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Martinez Leal I, Siddiqi AD, Rogova A, Britton M, Chen TA, Williams T, Casey K, Sanchez H, Reitzel LR. Enablers and Inhibitors to Implementing Tobacco Cessation Interventions within Homeless-Serving Agencies: A Qualitative Analysis of Program Partners' Experiences. Cancers (Basel) 2024; 16:2162. [PMID: 38893280 PMCID: PMC11171900 DOI: 10.3390/cancers16112162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and inhibitors of implementing an evidence-based tobacco-free workplace (TFW) program offering TFW policy adoption, specialized provider training to treat tobacco use, and nicotine replacement therapy (NRT) within HSAs. Pre- and post-implementation interviews with providers and managers (n = 13) pursued adapting interventions to specific HSAs and assessed the program success, respectively. The organizational readiness for change theory framed the data content analysis, yielding three categories: change commitment, change efficacy and contextual factors. Pre- to post-implementation, increasing challenges impacted the organizational capacity and providers' attitudes, wherein previously enabling factors were reframed as inhibiting, resulting in limited implementation despite resource provision. These findings indicate that low-resourced HSAs require additional support and guidance to overcome infrastructure challenges and build the capacity needed to implement a TFW program. This study's findings can guide future TFW program interventions, enable identification of agencies that are well-positioned to adopt such programs, and facilitate capacity-building efforts to ensure their successful participation.
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Affiliation(s)
- Isabel Martinez Leal
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
| | - Ammar D. Siddiqi
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
- Department of Biosciences, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Anastasia Rogova
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA;
| | - Maggie Britton
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd., Houston, TX 77204, USA;
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd., Houston, TX 77204, USA
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (T.W.); (K.C.)
| | - Hector Sanchez
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
| | - Lorraine R. Reitzel
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, TX 77030, USA; (A.D.S.); (M.B.); (H.S.); (L.R.R.)
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Onigbogi O, Pratt R, Luo X, Everson-Rose SA, Cooney NL, Specker S, Okuyemi K. Association between psychosocial factors and co-morbid cigarette smoking and alcohol use in a population experiencing homelessness. Addict Behav Rep 2024; 19:100523. [PMID: 38155753 PMCID: PMC10753056 DOI: 10.1016/j.abrep.2023.100523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6). Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.
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Affiliation(s)
- Olanrewaju Onigbogi
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414, USA
| | - Xianghua Luo
- Division of Biostatistics and Health Data Science, School of Public Health and Biostatistics Core, Masonic Cancer Center, University of Minnesota, 2221 University Ave SE, Suite 300, Minneapolis, MN 55414, USA
| | - Susan A. Everson-Rose
- Program in Health Disparities, School of Public Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414, USA
- Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Ned L. Cooney
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA
| | - Sheila Specker
- Department of Psychiatry and Behavioral Sciences, F282/2A West, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
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Gajos JM, Oliver JA, Hébert ET, Walters ST, Businelle MS. Does the Relationship between Affect and Social Interactions among Adults Experiencing Homelessness Differ during Moments when at a Shelter versus Not? MENTAL HEALTH SCIENCE 2024; 2:85-90. [PMID: 38827497 PMCID: PMC11142463 DOI: 10.1002/mhs2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/06/2023] [Indexed: 06/04/2024]
Abstract
The prevalence of alcohol use disorders is higher amongst adults experiencing homelessness (AEH) compared with domiciled adults. Greater exposure to heavy drinkers increases personal risk for heavy alcohol use. AEH spend substantial periods of time at shelters and report greater pressure to use alcohol when near shelter locations, as well as greater negative affect when near a shelter. It is unclear if the relationship between affect and 1) interacting with people and 2) being near someone AEH drank alcohol with before differs when AEH are at a shelter versus not. AEH reporting alcohol misuse (n = 72, Mage= 47, 85% Male, 68% Non-White) completed five daily smartphone-based ecological momentary assessments (EMAs) over 28 days. Generalized multilevel modeling revealed that when AEH were interacting with someone they drank with before, they had significantly lower positive affect when at a shelter (b = -0.17, p = 0.05), versus when not (b = 0.00, p = 0.99). AEH are likely to interact with previous drinking partners while at shelters. It may be important to deliver real-time treatment messages targeting affect in these moments, as well as deliver alcohol reduction/abstinence messages.
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Affiliation(s)
- Jamie M. Gajos
- University of Alabama at Birmingham, Department of Family and Community Medicine, Birmingham, AL, USA
| | - Jason A. Oliver
- University of Oklahoma Health Sciences Center, TSET Health Promotion Research Center, Stephenson Cancer Center, OK, USA
| | - Emily T. Hébert
- University of Texas Health Science Center, School of Public Health, Austin, TX, USA
| | - Scott T. Walters
- University of North Texas Health Science Center, School of Public Health, Ft. Worth, TX, USA
| | - Michael S. Businelle
- University of Oklahoma Health Sciences Center, TSET Health Promotion Research Center, Stephenson Cancer Center, OK, USA
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Wolff JM, McQueen A, Garg R, Thompson T, Fu Q, Brown DS, Kegler M, Carpenter KM, Kreuter MW. Expanding population-level interventions to help more low-income smokers quit: Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 129:107202. [PMID: 37080354 PMCID: PMC11440634 DOI: 10.1016/j.cct.2023.107202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Low-income Americans have higher rates of smoking and a greater burden of smoking-related disease. In the United States, smokers in every state can access evidence-based telephone counseling through free tobacco quitlines. However, quitlines target smokers who are ready to quit in the next 30 days, which can exclude many low-income smokers. A smoke-free homes intervention may help engage smokers in tobacco control services who are not yet ready to quit. Previous research in low-income populations suggests that receiving a smoke-free homes intervention is associated with higher quit rates. This study tests whether, at a population level, expanding on quitlines to include a smoke-free homes intervention for smokers not ready to quit could engage more low-income smokers and increase long-term cessation rates. METHODS In a Hybrid Type 2 design, participants are recruited from 211 helplines in 9 states and randomly assigned to standard quitline or quitline plus smoke-free homes intervention arms. Participants in both arms are initially offered quitline services. In the quitline plus smoke-free homes condition, participants who decline the quitline are then offered a smoke-free homes intervention. Participants complete a baseline and follow-up surveys at 3 and 6 months. Those who have not yet quit at the 3-month follow-up are re-offered the interventions, which differ by study arm. The primary study outcome is self-reported 7-day point prevalence abstinence from smoking at 6-month follow-up. CONCLUSION This real-world cessation trial involving 9 state tobacco quitlines will help inform whether offering smoke-free homes as an alternative intervention could engage more low-income smokers with evidence-based interventions and increase overall cessation rates. This study has been registered at ClinicalTrials.gov (Study Identifier: NCT04311983).
