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Protecting the homeless via shelter tobacco control policies

Institution: University of California, Los Angeles
Investigator(s): William McCarthy, Ph.D.
Award Cycle: 2008 (Cycle 17) Grant #: 17BT-1300 Award: $42,933
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Pilot CARA

Initial Award Abstract
Historically, tobacco control efforts have targeted middle-class American families and not those without permanent residence (i.e., the urban homeless – a segment of the population with high rates of tobacco use, tobacco related disease, and tobacco-related social consequences). The result has been a growing gap in the percentage of people who smoke, between middle-class families and those who are homeless. This, however, may be starting to change. The Los Angeles County Department of Public Health, for example, recently identified reducing the number of people using tobacco in vulnerable populations and ending homelessness as two of its ten primary strategic goals for 2007 and beyond. The proposed project aims to reduce the high rate of tobacco use among homeless residents of transitional shelters. The investigators propose collecting information about tobacco use from residents of homeless transitional shelters in Los Angeles County. The proposed research activities will be guided by the active participation of the Community Investigative Team (CIT). These activities include: (1) eight initial key stakeholder interviews, (2) development of the focus group design and discussion guides based on the stakeholder interviews, with input and approval from the CIT; (3) conducting one focus group involving the staff of a local transitional shelter (e.g., L.A. Family Housing) and four focus groups of residents recruited from participating transitional shelters. With the CIT’s guidance and approval, recommendations based on the focus group findings will be used to design and develop a multi-level (shelter-level, resident-level) intervention to promote tobacco cessation for homeless populations residing in transitional shelters. Based on previous studies, the investigators anticipate that the resulting intervention will feature motivational interviewing and nicotine replacement therapy.

Specific Aims #1: Strengthen working relationship between UCLA investigators and the staff of the Los Angeles Coalition to End Hunger and Homelessness, the main coalition of shelter and free meal providers in Los Angeles County. #2: Establish a working Community Investigative Team – the team will help design key stakeholder and focus group protocols, and will help guide data analysis, interpretation, and conclusions of the study’s findings. #3: Get suggestions from eight key stakeholders about tobacco control strategies that might be acceptable to transitional shelter staff and residents. Key stakeholders include community experts in transitional housing operation and management, and residents of transitional shelters. Using this information as well as information from the literature on tobacco control among the homeless, a multi-level tobacco abstinence promotion program will be developed. #4: Elicit suggestions and critical comments from one focus group of transitional shelter staff and four focus groups of transitional shelter residents (6 to 8 persons per group) with respect to the design and proposed implementation of a multilevel (shelter-level, resident-level), individually-tailored tobacco abstinence promotion program at transitional housing sites. The focus group participants will include current or recent tobacco smokers who are (1) staff members of transitional shelters (one focus group) and (2) residents of these shelters (four focus groups). #5: Apply focus group findings and Community Investigative Team input to design a state of the art multi-level tobacco abstinence promotion intervention program featuring individually-oriented motivational interviewing and nicotine replacement therapy as well as environmental policy strategies for encouraging transitional shelter staff and residents who currently smoke to quit their tobacco use habit.

The final objective of this project is for the research partners to design and submit a detailed proposal to TRDRP to conduct a rigorous scientific evaluation of the resulting abstinence promotion program developed specifically to promote smoke-free living among the homeless residing temporarily in transitional shelte