Tobacco Use Behaviors and Views on Engaging in Clinical Trials for Tobacco Cessation Among Individuals Who Experience Homelessness

Overview

Journal Contemp Clin Trials Commun

Date 2023 Feb 28

PMID 36852099

Authors

Joshua Miller

Jordan Cuby

Sharon M Hall

Maxine Stitzer

Margot Kushel

Donna Appiah

Maya Vijayaraghavan

Affiliations

Soon will be listed here.

Abstract

Background: Clinical trials that include contingency management for smoking cessation have shown promising results for short-term quitting, but none have explored this approach for long-term abstinence in people experiencing homelessness. We designed a clinical trial of an extended contingency management intervention for smoking cessation for people experiencing homelessness. This study has two aims: (1) to explore tobacco use behaviors, and views toward smoking cessation, and (2) to explore factors influencing acceptability of engaging in such a trial in a sample of adult smokers experiencing homelessness.

Methods: We administered a questionnaire to obtain information on tobacco use behaviors and conducted in-depth, semi-structured interviews with 26 patients who had experienced homelessness and were patients at a safety net health clinic in San Francisco, California, where we planned to pilot the intervention. We obtained information on triggers for tobacco use, prior cessation experiences, attitudes toward cessation, attitudes toward engaging in a clinical trial for cessation, and factors that might influence participation in our proposed contingency management clinical trial. We analyzed transcripts using content analysis.

Results: Participants described the normative experiences of smoking, co-occurring substance use, and the use of tobacco to relieve stress as barriers to quitting. Despite these barriers, most participants had attempted to quit smoking and most were interested in engaging in a clinical trial as a method to quit smoking. Participants noted that desirable features of the trial include: receiving financial incentives to quit smoking, having a flexible visit schedule, having the study site be easily accessible, and having navigators with lived experiences of homelessness.

Conclusion: A patient-centric clinical trial design that includes incentives, flexible visits and navigators from the community may increase feasibility of engaging in clinical trials among individuals experiencing homelessness.

References

Hall S, Humfleet G, Munoz R, Reus V, Robbins J, Prochaska J . Extended treatment of older cigarette smokers. Addiction. 2009; 104(6):1043-52. PMC: 2718733. DOI: 10.1111/j.1360-0443.2009.02548.x. View

Burling T, Burling A, Latini D . A controlled smoking cessation trial for substance-dependent inpatients. J Consult Clin Psychol. 2001; 69(2):295-304. DOI: 10.1037//0022-006x.69.2.295. View

Klemperer E, West J, Peasley-Miklus C, Villanti A . Change in Tobacco and Electronic Cigarette Use and Motivation to Quit in Response to COVID-19. Nicotine Tob Res. 2020; 22(9):1662-1663. PMC: 7197523. DOI: 10.1093/ntr/ntaa072. View

Clark L, Watkins L, Pina I, Elmer M, Akinboboye O, Gorham M . Increasing Diversity in Clinical Trials: Overcoming Critical Barriers. Curr Probl Cardiol. 2018; 44(5):148-172. DOI: 10.1016/j.cpcardiol.2018.11.002. View

Baggett T, Chang Y, Singer D, Porneala B, Gaeta J, OConnell J . Tobacco-, alcohol-, and drug-attributable deaths and their contribution to mortality disparities in a cohort of homeless adults in Boston. Am J Public Health. 2014; 105(6):1189-97. PMC: 4431083. DOI: 10.2105/AJPH.2014.302248. View

Hall S, Humfleet G, Munoz R, Reus V, Prochaska J, Robbins J . Using extended cognitive behavioral treatment and medication to treat dependent smokers. Am J Public Health. 2011; 101(12):2349-56. PMC: 3222443. DOI: 10.2105/AJPH.2010.300084. View

Petersen A, Elser H, Nguyen T, Alizaga N, Vijayaraghavan M . Smoke-Free or Not: Attitudes Toward Indoor Smoke-Free Policies Among Permanent Supportive Housing Residents. Am J Health Promot. 2019; 34(1):32-41. DOI: 10.1177/0890117119876763. View

Cornelius M, Wang T, Jamal A, Loretan C, Neff L . Tobacco Product Use Among Adults - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020; 69(46):1736-1742. PMC: 7676638. DOI: 10.15585/mmwr.mm6946a4. View

Spector A, Alpert H, Karam-Hage M . Smoking cessation delivered by medical students is helpful to homeless population. Acad Psychiatry. 2007; 31(5):402-5. DOI: 10.1176/appi.ap.31.5.402. View

10.

Vijayaraghavan M, Olsen P, Weeks J, McKelvey K, Ponath C, Kushel M . Older African American Homeless-Experienced Smokers' Attitudes Toward Tobacco Control Policies-Results from the HOPE HOME Study. Am J Health Promot. 2017; 32(2):381-391. PMC: 5858921. DOI: 10.1177/0890117117729928. View

11.

Pratt R, Pernat C, Kerandi L, Kmiecik A, Strobel-Ayres C, Joseph A . "It's a hard thing to manage when you're homeless": the impact of the social environment on smoking cessation for smokers experiencing homelessness. BMC Public Health. 2019; 19(1):635. PMC: 6534899. DOI: 10.1186/s12889-019-6987-7. View

12.

Schroeder S, Morris C . Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annu Rev Public Health. 2009; 31:297-314 1p following 314. DOI: 10.1146/annurev.publhealth.012809.103701. View

13.

Baggett T, Lebrun-Harris L, Rigotti N . Homelessness, cigarette smoking and desire to quit: results from a US national study. Addiction. 2013; 108(11):2009-18. PMC: 3797258. DOI: 10.1111/add.12292. View

14.

Rubin S, Vijayaraghavan M, Weiser S, Tsoh J, Cohee A, Delucchi K . Homeless women's perspectives on smoking and smoking cessation programs: A qualitative study. Int J Drug Policy. 2021; 98:103377. PMC: 9115776. DOI: 10.1016/j.drugpo.2021.103377. View

15.

Vijayaraghavan M, Neisler J, Wrighting Q, Reitzel L, Hebert E, Rash C . Income associations with cigarette purchasing behaviors and quit attempts among people experiencing homelessness. Addict Behav. 2019; 95:197-201. PMC: 6991985. DOI: 10.1016/j.addbeh.2019.04.002. View

16.

Vijayaraghavan M, Hurst S, Pierce J . A Qualitative Examination of Smoke-Free Policies and Electronic Cigarettes Among Sheltered Homeless Adults. Am J Health Promot. 2015; 31(3):243-250. DOI: 10.4278/ajhp.150318-QUAL-781. View

17.

Hsieh H, Shannon S . Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9):1277-88. DOI: 10.1177/1049732305276687. View

18.

Cahill K, Hartmann-Boyce J, Perera R . Incentives for smoking cessation. Cochrane Database Syst Rev. 2015; (5):CD004307. DOI: 10.1002/14651858.CD004307.pub5. View

19.

Stitzer M, Rand C, Bigelow G, Mead A . Contingent payment procedures for smoking reduction and cessation. J Appl Behav Anal. 1986; 19(2):197-202. PMC: 1308058. DOI: 10.1901/jaba.1986.19-197. View

20.

Okuyemi K, Goldade K, Whembolua G, Thomas J, Eischen S, Sewali B . Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial. Addiction. 2013; 108(6):1136-44. PMC: 3651796. DOI: 10.1111/add.12140. View