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Calvo F, Guillén A, Carbonell X, Alfranca R, Beranuy M, Parés-Bayerri A, Font-Mayolas S. "Healthy immigrant effect" among individuals experiencing homelessness in Spain?: Foreign-born individuals had higher average age at death in 15-year retrospective cohort study. BMC Public Health 2023; 23:1212. [PMID: 37349708 PMCID: PMC10286494 DOI: 10.1186/s12889-023-16109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Individuals experiencing homelessness (IEHs) suffer from severe health inequities. Place of origin is linked to health and mortality of IEHs. In the general population the "healthy immigrant effect" provides a health advantage to foreign-born people. This phenomenon has not been sufficiently studied among the IEH population. The objectives are to study morbidity, mortality, and age at death among IEHs in Spain, paying special attention to their origin (Spanish-born or foreign-born) and to examine correlates and predictors of age at death. METHODS Retrospective cohort study (observational study) of a 15-year period (2006-2020). We included 391 IEHs who had been attended at one of the city's public mental health, substance use disorder, primary health, or specialized social services. Subsequently, we noted which subjects died during the study period and analyzed the variables related to their age at death. We compared the results based on origin (Spanish-born vs. foreign-born) and fitted a multiple linear regression model to the data to establish predictors of an earlier age at death. RESULTS The mean age at death was 52.38 years. Spanish-born IEHs died on average almost nine years younger. The leading causes of death overall were suicide and drug-related disorders (cirrhosis, overdose, and chronic obstructive pulmonary disease [COPD]). The results of the linear regression showed that earlier death was linked to COPD (b = - 0.348), being Spanish-born (b = 0.324), substance use disorder [cocaine (b =-0.169), opiates (b =.-243), and alcohol (b =-0.199)], cardiovascular diseases (b = - 0.223), tuberculosis (b = - 0.163), high blood pressure (b =-0.203), criminal record (b =-0.167), and hepatitis C (b =-0.129). When we separated the causes of death for Spanish-born and foreign-born subjects, we found that the main predictors of death among Spanish-born IEHs were opiate use disorder (b =-0.675), COPD (b =-0.479), cocaine use disorder (b =-0.208), high blood pressure (b =-0.358), multiple drug use disorder (b =-0.365), cardiovascular disease (b =-0.306), dual pathology (b =-0.286), female gender (b =-0.181), personality disorder (b =-0.201), obesity (b =-0.123), tuberculosis (b =-0.120) and having a criminal record (b =-0.153). In contrast, the predictors of death among foreign-born IEHs were psychotic disorder (b =-0.134), tuberculosis (b =-0.132), and opiate (b =-0.119) or alcohol use disorder (b =-0.098). CONCLUSIONS IEHs die younger than the general population, often due to suicide and drug use. The healthy immigrant effect seems to hold in IEHs as well as in the general population.
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Affiliation(s)
- Fran Calvo
- Serra Húnter Fellow, Department of Pedagogy, Quality of Life Research Institute, Universitat de Girona, Girona, Spain.
| | - Ana Guillén
- Department of Personality, Evaluation and Clinical Psychology, Universidad Complutense, Madrid, Spain
| | | | - Rebeca Alfranca
- Primary Care Centre Santa Clara, Catalan Institute of Health, Girona, Spain
| | - Marta Beranuy
- Department of Health Sciences, Faculty of Health Sciences, Universidad Pública de Navarra (UPNA), Pamplona, Spain
- Cyberpsychology research group, Universidad Internacional de La Rioja, Logroño, Spain
| | - Alícia Parés-Bayerri
- Department of Psychology, Quality of Life Research Institute, Universitat de Girona, Girona, Spain
| | - Sílvia Font-Mayolas
- Department of Psychology, Quality of Life Research Institute, Universitat de Girona, Girona, Spain
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Nemeth JM, Glasser AM, Hinton A, Macisco JM, Wermert A, Smith R, Kemble H, Sasser G. Brain Injury Is Prevalent and Precedes Tobacco Use among Youth and Young Adults Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5169. [PMID: 36982077 PMCID: PMC10049052 DOI: 10.3390/ijerph20065169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
70%+ of youth and young adults experiencing homelessness (YYEH; 14-24 years old) smoke combustible tobacco. Little is known about the prevalence of acquired brain injury (ABI) among youth and young adult smokers experiencing homelessness (YYSEH) and its impact on tobacco use progression-the aim of our study. Through an interviewer-administered survey, YYSEH were asked about timing of tobacco use; exposure to causes of ABI; including brain oxygen deprivation (BOD; strangulation; accidental; choking games) and blunt force head trauma (BFHT; intentional; shaken violently; accidental); and perpetrators of intentional assault. Participants (n = 96) were on average 22 years old and from populations who experience structural disparities; including those minoritized by race (84.4%) and gender/sexual orientation (26.0%). In total, 87% of participants reported at least one exposure to BFHT and 65% to BOD. Intentional injury was more common than accidental. Furthermore, 60.4% of participants (n = 59) were classified as having ABI using the Brain Injury Severity Assessment. A significant proportion of YYSEH living with ABI were exposed to both BFHT and BOD prior to trying (68.5%, p = 0.002) and to first regular use (82.8%, p < 0.001) of tobacco. Among YYSEH with ABI; injury exposure occurred a median of 1 and 5 years before age of first regular tobacco use, dependent on injury mechanism. ABI from intentional violence is prevalent and precedes tobacco use among YYSEH.
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Affiliation(s)
- Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Allison M. Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Joseph M. Macisco
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Raya Smith
- College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Hannah Kemble
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
- Division of Health Services, Management, and Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Georgia Sasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
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Skelton E, Rich J, Handley T, Bonevski B. Prevalence of cannabis use among tobacco smokers: a systematic review protocol. BMJ Open 2022; 12:e050681. [PMID: 35501085 PMCID: PMC9062809 DOI: 10.1136/bmjopen-2021-050681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/08/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Understanding the prevalence of cannabis use among tobacco smokers has important implications for research in terms of intervention effectiveness and measurement in smoking cessation trials. The co-use of these substances also has important implications for health service planning, specifically ensuring appropriate and adequate clinical treatment. To date, there have been no synthesis of the literature on the prevalence of tobacco and cannabis co-use in adult clinical populations. Improved understanding of the current prevalence, route of administration and specific subpopulations with the highest rates of tobacco and cannabis co-use will support future intervention development. We aim to provide a pooled estimate of the percentage of smokers who report using cannabis and to examine the prevalence of co-use by sociodemographic characteristics. METHODS AND ANALYSIS We will conduct a systematic review using six scientific databases with published articles from 2000 to 2022 inclusive (CENTRAL, CINAHL, EMBASE, Medline, PsycINFO, Psychology and Behavioural Sciences Collection, Scopus). Peer-reviewed journal articles published in English that report on tobacco and cannabis use will be included. Rates of co-use (simultaneous or sequentially) and routes of administration will be assessed. Use in populations groups will be described. Quality assessments will be conducted for all included studies. Data will be synthesised using a narrative approach. This study will be conducted from June 2022 to the end of August 2022. ETHICS AND DISSEMINATION This review is based on previously published data and, therefore, ethical approval or written informed consent will not be required. It is the intention of the research team to disseminate the results of the systematic review as a peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020194051.
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Affiliation(s)
- Eliza Skelton
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jane Rich
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Tonelle Handley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- College of Health and Medicine, Flinders University, Bedford Park, South Australia, Australia
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Cox S, Ford A, Li J, Best C, Tyler A, Robson DJ, Bauld L, Hajek P, Uny I, Parrott SJ, Dawkins L. Exploring the uptake and use of electronic cigarettes provided to smokers accessing homeless centres: a four-centre cluster feasibility trial. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Smoking prevalence is extremely high in adults experiencing homelessness, and there is little evidence regarding which cessation interventions work best. This study explored the feasibility of providing free electronic cigarette starter kits to smokers accessing homeless centres in the UK.
Objectives
Seven key objectives were examined to inform a future trial: (1) assess willingness of smokers to participate in the study to estimate recruitment rates; (2) assess participant retention in the intervention and control arms; (3) examine the perceived value of the intervention, facilitators of and barriers to engagement, and influence of local context; (4) assess service providers’ capacity to support the study and the type of information and training required; (5) assess the potential efficacy of supplying free electronic cigarette starter kits; (6) explore the feasibility of collecting data on contacts with health-care services as an input to a main economic evaluation; and (7) estimate the cost of providing the intervention and usual care.
Design
A prospective cohort four-centre pragmatic cluster feasibility study with embedded qualitative process evaluation.
Setting
Four homeless centres. Two residential units in London, England. One day centre in Northampton, England. One day centre in Edinburgh, Scotland.
Intervention
In the intervention arm, a single refillable electronic cigarette was provided together with e-liquid, which was provided once per week for 4 weeks (choice of three flavours: fruit, menthol or tobacco; two nicotine strengths: 12 or 18 mg/ml). There was written information on electronic cigarette use and support. In the usual-care arm, written information on quitting smoking (adapted from NHS Choices) and signposting to the local stop smoking service were provided.
Results
Fifty-two per cent of eligible participants invited to take part in the study were successfully recruited (56% in the electronic cigarette arm; 50.5% in the usual-care arm; total n = 80). Retention rates were 75%, 63% and 59% at 4, 12 and 24 weeks, respectively. The qualitative component found that perceived value of the intervention was high. Barriers were participants’ personal difficulties and cannabis use. Facilitators were participants’ desire to change, free electronic cigarettes and social dynamics. Staff capacity to support the study was generally good. Carbon monoxide-validated sustained abstinence rates at 24 weeks were 6.25% (3/48) in the electronic cigarette arm compared with 0% (0/32) in the usual-care arm (intention to treat). Almost all participants present at follow-up visits completed measures needed for input into an economic evaluation, although information about staff time to support usual care could not be gathered. The cost of providing the electronic cigarette intervention was estimated at £114.42 per person. An estimated cost could not be calculated for usual care.
Limitations
Clusters could not be fully randomised because of a lack of centre readiness. The originally specified recruitment target was not achieved and recruitment was particularly difficult in residential centres. Blinding was not possible for the measurement of outcomes. Staff time supporting usual care could not be collected.
Conclusions
The study was associated with reasonable recruitment and retention rates and promising acceptability in the electronic cigarette arm. Data required for full cost-effectiveness evaluation in the electronic cigarette arm could be collected, but some data were not available in the usual-care arm.
Future work
Future research should focus on several key issues to help design optimal studies and interventions with this population, including which types of centres the intervention works best in, how best to retain participants in the study, how to help staff to deliver the intervention, and how best to record staff treatment time given the demands on their time.
Trial registration
Current Controlled Trials ISRCTN14140672; the protocol was registered as researchregistry4346.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sharon Cox
- Centre for Addictive Behaviours Research, London South Bank University, London, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | - Allison Ford
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Jinshuo Li
- Department of Health and Social Care Sciences, University of York, York, UK
| | - Catherine Best
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Allan Tyler
- Centre for Addictive Behaviours Research, London South Bank University, London, UK
| | - Deborah J Robson
- National Addiction Centre, Addictions Department and the National Institute for Health Research Applied Research Collaboration (NIHR ARC) South London, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Linda Bauld
- Usher Institute, Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Peter Hajek
- Academic Psychology and Health and Lifestyle Research Unit, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London, UK
| | - Isabelle Uny
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Steve J Parrott
- Department of Health and Social Care Sciences, University of York, York, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, London South Bank University, London, UK
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Linnemayr S, Zutshi R, Shadel W, Pedersen E, DeYoreo M, Tucker J. Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned From a Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e23989. [PMID: 33792551 PMCID: PMC8050749 DOI: 10.2196/23989] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/04/2021] [Accepted: 02/23/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. OBJECTIVE This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. METHODS Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. RESULTS Participants had widespread (smart)phone ownership-16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. CONCLUSIONS The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13722-020-00187-6.
