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Smoking amongst adults experiencing homelessness: a systematic review of prevalence rates, interventions and the barriers and facilitators to quitting and staying quit

Published online by Cambridge University Press:  23 March 2020

Kirstie Soar ,
Lynne Dawkins ,
Deborah Robson  and
Sharon Cox Open the ORCID record for Sharon Cox [Opens in a new window]
Kirstie Soar
Affiliation:
Schoolof Psychology, University of East London, Water Lane, London, E15 4LZ, UK
Lynne Dawkins
Affiliation:
Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA, UK
Deborah Robson
Affiliation:
Addictions Department & CLAHRC South London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, Denmark Hill, LondonSE5 8BB, UK
Sharon Cox*
Affiliation:
Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA, UK
*
Author for correspondence: Sharon Cox, E-mail: [email protected]
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Abstract

Background

To date, there has been no review of the research evidence examining smoking cessation among homeless adults. The current review aimed to: (i) estimate smoking prevalence in homeless populations; (ii) explore the efficacy of smoking cessation and smoking reduction interventions for homeless individuals; and (iii) describe the barriers and facilitators to smoking cessation and smoking reduction.

Method

Systematic review of peer-reviewed research. Data sources included electronic academic databases. Search terms: ‘smoking’ AND ‘homeless’ AND ‘tobacco’, including adult (18+ years) smokers accessing homeless support services.

Results

Fifty-three studies met the inclusion criteria (n = 46 USA). Data could not be meta-analysed due to large methodological inconsistencies and the lack of randomised controlled trials. Smoking prevalence ranged from 57% to 82%. Although there was no clear evidence on which cessation methods work best, layered approaches with additions to usual care seemed to offer modest enhancements in quit rates. Key barriers to cessation exist around the priority of smoking, beliefs around negative impact on mental health and substance use, and environmental influences.

Conclusions

Homeless smokers will benefit from layered interventions which support many of their competing needs. To best understand what works, future recommendations include the need for consensus on the reporting of cessation outcomes.

Keywords

Homelesshomelessnesssmokingsmoking cessationtobacco
Type
Review Article
Information
Journal of Smoking Cessation , Volume 15 , Issue 2 , June 2020 , pp. 94 - 108
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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