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Smoking's Grip Adds to Misery of the Homeless

Average spent on cigarettes was $44 a week, study reports

By Amy Norton
HealthDay Reporter

THURSDAY, Feb. 18, 2016 (HealthDay News) -- Smoking is common among the homeless, and it's costing them a large share of what little money they have, a new study finds.

The research, surveying over 300 homeless adults who smoked, found that on average, they spent $44 on tobacco in the past week. Meanwhile, their average income for the month was around $500, and one-third or more said they had difficulty finding shelter, food, clothing or a place to wash, the research showed.

"What does $44 in a week mean?" said lead researcher Dr. Travis Baggett, of Massachusetts General Hospital, in Boston. "It's a very high amount when people are really struggling."

Other experts said the findings, published online Feb. 17 in the New England Journal of Medicine, highlight an issue that has gotten little attention: An estimated three-quarters of homeless U.S. adults smoke, and help getting them to quit is lacking.

The health consequences are clear. Smoking-related health conditions -- such as heart disease and certain cancers -- are the leading causes of death among the homeless, said Molly Meinbresse, director of research for the National Health Care for the Homeless Council, in Nashville.

The new findings underscore the daily, practical hardship of smoking.

"Smoking places an extremely high health and financial burden on people who are homeless," said Meinbresse, who was not involved in the study.

But effective help with quitting can be hard to come by. Meinbresse said that health care clinics for the homeless often do screen patients for tobacco use, and offer advice on quitting.

"However," she added, "programs that may involve group counseling and support are not consistently available."

That's a significant shortcoming, according to Baggett, because medications that curb nicotine craving are "just one piece" of a successful quit effort. In general, he said, research shows that smokers often need counseling -- as well as support from family and friends.

When a smoker is homeless, that support system is often absent, and there are all the added stressors of day-to-day living. The tobacco habit, Meinbresse said, is often related to that stress -- as well as mental health issues, alcohol or drug abuse, or a history of trauma.

Plus, when most of the people around you are smoking, it's that much harder to quit.

"Social norms have a lot to do with smoking and your ability to your quit," said Dr. Donna Shelley, an associate professor of population health at NYU Langone Medical Center, in New York City.

Shelley, who was not involved in the new research, studies smoking cessation among the homeless and other disadvantaged groups. She said the high rates of smoking among not only the homeless, but poor Americans in general, are "disturbing."

"The fact that they're spending their scarce resources on tobacco is tragic," Shelley said.

On top of the financial drain, she added, a smoking habit can limit a poor or homeless person's housing options: Nationwide, public and low-income housing sources are increasingly going smoke-free.

The new study findings are based on surveys of 306 homeless adults in Boston, all of whom smoked. Half said they'd had problems finding shelter or clothing in the past month, while slightly smaller numbers said they'd had difficulty finding food, a place to wash or a bathroom to use.

Despite those hardships, they were spending an average of $44 a week on tobacco, the study revealed.

To some people, Baggett said, it might be easy to dismiss homeless smokers as having "bad priorities." But, he stressed, they are addicted to nicotine: His team found that the greater a survey respondent's nicotine dependence, the more he or she spent on tobacco.

Ideally, Shelley said, smoking cessation for the homeless would be "comprehensive," helping them deal with the life issues that feed their nicotine dependence.

Getting more programs into homeless shelters would help, according to Shelley, since that's a point where people would be receiving other services, such as mental health treatment and help with substance abuse.

Meinbresse said her group "strongly believes" smoking cessation should be a top priority for any organization that serves the homeless.

"Addiction to tobacco," she said, "should not be an additional burden that these individuals have to face when the struggle to find housing, health care, employment and food is already hard enough."

More information has more on quitting tobacco.

SOURCES: Travis Baggett, M.D., M.P.H., Massachusetts General Hospital, Boston, and staff physician, Boston Health Care for the Homeless; Donna Shelley, M.D., associate professor, department of population health, NYU Langone Medical Center, New York City; Molly Meinbresse, M.P.H., director of research, National Health Care for the Homeless Council, Nashville, Tenn.; Feb. 18, 2016, New England Journal of Medicine

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