Q&A: How to Help Homeless Youth Quit Smoking
Joan Tucker has been researching youth smoking for over a decade. In her work on smoking among homeless youth, the senior behavioral scientist and professor at Pardee RAND Graduate School in Santa Monica, California, has found that many young people would like to quit, and many youth workers would like to help them do so. Despite this interest, no one has created smoking cessation programs specifically for homeless youth, she says.
We asked Tucker why getting homeless youth to quit matters and what cessation programs designed for them might look like.
NCFY: Why did you decide to study smoking, out of all the challenges homeless youth face?
Joan Tucker: I was conducting a survey of homeless youth several years ago on social networks of homeless youth and the social context of risk behavior. We included a question about smoking and found that about 70 percent of Los Angeles County homeless youth were smokers. That’s several times higher than national estimates for the general youth population.
Studies of homeless youth in other cities, such as New York, have also found high rates of smoking among homeless youth. But there’s very little information on why homeless youth smoke, if they’ve tried quitting, and what services are available if they are interested in quitting.
NCFY: What are the larger implications of smoking among homeless youth?
Tucker: While smoking in itself is bad enough, most homeless youth who smoke engage in high-risk smoking practices. They smoke shared cigarettes and engage in sniping—smoking used butts they find on the street—which puts them at risk for communicable diseases. Homeless youth have other health vulnerabilities, like unstable living situations, nutritional deficiencies, and stress. Smoking adds to those already health-damaging effects. On average homeless youth spend about one-third of their monthly income on tobacco products. This is money that could be meeting the basic needs they have.
[Young people with friends who smoke are also more likely to run away.]
NCFY: Are there certain cases when it might not be right for homeless youth to quit smoking?
Tucker: If a youth is in crisis, it is probably not the best time for them to quit smoking. Homeless young people have a number of pressing issues, and smoking might not be the highest priority. Youth are in a good position to know whether the time is right for them to make this change. We’ve found that most youth are interested in quitting. Two-thirds of the youth we studied had quit in the last year for at least 24 hours, on their own, without counseling, support, or resources, and on average made nine to 10 quit attempts. There are not a lot of programs to help them quit, so they try to do it cold-turkey.
Just broaching the subject might increase youth’s motivation to quit. When we asked if youth had ever been asked by a service provider about their smoking during the intake process, those who were asked had a higher motivation to quit and more interest in cessation services. As we are addressing other forms of substance use, shouldn’t we be thinking about tobacco as well?
NCFY: What would cessation programs look like for homeless youth?
Tucker: We need to help them not start in the first place, and if they are interested in quitting, we need to give them the tools they need to quit. Part of what is needed is creating an environment that supports cessation. Some things providers can do to set the stage and encourage youth to think about quitting smoking are having materials on smoking cessation available, and having a dedicated no-smoking outdoor area.
The other part is having a protocol in place like referring youth to a quit line or other community resources, and having staff trained to give brief counseling on quitting smoking. A counselor follows a short script to ask about prior quit attempts, and to find out whether youth are willing to make a quit attempt now. If yes, staff provide recommendations or strategies youth can use to quit, and follow up to see how it’s going.
There are ways to do it that wouldn’t require a lot of resources. Agencies could partner with local university students to provide [brief cessation counseling], and they could also partner with local drug stores or physician practices to get donated nicotine patches and gums.
Read Tucker's research brief describing the results of her studies on reducing cigarette smoking among unaccompanied homeless youth.