Comparison of effective smoking cessation methods in underserved population

Abstract

BACKGROUND AND OBJECTIVES: In the U.S., smoking accounts for significant morbidity and mortality. While U.S. smoking rates have declined since the 1960s, they remain high, especially within the homeless population. However, effective smoking cessation programs have not been developed for this population. The primary goal of this project proposal is to facilitate smoking cessation among homeless populations. The secondary goal is to reduce the number of cigarettes smoked per day in this population. To achieve these goals, this project couples pharmacotherapy with nicotine patch and behavioral group therapy to reduce tobacco smoking among homeless adults. The greatest challenge to quitting smoking is nicotine addiction. Nicotine, a highly addictive substance, is the primary molecule in tobacco. Nicotine, when consumed, usually by smoking cigarettes or via chewing tobacco, produces the effects of reward and pleasure, which then become associated with smoking or chewing tobacco. The homeless have a unique challenge regarding smoking cessation for two reasons. The first is that this population has a higher rate of smoking compared to the general population. Secondly, the homeless have a higher rate of mental illness than the general population and those with mental illness have higher rates of smoking. This raises unique challenges for the homeless population and their healthcare providers whose goal is to help them quit smoking and maintain their health. Nicotine replacement therapy (NRT), with nicotine patch, has been shown to be an effective smoking cessation tool for the general population. These therapies, available over the counter, are relatively easy to access, affordable and easy to store, making NRT a useful tool for smoking cessation in the homeless population. In addition, cognitive behavioral therapy (CBT) has been shown to be effective in both smoking cessation and as therapy for mental illness. Therefore, NRT coupled with CBT could be a useful tool for smoking cessation programs for the homeless. PROPOSAL: A group of 50–60 participants will be recruited from Boston Health Care for the Homeless Program where they will receive 24 weeks of NRT in the form of a 21-mg/day nicotine patch coupled with 3 months of weekly CBT. CONCLUSION: The primary goal for this study is to increase smoking cessation amongst the homeless population in Boston. The secondary goal is to decrease the number of cigarettes smoked daily for the program participants. If these goals are met, this study can be implemented as a standard smoking cessation program for the homeless.