Topic: Innovative Tobacco Cessation Interventions for Homeless Individuals and Public Housing Residents
Organization Name: UCSF Smoking Cessation Leadership Center
Organization Type: Academic/Research
Location (city/state): San Francisco, California
Special or Vulnerable Population: People experiencing homelessness, Public Housing
Challenges: Inaccessibility of tobacco cessation programming
Promising Practice: Shelter and pharmacy partnership for cessation counseling and nicotine replacement therapy, contingency management with financial incentives, smoke-free housing program
High tobacco use prevalence among homeless individuals prompted innovative cessation interventions by the Smoking Cessation Leadership Center, University of California, San Francisco using a social-ecological model. This approach integrated services into community settings, considering individual, social, organizational, environmental, and policy levels. A Cochrane review highlighted that guideline-recommended smoking cessation care, longer interventions, and a focus on substance use along with trauma-informed care led to better outcomes.
The first intervention, funded by the San Francisco Cancer Initiative, partnered shelters with a pharmacy to provide free cessation counseling and nicotine replacement therapy (NRT) to MediCal-insured participants experiencing homelessness. After four years, there was a >50% decline in cigarette consumption and a 33% average quit attempt rate.
The second intervention, a randomized controlled trial funded by the Tobacco Related Disease Research Program, used contingency management with financial incentives. A total of 83 individuals were recruited for the study and their tobacco abstinence was tracked at 3, 6, and 12 months, with an additional follow-up conducted at the one-year mark. Participants in the intervention group could earn up to $475 over the course of 6 months by attending 25 visits, while the control group received a fixed incentive of $5 per visit. The intervention group achieved a 40% quit rate, compared to 10% in the control group, with high engagement in both groups.
The third intervention is a waitlist-controlled cluster randomized controlled trial promoting smoke-free housing in line with the U.S. Department of Housing and Urban Development’s (HUD) national smoke-free policy for Public Housing Authority (PHA) housing units. A trial across 38 supportive housing sites encourages staff training and resident-endorsed approaches to increase smoke-free living environments.
Source Link:
Webinar 2: Tobacco Cessation from Evidence to Practice