195120 Effect of a smoking cessation intervention in a sheltered homeless population: A pilot study

Wednesday, November 11, 2009

Donna Shelley, MD, MPH , College of Dentistry, New York University, New York, NY
Jennifer Cantrell, MPA, DrPH Cand , College of Dentistry, New York University, New York, NY
Doug Warn, LCSW-R, MSW , Project Renewal, New York, NY
Selena Wong, LMSW, MBA , Project Renewal, New York, NY
Homeless people are three to four times more likely to smoke and have twice the death rates from tobacco-related disease compared to the general population. Despite strong links between homelessness, poor health and smoking, research addressing tobacco treatment remains sparse. The aim of this pilot study was to evaluate the effect of a motivational interviewing plus cognitive behavioral therapy (MI+CBT) intervention coupled with pharmacotherapy on smoking cessation outcomes among a sheltered homeless population living in New York City.

A quasi-experimental design was used, with the intervention group (n=57) participating in a 12-week group MI+CBT counseling program plus pharmacotherapy and the comparison group (n=28) receiving usual care (brief advice to quit plus access to pharmacotherapy). Surveys were conducted at baseline and 12 weeks to assess abstinence, quit attempts and cigarettes smoked per day (CPD). Intervention clients were followed up at 24 weeks to assess continued abstinence.

Carbon monoxide-confirmed abstinence rates at 12 weeks were 16.1% for intervention versus 0% for comparison clients. Smokers who received the intervention were also significantly more likely to make a quit attempt at 12 weeks but were no more likely than comparison clients to reduce amount smoked. High rates of CO-confirmed abstinence (17.1%) were maintained by intervention clients at 24 weeks.

Findings support the feasibility and preliminary effectiveness of a smoking cessation intervention among homeless smokers. Tobacco dependence treatment based on MI+CBT principles with pharmacotherapy options and offered as part of existing homeless services may be effective in helping homeless smokers quit.

Learning Objectives:
1. Describe the links between homelessness, smoking, other physical and mental health problems, and poor health. 2. Evaluate the effects of a smoking cessation intervention offered as part of treatment services for homeless in shelters and transitional housing programs. 3. Articulate future research and program needs for addressing high rates of smoking among the homeless.

Keywords: Homeless Health Care, Smoking Cessation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Shelley is currently a professor at New York University and formerly at Columbia University School of Public Health. Dr. Shelley has worked as a physician, educator, and was the previous Director of the $13M NYCDOH Tobacco Control Program. She is currently the PI of several tobacco cessation grants. Dr. Shelley has extensive experience creating evidence-based interventions & evaluations of tobacco cessation programs and presenting findings to varied audiences, including students, fellow educators, policymakers, researchers and service professionals.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.