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Affiliation(s)
- Jennifer M Wolff
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America.
| | - Amy McQueen
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America; Washington University in St. Louis, School of Medicine, Department of Medicine, United States of America
| | - Rachel Garg
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America
| | - Tess Thompson
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America
| | - Qiang Fu
- Tufts University, Department of Community Health, United States of America
| | - Derek S Brown
- Washington University in St. Louis, Brown School, United States of America
| | - Michelle Kegler
- Emory University, Rollins School of Public Health, United States of America
| | | | - Matthew W Kreuter
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, United States of America
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5
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Garey L, Zvolensky MJ, Gallagher MW, Vujanovic A, Kendzor DE, Stephens L, Cheney MK, Cole AB, Kezbers K, Matoska CT, Robison J, Montgomery A, Zappi CV, Businelle MS. A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40713. [PMID: 36409958 PMCID: PMC9728024 DOI: 10.2196/40713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. OBJECTIVE This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. METHODS The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. RESULTS Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19-specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. CONCLUSIONS Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40713.
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Affiliation(s)
- Lorra Garey
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael J Zvolensky
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Department of Behavioral Science, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Matthew W Gallagher
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, United States
| | - Anka Vujanovic
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Lancer Stephens
- College of Public Health, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
- Oklahoma Shared Clinical and Translational Research Resources, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Ashley B Cole
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Cameron T Matoska
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Jillian Robison
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Audrey Montgomery
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Christopher V Zappi
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
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Bhattacharya M, Ojo-Fati O, Everson-Rose SA, Thomas JL, Miller JM, Ogedegbe G, Jean-Louis G, Joseph AM, Okuyemi KS. Smoking reduction among homeless smokers in a randomized controlled trial targeting cessation. Addict Behav 2022; 133:107373. [PMID: 35689905 DOI: 10.1016/j.addbeh.2022.107373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Homeless populations have high rates of smoking and unique barriers to quitting. General cessation strategies have been unsuccessful in this population. Smoking reduction may be a good intermediate goal. We conducted a secondary analysis to identify predictors of smoking reduction in a cohort of homeless smokers enrolled in a 26-week randomized clinical trial (RCT) targeting smoking cessation. METHODS Data are from an RCT comparing motivational interviewing counseling plus nicotine replacement therapy (NRT) to brief advice to quit (standard care) plus NRT among homeless smokers. Using bivariate analyses and multinomial logistic regression, we compared demographics, health and psychosocial variables, tobacco use, substance use, and NRT adherence among those who reported: quitting; reducing smoking by 50-99%; and not reducing smoking by 50%. RESULTS Of 324 participants who completed 26-week follow-up, 18.8% and 63.9% self-reported quitting and reducing, respectively. Compared to those who did not reduce smoking, participants reporting reducing indicated higher baseline cigarette use (OR=1.08; CI:1.04-1.12) and menthol use (OR=2.24; CI:1.05-4.77). Compared to participants who reduced, participants reporting quitting were more likely to be male (OR=1.998; CI:1.00-3.98), experience more housing instability (OR=1.97; CI:1.08-3.59), indicate higher importance of quitting (OR=1.27; CI:1.041.55), have higher NRT adherence (OR=1.75; CI:1.00-3.06), and lower odds of reported illicit drug use (OR=0.48; CI:0.24-0.95). CONCLUSIONS Over half of participants reduced smoking by at least 50%, indicating reduction is feasible among homeless smokers. Further research is required to understand the impact of reduction on future cessation attempts in homeless smokers. This study shows that reduction is achievable and may be a valid intermediate goal.
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Affiliation(s)
- Manami Bhattacharya
- University of Minnesota, Department of Health Policy and Management, Minneapolis, MN 55455, USA.
| | - Olamide Ojo-Fati
- California Department of Public Health, Sacramento, CA, United States
| | | | - Janet L Thomas
- University of Minnesota, Department of Medicine, Minneapolis, MN, United States
| | - Jonathan M Miller
- University of Minnesota, Department of Health Policy and Management, Minneapolis, MN 55455, USA
| | - Gbenga Ogedegbe
- New York University, Department of Population Health, New York, NY, United States
| | - Girardin Jean-Louis
- New York University, Department of Population Health, New York, NY, United States
| | - Anne M Joseph
- University of Minnesota, Department of Medicine, Minneapolis, MN, United States
| | - Kolawole S Okuyemi
- University of Utah, Department of Family & Preventive Medicine, Salt Lake City, UT, United States.
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Neale J, Parkin S, Hermann L, Metrebian N, Roberts E, Robson D, Strang J. Substance use and homelessness: A longitudinal interview study conducted during COVID-19 with implications for policy and practice. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103818. [PMID: 35961238 DOI: 10.1016/j.drugpo.2022.103818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who are homeless and using substances frequently encounter barriers to accessing support. This paper aims to inform policy and practice by analysing changes in the tobacco, alcohol and illicit drug use of people experiencing homelessness. METHODS Data derive from a qualitative longitudinal study (undertaken 2020/2021) and involving telephone interviews (n = 310) conducted with 34 people accommodated in two London hotels provided as part of a UK policy response to COVID-19. The hotels offered various supports, including opioid replacement therapy, prescribed alcohol, licensed nicotine replacement therapy, and e-cigarettes. Participants' substance use data were organised by Iterative Categorization and subjected to a content analysis to identify patterns and themes.. RESULTS At entry to the hotel, 5/34 participants (14.7%) had never used alcohol nor illicit drugs; 10/34 (29.4%) had only ever used alcohol (mostly without a problem); 11/34 (32.4%) had ever used illicit drugs but without a problem; and 8/34 (23.5%) had ever had a problem with illicit drugs. Sub-groups had different socio-demographic characteristics, particularly regarding being/not being a UK national, sex, and homelessness duration. Tobacco smoking was common across all sub-groups (18/34; 52.9%). Participants were often anxious about living with others who were using substances, and some worried about their own substance use. Substance use was changeable, with more decreases than increases. Changes related to intrapersonal (psychological), interpersonal (social) and structural (resource-based) factors. For example, decreases were precipitated by people feeling motivated to change, separation from others who used drugs, and receiving treatment or support. CONCLUSION Findings indicate that various interventions and accommodation models may benefit people who are homeless and using substances. An initiative that combined shelter and basic amenities, pharmacological treatment, psychosocial support, and space where substances were not available and other people using substances could be avoided resulted in an overall reduction in substance use amongst those accommodated.
