Homelessness, Cigarette Smoking and Desire to Quit: Results from a US National Study

Aims: We determined whether or not homelessness is associated with cigarette smoking independent of other socio-economic measures and behavioral health factors, and whether homeless smokers differ from non-homeless smokers in their desire to quit.

Design, Setting And Participants: We analyzed data from 2678 adult respondents to the 2009 Health Center Patient Survey, a nationally representative cross-sectional survey of homeless and non-homeless individuals using US federally funded community health centers.

Measurements: We used multivariable logistic regression to examine the association between homelessness and (i) current cigarette smoking among all adults, and (ii) past-year desire to quit among current smokers, adjusting for demographic, socio-economic and behavioral health characteristics.

Findings: Adults with any history of homelessness were more likely than never homeless respondents to be current smokers (57 versus 27%, P < 0.001). In multivariable models, a history of homelessness was associated independently with current smoking [adjusted odds ratio (AOR) 2.09; 95% confidence interval (CI) = 1.49-2.93], even after adjusting for age, sex, race, veteran status, insurance, education, employment, income, mental illness and alcohol and drug abuse. Housing status was not associated significantly with past-year desire to stop smoking in unadjusted (P = 0.26) or adjusted (P = 0.60) analyses; 84% of currently homeless, 89% of formerly homeless and 82% of never homeless smokers reported wanting to quit.

Conclusions: Among patients of US health centers, a history of homelessness doubles the odds of being a current smoker independent of other socio-economic factors and behavioral health conditions. However, homeless smokers do not differ from non-homeless smokers in their desire to quit and should be offered effective interventions.