Eliminating Tobacco-Related Disease and Death: Addressing Disparities: A Report of the Surgeon General

In this op-ed, Maya Vijayaraghavan, MD, MAS, director of the UCSF Smoking Cessation Leadership Center, calls for contingency management to reduce tobacco and substance use. She emphasizes that the US is grappling with two interwoven crises of addiction, tobacco use, and opioid and stimulant-related overdoses. Contingency management is underutilized because of legal, logistical, and philosophical reasons. "Through integration, these technical assistance centers could increase opportunities to utilize such effective treatment in community settings." Dr. Vijayaraghavan writes. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Over 60% of permanent supportive housing (PSH) residents smoke cigarettes, and over 50% use cannabis. Co-use of tobacco and cannabis may be linked with other substance use. We explored attitudes toward tobacco-free and cannabis-free policies among PSH residents who smoked cigarettes, co-used tobacco and cannabis, or other substances.

Over 70% of people experiencing homelessness report current tobacco use, compared to 14% in the general population. One of the structural barriers that hinder cessation attempts among people experiencing homelessness is inadequate access to health care and other smoking cessation services. Researchers in this study aimed to explore tobacco use behaviors and factors influencing acceptability of engaging in a clinical trials. Researchers found that participants had attempted to quit smoking, and were interested in engaging in clinical trials as a method to quit smoking.

Tobacco use remains the leading cause of preventable deaths worldwide. Despite efforts by many countries to reduce the impact of tobacco products and lower smoking rates, smoking prevalence is higher among people experiencing homelessness. The reasons are complex and go beyond individual choices, including limited awareness about quitting, restricted access to services, and previous negative experiences. Using the SEM framework, which emphasizes the policy and environmental contexts, this study offers a deeper understanding of the context of the lives women experiencing homelessness. The evidence from this study supports the implementation of gender- and age-appropriate holistic approaches to healthcare and tobacco interventions tailored to this community.