Trends in self-efficacy to quit and smoking urges among homeless smokers participating in a smoking cessation RCT

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.

Keywords: Growth curve modeling; Race/ethnicity; Self-efficacy to quit; Smoking cessation; Smoking urges.

Figure 1. Intrinsic Self-efficacy to Refrain from Smoking by Race among Homeless Smokers Over the Course of the Power to Quit Study Adjusting for Treatment Group, Age, and Gender (N=430)

Change in intrinsic self-efficacy to refrain from smoking from baseline to week 26 differed by race. Blacks experienced a greater increase in predicted intrinsic self-efficacy to refrain from smoking over time than Whites. Individuals of other race experienced the greatest increase in predicted intrinsic self-efficacy to refrain from smoking.

Figure 2. Extrinsic Self-efficacy to Refrain from Smoking by Race among Homeless Smokers Over the Course of the Power to Quit Study Adjusting for Treatment Group, Age, and Gender (N=430)

Change in extrinsic self-efficacy to refrain from smoking from baseline to week 26 differed by race. Individuals of other race experienced the greatest increase in predicted extrinsic self-efficacy to refrain from smoking. Whites and Blacks did not differ in predicted extrinsic-self efficacy to refrain from smoking over time.

Figure 3. Confidence to Quit among Homeless Smokers from Baseline to Week 26 of the Power to Quit Study (N=430)

Confidence to quit had a cubic trajectory from baseline to week 26, with increases in confidence to quit during the beginning of treatment and decreases in confidence to quit from the end of treatment (week 8) to 26-weeks follow-up.

Figure 4. Confidence to Quit by Race among Homeless Smokers from Baseline to Week 6 of the Power to Quit Study Adjusting for Treatment Group, Age, and Gender (N=430)

Change in confidence to quit from baseline to week 6 differed by race. Whites and individuals of other race did not differ in predicted confidence to quit over time. Blacks experienced less change in predicted confidence to quit than Whites and had higher confidence to quit at both early and later points in treatment.

Figure 5. Smoking Urges among Homeless Smokers from Baseline to Week 26 of the Power to Quit Study (N=430)

Smoking urges had a cubic trajectory from baseline to week 26, with decreases in smoking urges during the beginning of treatment and increases in smoking urges from the end of treatment (week 8) to 26-weeks follow-up.

Figure 6. Smoking Urges among Homeless Smokers from Baseline to Week 6 of the Power to Quit Study (N=430)

Smoking urges had a quadratic trajectory from baseline to week 6, with decreases from baseline to week 4 and increases from week 4 to 6.