Health & Healthcare: All Related Resources

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.

Californians experiencing homelessness have poor health, struggle to access care, and face high ER and hospitalization rates—despite high rates of insurance. In this cross-sectional, representative study of adults experiencing homelessness in California, we found poor access to health care and high rates of short-term health care utilization that reflected how homelessness is negatively associated with health care access. Predisposing contextual and need factors, including being unsheltered, using illicit drugs, and having functional impairments, were associated with reduced access to care and increased use of short-term care. These findings underscore the necessity for health care and housing interventions that are tailored to the needs of people experiencing homelessness.

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."