Health & Healthcare

Globally, tobacco use causes 8.7 million deaths annually. Approximately 50 % of formerly homeless adults in permanent supportive housing (PSH) in the United States smoke cigarettes. Secondhand smoke exposure is high in the absence of smoke-free policies. There is a need to understand attitudes toward smoke-free policies and factors associated with smoke-free home adoption attempts among PSH residents.

People experiencing homelessness have significantly lower life expectancies than the general population, and among those aged ≥ 45, tobacco-related illnesses are the leading cause of death.[1] Compared to the general population, tobacco use among people experiencing homelessness is six times higher, and the quit ratio (ratio of former to ever-smokers) is five times lower. [2],[3] We used the largest representative study of people experiencing homelessness since the 1990s to estimate tobacco use prevalence and its association with shelter status, behavioral health, and health services use among adults experiencing homelessness in California to identify opportunities to address unmet tobacco treatment needs.

Homelessness is detrimental to health, and clinicians can play an essential role in mitigating the deleterious effects of homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discusses this and more with JAMA Senior Editor Karen E. Lasser, MD, MPH. Dr. Kushel said, "When you are an individual provider, in a room, you are trying to understand the difficult environmental conditions that your patient has and do things to decrease that part."

People experiencing homelessness have worse mental and physical health than the general population. They also have limited access to primary care for reasons including the absence of health insurance, lack of money for co-payments or transportation, and communication barriers. In this JAMA Insights, researchers examine the adverse effects of homelessness on physical and mental health and suggest strategies to improve access to care.