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Affiliation(s)
- Joanne Neale
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - Stephen Parkin
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK.
| | - Laura Hermann
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - Nicola Metrebian
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - Emmert Roberts
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - Deborah Robson
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, SE5 8BB, UK
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Pratt R, Xiong S, Kmiecik A, Strobel-Ayres C, Joseph A, Rose SAE, Luo X, Cooney N, Thomas J, Specker S, Okuyemi K. The implementation of a smoking cessation and alcohol abstinence intervention for people experiencing homelessness. BMC Public Health 2022; 22:1260. [PMID: 35761310 PMCID: PMC9235189 DOI: 10.1186/s12889-022-13563-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In the United States, eighty percent of the adult homeless population smokes cigarettes compared to 15 percent of the general population. In 2017 Power to Quit 2 (PTQ2), a randomized clinical trial, was implemented in two urban homeless shelters in the Upper Midwest to address concurrent smoking cessation and alcohol treatment among people experiencing homelessness. A subset of this study population were interviewed to assess their experiences of study intervention. The objective of this study was to use participants’ experiences with the intervention to inform future implementation efforts of combined smoking cessation and alcohol abstinence interventions, guided by the Consolidated Framework for Implementation Research (CFIR).
Methods
Qualitative semi-structured interviews were conducted with 40 PTQ2 participants between 2016–2017 and analyzed in 2019. Interviews were audio-recorded, transcribed, and analyzed using a socially constructivist approach to grounded theory.
Results
Participants described the PTQ2 intervention in positive terms. Participants valued the opportunity to obtain both counseling and nicotine-replacement therapy products (intervention characteristics) and described forming a bond with the PTQ2 staff and reliance on them for emotional support and encouragement (characteristics of individuals). However, the culture of alcohol use and cigarette smoking around the shelter environment presented a serious challenge (outer setting). The study setting and the multiple competing needs of participants were reported as the most challenging barriers to implementation (implementation process).
Conclusion
There are unique challenges in addressing smoking cessation with people experiencing homelessness. For those in shelters there can be the difficulty of pro-smoking norms in and around the shelter itself. Considering pairing cessation with policy level interventions targeting smoke-free spaces, or pairing cessation with housing support efforts may be worthwhile.. Participants described a discord in their personal goals of reduction compared with the study goals of complete abstinence, which may pose a challenge to the ways in which success is defined for people experiencing homelessness.
Trial registration
Clinicaltrials.gov, NCT01932996, registered 08/30/2013.
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Sharbin GK, Rash CJ. Characterizing nicotine withdrawal in smokers experiencing homelessness. J Subst Abuse Treat 2022; 138:108748. [DOI: 10.1016/j.jsat.2022.108748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/28/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
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10
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Jafry MZ, Martinez J, Chen TA, Businelle MS, Kendzor DE, Reitzel LR. Perceived Social Support Attenuates the Association between Stress and Health-Related Quality of Life among Adults Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010713. [PMID: 34682458 PMCID: PMC8536194 DOI: 10.3390/ijerph182010713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
Health-related quality of life (HRQoL) is defined as a multidimensional subjective assessment of one’s physical and mental health. Homelessness is associated with numerous stressors that can reduce HRQoL. Social support is defined as the availability of individuals, or resources provided by individuals, to cope with stress. Interpersonal social support may be important in buffering HRQoL from the negative implications of stress. Here, we examine this association in a marginalized group known for high rates of physical and mental health comorbidities: adults experiencing homelessness. Participants (N = 581; 63.7% men; Mage = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Social support was measured with the 12-item Interpersonal Support Evaluation List (ISEL). HRQoL was measured by the Behavioral Risk Factor Surveillance System (BRFSS) survey using self-rated health, the number of poor mental and poor physical health days over the preceding 30 days, as well as the number of limited activity days as the result of poor mental and/or physical health. Perceived stress was assessed using the 4-item Perceived Stress Scale (PSS). The potential moderation effect of social support was examined by assessing the interaction term of social support and stress in a series of linear regression analyses, controlling for sex, age, months homeless, race, education, health insurance status, serious mental illness diagnosis, and recruitment agency/site. There was a significant interaction effect of social support and stress on the prediction of days of poor physical health, days of poor mental health, and days of limited activity (p in all cases ≤ 0.05). Results add to a growing literature on the potentially protective benefits of social support for HRQoL, extend them to a large sample of adults experiencing homelessness in the South, and demonstrate the significance of this moderating effect of social support over and above the influence of several prominent sociodemographic and diagnostic variables. Future work should determine if interventions designed to enhance social support can buffer HRQoL from the deleterious effects of stress among this vulnerable population.
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Affiliation(s)
- Midhat Z. Jafry
- Department of Biology and Biochemistry, College of Natural Sciences & Mathematics, University of Houston, Science & Research Building 2, 3455 Cullen Blvd Room 342, Houston, TX 77204, USA;
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
| | - Jayda Martinez
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
| | - Michael S. Businelle
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, University of Oklahoma, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, University of Oklahoma, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Services, College of Education, University of Houston, 491 Farish Hall, Houston, TX 77204, USA; (J.M.); (T.A.C.)
- HEALTH Research Institute, University of Houston, 1100 Health 2, 4849 Calhoun Rd., Houston, TX 77204, USA;
- Correspondence: ; Tel.: +1-713-743-6679
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Savoy EJ, Businelle MS, Nguyen N, Chen TA, Neighbors C, Norton PJ, Taing M, Reitzel LR. Examining moment to moment affective determinants of smoking rate following a quit attempt among homeless daily smokers. Addict Behav 2021; 115:106788. [PMID: 33360279 DOI: 10.1016/j.addbeh.2020.106788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cigarette smoking disproportionately affects homeless individuals, who have a higher smoking prevalence, fewer resources, and increased stressors compared to domiciled smokers. Little is known about how to facilitate smoking cessation among this population although some findings support focusing efforts on affective variables as well as alternate outcomes in order to optimize interventions for this group. METHODS Participants were homeless adults recruited from a Dallas, TX, shelter (N = 57, 61.4% male, Mage = 48.8 ± 9.0) to participate in tobacco cessation classes using an American Cancer Society-based therapy and support group with nicotine replacement therapy. Moment-to-moment changes in affect [e.g., negative affect (NA), positive affect (PA), and stress] were recorded via Ecological Momentary Assessments to assess whether they were associated with concurrent changes in cigarettes smoked per day (CPD) following a specific quit attempt. Separate generalized linear models (GLM) were evaluated for each predictor to examine the associations between affective variables and CPD in covariate-adjusted analyses. RESULTS Significant interaction effects of time and affect were found for all variables (NA: p = 0.0011, PA: p = 0.0006, stress: p = 0.0259), whereby the association of affect and CPD were significant in the early part of the week but the effects faded as time progressed. With regard to main effects, only increases in PA during the post-quit week significantly predicted fewer CPD (adjusted incidence rate ratio = 0.924, SE = 0.027, p = 0.0032). CONCLUSIONS Homeless smokers may be more likely to decrease their cigarette consumption during periods of greater PA throughout the post-quit week. Relationship between positive affect and reduction in CPD suggest focus on affective variables with homeless smokers may be an effective avenue for change in smoking behaviors, particularly in the days immediately following a quit attempt. Time effects should be further investigated to determine when these interventions might best be implemented.