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Affiliation(s)
| | | | | | - Eric Pedersen
- University of Southern California, Los Angeles, CA, United States
| | | | - Joan Tucker
- RAND Corporation, Santa Monica, CA, United States
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Vijayaraghavan M, Elser H, Frazer K, Lindson N, Apollonio D. Interventions to reduce tobacco use in people experiencing homelessness. Cochrane Database Syst Rev 2020; 12:CD013413. [PMID: 33284989 PMCID: PMC8130995 DOI: 10.1002/14651858.cd013413.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Populations experiencing homelessness have high rates of tobacco use and experience substantial barriers to cessation. Tobacco-caused conditions are among the leading causes of morbidity and mortality among people experiencing homelessness, highlighting an urgent need for interventions to reduce the burden of tobacco use in this population. OBJECTIVES To assess whether interventions designed to improve access to tobacco cessation interventions for adults experiencing homelessness lead to increased numbers engaging in or receiving treatment, and whether interventions designed to help adults experiencing homelessness to quit tobacco lead to increased tobacco abstinence. To also assess whether tobacco cessation interventions for adults experiencing homelessness affect substance use and mental health. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register, MEDLINE, Embase and PsycINFO for studies using the terms: un-housed*, homeless*, housing instability, smoking cessation, tobacco use disorder, smokeless tobacco. We also searched trial registries to identify unpublished studies. Date of the most recent search: 06 January 2020. SELECTION CRITERIA We included randomized controlled trials that recruited people experiencing homelessness who used tobacco, and investigated interventions focused on the following: 1) improving access to relevant support services; 2) increasing motivation to quit tobacco use; 3) helping people to achieve abstinence, including but not limited to behavioral support, tobacco cessation pharmacotherapies, contingency management, and text- or app-based interventions; or 4) encouraging transitions to long-term nicotine use that did not involve tobacco. Eligible comparators included no intervention, usual care (as defined by the studies), or another form of active intervention. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Tobacco cessation was measured at the longest time point for each study, on an intention-to-treat basis, using the most rigorous definition available. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study where possible. We grouped eligible studies according to the type of comparison (contingent reinforcement in addition to usual smoking cessation care; more versus less intensive smoking cessation interventions; and multi-issue support versus smoking cessation support only), and carried out meta-analyses where appropriate, using a Mantel-Haenszel random-effects model. We also extracted data on quit attempts, effects on mental and substance-use severity, and meta-analyzed these outcomes where sufficient data were available. MAIN RESULTS We identified 10 studies involving 1634 participants who smoked combustible tobacco at enrolment. One of the studies was ongoing. Most of the trials included participants who were recruited from community-based sites such as shelters, and three included participants who were recruited from clinics. We judged three studies to be at high risk of bias in one or more domains. We identified low-certainty evidence, limited by imprecision, that contingent reinforcement (rewards for successful smoking cessation) plus usual smoking cessation care was not more effective than usual care alone in promoting abstinence (RR 0.67, 95% CI 0.16 to 2.77; 1 trial, 70 participants). We identified very low-certainty evidence, limited by risk of bias and imprecision, that more intensive behavioral smoking cessation support was more effective than brief intervention in promoting abstinence at six-month follow-up (RR 1.64, 95% CI 1.01 to 2.69; 3 trials, 657 participants; I2 = 0%). There was low-certainty evidence, limited by bias and imprecision, that multi-issue support (cessation support that also encompassed help to deal with other challenges or addictions) was not superior to targeted smoking cessation support in promoting abstinence (RR 0.95, 95% CI 0.35 to 2.61; 2 trials, 146 participants; I2 = 25%). More data on these types of interventions are likely to change our interpretation of these data. Single studies that examined the effects of text-messaging support, e-cigarettes, or cognitive behavioral therapy for smoking cessation provided inconclusive results. Data on secondary outcomes, including mental health and substance use severity, were too sparse to draw any meaningful conclusions on whether there were clinically-relevant differences. We did not identify any studies that explicitly assessed interventions to increase access to tobacco cessation care; we were therefore unable to assess our secondary outcome 'number of participants receiving treatment'. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the effects of any tobacco cessation interventions specifically in people experiencing homelessness. Although there was some evidence to suggest a modest benefit of more intensive behavioral smoking cessation interventions when compared to less intensive interventions, our certainty in this evidence was very low, meaning that further research could either strengthen or weaken this effect. There is insufficient evidence to assess whether the provision of tobacco cessation support and its effects on quit attempts has any effect on the mental health or other substance-use outcomes of people experiencing homelessness. Although there is no reason to believe that standard tobacco cessation treatments work any differently in people experiencing homelessness than in the general population, these findings highlight a need for high-quality studies that address additional ways to engage and support people experiencing homelessness, in the context of the daily challenges they face. These studies should have adequate power and put effort into retaining participants for long-term follow-up of at least six months. Studies should also explore interventions that increase access to cessation services, and address the social and environmental influences of tobacco use among people experiencing homelessness. Finally, studies should explore the impact of tobacco cessation on mental health and substance-use outcomes.
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Affiliation(s)
- Maya Vijayaraghavan
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Holly Elser
- Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Kate Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dorie Apollonio
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
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Resilience is associated with importance of quitting in homeless adult smokers. Addict Behav 2020; 110:106515. [PMID: 32652387 DOI: 10.1016/j.addbeh.2020.106515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The prevalence of cigarette smoking in homeless populations is disproportionately high with rates between 57 and 80%. Resilience may affect a smoker's ability to successfully quit smoking. This cross-sectional study examined the association between resilience levels and smoking behaviors in homeless adults. METHOD Fifty-nine homeless adults were recruited from a large multi-service homelessness agency in the northeast United States. Surveys were administered to measure smoking behaviors and resilience. RESULTS Most participants were current smokers (83.1%), with more than half (67.1%) identifying as "moderate smokers" (smoking 10-20 cigarettes per day). Of the current smokers, 93.9% reported smoking daily and 71.4% had tried to quit at least once in their lifetime. The number of quit attempts was significantly (p < 0.05) associated with one's contemplation of quitting (r = 0.29) and how one viewed importance of quitting (r = 0.33). Resilience levels were significantly associated with how participants ranked importance of quitting (r = 0.37). Smokers reported a high desire to quit smoking, but level of confidence in their ability to quit was low. Difficulty in finding stable housing and social support were reported as barriers to quitting. CONCLUSIONS This study demonstrates an association between importance of quitting and resilience levels in homeless adult smokers. Future work is needed to examine whether resilience is related to successful smoking cessation in homeless adults, and whether resilience levels can be increased with targeted interventions.
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Dawkins L, Bauld L, Ford A, Robson D, Hajek P, Parrott S, Best C, Li J, Tyler A, Uny I, Cox S. A cluster feasibility trial to explore the uptake and use of e-cigarettes versus usual care offered to smokers attending homeless centres in Great Britain. PLoS One 2020; 15:e0240968. [PMID: 33095798 PMCID: PMC7584191 DOI: 10.1371/journal.pone.0240968] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/05/2020] [Indexed: 12/22/2022] Open
Abstract
Smoking rates in the UK are at an all-time low but this masks considerable inequalities; prevalence amongst adults who are homeless remains four times higher than the national average. The objective of this trial was to assess the feasibility of supplying free e-cigarette starter kits to smokers accessing homeless centres and to estimate parameters to inform a possible future larger trial. In this feasibility cluster trial, four homeless centres in Great Britain were non-randomly allocated to either a Usual Care (UC) or E-Cigarette (EC) arm. Smokers attending the centres were recruited by staff. UC arm participants (N = 32) received advice to quit and signposting to the local Stop Smoking Service. EC arm participants (N = 48) received an EC starter kit and 4-weeks supply of e-liquid. Outcome measures were recruitment and retention rates, use of ECs, smoking cessation/reduction and completion of measures required for economic evaluation. Eighty (mean age 43 years; 65% male) of the 153 eligible participants who were invited to participate, were successfully recruited (52%) within a five-month period, and 47 (59%) of these were retained at 24 weeks. The EC intervention was well received with minimal negative effects and very few unintended consequences (e.g. lost, theft, adding illicit substances). In both study arm, depression and anxiety scores declined over the duration of the study. Substance dependence scores remained constant. Assuming those with missing follow up data were smoking, CO validated sustained abstinence at 24 weeks was 3/48 (6.25%) and 0/32 (0%) respectively for the EC and UC arms. Almost all participants present at follow-up visits completed data collection for healthcare service and health-related quality of life measures. Providing an e-cigarette starter kit to smokers experiencing homelessness was associated with reasonable recruitment and retention rates and promising evidence of effectiveness and cost-effectiveness.
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Affiliation(s)
- Lynne Dawkins
- Centre for Addictive Behaviours Research, London South Bank University, London, England
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, Old Medical School, University of Edinburgh, Edinburgh, Scotland
| | - Allison Ford
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
| | - Deborah Robson
- National Addiction Centre and SPECTRUM Consortium, Addictions Department & ARC South London, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, England
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
| | - Steve Parrott
- Department of Health Sciences, University of York, York, England
| | - Catherine Best
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, England
| | - Allan Tyler
- Centre for Addictive Behaviours Research, London South Bank University, London, England
| | - Isabelle Uny
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
| | - Sharon Cox
- Centre for Addictive Behaviours Research, London South Bank University, London, England
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Taing M, Kyburz B, Leal IM, Le K, Chen TA, Correa-Fernandez V, Williams T, O’Connor DP, Obasi EM, Casey K, Koshy L, Reitzel LR. Clinician Training in the Adaptation of a Comprehensive Tobacco-Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6154. [PMID: 32854185 PMCID: PMC7503354 DOI: 10.3390/ijerph17176154] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022]
Abstract
Tobacco use is exceedingly high among those who are homeless or at risk of homelessness but not commonly addressed by clinicians. Taking Texas Tobacco Free (TTTF) is a tobacco control program that addresses known clinician barriers to intervention (e.g., low training receipt, limited resources). Here, we examine the process and outcomes of TTTF's adaptation within four agencies that provide housing or other services to individuals who are homeless or vulnerably housed. Pre- and post-implementation data were collected from clinicians (N = 68) to assess changes in training receipt, knowledge, and intervention behaviors, relative to program goals. Results indicated significant gains in clinicians' receipt of training in 9 (of 9) target areas (p's ≤ 0.0042) and a 53% knowledge gain (p < 0.0001). From pre- to post-implementation, there were mean increases in the use of the 5As (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with significant gains seen in assisting residents/clients to quit, arranging follow-ups, and providing or referring for non-nicotine medications (p's ≤ 0.0491). All program goals, except gains related to advising smokers to quit and the use of specific interventions (behavioral counseling), were met. Overall, TTTF improved clinicians' capacity to address tobacco use among homeless and vulnerably housed individuals and can serve as a model for tobacco control efforts in similar agencies.
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Affiliation(s)
- Matthew Taing
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Bryce Kyburz
- Integral Care, Austin, TX, USA; (B.K.); (T.W.); (K.C.)
