UK: Doctors Say 75% of Homeless Smoke, and It''s Time to Intervene

Source from:  Examiner.com (National)  07/22/2013

Approximately three-quarters of homeless people smoke cigarettes, and the complacent approach to that situation needs to change to support efforts to get them to quit, according to doctors writing in the New England Journal of Medicine.

A recent report in the Los Angeles Times said the authors acknowledged difficulties in getting homeless people to either reduce or stop their smoking, including psychiatric and substance abuse issues. A lack of health insurance also means a lack of access to smoking cessation programs.

"Vulnerable and marginalized populations continue to use tobacco at high rates," including the 2.3 million to 3.5 million people in the United States who are homeless. There exists "a fatalistic attitude among healthcare professionals toward addressing tobacco use in this population," the doctors wrote in the most recent issue of the journal.

Dr. Travis Baggett, lead author and an instructor in medicine at Harvard Medical School and Massachusetts General Hospital, said that during his 13 years of work with the homeless, he would have agreed that tobacco was not a priority. But he said his attitude has changed in the last five years.

Smoking "causes too many problems for us to ignore it," he said in an accompanying interview on the journal's website. It is "making our patients poorer or sicker, and they want to quit."

Smoking and mental illness are associated, but Baggett said the high rate of smoking among homeless is not fully explained by that complicating factor.

The Times reported that Baggett said the tobacco industry has taken advantage of the situation; the article cited a 1995 R.J. Reynolds program called Sub-Culture Urban Marketing, or SCUM, that targeted vulnerable people in San Francisco. However, a Reynolds spokesman said the program was never adopted.

"We have no programs or marketing that focus on that group," David Howard said in an email. "All of our marketing efforts are developed for and communicate to adult tobacco consumers, all adult tobacco consumers."

The rate of smoking among homeless people is four times that of the U.S. adult population, the doctors wrote in the journal. And the rate of smoking-related deaths is twice that among people with homes.

"Doing nothing about this problem is no longer acceptable," Baggett said. Enditem