Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota, 717 Delaware Street, Minneapolis, MN, 55414, USA.
Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street, Minneapolis, MN, 55414, USA.
BMC Public Health. 2022 Jun 27;22(1):1260. doi: 10.1186/s12889-022-13563-5.
In the United States, eighty percent of the adult homeless population smokes cigarettes compared to 15 percent of the general population. In 2017 Power to Quit 2 (PTQ2), a randomized clinical trial, was implemented in two urban homeless shelters in the Upper Midwest to address concurrent smoking cessation and alcohol treatment among people experiencing homelessness. A subset of this study population were interviewed to assess their experiences of study intervention. The objective of this study was to use participants' experiences with the intervention to inform future implementation efforts of combined smoking cessation and alcohol abstinence interventions, guided by the Consolidated Framework for Implementation Research (CFIR).
Qualitative semi-structured interviews were conducted with 40 PTQ2 participants between 2016-2017 and analyzed in 2019. Interviews were audio-recorded, transcribed, and analyzed using a socially constructivist approach to grounded theory.
Participants described the PTQ2 intervention in positive terms. Participants valued the opportunity to obtain both counseling and nicotine-replacement therapy products (intervention characteristics) and described forming a bond with the PTQ2 staff and reliance on them for emotional support and encouragement (characteristics of individuals). However, the culture of alcohol use and cigarette smoking around the shelter environment presented a serious challenge (outer setting). The study setting and the multiple competing needs of participants were reported as the most challenging barriers to implementation (implementation process).
There are unique challenges in addressing smoking cessation with people experiencing homelessness. For those in shelters there can be the difficulty of pro-smoking norms in and around the shelter itself. Considering pairing cessation with policy level interventions targeting smoke-free spaces, or pairing cessation with housing support efforts may be worthwhile.. Participants described a discord in their personal goals of reduction compared with the study goals of complete abstinence, which may pose a challenge to the ways in which success is defined for people experiencing homelessness.
Clinicaltrials.gov, NCT01932996 , registered 08/30/2013.
在美国，80%的成年无家可归者吸烟，而普通人群中这一比例为 15%。2017 年，“戒烟力量 2 号”（PTQ2）在中西部两个城市的无家可归者收容所进行了一项随机临床试验，旨在解决无家可归者同时戒烟和戒酒的问题。这项研究的一部分研究对象接受了采访，以评估他们对研究干预的体验。本研究的目的是利用参与者对干预措施的经验，为今后实施联合戒烟和戒酒干预措施提供信息，研究采用了实施研究综合框架（CFIR）。
2016 年至 2017 年期间，对 40 名参加 PTQ2 的参与者进行了定性半结构式访谈，并于 2019 年进行了分析。访谈进行了录音、转录，并采用社会建构主义扎根理论方法进行了分析。
参与者对 PTQ2 干预措施给予了积极评价。参与者非常重视同时获得咨询和尼古丁替代疗法产品的机会（干预措施特征），并描述了与 PTQ2 工作人员建立了联系，并依赖他们获得情感支持和鼓励（个人特征）。然而，收容所周围的饮酒和吸烟文化构成了一个严重的挑战（外部环境）。研究环境和参与者的多种竞争需求被报道为实施的最具挑战性的障碍（实施过程）。
在为无家可归者提供戒烟服务时存在独特的挑战。对于那些住在收容所的人来说，可能会有来自收容所内部和周围的支持吸烟的规范的困难。考虑将戒烟与针对无烟空间的政策层面干预措施相结合，或者将戒烟与住房支持努力相结合，可能是值得的。参与者描述了他们个人的减少目标与研究的完全戒除目标之间的不一致，这可能对无家可归者成功的定义方式构成挑战。
Clinicaltrials.gov，NCT01932996，注册于 2013 年 8 月 30 日。