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Affiliation(s)
- Elaine J Savoy
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA; Inpatient Program, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Michael S Businelle
- mHealth Shared Resource at Oklahoma Tobacco Research Center at the Stephenson Cancer Center, Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Nga Nguyen
- Biostatistics Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tzu-An Chen
- HEALTH Research Institute, University of Houston, Houston, TX, USA
| | - Clayton Neighbors
- Social Influences and Health Behaviors Lab, University of Houston, Houston, TX, USA
| | - Peter J Norton
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Matthew Taing
- HEALTH Research Institute, University of Houston, Houston, TX, USA; Department of Psychological, Health, & Learning Sciences, University of Houston, Texas, USA
| | - Lorraine R Reitzel
- HEALTH Research Institute, University of Houston, Houston, TX, USA; Department of Psychological, Health, & Learning Sciences, University of Houston, Texas, USA
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12
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Reuven SM, Chen TA, Zvolensky MJ, Businelle MS, Kendzor DE, Reitzel LR. Examining the moderating effect of anxiety sensitivity on past-month pain severity and heaviness of smoking among adult smokers experiencing homelessness. Addict Behav 2021; 112:106610. [PMID: 32861987 DOI: 10.1016/j.addbeh.2020.106610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pain and cigarette smoking are reciprocally related. Domiciled smokers with higher anxiety sensitivity (AS) - the fear of behaviors/sensations associated with the experience of anxiety - consume more cigarettes and report greater tobacco dependence than smokers with lower AS. AS treatment can reduce chronic pain and facilitate smoking cessation. Here, we examine the potentially moderating role of AS in the association between past-month pain (PMP) and heaviness of smoking (HS) among smokers experiencing homelessness. METHODS Participants (N = 461; 64.9% men, Mage = 43.1 ± 11.8) were smokers recruited from 6 homeless serving agencies in Oklahoma City, OK. Participants self-reported the presence and severity of PMP ("How much bodily pain have you had during the past four weeks?"), HS was measured via the heaviness of smoking index (HSI), and AS was measured via the Anxiety Sensitivity Index-III (ASI-III) and its 3 subscales: physical, cognitive, and social concerns. Linear regressions were used to examine potential ASI moderation controlling for age, sex, race, education, health insurance, perceived stress, and major depression. RESULTS ASI-III total, cognitive, and physical concerns each significantly moderated associations of PMP and HSI (ps < 0.05), whereas social concerns did not. Individuals with high AS had greater cigarette dependence as PMP values increased. CONCLUSION Similar to research with domiciled smokers, current results suggest that smokers experiencing homelessness who have high AS may benefit from AS-based interventions to reduce the association between PMP and HS, which may facilitate smoking cessation among this vulnerable group.
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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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Iwundu CN, Agrawal P, Businelle MS, Kendzor DE, Reitzel LR. Predictors of Overnight and Emergency Treatment among Homeless Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4271. [PMID: 32549281 PMCID: PMC7345623 DOI: 10.3390/ijerph17124271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 12/02/2022]
Abstract
High usage of emergency treatment and hospitalization has been reported among homeless individuals. Hence, this study aimed to identify the sociodemographic predictors associated with overnight and emergency hospital treatment among a sample of homeless adults. Participants were recruited from a shelter in Dallas, Texas (N = 354; Mage = 43.7 ± 11.7) and were predominantly uninsured, low-income men from various racial groups. The outcome variables were: (a) stayed overnight for treatment in a hospital; and (b) treated in a hospital emergency room. In logistic regression models, sex emerged as the only predictor of overnight treatment in a hospital (OR = 2.68, 95% CI = 1.61-4.47), and treatment in an emergency room (OR = 2.21, 95% CI = 1.34-3.65), such that women were more likely than men to be treated overnight and use emergency care. Targeted interventions and policies are needed to address homeless women's primary care needs and reduce costlier treatment.
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Affiliation(s)
- Chisom N. Iwundu
- Department of Rehabilitation and Health Services, College of Public and Health, University of North Texas Services, Denton, TX 76203, USA
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (P.A.); (L.R.R.)
| | - Pooja Agrawal
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (P.A.); (L.R.R.)
- School of Medicine, University of Texas Medical Branch, Galveston, TX 78701, USA
| | - Michael S. Businelle
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA; (M.S.B.); (D.E.K.)
| | - Darla E. Kendzor
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA; (M.S.B.); (D.E.K.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (P.A.); (L.R.R.)
- HEALTH Research Institute, University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
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Smoking amongst adults experiencing homelessness: a systematic review of prevalence rates, interventions and the barriers and facilitators to quitting and staying quit. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.11] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractBackgroundTo date, there has been no review of the research evidence examining smoking cessation among homeless adults. The current review aimed to: (i) estimate smoking prevalence in homeless populations; (ii) explore the efficacy of smoking cessation and smoking reduction interventions for homeless individuals; and (iii) describe the barriers and facilitators to smoking cessation and smoking reduction.MethodSystematic review of peer-reviewed research. Data sources included electronic academic databases. Search terms: ‘smoking’ AND ‘homeless’ AND ‘tobacco’, including adult (18+ years) smokers accessing homeless support services.ResultsFifty-three studies met the inclusion criteria (n = 46 USA). Data could not be meta-analysed due to large methodological inconsistencies and the lack of randomised controlled trials. Smoking prevalence ranged from 57% to 82%. Although there was no clear evidence on which cessation methods work best, layered approaches with additions to usual care seemed to offer modest enhancements in quit rates. Key barriers to cessation exist around the priority of smoking, beliefs around negative impact on mental health and substance use, and environmental influences.ConclusionsHomeless smokers will benefit from layered interventions which support many of their competing needs. To best understand what works, future recommendations include the need for consensus on the reporting of cessation outcomes.
