Factors Associated with Cigarette Smoking in Homeless Adults: Findings From an Outpatient Counseling Clinic

Those who are homeless are 4 times more likely to smoke cigarettes than the general population in the United States. Though research has investigated smoking risk factors among homeless individuals, further investigation is needed to understand factors that can be addressed by smoking cessation programs. This study seeks to understand characteristics associated with cigarette use in clients of the counseling clinic at a Midwest homeless shelter, including whether homeless individuals who smoke demonstrate lower self-efficacy, greater social isolation, poorer perception of therapy, and greater levels of chronic homelessness than nonsmokers.

From 2014 through 2019, clients of the counseling clinic were invited to contribute to a data bank. Logistic regression was performed to determine predictors of smoking status.

No association was identified between smoking status and self-efficacy, social isolation, perception of therapy, or chronic homelessness. Compared to those without a high school degree, odds of being a smoker were 95% lower for those with a high school degree or equivalent and 93% lower for those with more than a high school education. Those with 3 or more episodes of prior substance abuse treatment were more likely to be smokers.

This study demonstrates that cigarette use among the homeless population is associated with low education level and prior substance abuse treatment. Smoking cessation programs would benefit from tailoring information to the education level of their audience. Further study could determine whether use of other substances may contribute to cigarette use in the homeless population and how this may be addressed by smoking cessation programs.