Health Promotion Journal of Australia Health Promotion Journal of Australia Society
Journal of the Australian Health Promotion Association
RESEARCH ARTICLE

Underestimation of homeless clients’ interest in quitting smoking: a case for routine tobacco assessment

Sarah Maddox A B D and Catherine Segan A C
+ Author Affiliations
- Author Affiliations

A Cancer Council Victoria, 615 St Kilda Road, Melbourne, Vic. 3004, Australia.

B Centre for Rural and Remote Mental Health, University of Newcastle, Bloomfield Campus, Orange, NSW 2800, Australia.

C Centre for Health Policy, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Parkville, Vic. 3010, Australia.

D Corresponding author. Email: ms.sarah.maddox@gmail.com

Health Promotion Journal of Australia 28(2) 160-164 https://doi.org/10.1071/HE15102
Submitted: 13 August 2015  Accepted: 6 May 2016   Published: 9 June 2016

Abstract

Issue addressed: In Australia smoking rates among the homeless are extremely high; however, little is known about their interest in quitting and few homeless services offer cessation assistance. In an Australian homeless service, this research examined the clients’ smoking from the client, staff and organisational perspectives in order to assess the need for cessation assistance for clients and identify opportunities to increase access to it.

Methods: Twenty-six nurses completed an anonymous survey describing their attitudes to providing smoking-cessation support, current practices and estimates of client smoking and interest in quitting. Subsequently, nurses administered a survey to 104 clients to determine their smoking prevalence and interest in quitting. Organisation-wide tobacco-related policy and practices were audited.

Results: Most clients (82%) smoked, half of these (52%) reported wanting to quit and 64% reported trying to quit or reduce their smoking in the previous 3 months. Nurses approximated clients’ smoking prevalence (88% vs 82% reported by clients), but underestimated interest in quitting (33% vs 52% reported by clients). Among nurses 93% agreed that cessation support should be part of normal client care. The organisation’s client-assessment form contained fields for ‘respiratory issues’ and ‘drug issues’, but no specific field for smoking status. The organisation’s smoking policy focused on providing a smoke-free work environment.

Conclusions: Many smokers using homeless services want to quit and are actively trying to reduce and quit smoking. Smoking-cessation assistance that meets the needs of people experiencing homelessness is clearly warranted.

So what?: Homeless services should develop, and include in their smoking policy and intake processes, a practice of routinely assessing tobacco use, offering brief interventions and referral to appropriately tailored services.

Key words: attitudes, cessation, cigarettes, high-risk smoking, nurse, practice.


References

[1]  Kermode M, Crofts N, Miller P, Speed B, Streeton J (1998) Health indicators and risks among people experiencing homelessness in Melbourne, 1995–1996. Aust NZJ Publ Heal 22, 464–70.
Health indicators and risks among people experiencing homelessness in Melbourne, 1995–1996.CrossRef | 1:STN:280:DyaK1czitl2muw%3D%3D&md5=19a1755de8a81cd687a04f56055df1c1CAS |

[2]  Scutella R, Johnson G, Moschion J, Tseng Y-P, Wooden M. Wave 1 findings from Journeys Home: a longitudinal study of factors affecting housing stability. Melbourne Institute of Applied Economic and Social Research, RMIT University; 2012.

[3]  Australian Institute of Health and Welfare (AIHW). National drug strategy household survey detailed report: 2013. Canberra: AIHW; 2014.

[4]  Baggett TP, Lebrun-Harris LA, Rigotti NA (2013) Homelessness, cigarette smoking, and desire to quit: results from a US national study. Addiction 108, 2009–18.
Homelessness, cigarette smoking, and desire to quit: results from a US national study.CrossRef | 23834157PubMed |

[5]  Okuyemi KS, Caldwell AR, Thomas JL, Born W, Richter KP, Nollen N, et al (2006) Homelessness and smoking cessation: insights from focus groups. Nicotine Tob Res 8, 287–96.
Homelessness and smoking cessation: insights from focus groups.CrossRef | 16766421PubMed |

[6]  Connor SE, Cook R, Herbert M, Neal S, Williams J (2002) Smoking cessation in a homeless population: there is a will, but is there a way? J Gen Intern Med 17, 369–72.

