Subsistence difficulties are associated with more barriers to quitting and worse abstinence outcomes among homeless smokers: evidence from two studies in Boston, Massachusetts

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Creator
  • Baggett, Travis P
    • Other Affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
  • Yaqubi, Awesta
    • Other Affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA
  • Berkowitz, Seth A
    • Affiliation: School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology
  • Kalkhoran, Sara M
    • Other Affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
  • McGlave, Claire
    • Other Affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA
  • Chang, Yuchiao
    • Other Affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
  • Campbell, Eric G
    • Other Affiliation: Department of Medicine, Harvard Medical School, Boston, MA, USA; Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
  • Rigotti, Nancy A
    • Other Affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Tobacco Research & Treatment Center, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
Abstract
  • Background Three-quarters of homeless people smoke cigarettes. Competing priorities for shelter, food, and other subsistence needs may be one explanation for low smoking cessation rates in this population. We analyzed data from two samples of homeless smokers to examine the associations between subsistence difficulties and 1) smoking cessation readiness, confidence, and barriers in a cross-sectional study, and 2) smoking abstinence during follow-up in a longitudinal study. Methods We conducted a survey of homeless smokers (N = 306) in 4/2014–7/2014 and a pilot randomized controlled trial (RCT) for homeless smokers (N = 75) in 10/2015–6/2016 at Boston Health Care for the Homeless Program. In both studies, subsistence difficulties were characterized as none, low, or high based on responses to a 5-item scale assessing the frequency of past-month difficulty finding shelter, food, clothing, a place to wash, and a place to go to the bathroom. Among survey participants, we used linear regression to assess the associations between subsistence difficulty level and readiness to quit, confidence to quit, and a composite measure of perceived barriers to quitting. Among RCT participants, we used repeated-measures logistic regression to examine the association between baseline subsistence difficulty level and carbon monoxide-defined brief smoking abstinence assessed 14 times over 8 weeks of follow-up. Analyses adjusted for demographic characteristics, substance use, mental illness, and nicotine dependence. Results Subsistence difficulties were common in both study samples. Among survey participants, greater subsistence difficulties were associated with more perceived barriers to quitting (p < 0.001) but not with cessation readiness or confidence. A dose-response relationship was observed for most barriers, particularly psychosocial barriers. Among RCT participants, greater baseline subsistence difficulties predicted less smoking abstinence during follow-up in a dose-response fashion. In adjusted analyses, individuals with the highest level of subsistence difficulty had one-third the odds of being abstinent during follow-up compared to those without subsistence difficulties (OR 0.33, 95% CI 0.11–0.93) despite making a similar number of quit attempts. Conclusions Homeless smokers with greater subsistence difficulties perceive more barriers to quitting and are less likely to do so despite similar readiness, confidence, and attempts. Future studies should assess whether addressing subsistence difficulties improves cessation outcomes in this population. Trial registration ClinicalTrials.gov: NCT02565381 .
Date of publication
DOI
Identifier
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • The Author(s).
Journal title
  • BMC Public Health
Journal volume
  • 18
Journal issue
  • 1
Page start
  • 463
Language
  • English
Bibliographic citation
  • BMC Public Health. 2018 Apr 10;18(1):463
Publisher
  • BioMed Central

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details 12889_2018_article_5375.pdf 2019-05-06 Public Download