Although the prevalence of smoking has declined in the U.S., vulnerable populations continue to suffer from tobacco-related health disparities. An estimated 68.0- 80.0% of homeless adults are current cigarette smokers compared to 15.1% in the general population. The large gap in smoking rates suggests that current tobacco cessation programs designed to reduce smoking have little impact among individuals experiencing homelessness. The purpose of this study was to explore the barriers and facilitators to smoking cessation among the homeless. The second aim of this study was to explore if the barriers and facilitators to tobacco cessation differed among male smokers experiencing homelessness depending on housing program. The researcher conducted 30 in-depth individual interviews and 30 post-interview short-answer demographic questionnaires among men residing in a Housing First program, a Treatment First program, and those living on the street in Louisville, Kentucky.

Results from this study demonstrate that homeless men in Housing First and Treatment First programs were less likely to engage in high-risk smoking behaviors, vii more likely to have intentions to quit, and more likely to know where to access cessation compared to unsheltered homeless men. Additionally, results from this study demonstrate that barriers to smoking cessation are not equal across groups; unsheltered participants experienced more barriers to cessation compared to participants in the Housing First and Treatment First programs. Across groups, participants commonly reported intrapersonal struggles, such as associating smoking with personal identity and reducing stress associated with homelessness, living in a pro-tobacco environment, access and availability of cigarettes, and lack of access to care as barriers to smoking cessation. Participants commonly identified improving access, availability, and convenience to cessation interventions as a facilitator to smoking cessation. Collectively, these finding suggests an association between housing programs and barriers to smoking cessation. Findings from this study provide information for future development and tailoring of smoking cessation interventions; such interventions must be flexible, readily available, and accessible. Interventions should also consider housing programs when tailoring cessation to the homeless. Collaboration across disciplines is warranted to improve smoking cessation and reduce tobacco-related health disparities among the homeless.