Identifying Cigarette Smoking Trajectories from Homelessness to Housing

Abstract

AbstractThis study examines cigarette smoking trajectories from homelessness to housing and assesses demographic and clinical characteristics associated with multiple longitudinal smoking behavior patterns. Data were drawn from a longitudinal prospective cohort study of 421 adults experiencing homelessness who entered permanent supportive housing (PSH). Four quantitative surveys (baseline [while homeless], 3-, 6-, and 12 months post-housing) gathered participants’ smoking frequency used for Repeated Measure Latent Class Analysis (RMLCA), which identified subgroups that share longitudinal smoking behavior patterns. Baseline and time-varying demographic, mental health (e.g., schizophrenia), and substance use (e.g., cannabis use) measures were examined as correlates of class membership. RMLCA estimates supported a three-class model: (1) mixed-frequency decreasers (n = 71): who smoked at differing frequencies while demonstrating a significant decrease over time; (2) high-frequency maintainers (n = 194): participants who smoked daily/almost-daily and maintained this smoking rate across waves; and (3) low-frequency increasers (n = 56): participants who generally were non-smokers at baseline and significantly increased to monthly or weekly consumption longitudinally. Compared to Black and African American participants, Hispanic and Latino participants had greater odds of low-frequency increaser and mixed-frequency decreaser membership. Schizophrenia and bipolar disorder diagnoses increased odds of high-frequency maintainer membership compared to the two less-frequent-using subgroups. Cannabis use increased longitudinally and was associated with greater odds of high-frequency maintainer membership. This is the first study to find smoking changes from homelessness to housing. While encouraging that some residents reduce their smoking post-housing, many maintained high smoking rates. Cessation services that address mental health and co-occurring substance use within PSH are warranted.