Concurrent Nicotine and Tobacco Product Use Among Homeless Smokers and Associations with Cigarette Dependence and Other Factors Related to Quitting

Background: Cigarette smoking rates among homeless adults are exceptionally high, contributing to health disparities experienced by this disadvantaged population. Concurrent nicotine and tobacco product use have been shown to result in greater health problems than cigarette smoking alone, and little is known about the rates, motives, and perceived impacts of concurrent use in this group. The purpose of this study is to explore concurrent use rates and constructs of interest among homeless adult daily smokers and to examine differences between concurrent users and non-concurrent users on cigarette dependence, perceived risk of smoking, readiness to quit, and the receipt of recent cessation intervention.

Methods: Participants (N = 396) were recruited from six homeless-serving agencies and/or shelters in Oklahoma City. Enrolled participants completed self-report questionnaires.

Results: The rate of concurrent use was high -67.2%. Participants most frequently endorsed lower cost and a desire to cut down on cigarette smoking as motives for concurrent product use. Concurrent users indicated both a greater likelihood of developing a smoking-related disease if they did not quit for good and a greater number of past year quit attempts relative to non-concurrent users. There was no significant difference between concurrent users and non-concurrent users on readiness to quit or having received recent smoking cessation intervention.

Conclusion: The need for cessation efforts that account for concurrent use for homeless adult smokers is great. Study findings indicate that concurrent users are commonly pursuing the reduction or elimination of cigarette usage and should be specifically targeted for cessation intervention.