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Kathy Le
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
- Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Tzu-An Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Virmarie Correa-Fernandez
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | | | - Daniel P. O’Connor
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | | | - Litty Koshy
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (M.T.); (I.M.L.); (K.L.); (T.-A.C.); (V.C.-F.); (E.M.O.); (L.K.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA;
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10
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Alternative flavored and unflavored tobacco product use and cigarette quit attempts among current smokers experiencing homelessness. Addict Behav Rep 2020; 12:100280. [PMID: 32637560 PMCID: PMC7330871 DOI: 10.1016/j.abrep.2020.100280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 01/27/2023] Open
Abstract
Almost two-thirds of participants used alternative tobacco products. Cigars, blunts, and e-cigarettes most commonly used alternative tobacco products. Most cigar and e-cigarette users used fruit-flavored tobacco products. Discordance found between perceptions of addiction/harm and alternative tobacco use. Alternative tobacco product use was not associated with a past-year quit attempt.
Introduction Alternative tobacco product (ATP) use is common in the general population; however, few studies have explored ATP among individuals experiencing homelessness. We recruited individuals experiencing homelessness who were current cigarette smokers to explore flavored and unflavored ATP use and its association with past-year cigarette quit attempts. Methods Using time-location sampling, we recruited participants from eight service sites in San Francisco, CA between December 2017 and July 2018. We explored type of ATP use and perceptions of product addiction, harm and risk between cigarette-only smokers and those who used cigarettes and ATPs (‘ATP users’). We used logistic regression to examine the association between ATP and past-year quit attempts, adjusting for demographics, substance use disorders, depressive symptoms, and cigarette use characteristics. Results Among the 470 participants, 34.5% were cigarette-only users and 65.5% were ATP users. Among ATP users, 74.0% used cigars and 29.8% used e-cigarettes in the past month, with fruit-flavored products being the most common. ATP users were more likely to perceive cigars, blunts, and smokeless tobacco to be quite to extremely harmful or addictive compared to cigarette-only users. ATP use was not associated with past-year quit attempts, whereas hazardous alcohol use (OR = 2.07; CI 1.07–4.02) was associated with higher odds and and amphetamine use (OR = 0.50; CI 0.26–0.98) was associated with lower odds of past-year attempts. Conclusions High rates of ATP use highlight a need for studies that explore motivations for use, beyond use as a smoking cessation aid, among people experiencing homelessness.
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Vijayaraghavan M, Elser H, Apollonio D. Interventions to reduce tobacco use in people experiencing homelessness. Hippokratia 2019. [DOI: 10.1002/14651858.cd013413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maya Vijayaraghavan
- University of California, San Francisco; Division of General Internal Medicine; San Francisco California USA
| | - Holly Elser
- University of California, Berkeley; Epidemiology; Berkeley California USA
| | - Dorie Apollonio
- University of California San Francisco; Clinical Pharmacy; 3333 California Street Suite 420 San Francisco CA USA 94143-0613
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12
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Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. J Am Coll Cardiol 2019; 71:2585-2597. [PMID: 29852981 DOI: 10.1016/j.jacc.2018.02.077] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Samantha S Liauw
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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Vijayaraghavan M, Neisler J, Wrighting Q, Reitzel LR, Hébert ET, Rash CJ, Kendzor DE, Businelle MS. Income associations with cigarette purchasing behaviors and quit attempts among people experiencing homelessness. Addict Behav 2019; 95:197-201. [PMID: 30959414 DOI: 10.1016/j.addbeh.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Cigarette purchasing behavior may reflect quitting intentions. Little is known about how income could modify the association between cigarette purchasing behaviors and quit attempts among smokers experiencing homelessness. METHODS Homeless, current smokers completed a questionnaire on the amount spent weekly on cigarettes (≤$20/week versus >$20/week), source of cigarettes (store versus other source), quantity of cigarettes purchased (<pack versus ≥pack), and past-year quit attempts. The association of participant income and these cigarette purchasing behaviors were examined. The relationship between cigarette purchasing behaviors and quit attempts was also examined and monthly income (none versus any) was explored as a potential moderator of this relationship. RESULTS Of the 472 currently smoking individuals, 55% reported spending >$20/week on cigarettes, 83% reported purchasing cigarettes from a store, and 86% reported purchasing ≥pack during their last purchase. Those who reported an income spent a third of their monthly income on cigarettes, and were more likely to spend >$20/week on cigarettes. The amount spent weekly on cigarettes and the source of cigarettes was not associated with quit attempts, nor did income moderate these relationships. Persons without an income who bought a pack or more of cigarettes made fewer quit attempts (β = -0.4, 95% CI -0.7, -0.2), whereas the association between quantity of cigarettes purchased and quit attempts was not significant for those with an income (β = -0.2, 95% CI -0.4, 0.1). CONCLUSIONS Current smokers experiencing homelessness and who are without an income may find it particularly challenging to engage in attempts to quit smoking. Smoking cessation interventions that highlight relief of financial hardship as a potential benefit of successfully quitting smoking may be useful among this population.
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Baggett TP, McGlave C, Kruse GR, Yaqubi A, Chang Y, Rigotti NA. SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e13162. [PMID: 31165717 PMCID: PMC6746087 DOI: 10.2196/13162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/27/2019] [Accepted: 04/23/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. OBJECTIVE This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. METHODS From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. RESULTS Of the SmokefreeTXT arm participants (n=25), 88% (22) enrolled in the program, but only 56% (14) had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. CONCLUSIONS SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. TRIAL REGISTRATION ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ).
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Affiliation(s)
- Travis P Baggett
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Claire McGlave
- Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Gina R Kruse
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Awesta Yaqubi
- Boston University School of Medicine, Boston, MA, United States
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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15
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Collins SE, Nelson LA, Stanton J, Mayberry N, Ubay T, Taylor EM, Hoffmann G, Goldstein SC, Saxon AJ, Malone DK, Clifasefi SL, Okuyemi K. Harm reduction treatment for smoking (HaRT-S): findings from a single-arm pilot study with smokers experiencing chronic homelessness. Subst Abus 2019; 40:229-239. [PMID: 30924732 DOI: 10.1080/08897077.2019.1572049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Smoking prevalence and mortality is 5 times higher for the chronically homeless versus general population. Unfortunately, traditional smoking cessation treatment does not optimally engage this population. In a preliminary study, smokers experiencing chronic homelessness suggested providers avoid giving advice to quit and instead use a more compassionate, nonjudgmental style to discuss a broader menu of patient-driven options, including safer nicotine use. Most had negative perceptions of smoking cessation medications; however, 76% expressed interest in a switchover to electronic nicotine delivery systems (ENDS). Methods: Using a community-based participatory research approach, we codeveloped harm-reduction treatment for smoking (HaRT-S) together with people with lived experience of chronic homelessness and smoking and a community-based agency that serves them. In HaRT-S, interventionists embody a compassionate, advocacy-oriented "heart-set" and deliver manualized components: a) participant-led tracking of smoking-related outcomes, b) elicitation of harm-reduction goals and progress made toward them, c) discussion of relative risks of nicotine delivery systems, and d) distribution and instructions on use of safer nicotine products. We then conducted a single-arm, 14-week pilot of HaRT-S (N = 44). Results: Participants rated procedures "totally acceptable/effective," which was reflected in 26% overrecruitment within a 4-month period and 70% retention at the 14-week follow-up. For each week in the study, participants experienced an 18% increase in odds of reporting 7-day, biochemically verified, point-prevalence abstinence. All participants reporting abstinence used ENDS. Participants evinced reductions in cigarette dependence (-45%), frequency (-29%), and intensity (-78%; ps < .05). Participants who used ENDS experienced an additional 44% reduction in smoking intensity and a 1.2-point reduction in dependence compared to participants who did not. Conclusions: Harm-reduction counseling plus ENDS shows promise for smokers experiencing chronic homelessness. Randomized controlled trials are needed to establish the efficacy of this approach in decreasing smoking-related harm and improving health-related quality of life for this marginalized and disproportionately affected population.
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Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Lonnie A Nelson
- Washington State University West Campus , Seattle , Washington , USA
| | - Joey Stanton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Nigel Mayberry
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Tatiana Ubay
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Emily M Taylor
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Gail Hoffmann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Silvi C Goldstein
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA.,Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System , Seattle , Washington , USA
| | - Daniel K Malone
- Downtown Emergency Service Center , Seattle , Washington , USA
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle , Washington , USA
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- Downtown Emergency Service Center , Seattle , Washington , USA
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16
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Neisler J, Reitzel LR, Garey L, Kenzdor DE, Hébert ET, Vijayaraghavan M, Businelle MS. The moderating effect of perceived social support on the relation between heaviness of smoking and quit attempts among adult homeless smokers. Drug Alcohol Depend 2018; 190:128-132. [PMID: 30016736 PMCID: PMC6084469 DOI: 10.1016/j.drugalcdep.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Over 70% of homeless adults smoke cigarettes. Despite the desire to quit, this group rarely receives the external support to make or maintain a successful quit attempt (SQA; intentional quit attempt lasting >24 h). The Heaviness of Smoking Index (HSI) is a cigarette dependence measure that independently predicts SQAs among domiciled adults. For homeless adults, social support may be a way to buffer the impact of cigarette dependence on SQAs. METHODS The association of the HSI and past-year SQAs, and the potential moderating role of social support, was examined among 445 homeless smokers (Mage = 43.2 + 11.8, 65% male, 57.5% white). Support was measured by the International Support Evaluation List (ISEL-12) and its 3 subscales: tangible, belonging, & appraisal support. RESULTS The HSI was negatively correlated with SQAs (r=-.283, p < .01) and in a regression model controlling for age, sex, and race/ethnicity, appraisal support significantly moderated this relationship (p < .05). The HSI was significantly related to SQAs across low, moderate, and high levels of appraisal support [mean, +1 SD; low (β=-.657, p < .001), medium (β=-.457, p < .001), and high (β=-.258, p < .05)]. Neither the ISEL-12 total nor the other subscales were moderators. CONCLUSION The perceived availability of someone to talk to about one's problems appeared to attenuate the strength of the inverse relationship between the heaviness of smoking and SQAs. Fostering appraisal support for homeless smokers through group treatment may reduce the impact of cigarette dependence on making quit attempts. Social support coupled with the increased availability of empirically-supported cessation aids may improve dismal quit rates among homeless adults.
