Smoking Among Chronically Homeless Adults: Prevalence and Correlates

Objective: Cigarette smoking is one of the leading preventable causes of death, and adults who are chronically homeless have among the highest death rates. This study examined the prevalence and correlates of smoking in this population. Methods: Data were analyzed for 754 chronically homeless adults who were receiving mental health, primary care, and supported housing services at 11 U.S. sites in a federal initiative, the Collaborative Initiative to Help End Chronic Homelessness. The prevalence of current smoking (past three months), sociodemographic and clinical correlates of smoking, and change in smoking status (nonsmoker, self-limiting smoker, or regular smoker) over a one-year period were examined by use of stepwise multinomial regression analysis. Results: Overall, 80% of the 754 chronically homeless adults reported current cigarette smoking; 48% of the smokers reported trying to limit their smoking, and 75% of the smokers had discussed smoking with a health care professional. No significant overall change in smoking status was found during the study year, however, change in alcohol and drug use was associated with change in smoking status in the same direction. Having a diagnosis of posttraumatic stress disorder and reducing alcohol use predicted quitting or limiting smoking. Conclusions: A large majority of chronically homeless adults reported being current smokers. Smoking cessation interventions, integrated, with alcohol and drug treatment, that target this population are needed. (Psychiatric Services 63:569-576, 2012; doi: 10.1176/appi.ps.201100398)