Cigarette Purchasing Patterns, Readiness to Quit, and Quit Attempts Among Homeless Smokers.

INTRODUCTION: Cigarette purchasing patterns may be linked with greater readiness to make a quit attempt and more quit attempts among domiciled samples. However, little is known about the cigarette purchasing patterns of homeless smokers or their potential relations to quitting intention and behaviors. This study redressed this gap among a convenience sample of homeless adult smokers from a large shelter in Dallas, Texas. METHODS: Participants (N = 207; Mage = 43; 71.5% male) smoked ≥100 cigarettes over the lifetime and endorsed current daily smoking. Variables assessed included cigarette dependence (time to first cigarette of the day), monthly income, quantity of cigarettes most recently purchased, average money spent on cigarettes weekly, readiness/motivation to quit smoking, and the number intentional quit attempts lasting ≥24h in the past year. Regression analyses were conducted to characterize associations of cigarette purchasing patterns with readiness to quit and quit attempts controlling for sex, age, cigarette dependence, and income. RESULTS: Most participants purchased cigarettes by the pack (61.4%), and more than half the sample spent ≤$20 on cigarettes per week. Results indicated that spending less money per week on cigarettes was associated with greater readiness to quit (P = .016), even when controlling for income, cigarette dependence, and other covariates. Stratified analyses indicated that this association was significant only for homeless smokers reporting no regular monthly income. CONCLUSIONS: Homeless daily smokers with no reported income who spend little money on cigarettes may make particularly apt targets for cessation interventions due to potential associations with quitting motivation. IMPLICATIONS: Adults who are homeless smoke at greater rates and quit at lower rates than domiciled adults, leading to significant smoking-related health disparities among this group. Findings suggest that cigarette purchasing patterns are linked with readiness to quit smoking among smokers who are homeless. Results elucidate one of the myriad factors that contribute to tobacco-related disparities among this group and findings may have implications for cessation interventions in homeless shelters and other contexts where resources are limited.

Income associations with cigarette purchasing behaviors and quit attempts among people experiencing homelessness.

INTRODUCTION: Cigarette purchasing behavior may reflect quitting intentions. Little is known about how income could modify the association between cigarette purchasing behaviors and quit attempts among smokers experiencing homelessness. METHODS: Homeless, current smokers completed a questionnaire on the amount spent weekly on cigarettes (≤$20/week versus >$20/week), source of cigarettes (store versus other source), quantity of cigarettes purchased ($20/week on cigarettes, 83% reported purchasing cigarettes from a store, and 86% reported purchasing ≥pack during their last purchase. Those who reported an income spent a third of their monthly income on cigarettes, and were more likely to spend >$20/week on cigarettes. The amount spent weekly on cigarettes and the source of cigarettes was not associated with quit attempts, nor did income moderate these relationships. Persons without an income who bought a pack or more of cigarettes made fewer quit attempts (ß = -0.4, 95% CI -0.7, -0.2), whereas the association between quantity of cigarettes purchased and quit attempts was not significant for those with an income (ß = -0.2, 95% CI -0.4, 0.1). CONCLUSIONS: Current smokers experiencing homelessness and who are without an income may find it particularly challenging to engage in attempts to quit smoking. Smoking cessation interventions that highlight relief of financial hardship as a potential benefit of successfully quitting smoking may be useful among this population.

Characterizing Discrimination Experiences by Race among Homeless Adults.

Objectives: Among domiciled samples, racial discrimination is a known stressor linked with poorer quality of life. However, homeless adults may be particularly vulnerable to discrimination due to multiple factors beyond race. In this study, we characterized perceived discrimination and its reported impact on quality of life in a sample of adults who were homeless. Methods: Homeless adults recruited from Oklahoma City self-reported their socio-demographics, past discrimination experiences, and their impact on quality of life via the MacArthur Major Experiences of Discrimination Questionnaire. Descriptive statistics and frequencies were used to characterize perceived discrimination experiences and impact. Racial differences were examined using ANO- VAs/Kruskal-Wallis tests and chi-square tests. Results: Discrimination experiences attributed to homelessness were common and consistent between the races. Black adults perceived significantly more lifetime discrimination experiences than white adults, and attributed the majority to race. Relative to Whites and American Indians, black adults were more likely to endorse links between discrimination and having a harder life. Conclusions: Results suggest that black homeless adults may represent the most vulnerable racial subgroup for hardships in life as a conse- quence of perceived discrimination among homeless adults.

Characterizing Alcohol Use Behaviors among Homeless Men and Women.

Objectives: In this study, we characterized alcohol use behaviors by sex among sheltered homeless adults and explored associations with health and readiness to change drinking behaviors. Methods: Participants (N = 581; 63.7% men; Mage = 43.6, 29.4% white) self-reported alcohol use and readiness to change drinking behaviors. Sex differences were analyzed via Wilcoxon ranksum, chi-square tests, logistic regression, and ANCOVAs. Results: Overall, 38.5% of the sample met criteria for current at-risk drinking, 39.7% self-reported a history of alcohol problems, and 22.9% reported having a formal alcohol use disorder (AUD) diagnosis. Among current alcohol users, 83.8% reported at-risk drinking. Men had more drinks per drinking day, more drinks per week, and more drinking days per week when compared to women. No sex differences were found for at-risk drinking, self-reported alcohol problems, probable alcohol abuse/dependence, AUD diagnosis, readiness to change drinking, or recent alcohol/substance abuse counseling. Conclusions: High rates of at-risk drinking were found among alcohol users. Homeless men and women did not exhibit differences in several manifestations of problematic alcohol use. Alcohol use interventions might be equally appealing to both sexes given equivalent readiness to change drinking; however, rates of recent treatment receipt were low.