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Homeless Cessation Support

University College London research looked at smoking cessation policies and practice in homeless support centres and is very supportive of electronic cigarettes

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In a new study published in BMC Health Services Research, a team led by University College London’s Dr Sharon Cox asked 99 individual homeless services across the UK how they support reducing smoking through various policies and cessation support options. The paper contains powerful support for vaping and highlights the need for further action.

Sharon Cox, Jaimi Murray, Allison Ford, Lucy Holmes, Deborah Robson, and Lynne Dawkins say: “Tobacco smoking is a leading cause of premature death and disease and is strongly associated with deprivation and health inequalities. Homelessness and housing shortages are growing problems in the UK, leading to exacerbated poverty and poor health. Smoking rates are exceptionally high amongst adults accessing homeless support services, with rates ranging between 57 and 82%, this is up to four times higher than the national UK average (14.1%).”

They point out that smoking has a greater impact on this disadvantaged group because of a higher prevalence of chronic obstructive pulmonary disease (COPD), heart problems and respiratory viral illnesses.

Also, people experiencing homelessness tend to engage in “risky smoking practices”:

  • Puffing harder and longer
  • Smoking unfiltered cigarettes
  • Smoking discarded cigarettes
  • Sharing cigarettes
  • Concurrent use of illicit substances (e.g., heroin, crack)

All of these practices negatively impact lung function.

Owing to the complex nature of homelessness and needs of the people experiencing it, research shows that smoking takes low priority in the assessment of health needs.”

Homeless centre staff and their clients report the view that smoking is “beneficial” because it is seen as relieving stress “and providing comfort”. There is also a firmly held belief that “people experiencing homelessness do not want to quit smoking or would not take up the offer of support”. Consequently, smoking cessation is not seen as a high priority.

The Royal College of Physicians (2021) state that e-cigarettes are an effective treatment for tobacco dependency and their use should be included and encouraged in all treatment pathways” – Cox et al.

In our previous study by Dawkins et al.[second reference below], of 283 smokers accessing homeless services, 75% expressed a desire to quit smoking and quit attempts (albeit short-lived) were common. However, respondents also reported that many of their attempts were unaided, meaning participants did not use evidence-based treatments such as licensed nicotine replacement therapies, e-cigarettes or behavioural support.”

They note that vaping is “viewed more positively by people considering quitting smoking while experiencing homelessness”, and that the use of e-cigarettes fits in well with centres already offering harm reduction approaches for sexually transmitted diseases and opioid addictions.

While some centres support vaping, others ban it alongside smoking despite guidance from The National Institute of Health and Care Excellence in England.

This said, there were clear areas of excellence: “Specifically, at one centre those in the e-cigarette intervention created a ‘vaping community’ and a vaping drop-in service was offered by staff.”

They concluded: “Smoking is considered by many homeless services and several environmental and health policies exist which can prevent and reduce smoking. For smoking to be further reduced within this population, more comprehensive policies and interventions are needed which support the reduction of smoking in these organisations.”


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Dave Cross avatar

Dave Cross

Journalist at POTV
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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous vape companies to develop content for their websites.

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