Smoking rates are at an all-time low . As of 2017 , 17.7 percent of people aged 12 or above smoked – that ’ s down from 18.1 percent the previous year . For many of us , smoking has all but disappeared from our lives . The sight of smokers huddled from the cold is far less common than it once was . But as we have reported in recent issues of our UK & Ireland magazine , smoking rates among certain groups remain stubbornly high . More than half of people with serious mental illnesses smoke – around three times the rest of the population . There is another group that is significantly overrepresented in the statistics – the homeless community . A recent Ottawa public health study revealed that 96 percent of the homeless population smoked some form of tobacco . Many homeless people experience what are commonly referred to as concurrent disorders , where a person experiencing mental illness also uses alcohol or other drugs . Problematic drug and alcohol use are just two of many indicators that a homeless person is likely to smoke . Many people report being smokers before they ended up on the streets and the harsh realities of surviving without a home are far from conducive to smoking cessation . The reasons why homeless people smoke are both broad and complex . On a simple level , we know that smoking is harmful to physical and mental health and is likely to have a significant impact on roughsleepers who are already exposed to myriad potential health problems . Now a researcher based in Ottawa is investigating the impact of smoking on the health of the capital ’ s homeless population . Dr Smita Pakhalé is a respirologist at The Ottawa Hospital and is director of The Bridge , a community research and drop-in centre . Results of the first study were unveiled by Dr Pakhalé earlier this year . Eighty of Ottawa ’ s homeless and lowincome residents were offered traditional nicotinereplacement therapies such as patches , gum and inhalers , alongside counselling , peer support and life skills training . At the end of the six-month study , the remaining participants were found to have cut their cigarette use from an average of 20.5 to 9.3 per day . They also reported a considerable drop in illicit drug use – 18.8 percent . This is significant as there was a 76 percent rise in opioid deaths in the city between January and October 2017 . Any initiatives to reduce this figure would be welcomed by health officials and the wider community . As Dr Pakhalé explained , addiction among low-income and homeless residents is not a single issue , nor can it be treated as such . “ All these social determinants are intertwined : mental health issues , poverty , housing , food insecurity , trauma ,” she said . “ All of these are related to addictions . So you need an approach that addresses the whole person rather than just the opioid , or just the cigarette , or just their diabetes .”
“ You need an approach that addresses the whole person rather than just the opioid , or just the cigarette , or just their diabetes ”
The second study is ongoing , the goal of which is to see whether e-cigarettes could be used to help homeless people stop smoking . A group of 200 homeless people have been enrolled in a randomised controlled trial , with one group receiving traditional nicotine replacement therapy and the other group using e-cigarettes . All participants have access to nursing and peer support . “ We ’ re trying to understand if e-cigarettes can be in our toolbox since they have some features that could be attractive : They can deliver calculated doses of nicotine in an inhaled fashion and , secondly , they can give smokers that hand-to-mouth gesture that they crave ,” according to the respirologist . Two years ago , British American Tobacco ’ s ( BAT ) e-Voke device received approval to be prescribed by the UK ’ s National Health Service ( NHS ). Unfortunately , production costs and a shift in the market led BAT to scrap the product . However , if Dr Pakhalé ’ s study proves to be successful , this may be an avenue worthy of the consideration of our own health service . Until then , Canada ’ s growing homeless population will have to rely on traditional nicotine replacement therapy where they can access it . As studies show , the impact of quitting smoking has positive implications well beyond improving respiratory health and reducing the risk of cancer . Investment in the short-term could improve lives and reduce the burden on the health service in years to come .
VMC | 61