Underestimation of homeless clients' interest in quitting smoking: a case for routine tobacco assessment.

Issue addressed In Australia smoking rates among the homeless are extremely high; however, little is known about their interest in quitting and few homeless services offer cessation assistance. In an Australian homeless service, this research examined the clients' smoking from the client, staff and organisational perspectives in order to assess the need for cessation assistance for clients and identify opportunities to increase access to it. Methods Twenty-six nurses completed an anonymous survey describing their attitudes to providing smoking-cessation support, current practices and estimates of client smoking and interest in quitting. Subsequently, nurses administered a survey to 104 clients to determine their smoking prevalence and interest in quitting. Organisation-wide tobacco-related policy and practices were audited. Results Most clients (82%) smoked, half of these (52%) reported wanting to quit and 64% reported trying to quit or reduce their smoking in the previous 3 months. Nurses approximated clients' smoking prevalence (88% vs 82% reported by clients), but underestimated interest in quitting (33% vs 52% reported by clients). Among nurses 93% agreed that cessation support should be part of normal client care. The organisation's client-assessment form contained fields for 'respiratory issues' and 'drug issues', but no specific field for smoking status. The organisation's smoking policy focused on providing a smoke-free work environment. Conclusions Many smokers using homeless services want to quit and are actively trying to reduce and quit smoking. Smoking-cessation assistance that meets the needs of people experiencing homelessness is clearly warranted. So what? Homeless services should develop, and include in their smoking policy and intake processes, a practice of routinely assessing tobacco use, offering brief interventions and referral to appropriately tailored services.