Smoking Cessation Delivered by Medical Students Is Helpful to Homeless Population

University of Michigan, Ann Arbor, Michigan, United States
Academic Psychiatry (Impact Factor: 0.81). 10/2007; 31(5):402-5. DOI: 10.1176/appi.ap.31.5.402
Source: PubMed


The authors pilot a smoking-cessation outreach for the homeless that extends medical students' tobacco cessation education.
In this prospective study, second-year medical students administered cognitive behavior therapy or unstructured support to homeless subjects to help them quit smoking. Self-report and biological measures (carbon monoxide) of smoking taken at baseline and follow-up were analyzed using t tests to determine intervention efficacy.
Out of 11 enrolled subjects, six completed the protocol and all decreased their smoking frequency. The mean rate of smoking dropped significantly from 19 to nine cigarettes per day when pooling all subjects, and carbon monoxide mean level decreased from 28.0 to 20.2.
The homeless subjects who received counseling from medical students significantly reduced their smoking frequency. Subject recruitment and retention were challenges, but a close partnership with local homeless shelters and the addition of pharmacotherapy could improve outcomes and are recommended for future efforts.

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    • "In addition, research suggests that homeless smokers may face significantly more barriers to cessation than even low-income domiciled smokers, including more mental health problems, more exposure to other smokers, and more severe stressors (Businelle et al., 2013). These barriers might significantly affect self-efficacy for quitting among smokers of all levels and explain the generally low rates of cessation among homeless smokers even in the context of aided interventions (Businelle et al., 2014a,b; Goldade et al., 2011; Okuyemi et al., 2013, 2006b; Shelley et al., 2010; Spector et al., 2007). Thus, homeless smokers are considered a potentially unique group in need of targeted research to inform novel interventions (Baggett et al., 2013b). "
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    ABSTRACT: Introduction: Cigarette smoking prevalence rates are high among homeless adults (>70%); however, little is known about concurrent tobacco or other nicotine product use (i.e., concurrent use [CU]) in this population. CU may impact smoking quit rates and confer greater risk of health problems within this vulnerable population. This study characterized CU in a sample of homeless smokers and compared cigarette-only smokers (C-OS) to concurrent users (CUs) on participant characteristics and factors known to be associated with smoking cessation. Methods: Participants were 178 adult conventional cigarette smokers from a homeless shelter in Dallas, TX. Sociodemographic characteristics, number of homelessness episodes, tobacco dependence, and items characterizing use of several tobacco/nicotine products over the last 30 days including use frequency, reasons for use, and perceived health risks were described. Sociodemographic characteristics, number of homelessness episodes, tobacco dependence, stress, readiness to quit (RTQ) smoking, and number of smoking quit attempts in the last year were compared between the C-OS and CUs groups using t tests and chi-square tests. Results: CU was prevalent (n = 91; 51.1%), and 49.5% of CUs reported the use of ≥2 products in addition to conventional cigarettes. Compared with C-OS, CUs were younger and had more homelessness episodes, higher expired breath carbon monoxide levels, and higher stress (ps < .05). Groups did not differ on sex, race, other dependence indicators, RTQ, or previous quit attempts. Conclusions: CU is common among homeless smokers. CUs and C-OS did not differ in their RTQ smoking, though greater stress among the CUs may represent a hurdle for cessation.
    No preview · Article · Sep 2015 · Nicotine & Tobacco Research
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    • "Despite substantial health disadvantage, little intervention research exists that examines ways to improve preventive health-care delivery to homeless people [10]. A number of small pilot studies of smoking cessation interventions for people using homeless services have been reported [11] [12] [13]. Each of these studies supported the feasibility of delivering smoking cessation support including nicotine replacement therapy to homeless people. "
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    ABSTRACT: Despite substantial health disadvantage, few intervention studies have examined ways to deliver smoking cessation support to homeless people. This proof-of-concept study explored the feasibility and acceptability of a novel, low-cost, telephone-delivered program. Clients aged over 18 years, English-speaking and currently receiving accommodation support from a homelessness outreach centre were invited to participate in a 'Phone for Health' program. Six sessions conducted once per week provided participants with personalised counselling about smoking cessation or reduction, as well as fruit and vegetable consumption, alcohol use, physical activity and sun protection. Both clients and staff completed follow-up quantitative surveys, and clients completed qualitative interviews. Of 14 eligible participants, 12 consented to taking part and completed baseline measures, 10 commenced the telephone intervention and six completed the intervention program. Average length of telephone sessions was 17.8 min and participants completed an average of 3.8 sessions. Findings suggested high acceptability with most participants reporting that the Phone for Health program helped them meet their smoking reduction goals, and was convenient, useful and practical. Most participants reported making changes to their health risk behaviours as a result of taking part in the program. Telephone delivery of the smoking cessation and other health behaviours intervention was acceptable and feasible. The results provide pragmatic lessons for the development of future health research and practice with an underserved population markedly difficult to reach and engage.
    Full-text · Article · Apr 2012 · Drug and Alcohol Review
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    • "For such individuals, access to conventional healthcare resources is limited and the cost of pharmaceuticals is often prohibitive [6-9]. High rates of psychiatric co-morbidity, substance use, and medical non-adherence further complicate the delivery of tobacco treatment services to underserved populations [10]. Prior investigations have demonstrated lower smoking cessation success rates for such populations [11-13]. "
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    ABSTRACT: Smoking is common among medically underserved populations. Accessible resources to encourage and support smoking cessation among these patients are limited. Volunteer medical student-run free smoking cessation clinics may provide an effective option to help these individuals achieve smoking abstinence. In order to demonstrate the feasibility and cost-effectiveness of a student-run clinic, we analyzed a case series of patients receiving care in a medical student-run Smoking Cessation Clinic (SCC) at the Rochester, Minnesota Salvation Army Good Samaritan Health Clinic (GSHC). Between January 2005 and March 2009, 282 cigarette smokers seeking care at the SCC were analyzed. Student providers at the SCC conducted 1652 weekly individual counseling sessions averaging 18 minutes per encounter. Patients were offered a choice of pharmacotherapies including nicotine replacement therapy (NRT), bupropion, and varenicline for up to 12 weeks. Smoking abstinence was confirmed with exhaled carbon monoxide (CO). Thirty-two patients completed the entire 12-week program (11.3%). At last contact, 94 patients (33.3%) abstained from smoking for ≥ 7 days and 39 patients (13.8%) were continuously abstinent for ≥ 4 weeks. The 7-day point prevalence abstinence rates at last contact were 58.6% for varenicline, 41.2% for bupropion, 33.9% for NRT, and 23.5% for bupropion and NRT. Analyzing missing patients as smoking, the 7-day point prevalence abstinence rates were 7.1%, 8.9%, and 8.2%, at 1 month, 2 months, and 3 months after program enrollment, respectively. No serious adverse drug reactions were recorded. Our medical student-run smoking cessation clinic provided an effective and safe experience for medically underserved patients who might not otherwise have access to conventional smoking cessation programs because of high cost, lack of insurance, or other disparities. Similar medical student initiatives focusing on healthy lifestyles may be feasible and beneficial for individuals with limited access to healthcare resources.
    Full-text · Article · Mar 2011 · BMC Research Notes
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