By Shivan Sarna

A panel of policy experts, agencies serving the homeless and those facing homelessness themselves gathered in the nation’s capital on Oct. 21 to discuss the issue of tobacco usage among people of low socioeconomic status (SES).

The Break Free Alliance organized the meeting, attempting to engage chief organizations that serve low SES populations in tobacco control efforts.

The panel included experts Jill Jarvie, community health nurse specialist for the San Francisco Department of Public Health, and Michael Stoops, director of community organizing at the National Coalition for the Homeless (NCH).

Persons of low SES have low incomes, have fewer than twelve years of education, are medically underrepresented

and are unemployed or comprise the working poor. There is an 18% difference in the national smoking prevalence rate between people who make less than $15,000 a year (30.6%) and those people who make over $50,000 a year (12%). College graduates have an 8.8 percent smoking rate.

“Underserved populations are multi-ethnic, multi-cultural communities that have little to no resources that provide tobacco education or control services,” said Kristi Maryman, program coordinator for Break Free Alliance. “Many of these populations have been specifically targeted by the tobacco industry.”

Tobacco usage is a serious issue among the homeless population, according to the Break Free Alliance.

“The national smoking prevalence rate among adults is a little over 18%, while among homeless it is estimated at over 70%,” Maryman said.

“The homeless experience physical and emotional distress. They smoke so that they can lose weight, and to kill the hunger pains, as it is sometimes impossible for many to get three hot meals a day,” said Michael Stoops, director of community organizing at the NCH.

Stoops said that a study was conducted two years ago, in which NCH wanted to discover how shelters dealt with smokers.

The results of the study indicate that shelters more or less overlooked the problem, and that educational programming and peer counseling were not offered.

“People are ignorant about smoking as a health issue, they simply do not know enough about it,” Stoops said. “That is why we need one or two staff members at just about every homeless program to provide counseling techniques and to dispense nicotine patches.”

Programs to quit smoking that are available cost money and are not tailored for the life of a person that is homeless, according to Jill Jarvie, a shelter health coordinator.

“We need to follow up quit lines. Each state has quit lines through which smokers can seek services,” Jarvie said. “Though it is hard because people who work quit lines may not know what it is like to live in a shelter and may say something like ‘go take a bubble bath,’ not realizing that the homeless don’t have access to a bubble bath.”

However, there is a project under way in New York City, under Donna Shelley, director of Interdisciplinary Research and Practice at NYU, which will create services, including smokefree shelters and motivational interviewing.

“This population experiences a lot of barriers to quitting, such as mental illnesses and boredom,” Shelley

said.

The program is conducting research on more customized approaches that will work best with the homeless population.

“Essentially, we would like to see sites that treat the homeless incorporate smoking cessation services,” Shelley said.

A woman who lives at the House of Ruth, and goes by the name “Butterfly” has been smoking for five years.

She says that she buys a pack of cigarettes a day, at a price of $7.46 each.

As a result, she smokes approximately $52 of cigarettes a week. Butterfly receives her meals from and lives at the House of Ruth, and hence her only expense is for packs of Malboros.

Keith Wages, another homeless man, was startled by the proposed notion of quitting, “Quit what? Smoking? It’s a custom, a habit, my daily bread!”

Wages has been smoking for 35 years, and says that he purchases as many cigarettes as he can.

Instead of buying a relatively expensive pack of Marlboros, Wages purchases a four-dollar pack of forty cigarettes, known as Bugler. Wages explains that the pack is cheaper because the cigarettes are without filters.

Both Butterfly and Wages are fully aware of the risks that smoking poses to their health.

Funding has to be centered on low SES populations, and all communities need to have equal access to resources and information regarding tobacco use. Homeless shelters need to institute policies that would help bring about a significant change in the social norm, according to Break Free Alliance.

The National Coalition for the Homeless said that the purpose of the meeting was to “get this epidemic on the radar screen, by encouraging shelters to create programs that are targeted at the reduction of smoking among the homeless.”