"It's a hard thing to manage when you're homeless": The impact of the social environment on smoking cessation for smokers experiencing homelessness

Rebekah J Pratt, Claire Pernat, Linda Kerandi, Azul Kmiecik, Cathy Strobel-Ayres, Anne M Joseph, Susan A. Everson Rose, Xianghua Luo, Ned Cooney, Janet L Thomas, Kola Okuyemi

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: Up to 80% of the adult homeless population use tobacco, and smoking cessation programs could offer an important opportunity to address preventable mortality and morbidity for this population. This population faces serious challenges to smoking cessation, including the impact of the social environment. Methods: Forty participants (11 female; 29 male) from an ongoing smoking cessation randomized clinical trial conducted at 2 urban homeless shelters in the Upper Midwest were invited to take part in semi-structured interviews in 2016-2017. An interviewer used a semi-structured interview guide asking participants to describe their experience of how the social environment impacted their attempt to quit smoking. Results: Participants described feeling pressure to smoke and drink in and around shelters, and that this pressure had led some to start smoking or resume smoking, along with making it very challenging to quit. Participants described being motivated to quit, and seeing smoking cessation as positively impacting the time and focus they felt they had for finding housing. However many felt more interested in reducing their smoking, rather than quitting. Conclusions: Addressing smoking cessation for people experiencing homelessness is both an important public health opportunity, and a challenge. There is a need to consider cessation in the context of the social and environmental factors impacting smokers who are experiencing homelessness. In particular, there is a need to address the collective value placed on smoking in social interactions. Despite these challenges, there are high levels of motivation and interest in addressing smoking. Trial registration: NCT01932996. Date of registration 30th August 2013. Prospectively registered.

Original languageEnglish (US)
Article number635
JournalBMC public health
Issue number1
StatePublished - May 24 2019

Bibliographical note

Funding Information:
This work was funded by the National Heart, Lung and Blood institute of the National Institutes of Health, under award number R01HL08152. The funder provided guidance on the design of the study and, and did not participate in data collection, data analysis, interpretation of data or in writing the manuscript.

Publisher Copyright:
© 2019 The Author(s).


  • Homelessness
  • Participant experience
  • Qualitative
  • Randomized control trial
  • Smoking cessation
  • Social environment


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