1. Michael Stoops, Acting Executive Director, National Coalition for the Homeless Janet Porter MPH, Program Director, National Network on Tobacco Prevention and Poverty Problem/Objective: Homeless tobacco users are at a higher risk for tobacco- related death and disease than the general population. While smoking is the major cause of premature death among the homeless, many of those working with this population do not see tobacco cessation as a priority. Encouraging homeless shelters to be tobacco free and providing smoking cessation on site may increase the rate of quitting. Methods: To better understand the impact of tobacco use policies and cessation services among organizations serving the homeless, the National Network on Tobacco Prevention and Poverty (NNTPP) in conjunction with the National Coalition for the Homeless (NCH) and the Association of Gospel Rescue Missions (AGRM) conducted a survey of homeless shelters, soup kitchens and transitional housing facilities. Results: While the majority of respondents indicated that tobacco was an important issue to address among the homeless, only half of respondents indicated that they had a written tobacco use policy in place. Further, approximately 80% indicated that they offered no cessation programming for clients. Conclusions: To reduce tobacco related disparities, more tobacco education and cessation services are needed for homeless service providers. Encouraging policy development and cessation within agencies that have historically provided services to the impoverished can be a key strategy in reducing prevalence among the homeless population. Web-based survey created by the NCH, NNTPP and AGRM. Sent to NCH and AGRM electronic listserve members Open for responses between June - October 2007 Consists of 10 questions (some open-ended) Created and results analyzed in SurveyMonkey 189 responses from 35 states and the District of Columbia Greatest number of replies from California, Florida, New York, North Dakota, Georgia and Arkansas 84% felt that tobacco is an important issue to address with the people they serve 77.7% have a written tobacco policy in place, and 94.5% are compliant with tobacco use policies at their facilities In 53.8% of facilities, tobacco use is allowed only inside designated areas outside their organization’s main facility, while in18.5% tobacco use is prohibited in the facility and on facility grounds. In 22.3% of facilities tobacco use is prohibited within the facility only (see Figure 2). Figure 2: Tobacco use (TU) policies of respondents While a large majority of agencies surveyed thought tobacco was an important issue to address, over half of the agencies do not offer smoking cessation services, and less than one-third are able to provide NRT. This suggests that while there is an interest in treating nicotine dependency, there are barriers that prevent agencies from addressing tobacco. It is estimated that the prevalence of smoking among the homeless is as high as 80%. Bad nutrition and adverse environmental conditions lead to poor health that is exacerbated by smoking. While smoking is the major cause of premature death among the homeless, many of those working with this population do not see tobacco cessation as a priority. The objectives of this survey are as follows: Better understand the impact of tobacco use policies and cessation services among organizations serving the homeless Find out what resources service agencies need in order to address smoking among homeless people Respondents ranged from homeless shelters and soup kitchens to agencies that serve populations at risk for becoming homeless (see Figure 1 below). “During my time on the streets, I tried frequently to convince other homeless men to quit tobacco use, but was always unsuccessful. And for one reason: many of the homeless have used tobacco for decades and quitting is not a realistic option when you have little to do all day except contemplate your condition.” --Homeless respondent 11% of facilities did not see a need to adopt a tobacco use policy 9% have worked on tobacco use policies in varying degrees. 39.3% offer programs to help people stop using tobacco 67.2% are interested in training for staff in to help clients stop using tobacco 27% are able to provide nicotine replacement therapies (NRT) for clients who are trying to quit tobacco. As the findings from this survey indicate, there remains a great need to reduce the burden of tobacco use among the homeless, mentally ill, and substance abusing populations. To help agencies serving disadvantaged populations overcome these barriers, partnerships need to be formed between people experiencing homelessness, service providers, state and regional coalitions, and companies that could provide NRT and other cessation aides. Health Education Council 3950 Industrial Blvd., Ste. 600 West Sacramento, CA 95691 Tel: (916) 556-3344 Fax: (916) 446-0427 www.healthedcouncil.org National Coalition for the Homeless 2201 P. St., NW Washington, DC 20037 Tel: (202) 462-4822 Fax: (202) 462-4823 www.nationalhomeless.org