Short communicationThe moderating effect of perceived social support on the relation between heaviness of smoking and quit attempts among adult homeless smokers
Introduction
The prevalence of cigarette smoking among homeless adults in the United States is strikingly high (>70%) (Baggett and Rigotti, 2010; Businelle et al., 2015; Neisler et al., 2018). Relative to their domiciled counterparts, homeless smokers experience more smoking-related illnesses and deaths (Baggett et al., 2015; Butler et al., 2002; Kanjilal et al., 2006). Notably, most homeless smokers report a desire to quit (Arnsten et al., 2004; Businelle et al., 2015; Connor et al., 2002), but have limited access to the smoking cessation support they need to succeed (Baggett et al., 2013; Chen et al., 2016). Consequently, both lifetime and initial quit success rates [defined as intentionally quitting for at least 24 h, (Bailey et al., 2011)] are markedly low among homeless smokers (Baggett and Rigotti, 2010; Businelle et al., 2014; Reitzel et al., 2014). Considering that research consistently identifies initial quit success, or a successful quit attempt (SQA), as the necessary first step towards long-term abstinence (Burns et al., 2000; Marlatt et al., 1988), additional work is needed to understand factors that impede SQAs among homeless smokers.
One of the most robust predictors of an SQA within domiciled populations is the Heaviness of Smoking Index [HSI, (Kozlowski et al., 1994)]. The HSI is an index of cigarette dependence informed by smoking rate and latency to the first cigarette of the day. Among domiciled smokers, higher HSI scores are independently predictive of fewer SQAs and less successful prolonged smoking abstinence (Borland et al., 2010; Zawertailo et al., 2018). Although this provides initial evidence for the importance of HSI in conceptual models of initial quit success, the generalizability of these findings to vulnerable subgroups, including homeless smokers, remains unknown. Considering the specificity, strength of predictive validity, and brevity of the HSI relative to other indices of cigarette dependence (Courvoisier and Etter, 2010; Fidler et al., 2011; Kozlowski et al., 1994), there may be important clinical implications gained from elucidating how HSI relates to SQAs among homeless smokers.
Another factor that may be particularly relevant to SQAs among homeless smokers is social support. Homeless smokers generally experience low social support for quitting based on known contextual factors such as high use prevalence, social and organizational acceptance of tobacco use, and limited access to interventions (Businelle et al., 2015; Chen et al., 2016; Okuyemi et al., 2006; Twyman et al., 2014). At least one study suggests that those with greater perceived social support for quitting are more likely to be ready to quit than those with less social support (Connor et al., 2002). Thus, social support may serve as a buffer against factors that impede an SQA, including potentially HSI. To date, the precise role social support plays in the initial stages of active quitting (i.e., SQAs), and the potential for social support to buffer against factors known to impede SQAs (e.g., HSI), has not yet been investigated among homeless smokers.
Given the financial limitations of this population and the lack of access of cessation services (Neisler et al., 2018), identifying factors that may protect against the deleterious effect of HSI on initial quit success, such as social support, may suggest low-cost directions for current and future cessation interventions. The current study aimed to explore the potential moderating effect of social support on the evidence-supported relationship between HSI and SQAs among homeless adult smokers.
Section snippets
Participants
Participants were recruited from 6 homeless-serving agencies and/or shelters in Oklahoma City, OK, via posted fliers in July and August 2016. The posted fliers advertised the need for study volunteers for a study focused on the identification of “common health problems and unhealthy behaviors among adults who receive services at Oklahoma City homeless shelters.” The flyer listed dates during which study staff would be on site. Interested participants could sign up by being present on one of
Sample descriptives
Participants (n = 445; 65% male) were on average 43.2 (+11.8) years old and mostly white (57.5%). Participants reported an average of 2.2 (+2.8) past-year SQAs lasting at least 24 h. The average HSI score was 2.8 (+1.5). The average ISEL-12 score was 32.8 (+8.8) with subscale score means as follows: 10.2 (+3.4) for tangible, 11.5 (+3.2) for belonging, 11.1 (+3.2) for appraisal.
Results of correlation analyses indicated significant negative correlations between HSI and SQAs (r=−.283, p < .01),
Discussion
An inverse relationship existed between Heaviness of Smoking Index (HSI) and Successful Quit Attempts (SQAs), and across all three levels of social support (low, moderate, and high) where the perceived availability of someone to talk to about one’s problems appeared to attenuate the strength of this relationship. Domiciled adults report that greater social support is particularly beneficial for maintaining abstinence in the early stages of a quit attempt (Lawhon et al., 2009; Mermelstein et
Conclusion
Given the high prevalence of cigarette smoking and the financial limitations of homeless adults, low-cost recommendations and directions for current and future cessation interventions are needed to address the associated health disparities in this vulnerable population (Baggett et al., 2013, 2015). The current results indicate that perceived appraisal support, specifically the ability to talk to someone about one’s problems, impacted the association between level of cigarette dependence and
Role of funding sources
This work was supported by the Oklahoma Tobacco Research Center at the University of Oklahoma Health Sciences Center (to MSB) and Oklahoma Tobacco Settlement Endowment Trust (092-016-0002) (to MSB), with additional support from the University of Houston (to LRR). This work was also supported by funding from the American Cancer Society grant MRSGT-12-114-01-CPPB (to MSB), the NCI Center Support Grant awarded to the Stephenson Cancer Center (CA225520-01), the National Cancer Institute
Contributors
The author list for this submission is as follows: Julie Neisler, M.S., Lorraine R. Reitzel, Ph.D., Lorra Garey, M.A., Darla E. Kendzor, Ph.D., Emily T. Hébert, Dr.PH., Maya Vijayaraghavan, M.D. MAS, and Michael S. Businelle, Ph.D. Our roles on the manuscript and research project on which the manuscript was based are as follows: Businelle, Reitzel, Kendzor, Hébert, and Vijayaraghavan conceptualized the parent project and collected the data. Neisler and Reitzel conceptualized the research
Conflict of interests
Nothing to declare.
Acknowledgements
Authors would like to extend thanks to the individuals who assisted with data collection for this study, including but not limited to Alexis Moisiuc. Thanks, should also be extended to the individuals who participated in this study and the agencies that allowed this data collection.
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