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Preventing and Reducing Tobacco Use Among Homeless Youth

Institution: RAND Corporation
Investigator(s): Joan Tucker, Ph.D.
Award Cycle: 2012 (Cycle 21) Grant #: 21RT-0118 Award: $879,484
Subject Area: Disparities /Prevention/ Cessation/ Nicotine Dependence
Award Type: Research Project Awards

Initial Award Abstract

Approximately 70% of unaccompanied homeless youth are current smokers – a rate which is substantially higher than national estimates. The health status of homeless youth is already at high risk due to harsh living environments, poor nutrition, mental disorders, substance abuse, and inadequate access to health care and prevention services. Continued smoking in this lifestyle context promises to put homeless youth on a long-term trajectory of chronically compromised health functioning. A number of studies have examined smoking behaviors and evaluated smoking cessation programs among homeless adults. However, only three studies have examined the correlates of smoking behavior among homeless youth, and none have focused on how to reduce smoking in this population. There are significant gaps in understanding how and why homeless youth smoke, and what targeted treatment strategies might best fit their specific needs.

With input from homeless youth and service providers, the goal of this project is to develop a set of specific, feasible environmental policy and smoking cessation treatment strategies to help homeless youth quit smoking. Our geographic focus will be Los Angeles County; however, findings from this project can help inform similar efforts in other regions of California. The overall aim of this project will be achieved through a three-staged approach that utilizes multiple data sources and mixed methods to achieve a comprehensive understanding of how to best reduce smoking among homeless youth.

The first stage of this project involves using qualitative data to better understand the smoking behavior of homeless youth and gaps in smoking cessation services currently available to this population. We will first conduct focus groups with homeless youth who smoke to obtain information on their smoking behavior, perceived pros and cons of smoking, influences on their smoking, and their interest in quitting. We will then conduct a telephone survey with all shelters and access centers serving homeless youth in Los Angeles County about their current smoking policies, provision of smoking cessation services (if any), interest in providing these services to their clients, and potential barriers to providing these services.

The second stage of this project involves using quantitative data to: a) obtain information on the prevalence of past month smoking, nicotine dependence, and readiness to quit among homeless youth, including among key demographic subgroups (e.g,. by gender, race/ethnicity, and sexual orientation); b) identify correlates of past month smoking, nicotine dependence, and readiness to quit; and c) identify characteristics that differentiate youth who are interested vs. not interested in utilizing different smoking cessation services. We will analyze data from two surveys (one existing, the other conducted specifically for this project) of over 600 homeless youth in Los Angeles County.

The third stage of this project involves developing recommendations for environmental policy and smoking cessation treatment strategies to reduce smoking among homeless youth. These recommendations will be informed by findings from the focus groups, service provider telephone survey, and surveys of homeless youth, as well as a state-of-the-science literature review on smoking cessation and prevention services for youth and the delivery of smoking cessation treatments in community-based settings. We will conduct one-on-one expert interviews with service providers to obtain feedback on these recommendations, revise the recommendations in light of their feedback, and disseminate a final report to key stakeholders.

After the successful completion of the proposed project, we will seek funding to implement and pilot test a first-of-its-kind multi-level quit smoking program for homeless youth in Los Angeles County.