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Baggett TP, Chang Y, Yaqubi A, McGlave C, Higgins ST, Rigotti NA. Financial Incentives for Smoking Abstinence in Homeless Smokers: A Pilot Randomized Controlled Trial. Nicotine Tob Res 2019; 20:1442-1450. [PMID: 29059442 DOI: 10.1093/ntr/ntx178] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022]
Abstract
Introduction Three-quarters of homeless people smoke cigarettes. Financial incentives for smoking abstinence have appeared promising in nonexperimental studies of homeless smokers, but randomized controlled trial (RCT) data are lacking. Methods We conducted a pilot RCT of financial incentives for homeless smokers. Incentive arm participants (N = 25) could earn escalating $15-$35 rewards for brief smoking abstinence (exhaled carbon monoxide <8 parts per million) assessed 14 times over 8 weeks. Control arm participants (N = 25) were given $10 at each assessment regardless of abstinence. All participants were offered nicotine patches and counseling. The primary outcome was a repeated measure of brief smoking abstinence across 14 assessments. The secondary outcome was brief abstinence at 8 weeks. Exploratory outcomes were self-reported 1-day and 7-day abstinence from (1) any cigarette and (2) any puff of a cigarette. Other outcomes included 24-hour quit attempts, nicotine patch use, counseling attendance, and changes in alcohol and drug use. Results Compared to control, incentive arm participants were more likely to achieve brief abstinence overall (odds ratio 7.28, 95% confidence interval 2.89 to 18.3) and at 8 weeks (48% vs. 8%, p = .004). Similar effects were seen for 1-day abstinence, but 7-day puff abstinence was negligible in both arms. Incentive arm participants made more quit attempts (p = .03). Nicotine patch use and counseling attendance were not significantly different between the groups. Alcohol and drug use did not change significantly in either group. Conclusions Among homeless smokers, financial incentives increased brief smoking abstinence and quit attempts without worsening substance use. This approach merits further development focused on promoting sustained abstinence. Registration ClinicalTrials.gov (NCT02565381). Implications Smoking is common among homeless people, and conventional tobacco treatment strategies have yielded modest results in this population. This pilot RCT suggests that financial incentives may be a safe way to promote brief smoking abstinence and quit attempts in this vulnerable group of smokers. However, further development is necessary to translate this approach into real-world settings and to promote sustained periods of smoking abstinence.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA.,Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA
| | - Yuchiao Chang
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Awesta Yaqubi
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Claire McGlave
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, VT
| | - Nancy A Rigotti
- Division of General Internal Medicine, Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
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Dawkins L, Ford A, Bauld L, Balaban S, Tyler A, Cox S. A cross sectional survey of smoking characteristics and quitting behaviour from a sample of homeless adults in Great Britain. Addict Behav 2019; 95:35-40. [PMID: 30831339 DOI: 10.1016/j.addbeh.2019.02.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/11/2019] [Accepted: 02/21/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Smoking is a key contributor to health and social inequalities and homeless smoking prevalence rates are 4 times higher than the general population. Research on homelessness and smoking to date has been concentrated predominantly in the US and Australia. This study aimed to describe smoking and quitting behaviour in homeless adult smokers in Great Britain. Data on perceptions of, and willingness to try, e-cigarettes were also gathered. METHODS Cross sectional survey of 283 adult smokers accessing homeless support services in Kent, the Midlands, London and Edinburgh. Participants answered a four-part survey: i) demographics; ii) current smoking behaviour and dependence (including the Fagerström Test of Cigarette Dependence [FTCD]); iii) previous quit attempts; and iv) e-cigarettes perceptions. RESULTS High levels of cigarette dependence were observed (FTCD: M = 7.78, sd ± 0.98). Although desire to quit was high, most had made fewer than 5 quit attempts and 90% of these lasted less than 24 h. 91.5% reported that others around them also smoked. Previous quit methods used included cold turkey (29.7%), NRT (24.7%), varenicline (22.3%) and bupropion (14.5%). 34% were willing or able to spend £20 or more for an e-cigarette and 82% had tried one in the past although 54% reported that they preferred smoking. CONCLUSION We observed high nicotine dependence, few long-term quit attempts, strong desire to quit and amenability to both traditional cessation methods and e-cigarettes. Community embedded and non-routine approaches to cessation may be promising avenues promoting engagement with the homeless community. Likely barriers to uptake include low affordability, preference for cigarettes and high numbers of smoking acquaintances.
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Affiliation(s)
- Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom.
| | - Allison Ford
- Institute for Social Marketing, University of Stirling, Stirling FK9 4LA, United Kingdom
| | - Linda Bauld
- Usher Institute, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Sema Balaban
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom
| | - Allan Tyler
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom
| | - Sharon Cox
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London SE1 0AA, United Kingdom
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Taylor A, Murillo R, Businelle MS, Chen TA, Kendzor DE, McNeill LH, Reitzel LR. Physical activity and sleep problems in homeless adults. PLoS One 2019; 14:e0218870. [PMID: 31276513 PMCID: PMC6611579 DOI: 10.1371/journal.pone.0218870] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
Background For the estimated 554,000 homeless individuals on any given night in the United States, obtaining quality sleep is often challenging. This group is known to have multiple health disparities, potentially affected by sleep problems; therefore, identifying lifestyle factors–such as physical activity–that are associated with improving both quality and quantity of sleep has important implications for public health. Here, we examine associations of physical activity with subjective sleep problems within a large sample of homeless adults. Methods Participants were homeless adults recruited from Dallas and Oklahoma (N = 747; 66.1% men, Mage = 43.7±12.1). Participants self-reported insufficient sleep (number of days without sufficient rest/sleep in the last month; categorized as 0, 1–13, 14–29, or ≥30 days), sleep duration (over average 24 hours; categorized as ≤6 [short sleeper], 7–9 [optimal sleeper], or ≥10 hours [long sleeper]), and unintentional daytime sleep (number of days with unintentional sleep in the last month; categorized as 0 vs ≥30 days). Physical activity was assessed subjectively using the BRFSS Physical Activity Questionnaire. Regression analyses were performed to examine the associations between physical activity and sleep problems, controlling for age, sex, race, education, body mass, months homeless, at-risk drinking, self-rated health, serious mental illness, smoking status, and recruitment city. Results Failure to meet/exceed physical activity guidelines was associated with higher likelihood of being a long sleeper (OR = 2.64, 95% CI: 1.46, 4.78) but a lower likelihood of having ≥30 days of insufficient rest/sleep (OR = 0.52, 95% CI: 0.29, 0.93). Conclusions Findings suggest that physical activity promotion may hold promise for addressing the problem of too much sleep, but not other manifestations of sleep problems among this vulnerable group.