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Affiliation(s)
- Julie Neisler
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX, 77204, USA; HEALTH Research Institute, The University of Houston, 4849 Calhoun Road, Houston, TX, 77204, USA
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX, 77204, USA; HEALTH Research Institute, The University of Houston, 4849 Calhoun Road, Houston, TX, 77204, USA.
| | - Lorra Garey
- Department of Psychology, The University of Houston, 126 Heyne Building, Houston, TX, 77204, USA
| | - Darla E Kenzdor
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Emily T Hébert
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Maya Vijayaraghavan
- Division of General Internal Medicine/Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave., Rm. 1311E, San Francisco, CA, 94110, USA
| | - Michael S Businelle
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
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Baggett TP, Yaqubi A, Berkowitz SA, Kalkhoran SM, McGlave C, Chang Y, Campbell EG, Rigotti NA. Subsistence difficulties are associated with more barriers to quitting and worse abstinence outcomes among homeless smokers: evidence from two studies in Boston, Massachusetts. BMC Public Health 2018; 18:463. [PMID: 29631559 PMCID: PMC5891993 DOI: 10.1186/s12889-018-5375-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background Three-quarters of homeless people smoke cigarettes. Competing priorities for shelter, food, and other subsistence needs may be one explanation for low smoking cessation rates in this population. We analyzed data from two samples of homeless smokers to examine the associations between subsistence difficulties and 1) smoking cessation readiness, confidence, and barriers in a cross-sectional study, and 2) smoking abstinence during follow-up in a longitudinal study. Methods We conducted a survey of homeless smokers (N = 306) in 4/2014–7/2014 and a pilot randomized controlled trial (RCT) for homeless smokers (N = 75) in 10/2015–6/2016 at Boston Health Care for the Homeless Program. In both studies, subsistence difficulties were characterized as none, low, or high based on responses to a 5-item scale assessing the frequency of past-month difficulty finding shelter, food, clothing, a place to wash, and a place to go to the bathroom. Among survey participants, we used linear regression to assess the associations between subsistence difficulty level and readiness to quit, confidence to quit, and a composite measure of perceived barriers to quitting. Among RCT participants, we used repeated-measures logistic regression to examine the association between baseline subsistence difficulty level and carbon monoxide-defined brief smoking abstinence assessed 14 times over 8 weeks of follow-up. Analyses adjusted for demographic characteristics, substance use, mental illness, and nicotine dependence. Results Subsistence difficulties were common in both study samples. Among survey participants, greater subsistence difficulties were associated with more perceived barriers to quitting (p < 0.001) but not with cessation readiness or confidence. A dose-response relationship was observed for most barriers, particularly psychosocial barriers. Among RCT participants, greater baseline subsistence difficulties predicted less smoking abstinence during follow-up in a dose-response fashion. In adjusted analyses, individuals with the highest level of subsistence difficulty had one-third the odds of being abstinent during follow-up compared to those without subsistence difficulties (OR 0.33, 95% CI 0.11–0.93) despite making a similar number of quit attempts. Conclusions Homeless smokers with greater subsistence difficulties perceive more barriers to quitting and are less likely to do so despite similar readiness, confidence, and attempts. Future studies should assess whether addressing subsistence difficulties improves cessation outcomes in this population. Trial registration ClinicalTrials.gov: NCT02565381.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. .,Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA.
| | - Awesta Yaqubi
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Sara M Kalkhoran
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Claire McGlave
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Eric G Campbell
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nancy A Rigotti
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
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18
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Neisler J, Reitzel LR, Garey L, Kenzdor DE, Hébert ET, Vijayaraghavan M, Businelle MS. Concurrent nicotine and tobacco product use among homeless smokers and associations with cigarette dependence and other factors related to quitting. Drug Alcohol Depend 2018; 185:133-140. [PMID: 29448145 PMCID: PMC10032424 DOI: 10.1016/j.drugalcdep.2017.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/09/2017] [Accepted: 12/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cigarette smoking rates among homeless adults are exceptionally high, contributing to health disparities experienced by this disadvantaged population. Concurrent nicotine and tobacco product use have been shown to result in greater health problems than cigarette smoking alone, and little is known about the rates, motives, and perceived impacts of concurrent use in this group. The purpose of this study is to explore concurrent use rates and constructs of interest among homeless adult daily smokers and to examine differences between concurrent users and non-concurrent users on cigarette dependence, perceived risk of smoking, readiness to quit, and the receipt of recent cessation intervention. METHODS Participants (N = 396) were recruited from six homeless-serving agencies and/or shelters in Oklahoma City. Enrolled participants completed self-report questionnaires. RESULTS The rate of concurrent use was high -67.2%. Participants most frequently endorsed lower cost and a desire to cut down on cigarette smoking as motives for concurrent product use. Concurrent users indicated both a greater likelihood of developing a smoking-related disease if they did not quit for good and a greater number of past year quit attempts relative to non-concurrent users. There was no significant difference between concurrent users and non-concurrent users on readiness to quit or having received recent smoking cessation intervention. CONCLUSION The need for cessation efforts that account for concurrent use for homeless adult smokers is great. Study findings indicate that concurrent users are commonly pursuing the reduction or elimination of cigarette usage and should be specifically targeted for cessation intervention.
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Affiliation(s)
- Julie Neisler
- Department of Psychological, Health, and Learning Sciences, The University of Houston, College of Education, 491 Farish Hall, Houston, TX 77204-5029, United States
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, The University of Houston, College of Education, 491 Farish Hall, Houston, TX 77204-5029, United States.
| | - Lorra Garey
- Department of Psychology, The University of Houston, 126 Heyne Building, Houston, TX 77204-5029, United States
| | - Darla E Kenzdor
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, United States
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, United States
| | - Maya Vijayaraghavan
- Division of General Internal Medicine, University of California San Francisco, 1001 Potrero Avenue, 1311 E, Box 1364, San Francisco, CA 94110, United States
| | - Michael S Businelle
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, United States
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19
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Rash CJ, Petry NM, Alessi SM. A randomized trial of contingency management for smoking cessation in the homeless. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:141-148. [PMID: 29461070 PMCID: PMC5858980 DOI: 10.1037/adb0000350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Smoking-cessation services are an unmet need among the homeless, who smoke at rates more than 4 times the national estimate. Successful interventions have high potential for improving tobacco-related health disparities among homeless smokers. Contingency management (CM) is a behavioral intervention with efficacy in a number of substance-use disorder populations, including smokers. However, no randomized studies have evaluated the effect of CM in homeless smokers. We examined smoking-related outcomes in homeless smokers (N = 70) randomized to standard-care (SC) smoking cessation involving transdermal nicotine-replacement therapy (NRT), standard counseling, and carbon monoxide (CO) monitoring or the same SC plus CM for negative CO sample submissions. Participants randomized to CM achieved significantly longer durations of consecutive abstinence and submitted a significantly higher proportion of CO-negative samples relative to standard-care participants. At 4 weeks postquit day, 22% were abstinent in the CM condition and 9% were abstinent in the SC condition. At the 6-month follow-up, about 10% of smokers in both conditions were abstinent. This study demonstrates that CM is an efficacious option to increase initial quit rates in homeless smokers, but methods to extend effects are needed. (PsycINFO Database Record
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20
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Collins SE, Orfaly VE, Wu T, Chang S, Hardy RV, Nash A, Jones MB, Mares L, Taylor EM, Nelson LA, Clifasefi SL. Content analysis of homeless smokers' perspectives on established and alternative smoking interventions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 51:10-17. [PMID: 29144995 DOI: 10.1016/j.drugpo.2017.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/14/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cigarette smoking is 5 times more prevalent among homeless individuals than in the general population, and homeless individuals are disproportionately affected by smoking-related morbidity and mortality. Homeless smokers report interest in changing their smoking behavior; however, established smoking cessation interventions are neither desirable to nor highly effective for most members of this population. The aim of this study was to document homeless smokers' perceptions of established smoking interventions as well as self-generated, alternative smoking interventions to elucidate points for intervention enhancement. METHODS Participants (N=25) were homeless smokers who responded to semistructured interviews regarding smoking and nicotine use as well as experiences with established and alternative smoking interventions. Conventional content analysis was used to organize data and identify themes. RESULTS Participants appreciated providers' initiation of conversations about smoking. They did not, however, feel simple advice to quit was a helpful approach. Instead, they suggested providers use a nonjudgmental, compassionate style, offer more support, and discuss a broader menu of options, including nonabstinence-based ways to reduce smoking-related harm and improve health-related quality of life. Most participants preferred engaging in their own self-defined, alternative smoking interventions, including obtaining nicotine more safely (e.g., vaping, using smokeless tobacco) and using behavioral (e.g., engaging in creative activities and hobbies) and cognitive strategies (e.g., reminding themselves about the positive aspects of not smoking and the negative consequences of smoking). Abrupt, unaided quit attempts were largely unsuccessful. CONCLUSIONS The vast majority of participants with the lived experience of homelessness and smoking were uninterested in established smoking cessation approaches. They did, however, have creative ideas about alternative smoking interventions that providers may support to reduce smoking-related harm and enhance quality of life. These ideas included providing information about the relative risks of smoking and the relative benefits of alternative strategies to obtaining nicotine and avoiding smoking.
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Affiliation(s)
- Susan E Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Victoria E Orfaly
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Teresa Wu
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Sunny Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Robert V Hardy
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Amia Nash
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Matthew B Jones
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Leslie Mares
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
| | - Emily M Taylor
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA
| | - Lonnie A Nelson
- School of Nursing, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA 98101, USA.
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Sciences, University of Washington - Harborview Medical Center, 325 Ninth Ave, Box 359911, Seattle, WA 98104, USA.
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21
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Ojo-Fati O, Joseph AM, Ig-Izevbekhai J, Thomas JL, Everson-Rose SA, Pratt R, Raymond N, Cooney NL, Luo X, Okuyemi KS. Practical issues regarding implementing a randomized clinical trial in a homeless population: strategies and lessons learned. Trials 2017; 18:305. [PMID: 28679430 PMCID: PMC5498931 DOI: 10.1186/s13063-017-2046-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/14/2017] [Indexed: 12/03/2022] Open
Abstract
Abstract There is a critical need for objective data to guide effective health promotion and care for homeless populations. However, many investigators exclude homeless populations from clinical trials due to practical concerns about conducting research with this population. This report is based on our experience and lessons learned while conducting two large NIH-funded randomized controlled trials targeting smoking cessation among persons who are homeless. The current report also addresses challenges when conducting clinical trials among homeless populations and offers potential solutions. Homeless individuals face several challenges including the need to negotiate daily access to food, clothing, and shelter. Some of the critical issues investigators encounter include recruitment and retention obstacles; cognitive impairment, mental health and substance abuse disorders; transportation and scheduling challenges; issues pertaining to adequate study compensation; the need for safety protocols for study staff; and issues related to protecting the wellbeing of these potentially vulnerable adults. Anticipating realistic conditions in which to conduct studies with participants who are homeless will help investigators to design efficient protocols and may improve the feasibility of conducting clinical trials involving homeless populations and the quality of the data collected by the researchers. Trial registration ClinicalTrials.gov, ID: NCT00786149. Registered on 5 November 2008; ClinicalTrials.gov, ID: NCT01932996. Registered on 20 November 2014.
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Affiliation(s)
- Olamide Ojo-Fati
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA. .,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Anne M Joseph
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Medicine, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Jed Ig-Izevbekhai
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Janet L Thomas
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Medicine, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Susan A Everson-Rose
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Medicine, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Nancy Raymond
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Ave., F282/2AW, Minneapolis, MN, 55454, USA
| | - Ned L Cooney
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Xianghua Luo
- Division of Biostatistics, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.,Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Kolawole S Okuyemi
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Family & Preventive Medicine, University of Utah, 375 Chipeta, Suite A, Salt Lake, UT, 84108, USA
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22
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van der Laan J, Boersma SN, van Straaten B, Rodenburg G, van de Mheen D, Wolf JRLM. Personal goals and factors related to QoL in Dutch homeless people: what is the role of goal-related self-efficacy? HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1265-1275. [PMID: 28122408 DOI: 10.1111/hsc.12429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 06/06/2023]
Abstract
Very little is known about the personal goals of homeless people and how these relate to their quality of life (QoL). By using survey data on 407 homeless adults upon entry to the social relief system in 2011, we examined the personal goals of homeless adults and the association between their perceived goal-related self-efficacy and their QoL. A hierarchical regression analysis was used to analyse the association between QoL and goal-related self-efficacy, relative to factors contributing to QoL, such as demographic characteristics, socioeconomic resources, health and service use. Results indicate that the majority of homeless adults had at least one personal goal for the coming 6 months and that most goals concerned housing and daily life (94.3%) and finances (83.6%). The QoL of homeless adults appeared to be lower in comparison with general population samples. General goal-related self-efficacy was positively related to QoL (β = 0.09, P = 0.042), independent of socioeconomic resources (i.e. income and housing), health and service use. The strongest predictors of QoL were psychological distress (β = -0.45, P < 0.001), income (β = 0.14, P = 0.002) and being institutionalised (β = 0.12, P = 0.004). In conclusion, the majority of homeless adults entering the social relief system have personal goals regarding socioeconomic resources and their goal-related self-efficacy is positively related to QoL. It is therefore important to take the personal goals of homeless people as the starting point of integrated service programmes and to promote their goal-related self-efficacy by strength-based interventions.
