REGENTS OF THE UNIVERSITY OF MINNESOTA
In the United States, homeless people number at least four million, a figure that is currently growing rapidly due to the recent rise in mortgage foreclosures across the nation. Despite progress made in reducing cigarette smoking in the general population, smoking rates and related morbidity remain strikingly high – 70% -- among the homeless. With an administrative supplement, we propose to expand the study funded under the parent grant (R01 HL081522-01A2) to explore innovative interventions for tobacco cessation among this marginalized and underserved group. In addition to Nicotine Replacement Therapy under evaluation in the current study, behavioral interventions will be the focus of this supplement. Specifically, we will: 1) Assess the extent to which non - smokers may serve as resources for smoking cessation among the homeless; and 2) Determine the motivations and challenges behind the quitting process for homeless persons by exploring themes of quitting identity, social support, and risk perception. These specific aims will be accomplished through an innovative mix of quantitative and qualitative methods: 1) by adding questions to a comprehensive survey (N=4000) of homeless people in Minnesota and 2) using grounded theory and content analysis of the transcripts from the Motivational Interviewing sessions with participants enrolled in the intervention arm of the original study. We propose to increase analytical time of the study’s statistician, Principal Investigators and consultants, as well as to hire additional personnel; a postdoctoral medical anthropologist with significant experience in tobacco cessation research. So far, little is known about the dynamic process of quitting smoking for homeless people, an insight to be provided by analyzing the longitudinal qualitative data. Themes evident in preliminary analysis include quitting identity, social support, and multidimensional risk perception. In addition, little is known about non-smokers in this population, when and how they quit or prevented relapse in light of a strong smoking culture. The main aims of this supplemental study are to explore the dynamic process of quitting smoking for homeless persons, discern the proportion and quit histories of homeless non-smokers, and ass the extent to which non-smokers may serve as resources for cessation. This low-cost supplement is particularly timely since it fulfills goals of the American Recovery Act insofar as it creates jobs, saves health care costs and addresses morbidities caused by tobacco use among an underserved population that is arguably the most vulnerable to the nation’s current economic crisis.