title: Characterizing Concurrent Tobacco Product Use Among Homeless Cigarette Smokers.
abstract: BACKGROUND
  Cigarette smoking prevalence rates are high among homeless adults (>70%); however, little is known about concurrent tobacco or other nicotine product use (i.e., concurrent use [CU]) in this population. CU may impact smoking quit rates and confer greater risk of health problems within this vulnerable population. This study characterized CU in a sample of homeless smokers and compared cigarette-only smokers (C-OS) to concurrent users (CUs) on participant characteristics and factors known to be associated with smoking cessation.
  
  
  METHODS
  Participants were 178 adult conventional cigarette smokers from a homeless shelter in Dallas, TX. Sociodemographic characteristics, number of homelessness episodes, tobacco dependence, and items characterizing use of several tobacco/nicotine products over the last 30 days including use frequency, reasons for use, and perceived health risks were described. Sociodemographic characteristics, number of homelessness episodes, tobacco dependence, stress, readiness to quit (RTQ) smoking, and number of smoking quit attempts in the last year were compared between the C-OS and CUs groups using t tests and chi-square tests.
  
  
  RESULTS
  CU was prevalent (n = 91; 51.1%), and 49.5% of CUs reported the use of ≥2 products in addition to conventional cigarettes. Compared with C-OS, CUs were younger and had more homelessness episodes, higher expired breath carbon monoxide levels, and higher stress (ps < .05). Groups did not differ on sex, race, other dependence indicators, RTQ, or previous quit attempts.
  
  
  CONCLUSIONS
  CU is common among homeless smokers. CUs and C-OS did not differ in their RTQ smoking, though greater stress among the CUs may represent a hurdle for cessation.
authors.affiliation: Department of Educational Psychology, College of Education, University of Houston, Houston, TX;
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kish
authors.affiliation: Department of Educational Psychology, College of Education, University of Houston, Houston, TX; lrreitzel@uh.edu.
authors.forename: Lorraine R
authors.initials: LR
authors.lastname: Reitzel
authors.affiliation: University of Texas School of Public Health, Dallas, TX; Population Science and Cancer Control Program, UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX.
authors.forename: Darla E
authors.initials: DE
authors.lastname: Kendzor
authors.affiliation: Department of Educational Psychology, College of Education, University of Houston, Houston, TX;
authors.forename: Hiroe
authors.initials: H
authors.lastname: Okamoto
authors.affiliation: University of Texas School of Public Health, Dallas, TX; Population Science and Cancer Control Program, UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, TX.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Businelle
mesh_terms: D000328:Adult; D000367:Age Factors; D001944:Breath Tests; D002248:Carbon Monoxide / Q000032:analysis; D015897:Comorbidity; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013315:Stress, Psychological; D013781:Texas / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology
chemical_list: D002248:Carbon Monoxide