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Affiliation(s)
- Ashley Taylor
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, Houston, Texas, United States of America
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
| | - Rosenda Murillo
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, Houston, Texas, United States of America
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
| | - Michael S. Businelle
- School of Public Health, The University of Texas Health Science Center, Dallas, Texas, United States of America
| | - Tzu-An Chen
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, Houston, Texas, United States of America
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
| | - Darla E. Kendzor
- School of Public Health, The University of Texas Health Science Center, Dallas, Texas, United States of America
| | - Lorna H. McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Lorraine R. Reitzel
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
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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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Nair US, Reikowsky RC, Allen AM, Bell ML. Quitline program utilization and cessation outcomes: A comparison of provider-referred clients by healthcare settings. Prev Med Rep 2019; 14:100863. [PMID: 31011517 PMCID: PMC6462770 DOI: 10.1016/j.pmedr.2019.100863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022] Open
Abstract
US Public Health Service guidelines recommend that healthcare providers assess patients for tobacco use and refer tobacco users to cessation services (e.g., quitlines). However, once referred, little is known on how program outcomes for referred tobacco users vary across healthcare settings. To examine differences in program enrollment, dropout at follow-up, utilization (number of coaching sessions and nicotine replacement therapy use), and quit outcomes among tobacco users referred across settings to a state quitline. In a retrospective analysis of clients referred to the quitline (January 2011-June 2016), referrals were categorized into six settings: general medical practice (reference group), acute care hospitals, behavioral health, federally qualified health centers (FQHCs), county health departments, and specialty clinics. Outcome variables included enrollment, dropout, program utilization, and 30-day tobacco abstinence at 7-month follow-up. Compared to medical practices, clients referred from behavioral health were less likely to enroll in services (OR = 0.81, 95%CI: 0.76, 0.87), less likely to report using NRT in-program (OR = 0.51, 95%CI: 0.42, 0.62), and along with clients referred from FQHCs (OR = 0.78, 95%CI: 0.64, 0.94) were less likely to be quit at follow-up (OR = 0.73, 95%CI: 0.59, 0.92). Clients referred from acute care hospitals were less likely to enroll in services (OR = 0.60, 95%CI: 0.56, 0.64) and were more likely to drop-out of cessation services (OR = 1.12; 95%CI: 1.00-1.26). Findings reflect the need for better tailoring of messages for tobacco assessment within specific healthcare settings while bolstering behavioral counseling that quitlines provide to increase enrollment, engagement, and retention in tobacco cessation services.
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Affiliation(s)
- Uma S. Nair
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, Tucson AZ-85724, United States of America
| | - Ryan C. Reikowsky
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, Tucson AZ-85724, United States of America
| | - Alicia M. Allen
- Family & Community Medicine Department, College of Medicine, University of Arizona, 3950 South Country Club Drive, Suite 330, Tucson, AZ 85714, United States of America
| | - Melanie L. Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Drachman Hall, Tucson AZ-85724, United States of America
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Pratt R, Pernat C, Kerandi L, Kmiecik A, Strobel-Ayres C, Joseph A, Everson Rose SA, Luo X, Cooney N, Thomas J, Okuyemi K. "It's a hard thing to manage when you're homeless": the impact of the social environment on smoking cessation for smokers experiencing homelessness. BMC Public Health 2019; 19:635. [PMID: 31126265 PMCID: PMC6534899 DOI: 10.1186/s12889-019-6987-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 05/15/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Up to 80% of the adult homeless population use tobacco, and smoking cessation programs could offer an important opportunity to address preventable mortality and morbidity for this population. This population faces serious challenges to smoking cessation, including the impact of the social environment. METHODS Forty participants (11 female; 29 male) from an ongoing smoking cessation randomized clinical trial conducted at 2 urban homeless shelters in the Upper Midwest were invited to take part in semi-structured interviews in 2016-2017. An interviewer used a semi-structured interview guide asking participants to describe their experience of how the social environment impacted their attempt to quit smoking. RESULTS Participants described feeling pressure to smoke and drink in and around shelters, and that this pressure had led some to start smoking or resume smoking, along with making it very challenging to quit. Participants described being motivated to quit, and seeing smoking cessation as positively impacting the time and focus they felt they had for finding housing. However many felt more interested in reducing their smoking, rather than quitting. CONCLUSIONS Addressing smoking cessation for people experiencing homelessness is both an important public health opportunity, and a challenge. There is a need to consider cessation in the context of the social and environmental factors impacting smokers who are experiencing homelessness. In particular, there is a need to address the collective value placed on smoking in social interactions. Despite these challenges, there are high levels of motivation and interest in addressing smoking. TRIAL REGISTRATION NCT01932996 . Date of registration 30th August 2013. Prospectively registered.
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Affiliation(s)
- Rebekah Pratt
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street, Minneapolis, MN 55414 USA
| | - Claire Pernat
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street, Minneapolis, MN 55414 USA
| | - Linda Kerandi
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street, Minneapolis, MN 55414 USA
| | - Azul Kmiecik
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street, Minneapolis, MN 55414 USA
| | - Cathy Strobel-Ayres
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street, Minneapolis, MN 55414 USA
| | - Anne Joseph
- Department of Medicine, University of Minnesota, 401 East River Parkway, Minneapolis, MN 55455 USA
| | - Susan A. Everson Rose
- Department of Medicine & Program in Health Disparities Research, University of Minnesota, Minneapolis, USA
| | - Xianghua Luo
- Division of Biostatistics, School of Public Health and Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE, MMC 303, Minneapolis, MN 55455 USA
| | - Ned Cooney
- Department of Psychiatry, Yale University School of Medicine, 300 George Street #901, New Haven, CT 06511 USA
| | - Janet Thomas
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street, Minneapolis, MN 55414 USA
| | - Kola Okuyemi
- Department of Family & Preventive Medicine, University of Utah, 375 Chipeta, Suite A, Salt Lake City, UT 84108 USA
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Garey L, Reitzel LR, Neisler J, Kendzor DE, Zvolensky MJ, Neighbors C, Hernandez DC, Businelle MS. Health-Related Quality of Life Among Homeless Smokers: Risk and Protective Factors of Latent Class Membership. Behav Med 2019; 45:40-51. [PMID: 29558273 PMCID: PMC6148434 DOI: 10.1080/08964289.2018.1447905] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Health-related quality of life (HRQoL) is a multidimensional assessment of well-being and health status. Most work in this area assumes that HRQoL is a homogenous construct; however, it is possible HRQoL subgroups may exist. The purpose of the study was to characterize common classes of HRQoL among adult, homeless smokers, a particularly vulnerable group of the larger population, and to evaluate risk and protective factors of HRQoL class membership. Homeless smokers (N = 456; 65.1% male; Mage = 43.19 years [SD = 11.77]) completed self-report measures of sociodemographics, smoking characteristics, anxiety sensitivity, stress, social support, and the Center for Disease Control (CDC) four-item HRQoL measure. A latent class analysis was conducted for HRQoL. Multinomial regression models were used to simultaneously test correlates of class membership. A three-class solution, consisting of poor HRQoL, moderate HRQoL, and excellent HRQoL, demonstrated superior fit. Correlates of class membership included sex, age, lifetime months of being homeless, smoking characteristics, anxiety sensitivity, stress, and social support. The current findings provide novel evidence for three distinct classes of HRQoL among homeless smokers. Results suggest that older smokers with greater emotional distress, as evidenced by greater anxiety sensitivity, greater stress, and less social support, may be particularly vulnerable to poorer HRQoL.