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Affiliation(s)
- Jorien van der Laan
- Impuls - Netherlands Center for Social Care Research, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Sandra N Boersma
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Barbara van Straaten
- IVO, Addiction Research Institute, Rotterdam, The Netherlands
- Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Gerda Rodenburg
- IVO, Addiction Research Institute, Rotterdam, The Netherlands
- Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Dike van de Mheen
- IVO, Addiction Research Institute, Rotterdam, The Netherlands
- Erasmus Medical Centre, Rotterdam, the Netherlands
- Department of Health Promotion, Maastricht University, the Netherlands
| | - Judith R L M Wolf
- Impuls - Netherlands Center for Social Care Research, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Brown LF, Ford PJ, Symons AL. Periodontal disease and the special needs patient. Periodontol 2000 2017; 74:182-193. [DOI: 10.1111/prd.12198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 12/22/2022]
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24
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Stewart HC, Stevenson TN, Bruce JS, Greenberg B, Chamberlain LJ. Attitudes Toward Smoking Cessation Among Sheltered Homeless Parents. J Community Health 2016; 40:1140-8. [PMID: 25980523 DOI: 10.1007/s10900-015-0040-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The prevalence of smoking among homeless adults is approximately 70 %. Cessation programs designed for family shelters should be a high priority given the dangers cigarette smoke poses to children. However, the unique nature of smoking in the family shelter setting remains unstudied. We aimed to assess attitudes toward smoking cessation, and unique barriers and motivators among homeless parents living in family shelters in Northern California. Six focus groups and one interview were conducted (N = 33, ages 23-54). The focus groups and interviews were audiorecorded, transcribed verbatim, and a representative team performed qualitative theme analysis. Eight males and 25 females participated. The following major themes emerged: (1) Most participants intended to quit eventually, citing concern for their children as their primary motivation. (2) Significant barriers to quitting included the ubiquity of cigarette smoking, its central role in social interactions in the family shelter setting, and its importance as a coping mechanism. (3) Participants expressed interest in quitting "cold turkey" and in e-cigarettes, but were skeptical of the patch and pharmacotherapy. (4) Feelings were mixed regarding whether individual, group or family counseling would be most effective. Homeless parents may be uniquely motivated to quit because of their children, but still face significant shelter-based social and environmental barriers to quitting. Successful cessation programs in family shelters must be designed with the unique motivations and barriers of this population in mind.
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Affiliation(s)
- Holly C Stewart
- Stanford Medical School, 291 Campus Drive, Stanford, CA, 94305, USA.
| | | | - Janine S Bruce
- Stanford Medical School, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Brian Greenberg
- Stanford Medical School, 291 Campus Drive, Stanford, CA, 94305, USA
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25
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Nam S, Whittemore R, Jeon S, Davey‐Rothwell MA, Latkin C. High Blood Pressure and Related Factors Among Individuals at High Risk for HIV/Sexually Transmitted Infections. J Clin Hypertens (Greenwich) 2016; 18:572-80. [PMID: 26514661 PMCID: PMC4851924 DOI: 10.1111/jch.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 12/31/2022]
Abstract
Data from a social network-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention study with a total of 330 men and women at high risk for HIV/STIs were used to examine the relationships between substance use, depressive symptoms, general health, cardiovascular disease risk factors, sociodemographic characteristics, and systolic/diastolic blood pressure (SBP/DBP). Approximately 60% of the participants had prehypertension to stage 2 hypertension. In the base model, older patients (P<.0001), men (P=.003), and patients with poorer self-reported health (P=.029) were significantly associated with high SBP, whereas older age (P<.001) and higher body mass index (P<.001) were significantly associated with higher DBP. After adjusting for the base model, high frequency of alcohol drinking and high frequency of binge drinking remained significant for high SBP and DBP. These data suggest that future cardiovascular disease programs should target moderate alcohol consumption to improve blood pressure among individuals at high risk for HIV/STIs.
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Affiliation(s)
- Soohyun Nam
- Division of Primary CareYale School of NursingOrangeCT
| | | | - Sangchoon Jeon
- Division of Acute Care/Health SystemsYale School of NursingOrangeCT
| | | | - Carl Latkin
- Department of Health, Behavior and SocietyJohns Hopkins School of Public HealthBaltimoreMD
- Department of EpidemiologyJohns Hopkins School of Public HealthBaltimoreMD
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26
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Nguyen MAH, Reitzel LR, Kendzor DE, Businelle MS. Perceived cessation treatment effectiveness, medication preferences, and barriers to quitting among light and moderate/heavy homeless smokers. Drug Alcohol Depend 2015; 153:341-5. [PMID: 26072221 DOI: 10.1016/j.drugalcdep.2015.05.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Homeless individuals smoke at disproportionately high rates and quit at disproportionately low rates relative to domiciled smokers. Targeted research is needed to inform future interventions. Socio-demographic characteristics of homeless adults suggest that light smoking may be prevalent, and the relation between smoking level and treatment-related preferences/needs is unknown. The current study addressed these gaps in a sample of homeless smokers. METHODS Participants (N=237) were homeless adult daily light (1-10 cigarettes per day) and moderate/heavy (>10 cigarettes per day) smokers recruited from a single shelter that offered cessation treatment. Survey items assessed perceived treatment effectiveness, pharmacological intervention preferences, and barriers to quitting smoking. Logistic regressions were used to assess differences in treatment-related factors by smoking level. RESULTS The prevalence of light smoking (44.7%) was higher than in previously studied samples of domiciled smokers. Relative to moderate/heavy smokers, light smokers smoked for fewer years, had more quit attempts in the last year, and were more likely to smoke menthol cigarettes. They were less likely to believe that medications would give them the greatest chance of quitting and more likely to believe that group counseling would be helpful. Light smokers did not differ from moderate/heavy smokers on specific pharmacological intervention preferences or on perceived barriers to quitting smoking, including craving. CONCLUSIONS The promotion of pharmacotherapy to address cravings may be necessary for light smokers, who represent a sizeable proportion of homeless smokers and who may make apt intervention targets given their higher rates of purposeful quit attempts relative to heavier smoking counterparts.
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Affiliation(s)
- Minh-Anh H Nguyen
- The University of Houston, College of Natural Sciences and Mathematics, Department of Biology and Biochemistry, Houston, TX 77204, USA
| | - Lorraine R Reitzel
- The University of Houston, College of Education, Department of Psychological, Health and Learning Sciences, 491 Farish Hall, Houston, TX 77204-5029, USA.
| | - Darla E Kendzor
- The University of Texas Health Science Center, School of Public Health, 6011 Harry Hines Blvd., Dallas, TX 75390-9128, USA; The UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Population Science and Cancer Control Program, 6011 Harry Hines Blvd., Dallas, TX 75390-9128, USA
| | - Michael S Businelle
- The University of Texas Health Science Center, School of Public Health, 6011 Harry Hines Blvd., Dallas, TX 75390-9128, USA; The UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Population Science and Cancer Control Program, 6011 Harry Hines Blvd., Dallas, TX 75390-9128, USA
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27
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Carpenter VL, Hertzberg JS, Kirby AC, Calhoun PS, Moore SD, Dennis MF, Dennis PA, Dedert EA, Hair LP, Beckham JC. Multicomponent smoking cessation treatment including mobile contingency management in homeless veterans. J Clin Psychiatry 2015; 76:959-64. [PMID: 25699616 PMCID: PMC4522209 DOI: 10.4088/jcp.14m09053] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 07/08/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Smoking rates are 80% among persons who are homeless, and these smokers have decreased odds of quitting smoking. Little is known about relapse rates among homeless smokers. More information is needed regarding both quit rates and innovative methods to treat smoking cessation among homeless smokers. Web-based contingency management (CM) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker populations but have been generally limited by the need for computers or frequent clinic-based carbon monoxide (CO) monitoring. This open pilot study builds on a web-based CM approach by evaluating a smartphone-based application for CM named mobile CM (mCM). The study was conducted from January 1, 2013-April 15, 2014. METHOD Following a 1-week training period, 20 homeless veteran smokers (≥ 10 cigarettes daily for 1 year or more and a CO baseline level ≥ 10 ppm) participated in a multicomponent smoking cessation intervention including 4 weeks of mCM. All smokers received 4 smoking cessation counseling sessions, nicotine replacement, and bupropion (if medically eligible). Participants could earn up to $815 ($480 for mCM, $100 for CO readings showing abstinence [ie, 6 ppm or less] at posttreatment and follow-up, and $35 for equipment return). RESULTS Mean compensation for the mCM component was $286 of a possible $480. Video transmission compliance was high during the 1-week training (97%) and the 4-week treatment period (87%). Bioverified 7-day point prevalence abstinence was 50% at 4 weeks. Follow-up bioverified single assessment point prevalence abstinence was 55% at 3 months and 45% at 6 months. CONCLUSIONS Results of this open pilot study suggest that mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among homeless veterans. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01789710.
