Built Environment and Tobacco Use in Homeless Shelters

Tobacco use continues to be a significant public health problem in the United States. There is limited research on tobacco use in the homeless population. The homeless are one of the most underserved populations in CA, and suffer from disproportionately high rates of tobacco use, with up to 70% of those who are homeless using tobacco (Conner 2002). The TRDRP has highlighted this population as an underserved population. Very little research has been conducted regarding this population. To date, the literature includes no studies that have examined the influence of elements of the built environment on tobacco use among the homeless. Research on other populations has shown a link between the density of tobacco retailers and tobacco use by residents near the tobacco retailers. Features of the built environment may be related to tobacco use among the homeless as well. Exposure to tobacco control signage in the shelters or to smoking policies at the shelter level may be related to tobacco use by residents and staff of the shelter. Policies at the local community level are also known to have an impact on smoking rates by residents of the community. The purpose of this research is to better understand elements of the built environment which may impact tobacco reduction of homeless clients living in transitional housing shelters. This research is a secondary analyses of data collected as part of a larger program to reduce tobacco use in 26 shelters throughout LA County.

Aims:

The specific aims address the micro environment, the macro environment, and the policy environment that may impact tobacco use and reduction in transitional homeless shelters.

1. Examine the relationship of the micro built environment of transitional shelters regarding the immediate area of exposure at the shelter site and tobacco use among homeless residing in transitional homeless shelters.
2. Describe and analyze the elements of the neighborhood level built environment characteristics that are related to tobacco use of residents living in transitional homeless shelters. Examples include tobacco retailers and advertisements promoting tobacco use within a walkable distance of the shelters.
3. Examine the relationship between shelter-specific and local community-level tobacco control policies to tobacco use prevalence and smoking reduction rates in transitional shelters.

Methods:

Data sources:

Tobacco use was measured through a self-reported survey at baseline and 3 month follow-up as well as through Carbon Monoxide level measurements collected weekly as part of an 8 week program. An environmental audit was conducted at the shelter to assess micro level factors related to tobacco use. A neighborhood assessment using a GPS device was also conducted in a 1000 feet radius around each shelter, allowing for factors of the macro built environment, such as tobacco retailers, to be captured. A telephone survey was conducted with shelter executives at each site to understand the current policies in place at the shelter level. Mutual Learning Dialogues were conducted with key staff at each site to get a better understanding of program implementation, and tobacco reduction among participants.

Analyses:

Multilevel models will be used to determine the impact of the macro environment on tobacco use and tobacco reduction rates of residents at the shelters. Geospatial analyses will be conducted using ArcGIs 10.1, and will include spatial correlations, hotspot analyses, and road network analyses assessing macro tobacco environmental factors within 1000 feet of shelters.

Conclusion:

This research will allow us better understand built and social environmental determinants of homeless tobacco use. The use of GIS will also help address contextual factors that shape health behaviors among the homeless and will contribute to existing literature by better understanding the built environment. Furthermore, the findings of this research can be disseminated to community groups throughout CA who can benefit from these study results. The findings of this study can inform new policies related to tobacco use reduction in underserved populations.