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. 2021 Dec:98:103377.
doi: 10.1016/j.drugpo.2021.103377. Epub 2021 Sep 1.

Homeless women's perspectives on smoking and smoking cessation programs: A qualitative study

Sara Bissell Rubin  1 , Maya Vijayaraghavan  2 , Sheri D Weiser  2 , Janice Y Tsoh  1 , Alison Cohee  3 , Kevin Delucchi  1 , Elise D Riley  4
Affiliations

Homeless women's perspectives on smoking and smoking cessation programs: A qualitative study

Sara Bissell Rubin et al. Int J Drug Policy. 2021 Dec.

Abstract

Background: Individuals who are unsheltered or experiencing homelessness are more likely to smoke than those in the general population and have a higher prevalence of tobacco-related illnesses. Those who are unhoused make quit attempts at rates similar to the general population, however rates of successful quitting are much lower. Women bear a higher burden of smoking-related diseases and are less successful in their cessation efforts than men. Despite these increased risks and challenges, cessation programs specifically designed to meet the needs of women experiencing homelessness are extremely rare.

Methods: To examine perceptions of smoking cessation programs among women who are unstably housed, we conducted in-depth, semi-structured interviews with twenty-nine women experiencing homelessness or unstable housing who had histories of tobacco and substance use. Interviews explored the social context of smoking, as well as interest in, barriers to, and facilitators of quitting. We used a grounded theory approach to analyze the transcripts.

Results: Participants reported a number of structural barriers to cessation. They reported obstacles to participating in existing cessation programs, including chronic stress related to experiences of being unsheltered and fear of being exposed to neighborhood violence. These conditions were paired with a strong need to self-isolate in order to maintain personal safety, which runs counter to traditional group-based cessation programs.

Conclusion: A dissonance exists between current smoking cessation programs and the needs of women who are unsheltered or unstably housed. Alternative cessation treatment delivery models that address extremely high levels of chronic stress violence, and avoidance of group settings are needed, as are programs that provide options for safe participation.

Keywords: Cessation; Homelessness; Qualitative research; Tailored programs; Tobacco.

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Conflict of interest statement

Declarations of Interest The authors have no disclosures to report. All study procedures reported here were approved by the Institutional Review Board at the University of California, San Francisco.

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