Changes necessary to help homeless quit smoking

(HealthDay)—Many homeless are interested in quitting smoking, and specific interventions are necessary for this population, according to a perspective piece published in the July 18 issue of the New England Journal of Medicine.

Noting that approximately three-quarters of homeless adults are cigarette smokers and that smoking-related deaths occur at double the rate among homeless and marginally-housed people than among stably-housed individuals, Travis P. Baggett, M.D., M.P.H., from Massachusetts General Hospital in Boston, and colleagues discuss the need to address this problem.

The authors report that evidence suggests many homeless are interested in quitting smoking and that specific interventions are necessary to support smoking cessation. Addressing this issue will likely require intervention strategies at multiple levels. At the individual level, interventions should be delivered at or near shelters or drop-in facilities to encourage participation. At the interpersonal level, group-oriented or peer-based strategies may be promising. At the health care delivery level, guideline-supported measures such as screening and brief interventions for tobacco use should be employed as part of a comprehensive care model for homeless people. At the shelter level, smoke-free policies should be coupled with efforts to assess their unintended consequences, such as discouraging smokers from coming to shelters. At the policy level, tobacco excise tax increases may help reduce smoking, while expansion of health insurance and coverage of comprehensive tobacco treatment may reduce some of the barriers to quitting.

"Underlying all these strategies is the need to change the culture of complacency that has enabled our acceptance of smoking as an inextricable aspect of homelessness," the authors write.

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