeless: A pilot. American Journal of Health Behavior, 34(5), 544–552.CrossRefGoogle ScholarPubMed
Spector, A., Alpert, H., & Karam-Hage, M. (2007). Smoking cessation delivered by medical students is helpful to homeless population. Academic Psychiatry, 31(5), 402–405.CrossRefGoogle ScholarPubMed
Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., … Carpenter, J. R. (2016). ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 355, i4919.CrossRefGoogle ScholarPubMed
Stewart, H. C., Stevenson, T. N., Bruce, J. S., Greenberg, B., & Chamberlain, L. J. (2015). Attitudes toward smoking cessation among sheltered homeless parents. Journal of Community Health, 40(6), 1140–1148.CrossRefGoogle ScholarPubMed
Taylor, E. M., Kendzor, D. E., Reitzel, L. R., & Businelle, M. S. (2016). Health risk factors and desire to change among homeless adults. American Journal of Health Behavior, 40(4), 455–460.CrossRefGoogle ScholarPubMed
Thirlway, F. (2016). Everyday tactics in local moral worlds: E-cigarette practices in a working-class area of the UK. Social Science & Medicine, 170, 106–113.CrossRefGoogle Scholar
Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8(1), 45.CrossRefGoogle ScholarPubMed
Torchalla, I., Strehlau, V., Okoli, C. T., Li, K., Schuetz, C., & Krausz, M. (2011). Smoking and predictors of nicotine dependence in a homeless population. Nicotine & Tobacco Research, 13(10), 934–942.CrossRefGoogle Scholar
Tsai, J., & Rosenheck, R. A. (2012). Smoking among chronically homeless adults: Prevalence and correlates. Psychiatric Services, 63(6), 569–576.CrossRefGoogle ScholarPubMed
Twyman, L., Bonevski, B., Paul, C., & Bryant, J. (2014). Perceived barriers to smoking cessation in selected vulnerable groups: A systematic review of the qualitative and quantitative literature. BMJ Open, 4(12), e006414.CrossRefGoogle ScholarPubMed
Vijayaraghavan, M., Guydish, J., & Pierce, J. P. (2016b). Building tobacco cessation capacity in homeless shelters: A pilot study. Journal of Community Health, 41(5), 998–1005.CrossRefGoogle Scholar
Vijayaraghavan, M., & Pierce, J. P. (2015). Interest in smoking cessation related to a smoke-free policy among homeless adults. Journal of Community Health, 40(4), 686–691.CrossRefGoogle ScholarPubMed
Vijayaraghavan, M., Tieu, L., Ponath, C., Guzman, D., & Kushel, M. (2016a). Tobacco cessation behaviors among older homeless adults: Results from the HOPE HOME study. Nicotine & Tobacco Research, 18(8), 1733–1739.CrossRefGoogle Scholar
Weiner, A., Rabiner, M., & Marron, T. (2016). Smoking habits of the homeless. Journal of Smoking Cessation, 11(4), 236–238.CrossRefGoogle Scholar
Wells, G. A., Shea, B., O'Connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (2008). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. The Ottawa Hospital research Institute. Retrieved from http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.Google Scholar
West, R., Hajek, P., Stead, L., & Stapleton, J. (2005). Outcome criteria in smoking cessation trials: Proposal for a common standard. Addiction, 100(3), 299–303.CrossRefGoogle ScholarPubMed
World Health Organization. (2003). WHO framework convention on tobacco control. Retrieved from http://whqlibdoc.who.int/publications/2003/9241591013.pdf.Google Scholar
Supplementary material: File

Soar et al. supplementary material

Soar et al. supplementary material 1

Download Soar et al. supplementary material(File)
File 31.3 KB
Supplementary material: File

Soar et al. supplementary material

Soar et al. supplementary material 2

Download Soar et al. supplementary material(File)
File 18.9 KB