[7]  Butler J, Okuyemi KS, Jean S, Nazir N, Ahluwalia JS, Resnicow K (2002) Smoking characteristics of a homeless population. Subst Abus 23, 223–31.
Smoking characteristics of a homeless population.CrossRef | 12438835PubMed |

[8]  Connor SE, Scharf D, Jonkman L, Herbert M (2014) Focusing on the five A’s: a comparison of homeless and housed patients’ access to and use of pharmacist-provided smoking cessation treatment. Res Social Adm Pharm 10, 369–77.
Focusing on the five A’s: a comparison of homeless and housed patients’ access to and use of pharmacist-provided smoking cessation treatment.CrossRef | 24607151PubMed |

[9]  Chamberlain C, MacKenzie D. Counting the homeless 2006: Victoria. Cat. no. HOU203. Canberra: Australian Institute of Health and Welfare; 2009.

[10]  Bain E, Durkin S, Wakefield M. Smoking prevalence and consumption in Victoria: key findings from the 1988–2012 population surveys. CBRC Research Paper Series No. 45. July 2013. Available from: http://www.cancervic.org.au/research/behavioural/research-papers/smoking_prevalence_consumption_vic_1988-2012.html. [Verified 20 October 2015].

[11]  O’Brien J, Salmon A, Geikie A, Jardine A, Oakes W (2010) Integrating smoking care in community welfare agencies to reach disadvantaged people: Findings from the Smoking Matters Project. Health Promot J Austr 21, 176–82.

[12]  Franco L, Welsby D, Eccleston P, Furber S (2011) A qualitative study about smoking cessation with clients of community service organisations that work with disadvantaged families. Health Promot J Austr 22, 153–5.

[13]  Okuyemi KS, Goldade K, Whembolua G, Thomas JL, Eischen S, Barrett S, et al (2013) Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial. Addiction 108, 1136–44.
Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial.CrossRef | 23510102PubMed |

[14]  Shelley D, Cantrell J, Warn D, Wong S (2010) Smoking cessation among sheltered homeless: a pilot. Am J Health Behav 34, 544–52.
Smoking cessation among sheltered homeless: a pilot.CrossRef | 20524884PubMed |

[15]  Okuyemi KS, Thomas JL, Hall S, Nollen NL, Richter KP, Jeffries SK, Caldwell AR, et al (2006) Smoking cessation in homeless populations: a pilot clinical trial. Nicotine Tob Res 8, 689–99.
Smoking cessation in homeless populations: a pilot clinical trial.CrossRef | 17008196PubMed |

[16]  Power J, Mallat C, Bonevski B, Nielssen O (2015) An audit of assessment and outcome of intervention at a quit smoking clinic in a homeless hostel. Australas Psychiatry 23, 528–30.
An audit of assessment and outcome of intervention at a quit smoking clinic in a homeless hostel.CrossRef | 26139703PubMed |

[17]  Segan CJ, Maddox S, Borland R (2015) Homeless clients benefit from smoking cessation treatment delivered by a homeless persons’ program. Nicotine Tob Res 17, 996–1001.
Homeless clients benefit from smoking cessation treatment delivered by a homeless persons’ program.CrossRef | 26180225PubMed |

[18]  Okuyemi KS, Goldade K, Whembolua G, Thomas JL, Eischen S, Guo H, et al (2013) Smoking characteristics and comorbidities in the power to quit randomized clinical trial for homeless smokers. Nicotine Tob Res 15, 22–8.
Smoking characteristics and comorbidities in the power to quit randomized clinical trial for homeless smokers.CrossRef | 22589422PubMed |

[19]  Royal Australian College of General Practitioners. Supporting smoking cessation: a guide for health professionals. Melbourne: Royal Australian College of General Practitioners; 2014.

[20]  Mendelsohn CP, Kirby D, Castle D (2015) Smoking and mental illness. An update for psychiatrists. Australas Psychiatry 23, 37–43.
Smoking and mental illness. An update for psychiatrists.CrossRef | 25512967PubMed |



Export Citation