Book Description

The homeless population in the United States (US) is diverse and consists of men, women, families, youth and veterans dealing with a range of issues related to domestic violence, post-traumatic stress disorder, mental illness, substance abuse, and poor physical health. Homeless populations are especially vulnerable to chronic diseases including lung and colorectal cancer, asthma, heart disease, chronic obstructive pulmonary disease, and stroke, all of which are exacerbated by their poor housing conditions and lifestyle behaviors. Tobacco use is highly prevalent and an understudied health issue in homeless populations. Up to 80% of those who are homeless are using tobacco. Homeless individuals recognize the negative consequences of smoking, including the dangers to their health, to their appearance, and the high cost of smoking. Notably, evidence suggests that 37%-76% of homeless adult smokers would like to quit their smoking habit. Yet, remarkably few studies on tobacco use and cessation among homeless populations have been conducted, despite their known vulnerability to tobacco use. This dissertation addresses a unique set of gaps in the literature that focus on the possible influences of the built environment and local or city/county-level tobacco use policies on tobacco use prevalence among homeless adults living in transitional shelters in Los Angeles County. The findings from this research can inform the efforts of policy makers, shelter staff, and homeless services providers to create more relevant and effective programs for addressing tobacco use in this vulnerable population. There are several important findings from this dissertation. First, rates of smoking are high among those living in transitional homeless shelters in Los Angeles County, with 63% of participants reporting being a current smoker. Second, we did not find the expected individual-level demographic differences, with the exception of Latinos, who reported less smoking than other race/ethnicity subgroups. Third, there were few differences at the shelter level in regards to residents' smoking status, contrary to what was expected considering the variations in populations served at the various shelters. Fourth, qualitative data analyses indicated findings showed a need for tobacco use reduction/cessation efforts at the shelter-level, and identified suggestions for improving the effectiveness of smoking reduction interventions with this population. Finally, to our knowledge, this research constitutes the first study to assess tobacco use behaviors in conjunction with conventional measures of the built and policy environments surrounding transitional shelters. The new as well as the unexpected findings for transitional shelters for the homeless support the need to expand on current measures of the social, built, and policy environment to include attention to more informal sources of tobacco and better measures to capture the cultural rules operating for this unique population.