The implementation of a smoking cessation and alcohol abstinence intervention for people experiencing homelessness

Rebekah J Pratt, Serena Xiong, Azul Kmiecik, Cathy Strobel-Ayres, Anne M Joseph, Susan A.Everson Rose, Xianghua Luo, Ned Cooney, Janet L Thomas, Shelia Specker, Kola Okuyemi

Research output: Contribution to journalArticlepeer-review


Background: In the United States, eighty percent of the adult homeless population smokes cigarettes compared to 15 percent of the general population. In 2017 Power to Quit 2 (PTQ2), a randomized clinical trial, was implemented in two urban homeless shelters in the Upper Midwest to address concurrent smoking cessation and alcohol treatment among people experiencing homelessness. A subset of this study population were interviewed to assess their experiences of study intervention. The objective of this study was to use participants’ experiences with the intervention to inform future implementation efforts of combined smoking cessation and alcohol abstinence interventions, guided by the Consolidated Framework for Implementation Research (CFIR). Methods: Qualitative semi-structured interviews were conducted with 40 PTQ2 participants between 2016–2017 and analyzed in 2019. Interviews were audio-recorded, transcribed, and analyzed using a socially constructivist approach to grounded theory. Results: Participants described the PTQ2 intervention in positive terms. Participants valued the opportunity to obtain both counseling and nicotine-replacement therapy products (intervention characteristics) and described forming a bond with the PTQ2 staff and reliance on them for emotional support and encouragement (characteristics of individuals). However, the culture of alcohol use and cigarette smoking around the shelter environment presented a serious challenge (outer setting). The study setting and the multiple competing needs of participants were reported as the most challenging barriers to implementation (implementation process). Conclusion: There are unique challenges in addressing smoking cessation with people experiencing homelessness. For those in shelters there can be the difficulty of pro-smoking norms in and around the shelter itself. Considering pairing cessation with policy level interventions targeting smoke-free spaces, or pairing cessation with housing support efforts may be worthwhile. Participants described a discord in their personal goals of reduction compared with the study goals of complete abstinence, which may pose a challenge to the ways in which success is defined for people experiencing homelessness. Trial registration:, NCT01932996, registered 08/30/2013.

Original languageEnglish (US)
Article number1260
JournalBMC public health
Issue number1
StatePublished - Dec 2022

Bibliographical note

Funding Information:
This work was supported by the National Heart, Lung, and Blood Institute under Grant number R01HL08152. Effort for the co-author (SX) was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences grant TL1R002493. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Publisher Copyright:
© 2022, The Author(s).

PubMed: MeSH publication types

  • Journal Article
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural


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