Homelessness and Smoking: How to Protect Those Most in Need

Homeless people smoke at much higher rates than most people in the country, and they don’t ordinarily have access to the healthcare services they need. This is a dangerous combination, and helping more homeless people quit smoking can save thousands of lives.

Around 560,000 people were currently homeless in January 2015 in the U.S., and although rates of homelessness are decreasing, this is still a huge number of people in a very vulnerable situation. The link between homelessness and smoking – with people living on the street being much more likely to smoke than housed citizens – makes this already awful situation even worse. Contrary to many people’s beliefs, homeless smokers are just as likely to quit as any other smoker, but we need to go the extra mile if we want to help them successfully kick the habit.

Homelessness and Smoking: How Many Homeless People Smoke?

Smoking rates among homeless people are consistently higher than rates among the general population. One study found that around three-quarters of homeless adults in the U.S. are current smokers, and others have found that around 57 % of adults either currently homeless or with a history of homeless smoked cigarettes. Overall, the smoking rate among homeless people in the U.S. is anywhere between 2 and 4 times that of the general population.

Ordinarily, smoking rates are higher among more disadvantaged groups, and while the same factors likely have a role to play, the issue with homelessness and smoking isn’t completely explained by this. Even when compared to impoverished Americans overall, homeless people are still more than twice as likely to smoke.

Why Do Homeless People Smoke?

The problems with homelessness and smoking ultimately come down to something many people can relate to. Many people smoke, drink alcohol or even use drugs to cope with difficult emotions, and others may engage in other activities such as gambling or even shopping. These activities might all seem distinct, but the common thread is that they offer superficial relief from negative emotions. From the stressed worker who pours herself a glass of wine as soon as she kicks off her shoes through to the young adult whose low self esteem makes him think he’s only likeable when he’s on cocaine, substances and some activities are used as a poor coping mechanism for emotional or psychological issues.

This might not seem too related to smoking, but the same factors are at play. For homeless people, the pressure of their situation, the possibility that they’re suffering from mental health issues, the challenging past experiences and many, many other things make anything that can improve mood (even temporarily) very tempting. Cigarettes provide a brief moment of relief that it’s difficult for them to find any other way.

Although the various factors interact in complex ways, emotional issues and the destitute situation they’re in are behind most smoking among the homeless. Throw in a culture where smoking is seen as the norm and things only get worse.

Do Homeless Smokers Want to Quit?

One misconception when discussing the issue of homelessness and smoking is the idea that homeless smokers don’t actually want to quit. However, this perception is entirely unsupported by evidence. When researchers (in a study cited earlier) asked homeless smokers whether they wanted to quit, 84 % said that they did, compared to 82 % of people who’ve never been homeless. Statistically, these figures show that there is no significant difference between homeless smokers and non-homeless smokers in their desire to quit smoking.

The idea that homeless smokers aren’t particularly interested in quitting is hard to trace back to its roots, but there are some more practical concerns that cause problems for physicians. Firstly, many people feel it’s unrealistic to try to stop homeless people smoking (because as homeless smokers say, it “helps them cope” with the pressures of being homeless), but also, many physicians don’t see it as a major priority for a homeless person. However, since homeless people usually have poor access to healthcare, it seems hard to justify passing up an opportunity to encourage them to make a positive change.

Reducing Smoking Among the Homeless: How to Make a Difference

The high smoking rates among homeless Americans and the likelihood that health problems won’t be treated in a timely fashion mean that solving the problem should be a priority. Actually doing this is challenging, though, and will require a multi-faceted approach. Smoke-free policies in shelters can make a difference, but smoking cessation advice should also be provided by people providing healthcare to the homeless.

Although there isn’t much evidence on what approaches will benefit homeless smokers specifically, methods used for similar groups – such as people who abuse other substances or smokers with mental health issues – are probably the best option. Even rewarding homeless smokers with money for staying smoke-free could be a valuable strategy, based on research in other vulnerable groups of smokers.

Regardless of the approach used, one thing is clear: hundreds of thousands of homeless people smoke, and as well as ensuring they have somewhere to stay, we should be doing everything we can to help them kick the habit.