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Affiliation(s)
| | - Jeffrey S. Hertzberg
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Institute of Medical Research, Durham, NC, 27705, USA
| | - Angela C. Kirby
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA,Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Scott D. Moore
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Michelle F. Dennis
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Paul A. Dennis
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA
| | - Eric A. Dedert
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Lauren P. Hair
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC, 27705, USA
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center, Durham, NC, 27705, USA,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
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28
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Gozdzik A, Salehi R, O'Campo P, Stergiopoulos V, Hwang SW. Cardiovascular risk factors and 30-year cardiovascular risk in homeless adults with mental illness. BMC Public Health 2015; 15:165. [PMID: 25886157 PMCID: PMC4339633 DOI: 10.1186/s12889-015-1472-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/27/2015] [Indexed: 01/24/2023] Open
Abstract
Background Cardiovascular disease (CVD) is a leading cause of death among homeless people. This study examines CVD risk factors and 30-year CVD risk in a population of homeless individuals with mental illness. Methods CVD risks factors were assessed in 352 homeless individuals with mental illness in Toronto, Canada, at the time of their enrollment in the At Home/Chez Soi Project, a randomized trial of a Housing First intervention. The 30-year risk for CVD (coronary death, myocardial infarction, and fatal or nonfatal stroke) was calculated using published formulas and examined for association with need for mental health services, diagnosis of psychotic disorder, sex, ethnicity, access to a family physician and diagnosis of substance dependence. Results The 30-year CVD risk for study participants was 24.5 ± 18.4%, more than double the reference normal of 10.1 ± 7.21% (difference = −13.0% 95% CI −16.5% to −9.48%). Univariate analyses revealed 30-year CVD risk was greater among males (OR 3.99, 95% CI 2.47 to 6.56) and those who were diagnosed with substance dependence at baseline (OR 1.94 95% CI 1.23 to 3.06) and reduced among those who were non-white (OR 0.62 95% CI 0.39 to 0.97). In adjusted analyses, only male sex (OR 4.71 95% CI 2.76 to 8.05) and diagnosis of substance dependence (OR 1.78 95% CI 1.05 to 3.00) remained associated with increased CVD risk. Conclusions Homeless people with mental illness have highly elevated 30-year CVD risk, particularly among males and those diagnosed with substance dependence. This study adds to the literature by reporting on CVD risk in a particularly vulnerable population of homeless individuals experiencing mental illness, and by using a 30-year CVD risk calculator which provides a longer time-frame during which the effect of modifiable CVD risk factors could be mitigated. Trial registration Current Controlled Trials ISRCTN42520374 Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1472-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agnes Gozdzik
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Roxana Salehi
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
| | - Patricia O'Campo
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. O'.,Dalla Lana School of Public Health, University of Toronto Health Sciences Building, 6th floor, 155 College Street, Toronto, ON, M5T 3 M7, Canada. O'
| | - Vicky Stergiopoulos
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada.
| | - Stephen W Hwang
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. .,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Twyman L, Bonevski B, Paul C, Bryant J. Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature. BMJ Open 2014; 4:e006414. [PMID: 25534212 PMCID: PMC4275698 DOI: 10.1136/bmjopen-2014-006414] [Citation(s) in RCA: 301] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth. DESIGN A systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups. DATA SOURCES MEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014. STUDY SELECTION Studies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included. DATA EXTRACTION Two authors independently assessed studies for inclusion and extracted data. RESULTS 65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco). CONCLUSIONS Vulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups. TRIAL REGISTRATION NUMBER A protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761).
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Affiliation(s)
- Laura Twyman
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christine Paul
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Darville A, Hahn EJ. Hardcore smokers: what do we know? Addict Behav 2014; 39:1706-12. [PMID: 25117846 DOI: 10.1016/j.addbeh.2014.07.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 06/27/2014] [Accepted: 07/10/2014] [Indexed: 12/14/2022]
Abstract
AIMS The existence of smokers who are resistant to smoking cessation treatment has long been noted in the literature. There has been ongoing debate as to whether the proportion of these smokers is increasing as smoking prevalence rates stagnate. Studies define hardcore smokers inconsistently and within the context of specific illnesses, addiction, population, and/or theoretical paradigms. This review examines the existing literature related to hardcore smokers to develop a better understanding of what is known and not known about this group to guide smoking cessation treatment. METHODS PubMed MESH search and review of research publications from 1998 to 2012 (N=61). RESULTS Inconsistent definitions of hardcore smoking make it difficult to estimate prevalence rates and to identify specific characteristics of persistent smokers. Generally, persistent smokers have higher levels of nicotine dependence, are disproportionately from lower socioeconomic groups, start smoking at an earlier age, and are more likely to have a psychological co-morbidity. DISCUSSION Defining some smokers as hardcore is limiting. Targeted and tailored interventions for smoking cessation for persistent smoking have demonstrated effectiveness in a small number of studies. Treatment access barriers need to be addressed to improve the reach and effectiveness of cessation with persistent smokers. Efforts to limit early age initiation of tobacco use are a critical element in averting persistent smoking.
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Affiliation(s)
- Audrey Darville
- UK HealthCare, USA; University of Kentucky College of Nursing, 450F College of Nursing, Lexington, KY 40536-0232, USA.
| | - Ellen J Hahn
- University of Kentucky College of Nursing, 450F College of Nursing, Lexington, KY 40536-0232, USA; Tobacco Policy Research Program and Kentucky Center for Smoke-free Policy, USA; Center for Biobehavioral Research in Self-Management, Lexington, KY, USA
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Reitzel LR, Nguyen N, Eischen S, Thomas J, Okuyemi KS. Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults? Addiction 2014; 109:2098-104. [PMID: 25041459 PMCID: PMC4229393 DOI: 10.1111/add.12688] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/20/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Smoking prevalence among homeless adults is exceedingly high, and high rates of comorbid substance use are among the barriers to abstinence experienced by this group. The extent to which smoking cessation might engender an escalation in comorbid substance use could be a concern prohibiting treatment provision and engagement. This study examined whether smoking abstinence status was associated with alcohol and substance use at 26 weeks post-randomization among homeless smokers in a smoking cessation trial. DESIGN The current study was a secondary analysis of randomized smoking cessation intervention trial data. SETTING The parent study was conducted in the Minneapolis/St Paul area of Minnesota, USA. PARTICIPANTS Participants were 427 homeless adult smokers interested in quitting smoking. MEASUREMENTS Covariates collected at baseline included alcohol, cocaine, marijuana/hashish, heroin and 'any' drug use, age, sex, race/ethnicity, education, tobacco dependence, length of time homeless and treatment group. Biochemically verified smoking abstinence and self-reported alcohol and substance use were collected at 26 weeks post-randomization. FINDINGS Smoking abstinence was associated with fewer drinking days (P = 0.03), fewer drinks consumed on drinking days (P = 0.01), and lower odds of heavy drinking (P = 0.05), but not with differences in the number of days of cocaine, marijuana/hashish, heroin or any drug use. CONCLUSIONS In homeless smokers, achieving smoking abstinence may be associated with a reduction in alcohol consumption but appears not to be associated with a substantial change in other drug use.
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Affiliation(s)
- Lorraine R. Reitzel
- College of Education, Department of Educational Psychology, University of Houston, Houston, TX, USA
| | - Nga Nguyen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sara Eischen
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Janet Thomas
- General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kolawole S. Okuyemi
- Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 2014; 384:1529-40. [PMID: 25390578 PMCID: PMC4520328 DOI: 10.1016/s0140-6736(14)61132-6] [Citation(s) in RCA: 865] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In the European Union, more than 400,000 individuals are homeless on any one night and more than 600,000 are homeless in the USA. The causes of homelessness are an interaction between individual and structural factors. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing. Although engagement with health services and adherence to treatments is often compromised, homeless people typically attend the emergency department more often than non-homeless people. We discuss several recommendations to improve the surveillance of morbidity and mortality in homeless people. Programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals, and the child welfare system, and the introduction of national and state-wide plans that target homeless people are likely to improve outcomes.
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Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Margot Kushel
- University of California San Francisco/San Francisco General Hospital, San Francisco, CA, USA
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Richards CM, Sharif F, Eischen S, Thomas J, Wang Q, Guo H, Luo X, Okuyemi K. Retention of Homeless Smokers in the Power to Quit Study. Nicotine Tob Res 2014; 17:1104-11. [PMID: 25301816 DOI: 10.1093/ntr/ntu210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/26/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Concerns about retention are a major barrier to conducting studies enrolling homeless individuals. Since smoking is a major problem in homeless communities and research on effective methods of promoting smoking cessation is needed, we describe strategies used to increase retention and participant characteristics associated with retention in smoking cessation study enrolling homeless adults. METHODS The parent study was a 2-group randomized controlled trial with 26-week follow-up enrolling 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/Saint Paul, MN, USA. Multiple strategies were used to increase retention, including conducting visits at convenient locations for participants, collecting several forms of contact information from participants, using a schedule that was flexible and included frequent low-intensity visits, and providing incentives. Participant demographics as well as characteristics related to tobacco and drug use and health status were analyzed for associations with retention using univariate and multivariate analysis. RESULTS Overall retention was 75% at 26 weeks. Factors associated with increased retention included greater age; having healthcare coverage; history of multiple homeless episodes, lower stress level; and higher PHQ-9 (Patient Health Questionnaire-9) score. A history of excessive drinking and drug use were associated with decreased retention. CONCLUSIONS It is possible to successfully retain homeless individuals in a smoking cessation study if the study is designed with participants' needs in mind.
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Affiliation(s)
- Christina M Richards
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Faduma Sharif
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Sara Eischen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | | | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Hongfei Guo
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kolawole Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN; Center for Health Equity, University of Minnesota, Minneapolis, MN; Masonic Cancer Center, University of Minnesota, Minneapolis, MN;
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Shadel WG, Tucker JS, Mullins L, Staplefoote L. Providing smoking cessation programs to homeless youth: The perspective of service providers. J Subst Abuse Treat 2014; 47:251-7. [DOI: 10.1016/j.jsat.2014.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/08/2014] [Accepted: 05/12/2014] [Indexed: 11/28/2022]
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Businelle MS, Ma P, Kendzor DE, Reitzel LR, Chen M, Lam CY, Bernstein I, Wetter DW. Predicting quit attempts among homeless smokers seeking cessation treatment: an ecological momentary assessment study. Nicotine Tob Res 2014; 16:1371-8. [PMID: 24893602 PMCID: PMC4207873 DOI: 10.1093/ntr/ntu088] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/25/2014] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Homeless adults are more likely to smoke tobacco and are less likely to successfully quit smoking than smokers in the general population, despite comparable numbers of cessation attempts and desire to quit. To date, studies that have examined smoking cessation in homeless samples have used traditional lab/clinic-based assessment methodologies. Real-time assessment of key variables may provide new insights into the process of quitting among homeless smokers. METHODS The purpose of the current study was to identify predictors of a quit attempt using real-time assessment methodology during the 6 days prior to a scheduled quit attempt among homeless adults seeking care at a shelter-based smoking cessation clinic. Parameters for multiple variables (i.e., motivation for quitting, smoking expectancies, quit self-efficacy, smoking urges, negative affect, positive affect, restlessness, hostility, and stress) were calculated and were used as predictors of biochemically verified quit date abstinence (i.e., ≥13hr abstinent) using logistic regression analyses. RESULTS Participants (n = 57) were predominantly male (59.6%), non-White (68.4%), and smoked an average of 18 cigarettes per day. A total of 1,132 ecological momentary assessments (83% completion rate) were collected at random times (i.e., up to 4 assessments/day) during the 6 days prior to a scheduled quit attempt. Results indicated that declining (negative slope) negative affect, restlessness, and stress predicted quit date abstinence. Additionally, increasing positive coping expectancies across the prequit week predicted quit date abstinence. CONCLUSIONS Study findings highlight multiple variables that may be targeted during the precessation period to increase smoking cessation attempts in this difficult to treat population of smokers.
