Smoking among the homeless, a neglected population of smokers

According to a study published in December 2016[1], it is estimated that in the United States, at least 70% of homeless people smoke, four times more than the national average, and two and a half times more than the disadvantaged population. If the effects of smoking are out of step with the daily emergency situation experienced by these people, the consequences of tobacco consumption nevertheless remain a priority issue for this population. Thus Smoking is one of the leading causes of illness and death among homeless people and aggravates diseases commonly encountered among these people: hepatitis C, tuberculosis, HIV infection, diabetes. Cardiovascular diseases are the leading cause of death among the homeless, who are also twice as likely to suffer from obstructive pulmonary diseases as the rest of the population. Thus, smoking contributes to making homeless people at least three times more likely to die prematurely compared to the general population. Social inequality in smoking is compounded by inequality in quitting smoking. The lack of information on the various risks, the lack of long-term projection, the stressful survival conditions, the trivialization of the use of this drug, the lack of medical and social monitoring are all reasons that explain the difficulties encountered by the homeless in quitting smoking. The homeless population includes between 20% and 30% people suffering from serious mental illnesses and 30% to 50% suffer from a co-addiction. These illnesses, very often associated with tobacco consumption, reduce attempts to quit and constitute factors for relapse. Added to this is the resignation of health professionals faced with the smoking of the homeless and the difficulties in understanding the behaviors that are unfavorable to the health of these people and lastly, their smoking. However, faced with this observation, options could be proposed such as:

• Providing documentation, along with food, because the majority of homeless people would like to stop smoking;
• The opening of specialized and free centers, essential for monitoring the homeless for a variety of services: hairdresser, HIV screening, free dental services, list of potential accommodation, help with quitting smoking;
• The provision of free meals in public spaces where smoking cessation aids could be offered alongside free health services;
• An adapted housing policy, with mainly smoke-free areas and restricted smoking areas.

The American experiences reported show that services closer to this population can allow the start of treatment to be given to tobacco treatment. ©Generation Without Tobacco

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Source : Fig.1: https://pixabay.com/fr/photos/sans-abri-matelas-fume-assis-2527051/ [1] https://www.publichealthlawcenter.org/sites/default/files/resources/tclc-homeless-tobacco-FAQ-2016.pdf | ©National Committee Against Smoking |