Receptivity to hosting tobacco cessation programs in transitional shelters for the homeless

Background: Transitional housing shelters serve the homeless, a deeply underserved population, by providing services to assist transition into society. However, few shelters offer tobacco cessation programs, which would reduce tobacco-related health burdens.

Methods: We conducted a telephone survey with existing Los Angeles County shelters (n=90). Questions included population demographics, services offered, receptivity to tobacco reduction programs, and staff and residents' smoking rates. A separate 26-shelter survey assessed individual smoking rates and behaviors of randomly selected staff and residents (N=263). T-tests, ANOVA and linear regressions tested differences in cessation program receptivity by shelter size.

Results: Most shelters offered substance abuse counseling (64.4%), and life skills training (93.3%). Small shelters (<50 beds, n=33) were less likely to be open to adopting new tobacco reduction policies (74.2%) vs. medium (50-199 beds, n=51, 97.9%) and large shelters (200+ beds, n=6, 100%) (p<0.05). Although no shelters offered tobacco cessation programs, 89.4% were open to adding them. Fewer small shelters were open to programs (80.6%) vs. medium and large shelters (both 100%, p<0.05). Shelter staff estimates of the percent of residents who smoke were higher at medium (β=13.6, p<0.05), and large shelters (β=26.9, p<0.05). Individual survey results showed 67.4% of residents were current smokers, and of those, 59.7% planned on quitting within 12 months, highlighting a need for cessation services.

Conclusion: Shelters could play an important role in providing smoking cessation services to the most resource-poor populations. Results indicate a demand for systems-level cessation programs at shelters which may impact tobacco use rates and reduce disparities.