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Affiliation(s)
- Michael S Businelle
- University of Texas Health Science Center School of Public Health, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX;
| | - Ping Ma
- University of Texas Health Science Center School of Public Health, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX
| | - Darla E Kendzor
- University of Texas Health Science Center School of Public Health, Dallas, TX; University of Texas Southwestern Medical Center, Dallas, TX
| | - Lorraine R Reitzel
- Department of Educational Psychology, University of Houston, Houston, TX
| | - Minxing Chen
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cho Y Lam
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ira Bernstein
- University of Texas Southwestern Medical Center, Dallas, TX
| | - David W Wetter
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX
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Pacek LR, Latkin C, Crum RM, Stuart EA, Knowlton AR. Interest in quitting and lifetime quit attempts among smokers living with HIV infection. Drug Alcohol Depend 2014; 138:220-4. [PMID: 24602364 PMCID: PMC4015183 DOI: 10.1016/j.drugalcdep.2014.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/31/2014] [Accepted: 02/02/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cigarette smoking is highly prevalent among people living with HIV, and is associated with many negative health outcomes, including death. There is little research on smoking behaviors such as interest in quitting and lifetime quit attempts among smokers living with HIV. Existing research has focused on individual-level characteristics, to the neglect of social environmental characteristics. We explored individual- and social-level characteristics associated with interest in quitting and lifetime nicotine replacement (NRT) or medication use for smoking cessation. METHODS Data are from a study of participants recruited from clinic and community venues originally designed to examine social environmental influences on current/former drug users' HIV medication adherence and health outcomes. This analysis comprised 267 current smokers living with HIV. Chi-square tests were used to describe the sample; logistic regression was used to explore associations between covariates and outcomes. RESULTS In adjusted analyses, older age (age 54-65: aOR=4.64, 95% CI=1.59-13.47) and lifetime use of NRT/medications (aOR=2.02, 95% CI=1.08-3.80) were associated with an interest in quitting smoking. Additionally, older age (age 45-49: aOR=3.38, 95% CI=1.57-7.26; age 54-65: aOR=2.70 95% CI=1.20-6.11), White race (aOR=3.56, 95% CI=1.20-10.62), and having a Supporter who had used NRT/medications for cessation (aOR=2.13, 95% CI=1.05-4.29) were associated with lifetime NRT/medications use. CONCLUSIONS Findings corroborate prior research concerning individual-level characteristics, and indicate the importance of social-level characteristics in association with prior use of NRT/medications for cessation. Findings have implications for the implementation of cessation interventions for smokers living with HIV.
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Affiliation(s)
- Lauren R. Pacek
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland 21205,Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland 21205,Address correspondence to: Lauren R. Pacek. Address: 5510 Nathan Shock Drive, Suite 1708, Baltimore, MD 21224. Phone: 410-550-1975, Fax: 410-550-0030,
| | - Carl Latkin
- Johns Hopkins University Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, Maryland 21205,Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205
| | - Rosa M. Crum
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland 21205,Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland 21205,Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205
| | - Elizabeth A. Stuart
- Johns Hopkins University Bloomberg School of Public Health, Department of Mental Health, Baltimore, Maryland 21205,Johns Hopkins University Bloomberg School of Public Health, Department of Biostatistics, Baltimore, Maryland 21205
| | - Amy R. Knowlton
- Johns Hopkins University Bloomberg School of Public Health, Department of Health, Behavior & Society, Baltimore, Maryland 21205
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Businelle MS, Kendzor DE, Kesh A, Cuate EL, Poonawalla IB, Reitzel LR, Okuyemi KS, Wetter DW. Small financial incentives increase smoking cessation in homeless smokers: a pilot study. Addict Behav 2014; 39:717-20. [PMID: 24321696 DOI: 10.1016/j.addbeh.2013.11.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/05/2013] [Accepted: 11/18/2013] [Indexed: 11/30/2022]
Abstract
Although over 70% of homeless individuals smoke, few studies have examined the effectiveness of smoking cessation interventions in this vulnerable population. The purpose of this pilot study was to compare the effectiveness of shelter-based smoking cessation clinic usual care (UC) to an adjunctive contingency management (CM) treatment that offered UC plus small financial incentives for smoking abstinence. Sixty-eight homeless individuals in Dallas, Texas (recruited in 2012) were assigned to UC (n=58) or UC plus financial incentives (CM; n=10) groups and were followed for 5 consecutive weeks (1 week pre-quit through 4 weeks post-quit). A generalized linear mixed model regression analysis was conducted to compare biochemically-verified abstinence rates between groups. An additional model examined the interaction between time and treatment group. The participants were primarily male (61.8%) and African American (58.8%), and were 49 years of age on average. There was a significant effect of treatment group on abstinence overall, and effects varied over time. Follow-up logistic regression analyses indicated that CM participants were significantly more likely than UC participants to be abstinent on the quit date (50% vs. 19% abstinent) and at 4 weeks post-quit (30% vs. 1.7% abstinent). Offering small financial incentives for smoking abstinence may be an effective way to facilitate smoking cessation in homeless individuals.
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Affiliation(s)
- Michael S Businelle
- University of Texas Health Science Center School of Public Health, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA; University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center, Population Science and Cancer Control Program, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
| | - Darla E Kendzor
- University of Texas Health Science Center School of Public Health, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA; University of Texas Southwestern Harold C. Simmons Comprehensive Cancer Center, Population Science and Cancer Control Program, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Anshula Kesh
- University of Texas Health Science Center School of Public Health, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Erica L Cuate
- University of Texas Health Science Center School of Public Health, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Insiya B Poonawalla
- University of Texas Health Science Center School of Public Health, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA
| | - Lorraine R Reitzel
- University of Houston, Department of Educational Psychology, 491 Farish Hall, Houston, TX, 77204-5029, USA
| | - Kolawole S Okuyemi
- University of Minnesota, Family Medicine and Community Health, 717 Delaware St SE, Ste 166, Minneapolis, MN, 55414, USA
| | - David W Wetter
- University of Texas MD Anderson Cancer Center, Department of Health Disparities Research, PO Box 301402, Unit 1440, Houston, TX, 77230, USA
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Vijayaraghavan M, Penko J, Vittinghoff E, Bangsberg DR, Miaskowski C, Kushel MB. Smoking behaviors in a community-based cohort of HIV-infected indigent adults. AIDS Behav 2014; 18:535-43. [PMID: 23918243 DOI: 10.1007/s10461-013-0576-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We conducted a longitudinal study of a community-based cohort of HIV-infected indigent adults to examine smoking behaviors and factors associated with quitting. We assessed "hardcore" smoking behaviors associated with a low probability of quitting. Of the 296 participants, 218 were current smokers (73.6 %). The prevalence of "hardcore" smoking was high: 59.6 % smoked ≥15 cigarettes per day, and 67.3 % were daily smokers. During the study interval, 20.6 % made at least one quit attempt. Of these, 53.3 % were abstinent at 6 months. The successful quit rate over 2 years was 4.6 %. Illegal substance use (adjusted odds ratio, AOR 0.2, 95 % CI 0.1-0.6) and smoking within 30 min of waking (AOR 0.2, 95 % CI 0.1-0.7) were associated with lower likelihood of making a quit attempt. Interventions that reduce nicotine dependence prior to smoking cessation and those that are integrated with substance use treatment may be effective for this population.
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Affiliation(s)
- Maya Vijayaraghavan
- Moores UCSD Cancer Center, University of California, San Diego, 3855 Health Science Drive, MC 0901, La Jolla, CA, 92093-0901, USA,
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Reitzel LR, Kendzor DE, Nguyen N, Regan SD, Okuyemi KS, Castro Y, Wetter DW, Businelle MS. Shelter proximity and affect among homeless smokers making a quit attempt. Am J Health Behav 2014; 38:161-9. [PMID: 24629545 DOI: 10.5993/ajhb.38.2.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To explore the associations between shelter proximity and real-time affect during a specific smoking quit attempt among 22 homeless adults. METHODS Affect was measured via 485 smartphone-based Ecological Momentary Assessments randomly administered during the weeks immediately before and after the quit day, and proximity to the shelter was measured via GPS. Adjusted linear mixed model regressions examined associations between shelter proximity and affect. RESULTS Closer proximity to the shelter was associated with greater negative affect only during the post-quit attempt week (p = .008). All participants relapsed to smoking by one week post-quit attempt. CONCLUSIONS Among homeless smokers trying to quit, the shelter may be associated with unexpected negative affect/stress. Potential intervention applications are suggested.
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Affiliation(s)
- Lorraine R Reitzel
- Department of Educational Psychology, College of Education, University of Houston, Houston, Health Disparities Research at The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Darla E Kendzor
- Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health and The University of Texas Southwestern Harold C. Simmons Comprehensive Cancer, Dallas, TX, USA
| | - Nga Nguyen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seann D Regan
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kolawole S Okuyemi
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yessenia Castro
- School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - David W Wetter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael S Businelle
- Division of Health Promotion and Behavioral Sciences, University of Texas School of Public Health and The University of Texas Southwestern Harold C. Simmons Comprehensive Cancer, Dallas, TX, USA.
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Focusing on the five A's: A comparison of homeless and housed patients' access to and use of pharmacist-provided smoking cessation treatment. Res Social Adm Pharm 2014; 10:369-77. [DOI: 10.1016/j.sapharm.2013.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 05/24/2013] [Accepted: 05/25/2013] [Indexed: 11/19/2022]
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Baggett TP, Lebrun-Harris LA, Rigotti NA. Homelessness, cigarette smoking and desire to quit: results from a US national study. Addiction 2013; 108:2009-18. [PMID: 23834157 PMCID: PMC3797258 DOI: 10.1111/add.12292] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/09/2013] [Accepted: 06/28/2013] [Indexed: 11/30/2022]
Abstract
AIMS We determined whether or not homelessness is associated with cigarette smoking independent of other socio-economic measures and behavioral health factors, and whether homeless smokers differ from non-homeless smokers in their desire to quit. DESIGN, SETTING AND PARTICIPANTS We analyzed data from 2678 adult respondents to the 2009 Health Center Patient Survey, a nationally representative cross-sectional survey of homeless and non-homeless individuals using US federally funded community health centers. MEASUREMENTS We used multivariable logistic regression to examine the association between homelessness and (i) current cigarette smoking among all adults, and (ii) past-year desire to quit among current smokers, adjusting for demographic, socio-economic and behavioral health characteristics. FINDINGS Adults with any history of homelessness were more likely than never homeless respondents to be current smokers (57 versus 27%, P < 0.001). In multivariable models, a history of homelessness was associated independently with current smoking [adjusted odds ratio (AOR) 2.09; 95% confidence interval (CI) = 1.49-2.93], even after adjusting for age, sex, race, veteran status, insurance, education, employment, income, mental illness and alcohol and drug abuse. Housing status was not associated significantly with past-year desire to stop smoking in unadjusted (P = 0.26) or adjusted (P = 0.60) analyses; 84% of currently homeless, 89% of formerly homeless and 82% of never homeless smokers reported wanting to quit. CONCLUSIONS Among patients of US health centers, a history of homelessness doubles the odds of being a current smoker independent of other socio-economic factors and behavioral health conditions. However, homeless smokers do not differ from non-homeless smokers in their desire to quit and should be offered effective interventions.
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Affiliation(s)
- Travis P. Baggett
- Tobacco Research and Treatment Center, General Medicine Division, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Boston Health Care for the Homeless Program, Boston, MA
| | - Lydie A. Lebrun-Harris
- Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, MD
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, General Medicine Division, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Warner C, Sewali B, Olayinka A, Eischen S, Wang Q, Guo H, Ahluwalia JS, Okuyemi KS. Smoking cessation in homeless populations: who participates and who does not. Nicotine Tob Res 2013; 16:369-72. [PMID: 24158227 DOI: 10.1093/ntr/ntt169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Although homeless individuals smoke at an alarmingly high rate, few smoking cessation clinical trials have focused on this vulnerable population. Little is known about recruitment efforts and suitable eligibility criteria for tobacco control research in homeless populations. METHODS The aim of this article is to describe the recruitment, eligibility, and enrollment of homeless smokers who participated in the Power to Quit smoking study, a randomized smoking cessation clinical trial funded by the National Institutes of Health. The study compared motivational interviewing and standard counseling while participants received an 8-week treatment of the nicotine patch. RESULTS Working with local emergency shelters, a total of 839 adult smokers were screened for study eligibility, 580 of whom (69.1%) met eligibility criteria. Of those eligible, 430 (74.1%) returned for randomization. Those who returned for randomization were older and more likely to have a phone number compared with eligible participants not enrolled. The most common reasons for exclusion included exhaled carbon monoxide levels less than or equal to 5 parts per million (indicating nonsmoking status), use of smoking cessation aid during the past 30 days, and not meeting the study definition of homelessness. CONCLUSION Knowledge of these factors may help researchers tailor criteria that accurately identify and include homeless smokers in future research.
