Background and Context:
The prevalence of smoking amongst homeless populations is extraordinarily high and may not be declining, unlike general population rates. Despite emerging evidence that homeless smokers are as interested in quitting as non-homeless smokers, few homeless programs offer smoking cessation treatment.
To examine the feasibility, acceptability and effectiveness of a financially-sustainable smoking cessation treatment model that was delivered by staff of a homeless persons’ program.
Fourteen nurses from Melbourne’s Royal District Nursing Service Homeless Persons’ Program recruited 49 clients into a 12-week program offering weekly nurse-delivered smoking cessation appointments with intermittent carbon monoxide (CO) measurements, GP-prescribed free nicotine patch, bupropion or varenicline, and Quitline phone support. Surveys were completed at program enrolment, end of program (EoP, 3 months) and six months post-enrolment.
Clients attended on average 6.7 nurse-delivered appointments. Most used pharmacotherapy (69%, n=34) and Quitline (61%, n=30, average 8.4 calls among users). Using all-cases analyses 29% had made a quit attempt by EoP; 24-hour point prevalence abstinence rates were 6% at EoP and 4% at 6 months (no participants achieved sustained cessation), and 29% reported 50% consumption reduction at 6 months, the latter positively associated with increased Quitline use. Tobacco consumption and money spent on tobacco halved by EoP with similar levels maintained at 6 months. Butt smoking reduced. Using within-subjects analyses, all participants reported either the same or less symptoms of anxiety at EoP compared to baseline and 92% reported the same or less depressive symptoms.
Integrating nurse support with low-cost cessation interventions (government subsidised pharmacotherapy plus Quitline) was feasible and acceptable. While quit rates were low, treatment benefits included harm-reduction (reduced consumption and butt smoking), significant financial savings, and psychological benefits (improved or stable mood).