Implementation of a Low-Cost Tobacco-Free Intervention in a Permanent Supportive Housing Program to Address Cancer Disparities Among People Who Have Experienced Homelessness

Authors

• Ammar D. Siddiqi, The University of California, San FranciscoFollow
• Phoebe Wong, SEARCH Homeless ServicesFollow
• Cathy Crouch, SEARCH Homeless ServicesFollow
• Lorraine R. Reitzel, The University of Texas MD Anderson Cancer CenterFollow

Document Type

Article

Abstract

Objectives: Permanent supportive housing residents who have experienced homelessness use tobacco products at elevated rates, contributing to higher cancer risk. Agencies that provide wraparound support services to this group are committed to rebuilding their stability by improving their health. Yet, their delivery of tobacco screening and cessation care is limited, as is information about their clients’ tobacco use behaviors. Here, we evaluated a low-cost intervention for an Albert Schweitzer Fellowship project conducted in a permanent supportive housing program with 650 adults who had experienced homelessness in Houston, Texas.

Materials and Methods: Between August 2024 and February 2025, client-facing staff members of the Housing Program (N = 45) were offered training on tobacco screening and intervention delivery and education on the dangers posed by tobacco use. They were also provided with dissemination resources and guidance on how to make quitline referrals. As part of the intervention, Housing Program staff were challenged to complete a tobacco use assessment with as many clients on their caseload as possible; workers who screened their entire caseload were incentivized. The screening included questions about their clients’ current and past tobacco use, interest in quitting, stage of behavior change (informed by the Transtheoretical Model), past quit attempts, and what evidence-based interventions the staff provided.

Results: Overall, 43 (96%) staff received education and collectively screened 586 (90%) clients. Among those screened, 74% were lifetime tobacco users, 50% currently smoked cigarettes, and 12% currently used non-cigarette tobacco products. Current tobacco users (n = 310) were primarily in the precontemplation (43%), contemplation (39%), and preparation (17%) stages of the Transtheoretical Model, with 57% reporting having an interest in quitting and 70% having tried quitting. Staff reported making 86 referrals to the quitline for clients who had a phone and consented. However, the quitline reported they were only able to enroll 8 of these referrals for services.

Conclusions: On the basis of high training and screening participation, the low-cost intervention was well-received by Housing Program staff. While tobacco use remains elevated among permanent supportive housing residents, interest in quitting and past quit attempts were common. Most clients who endorsed lifetime tobacco use were in the early stages of the Transtheoretical Model, and many who were referred to the quitline were unreachable, which highlights some challenges in promoting tobacco cessation in this group. Future work should focus on building greater readiness to quit tobacco and capacity to offer on-site cessation services to reduce the cancer disparities they experience from elevated tobacco use.

DOI

https://doi.org/10.52519/ACEQI.26.2.2.a8

Grants and Funding

Albert Schweitzer Fellowship Houston Galveston/ Non-U.S.Gov't

CPRIT PP210026

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

Recommended Citation

Siddiqi AD, Wong P, Crouch C, Reitzel LR. Implementation of a Low-Cost Tobacco-Free Intervention in a Permanent Supportive Housing Program to Address Cancer Disparities Among People Who Have Experienced Homelessness. Advances in Cancer Education and Quality Improvement. 2026; 2(2). doi: https://doi.org/10.52519/ACEQI.26.2.2.a8.