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Affiliation(s)
- Carolyn Warner
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
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Businelle MS, Cuate EL, Kesh A, Poonawalla IB, Kendzor DE. Comparing homeless smokers to economically disadvantaged domiciled smokers. Am J Public Health 2013; 103 Suppl 2:S218-20. [PMID: 24148069 DOI: 10.2105/ajph.2013.301336] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We compared characteristics of homeless smokers and economically disadvantaged domiciled smokers (Dallas, TX; August 2011-November 2012). Although findings indicated similar smoking characteristics across samples, homeless smokers (n = 57) were exposed to more smokers and reported lower motivation to quit, lower self-efficacy for quitting, more days with mental health problems, and greater exposure to numerous stressors than domiciled smokers (n = 110). The sample groups reported similar scores on measures of affect, perceived stress, and interpersonal resources. Results may inform novel cessation interventions for homeless smokers.
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Affiliation(s)
- Michael S Businelle
- Michael S. Businelle, Erica L. Cuate, Anshula Kesh, Insiya B. Poonawalla, and Darla E. Kendzor are with the University of Texas Health Science Center at Houston, School of Public Health, Dallas. Michael S. Businelle and Darla E. Kendzor are also with the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Population Science and Cancer Control Program, Dallas
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Garner L, Ratschen E. Tobacco smoking, associated risk behaviours, and experience with quitting: a qualitative study with homeless smokers addicted to drugs and alcohol. BMC Public Health 2013; 13:951. [PMID: 24112218 PMCID: PMC3853113 DOI: 10.1186/1471-2458-13-951] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of tobacco smoking among homeless people can reach more than 90%, with related morbidity and mortality being high. However, research in this area is scarce. This study aims to explore smoking and quitting related behaviours, experiences and knowledge in homeless smokers in the context of other substance abuse. METHODS Face-to-face interviews were conducted with homeless smokers accessing a harm reduction service in Nottingham, UK. Data on smoking history, nicotine dependence, motivation and confidence to quit were collected using structured instruments; a semi-structured interview guide was used to elicit responses to predefined subject areas, and to encourage the emergence of unprecedented themes. Data were analysed using framework analysis and descriptive statistics. RESULTS Participants were generally highly dependent smokers who did not display good knowledge/awareness of smoking related harms and reported to engage in high risk smoking behaviours. The majority reported notable motivation and confidence to quit in the future, despite or indeed for the benefit of addressing other dependencies. Of the many who had tried to quit in the past, all had done so on their own initiative, and several described a lack of support or active discouragement by practitioners to address smoking. CONCLUSION High levels of tobacco dependence and engagement in unique smoking related risk behaviours and social interplays appear to add to the vulnerability of homeless smokers. Given reported motivation, confidence, previous attempts and lack of support to quit, opportunities to address smoking in one of the most disadvantaged groups are currently missed.
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Affiliation(s)
- Laura Garner
- Department of Epidemiology and Public Health; City Hospital, Clinical Sciences Building, University of Nottingham, Hucknall Road, Nottingham NG5 1PB, UK.
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Baggett TP, Tobey ML, Rigotti NA. Tobacco use among homeless people--addressing the neglected addiction. N Engl J Med 2013; 369:201-4. [PMID: 23863048 DOI: 10.1056/nejmp1301935] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Travis P Baggett
- Tobacco Research and Treatment Center, General Medicine Division, Massachusetts General Hospital, Boston, USA
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Goldade K, Des Jarlais D, Everson-Rose SA, Guo H, Thomas J, Gelberg L, Joseph AM, Okuyemi KS. Knowing quitters predicts smoking cessation in a homeless population. Am J Health Behav 2013; 37:517-24. [PMID: 23985232 DOI: 10.5993/ajhb.37.4.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the impact of knowing quitters on cessation among homeless smokers. METHODS Secondary analysis of data derived from a community-based randomized controlled trial of 430 homeless smokers. We conducted multivariable logistic regression analysis to determine whether knowing quitters impacted the likelihood of cessation (salivary cotinine ≤ 20 ng/ml) at 26-week follow-up. RESULTS Multivariable logistic regression showed cessation was more likely for smokers who knew ≥ 5 quitters compared with those who knew no quitters (Odds Ratio = 3.79, CI = 1.17, 12.27, p = .008), adjusting for age, education, income, and time to first cigarette in morning. CONCLUSIONS Knowing former smokers was associated with increased likelihood of achieving smoking abstinence among homeless smokers.
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Affiliation(s)
- Kathryn Goldade
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
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Okuyemi KS, Goldade K, Whembolua GL, Thomas JL, Eischen S, Sewali B, Guo H, Connett JE, Grant J, Ahluwalia JS, Resnicow K, Owen G, Gelberg L, Jarlais DD. Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial. Addiction 2013; 108:1136-44. [PMID: 23510102 PMCID: PMC3651796 DOI: 10.1111/add.12140] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 09/06/2012] [Accepted: 01/29/2013] [Indexed: 11/29/2022]
Abstract
AIMS To assess the effects of adding motivational interviewing (MI) counseling to nicotine patch for smoking cessation among homeless smokers. DESIGN Two-group randomized controlled trial with 26-week follow-up. PARTICIPANTS AND SETTING A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul, Minnesota, USA. INTERVENTION AND MEASUREMENTS All participants received 8-week treatment of 21-mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine. FINDINGS Using intention-to-treat analysis, verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group (9.3% versus 5.6%, P = 0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (-13.7 ± 11.9 for MI versus -13.5 ± 16.2 for standard care). CONCLUSIONS Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers.
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Affiliation(s)
- Kolawole S. Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN,Center for Health Equity, University Of Minnesota, Minneapolis, MN,Masonic Cancer Center, University Of Minnesota, Minneapolis, MN
| | - Kate Goldade
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN
| | - Guy-Lucien Whembolua
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN,Center for Health Equity, University Of Minnesota, Minneapolis, MN
| | - Janet L. Thomas
- Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN,Center for Health Equity, University Of Minnesota, Minneapolis, MN,Masonic Cancer Center, University Of Minnesota, Minneapolis, MN,Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Sara Eischen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN
| | - Barrett Sewali
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN,Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN
| | - Hongfei Guo
- Division of Biostatistics, School of Public Health, and Clinical and Translational Institute, University of Minnesota, Minneapolis, MN
| | - John E. Connett
- Division of Biostatistics, School of Public Health, and Clinical and Translational Institute, University of Minnesota, Minneapolis, MN
| | - Jon Grant
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Jasjit S. Ahluwalia
- Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN,Center for Health Equity, University Of Minnesota, Minneapolis, MN,Masonic Cancer Center, University Of Minnesota, Minneapolis, MN,Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Ken Resnicow
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI
| | | | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Don Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY
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Goldade K, Whembolua GL, Thomas J, Eischen S, Guo H, Connett J, Des Jarlais D, Resnicow K, Gelberg L, Owen G, Grant J, Ahluwalia JS, Okuyemi KS. Designing a smoking cessation intervention for the unique needs of homeless persons: a community-based randomized clinical trial. Clin Trials 2012; 8:744-54. [PMID: 22167112 DOI: 10.1177/1740774511423947] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although smoking prevalence remains strikingly high in homeless populations (~70% and three times the US national average), smoking cessation studies usually exclude homeless persons. Novel evidence-based interventions are needed for this high-risk subpopulation of smokers. PURPOSE To describe the aims and design of a first-ever smoking cessation clinical trial in the homeless population. The study was a two-group randomized community-based trial that enrolled participants (n = 430) residing across eight homeless shelters and transitional housing units in Minnesota. The study objective was to test the efficacy of motivational interviewing (MI) for enhancing adherence to nicotine replacement therapy (NRT; nicotine patch) and smoking cessation outcomes. METHODS Participants were randomized to one of the two groups: active (8 weeks of NRT + 6 sessions of MI) or control (NRT + standard care). Participants attended six in-person assessment sessions and eight retention visits at a location of their choice over 6 months. Nicotine patch in 2-week doses was administered at four visits over the first 8 weeks of the 26-week trial. The primary outcome was cotinine-verified 7-day point-prevalence abstinence at 6 months. Secondary outcomes included adherence to nicotine patch assessed through direct observation and patch counts. Other outcomes included the mediating and/or moderating effects of comorbid psychiatric and substance abuse disorders. RESULTS Lessons learned from the community-based cessation randomized trial for improving recruitment and retention in a mobile and vulnerable population included: (1) the importance of engaging the perspectives of shelter leadership by forming and convening a Community Advisory Board; (2) locating the study at the shelters for more visibility and easier access for participants; (3) minimizing exclusion criteria to allow enrollment of participants with stable psychiatric comorbid conditions; (4) delaying the baseline visit from the eligibility visit by a week to protect against attrition; and (5) regular and persistent calls to remind participants of upcoming appointments using cell phones and shelter-specific channels of communication. LIMITATIONS The study's limitations include generalizability due to the sample drawn from a single Midwestern city in the United States. Since inclusion criteria encompassed willingness to use NRT patch, all participants were motivated and were ready to quit smoking at the time of enrollment in the study. Findings from the self-select group will be generalizable only to those motivated and ready to quit smoking. High incentives may limit the degree to which the intervention is replicable. CONCLUSIONS Lessons learned reflect the need to engage communities in the design and implementation of community-based clinical trials with vulnerable populations.
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Affiliation(s)
- Kate Goldade
- Department of Family Medicine and Community Health, University of Minnesota, Medical School, Minneapolis, MN 55116, USA.
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Porter J, Houston L, Anderson RH, Maryman K. Addressing tobacco use in homeless populations: recommendations of an expert panel. Health Promot Pract 2012; 12:144S-51S. [PMID: 22068577 DOI: 10.1177/1524839911414412] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A diverse group of panelists met for one day on October 21, 2009, in Washington, DC, for the purpose of addressing the high tobacco use prevalence rates in homeless populations; identifying appropriate policy, cessation practices and models for implementation in this population; and providing targeted recommendations for researchers, homeless service providers, tobacco control advocates, and policy makers. The panel was convened by Break Free Alliance, one of six national networks funded by the Centers for Disease Control and Prevention, Office on Smoking and Health. The panelists worked through a process of problem identification, generation of responses, analysis and prioritization, development of recommendations, and arrival of final decisions reached by consensus. The resulting recommendations for addressing tobacco use in homeless populations focused on tobacco non-use policy implementation, cessation programming, and expansion of partnerships and collaborations between tobacco control advocates and social service providers. The panel also identified unanswered research questions that can serve to develop a framework for future initiatives to reduce tobacco use among homeless persons. The expert panel model serves as one approach for engaging nontraditional partners and building consensus among leaders from a variety of sectors to address tobacco use in special populations.
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Affiliation(s)
- Janet Porter
- Health Education Council, West Sacramento, CA, USA
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