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Affiliation(s)
- Lorra Garey
- The University of Houston, Department of Psychology, 126 Heyne Building, Houston, TX 77204-5029
| | - Lorraine R. Reitzel
- The University of Houston, Department of Psychological, Health, and Learning Sciences, 491 Farish Hall, Houston, TX 77204-5029
| | - Julie Neisler
- The University of Houston, Department of Psychological, Health, and Learning Sciences, 491 Farish Hall, Houston, TX 77204-5029
| | - Darla E. Kendzor
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104
| | - Michael J. Zvolensky
- The University of Houston, Department of Psychology, 126 Heyne Building, Houston, TX 77204-5029,The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Unit 1330, P.O. Box 301439, Houston, TX 77230-1439
| | - Clayton Neighbors
- The University of Houston, Department of Psychology, 126 Heyne Building, Houston, TX 77204-5029
| | - Daphne C. Hernandez
- The University of Houston, Department of Health and Human Performance, Houston, TX, USA
| | - Michael S. Businelle
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104
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Pinsker EA, Hennrikus DJ, Erickson DJ, Call KT, Forster JL, Okuyemi KS. Trends in self-efficacy to quit and smoking urges among homeless smokers participating in a smoking cessation RCT. Addict Behav 2018; 78:43-50. [PMID: 29125976 DOI: 10.1016/j.addbeh.2017.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In the U.S., approximately 73% of homeless adults smoke cigarettes and they experience difficulty quitting. Homeless smokers report low self-efficacy to quit and that smoking urges are a barrier to quitting. Self-efficacy to quit and smoking urges are dynamic and change throughout smoking cessation treatment. This study examines changes in self-efficacy to quit and smoking urges throughout a smoking cessation intervention among the homeless and identifies predictors of change in these characteristics. METHODS Homeless smokers (n=430) participating in a smoking cessation randomized controlled trial in the U.S. completed surveys at baseline, and weeks 1, 2, 4, 6, 8, and 26 on demographic and smoking characteristics (i.e., confidence to quit, self-efficacy to refrain from smoking, and smoking urges). A growth curve analysis was conducted by modeling change in the smoking characteristics over time and examining the variability in the change in smoking characteristics by demographic characteristics and treatment group. RESULTS Among the full sample, self-efficacy to refrain from smoking increased linearly over time, confidence to quit increased until the midpoint of treatment but subsequently decreased, and smoking urges decreased until the midpoint of treatment but subsequently increased. There were race differences in these trajectories. Racial minorities experienced significantly greater increases in self-efficacy to refrain from smoking than Whites and Blacks had higher confidence to quit than Whites. CONCLUSIONS White participants experienced less increase in self-efficacy to refrain from smoking and lower confidence to quit and therefore may be a good target for efforts to increase self-efficacy to quit as part of homeless-targeted smoking cessation interventions. Sustaining high confidence to quit and low smoking urges throughout treatment could be key to promoting higher cessation rates among the homeless.
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24
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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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25
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Wrighting Q, Businelle MS, Kendzor DE, LeBlanc H, Reitzel LR. Cigarette Purchasing Patterns, Readiness to Quit, and Quit Attempts Among Homeless Smokers. Nicotine Tob Res 2017; 19:1526-1530. [PMID: 27613948 DOI: 10.1093/ntr/ntw227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/02/2016] [Indexed: 11/12/2022]
Abstract
Introduction Cigarette purchasing patterns may be linked with greater readiness to make a quit attempt and more quit attempts among domiciled samples. However, little is known about the cigarette purchasing patterns of homeless smokers or their potential relations to quitting intention and behaviors. This study redressed this gap among a convenience sample of homeless adult smokers from a large shelter in Dallas, Texas. Methods Participants (N = 207; Mage = 43; 71.5% male) smoked ≥100 cigarettes over the lifetime and endorsed current daily smoking. Variables assessed included cigarette dependence (time to first cigarette of the day), monthly income, quantity of cigarettes most recently purchased, average money spent on cigarettes weekly, readiness/motivation to quit smoking, and the number intentional quit attempts lasting ≥24h in the past year. Regression analyses were conducted to characterize associations of cigarette purchasing patterns with readiness to quit and quit attempts controlling for sex, age, cigarette dependence, and income. Results Most participants purchased cigarettes by the pack (61.4%), and more than half the sample spent ≤$20 on cigarettes per week. Results indicated that spending less money per week on cigarettes was associated with greater readiness to quit (P = .016), even when controlling for income, cigarette dependence, and other covariates. Stratified analyses indicated that this association was significant only for homeless smokers reporting no regular monthly income. Conclusions Homeless daily smokers with no reported income who spend little money on cigarettes may make particularly apt targets for cessation interventions due to potential associations with quitting motivation. Implications Adults who are homeless smoke at greater rates and quit at lower rates than domiciled adults, leading to significant smoking-related health disparities among this group. Findings suggest that cigarette purchasing patterns are linked with readiness to quit smoking among smokers who are homeless. Results elucidate one of the myriad factors that contribute to tobacco-related disparities among this group and findings may have implications for cessation interventions in homeless shelters and other contexts where resources are limited.
