Cox, S.

Dawkins, L.

Robson, D.

Soar, K.

English

LSBU Research Open

Overview of studies (n):Smoking prevalence and characteristics:• 14 studies (n=14,716) reported current prevalence rates = 57-82% (mean = 73%)• Follow up rates varied 1-26 weeks• Drop rates ranged from 10-77%Smoking Cessation Interventions:12 studies reported various types of interventions (e.g. personalised counselling, NRT, MI, combinations).  Of the 5 studies which reported either 24-hour or 7-day point prevalence abstinence rates ranged from 4%-45%. Barriers and facilitators to smoking cessation:37 studies identified barriers and facilitators to smoking cessation programmes.Barriers were categorised as:• Personal (e.g. comorbidities, own awareness and knowledge)• Social (e.g. pressure from other smokers, ability to socialise)• Structured and practical (e.g. access, staff not prioritising client’s needs)Facilitators included:• Offering financial incentives• Social support• Trained staffQuality Assessment:The one RCT6 was assessed as uncertain risk of bias. Other interventionstudies were judged as low/medium risk of bias. Biases were observed in thereporting of barriers, with less weight to possible facilitators to engaging insmoking cessation.Limitations:We identified only one RCT6 (n=430). There was a lack of well conductedintervention studies, large methodological inconsistencies between studies (e.g.different outcome measures reported, methods offered, absence in recordingabstinence measures) and data mostly derived from the US.A systematic review of smoking, smoking cessation and the homeless: there is a will but is there a way?Kirstie Soar1, Lynne Dawkins2, Deborah Robson3, Sharon Cox21University of East London,2 London South Bank University,3Kings College London Corresponding author: k.soar@uel.ac.ukReferences:1. Department of Health (2017). Towards a smoke-free generation: a tobacco control plan for England. https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england (Accessed 18 July 2017)2. Twyman L, Bonevski B, Paul C, Bryant J. (2014) Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature. BMJ open. 4(12):e006414. 3. Higgins JP, Green S, (Eds) (2011) Cochrane handbook for systematic reviews of interventions. John Wiley & Sons 4. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR. (2016)  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 12;355:i4919. 20. 5. National Institute for Health and Clinical Excellence (2015). Developing the NICE guidelines: the manual. http://www.nice.org.uk/process/pmg20/chapter/reviewingresearchevidence. (Accessed on 20 Aug 2019).6. Okuyemi KS, Goldade K, Whembolua GL, Thomas JL, Eischen S, Sewali B, Guo H, Connett JE, Grant J, Ahluwalia JS, Resnicow K.  (2013) Motivational interviewing to enhance nicotine patch treatment for smoking cessation among homeless smokers: a randomized controlled trial.  Addiction. 108(6):1136-44 ResultsDisclosures:  KS and Dr have no competing interests.  LD has provided consultancy for the pharmaceutical industry (2015, 2017) and acted as an expert witness for an e-cigarette patent infringement case (2015).  SC has provided expert consultancy to the Pacific Life Insurance Group on UK tobacco and reduced risk product use and prevalence rates.4814Europe has overlooked this group in relation to smoking1Smoking continues to be a lead risk factor of morbidity and early mortality which is particularly unevenly distributed amongst marginalised groups such as the homeless. In the UK, the Department of Health's’ (2017)1 tobacco control plan has explicitly stated that health inequalities caused by smoking must be reduced.  In order to achieve this aim, understanding the landscape of smoking in one of the most socioeconomically deprived communities is needed. Little work to date has addressed smoking cessation in homeless groups.  As such this is the first systematic review of the evidence relating to smoking prevalence, efficacy and effectiveness of smoking interventions, and barriers and facilitators to smoking cessation/reduction amongst homeless adults. Smoking prevalence is disproportionally high amongst homeless adults,even when compared to other marginalised groups. Efforts to reducesmoking rates and subsequent health inequalities in the homelessrepresent a key group in need of support. Due to the low number ofRCTs, the majority of research deriving from the US (hampering extentto which data represents the homeless elsewhere) and wide differencesin intervention studies there is no evidence to support one type ofeffective intervention for this target group. There is a need for greaterconsistency in research design and treatment outcomes. Evidence doessuggest however smoking cessation interventions are accepted and takenup by homeless adults but cessation is low. Multi-targeted and holisticapproaches are needed, placing the person and the situation in thecentre of care, including interventions which offer staff support andtraining and incentives for follow-up.ConclusionRecords excluded(n =52 )Full-text articles excluded, with reasons(n =0 )Study DesignA systematic review (registered with PROSPERO: CRD42017081843) of peer-reviewed research literaturePrimary outcomes:• rates of smoking prevalence• Rates of smoking cessation• Effective methods of smoking cessation/reduction• Barriers and facilitators to smoking cessation/reductionSearches: Conducted from January –May 2017 (see diagram for databases),  using search terms ‘smoking’ AND ‘homeless’ AND ‘tobacco’.Participants/population:Homeless adult (18+ years) smokers.  Accessing services provided to those who are deemed homeless; both temporary and long-term homelessness2.Intervention(s), exposure(s)Inclusions:• Written in English• Documented smoking rates in adult (18+) homeless populations and/or measured efficacy and effectiveness of cessation interventions and/or documented barriers and facilitators to quit• Participants were users of smokeExclusions:Any studies where the primary and/or secondary aim was not related to smoking behaviours in the homelessRisk of bias (quality) assessment:Assessed independently by two reviewers following a standardised approach3. ROBINS_I for nonrandomised intervention studies4and the quality appraisal checklist5 for qualitative studies.ScreeningIncludedEligibilityIdentificationAcademic Search Complete    n=85Cochrane Library n=20Medline (PUBMED) n=92CINAHL Plus (via EBSCO) n=55PsychARTICLES (via EBSCO) n=2PsycINFO (via EBSCO) n=98OVID online n=593Scopus n=108Additional records identified through other sources(n =  0)Records after duplicates removed(n =108)Records screened(n = 108)Full-text articles assessed for eligibility(n = 54 )Studies included in qualitative synthesis (n =5 )Studies included in quantitative synthesis (n =  54 )Full-text articles excluded, with reasons(n = 0)Records excluded(n = 63)MethodBackground

A systematic review of smoking, smoking cessation and the homeless: there is a will but is there a way?

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A systematic review of smoking, smoking cessation and the homeless: there is a will but is there a way?

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