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Affiliation(s)
- Quentaxia Wrighting
- Department of Psychological, Health, & Learning Sciences, Social Determinants/Health Disparities Lab, University of Houston, Houston, TX
| | - Michael S Businelle
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK.,Stephenson Cancer Center, Oklahoma City, OK
| | - Darla E Kendzor
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK.,Stephenson Cancer Center, Oklahoma City, OK
| | - Hannah LeBlanc
- Department of Psychological, Health, & Learning Sciences, Social Determinants/Health Disparities Lab, University of Houston, Houston, TX
| | - Lorraine R Reitzel
- Department of Psychological, Health, & Learning Sciences, Social Determinants/Health Disparities Lab, University of Houston, Houston, TX
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26
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Zvolensky MJ, Paulus DJ, Langdon KJ, Robles Z, Garey L, Norton PJ, Businelle MS. Anxiety sensitivity explains associations between anxious arousal symptoms and smoking abstinence expectancies, perceived barriers to cessation, and problems experienced during past quit attempts among low-income smokers. J Anxiety Disord 2017; 48:70-77. [PMID: 28024913 PMCID: PMC5476482 DOI: 10.1016/j.janxdis.2016.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/07/2016] [Accepted: 12/15/2016] [Indexed: 11/23/2022]
Abstract
Disproportionately more smokers report low-income and mental health problems relative to non-smokers. Low-income smokers may use smoking to alleviate negative emotional states resulting from exposure to multiple stressors. Yet, little work has been devoted to elucidating mechanisms that may explain the association between negative emotional states and smoking-related processes among low-income smokers. The present study sought to address this gap by examining anxiety sensitivity, a transdiagnostic factor related to both anxiety and smoking, as a potential mediator for the influence of anxiety symptoms on smoking-related processes, including threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), perceived barriers for cessation, and problems experienced during past quit attempts. Participants included treatment-seeking daily cigarette smokers (n=101; 68.3% male; Mage=47.1; SD=10.2). Results indicated that anxiety symptoms exerted a significant indirect effect through anxiety sensitivity for threat-related smoking abstinence expectancies (somatic symptoms and harmful consequences), perceived barriers for cessation, and problems experienced during past quit attempts. The present results provide empirical support that anxiety sensitivity may be an underlying mechanism that partially explains the relation between anxiety symptoms and smoking processes among low-income treatment-seeking smokers. Findings broaden current theoretical understanding of pathways through which anxiety symptoms contribute to maladaptive smoking processes and cognitions among socioeconomically disadvantaged smokers.
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Affiliation(s)
- Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, United States; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States.
| | - Daniel J Paulus
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Kirsten J Langdon
- Rhode Island Hospital, Department of Psychiatry, Providence, RI, United States
| | - Zuzuky Robles
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Lorra Garey
- University of Houston, Department of Psychology, Houston, TX, United States
| | - Peter J Norton
- Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Michael S Businelle
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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27
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Garey L, Reitzel LR, Kendzor DE, Businelle MS. The Potential Explanatory Role of Perceived Stress in Associations Between Subjective Social Status and Health-Related Quality of Life Among Homeless Smokers. Behav Modif 2015; 40:303-24. [PMID: 26530474 DOI: 10.1177/0145445515612396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Homeless individuals smoke at high rates relative to the general population and are at heightened risk of tobacco-related illnesses and poor health-related quality of life (HRQoL). Homeless smokers also report low subjective social status (SSS) or perceived social standing relative to others. SSS may contribute to poor HRQoL, potentially through perceived stress. The current study examined the role of perceived stress in the association of SSS and HRQoL among 227 (70.9% male, Mage = 43.2) homeless smokers. Participants completed self-report measures of SSS, perceived stress, and HRQoL. Perceived stress partially explained the relation between SSS (United States and Community) and HRQoL in covariate-adjusted analyses. Results suggested that perceived stress is a pathway through which SSS contributes to HRQoL among homeless smokers. Findings broaden current understanding of the impact of social disadvantage and perceived stress on HRQoL among homeless smokers.
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Affiliation(s)
| | | | - Darla E Kendzor
- The University of Texas Southwestern Medical Center, Dallas, TX, USA The University of Texas School of Public Health, Dallas, TX, USA
| | - Michael S Businelle
- The University of Texas Southwestern Medical Center, Dallas, TX, USA The University of Texas School of Public Health, Dallas, TX, USA
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28
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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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Businelle MS, Poonawalla IB, Kendzor DE, Rios DM, Cuate EL, Savoy EJ, Ma P, Baggett TP, Reingle J, Reitzel LR. Smoking policy change at a homeless shelter: attitudes and effects. Addict Behav 2015; 40:51-6. [PMID: 25222848 DOI: 10.1016/j.addbeh.2014.08.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/26/2014] [Accepted: 08/29/2014] [Indexed: 11/30/2022]
Abstract
Homeless adults are exposed to more smokers and smoke in response to environmental tobacco cues more than other socioeconomically disadvantaged groups. Addressing the culture of smoking in homeless shelters through policy initiatives may support cessation and improve health in this vulnerable and understudied population. This study examined support for and expected/actual effects of a smoking ban at a homeless shelter. A 2-wave cross-sectional study with an embedded cohort was conducted in the summer of 2013 two weeks before (wave 1) and two months after (wave 2) a partial outdoor smoking ban was implemented. A total of 394 homeless adults were surveyed (i.e., wave 1 [n=155]; wave 2 [n=150]; and 89 additional participants completed both waves). On average, participants were 43 years old, primarily African American (63%), male (72%), and had been homeless for the previous 12 months (median). Most participants were smokers (76%) smoking 12 cigarettes per day on average. Most participants supported the creation of a large smoke-free zone on the shelter campus, but there was less support for a shelter-wide smoking ban. Average cigarettes smoked per day did not differ between study waves. However, participants who completed both study waves experienced a reduction in expired carbon monoxide at wave 2 (W1=18.2 vs. W2=15.8 parts per million, p=.02). Expected effects of the partial ban were similar to actual effects. Partial outdoor smoking bans may be well supported by homeless shelter residents and may have a positive impact on shelter resident health.
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Affiliation(s)
- Michael S Businelle
- University of Texas School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Insiya B Poonawalla
- University of Texas School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA
| | - Darla E Kendzor
- University of Texas School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Debra M Rios
- University of Texas School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA
| | - Erica L Cuate
- University of Texas School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA
| | - Elaine J Savoy
- University of Houston, Department of Clinical Psychology, Houston, TX, USA
| | - Ping Ma
- University of Texas School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Travis P Baggett
- Massachusetts General Hospital, Division of General Internal Medicine, Boston, MA, USA
| | - Jennifer Reingle
- University of Texas School of Public Health, Department of Health Promotion and Behavioral Sciences, Dallas, TX, USA
| | - Lorraine R Reitzel
- University of Houston, Department of Educational Psychology, Houston, TX, USA
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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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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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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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