Introduction In the U.S., approximately 73% of homeless adults smoke cigarettes and they experience difficulty quitting. Homeless smokers report low self-efficacy to quit and that smoking urges are a barrier to quitting. Self-efficacy to quit and smoking urges are dynamic and change throughout smoking cessation treatment. This study examines changes in self-efficacy to quit and smoking urges throughout a smoking cessation intervention among the homeless and identifies predictors of change in these characteristics. Methods Homeless smokers (n = 430) participating in a smoking cessation randomized controlled trial in the U.S. completed surveys at baseline, and weeks 1, 2, 4, 6, 8, and 26 on demographic and smoking characteristics (i.e., confidence to quit, self-efficacy to refrain from smoking, and smoking urges). A growth curve analysis was conducted by modeling change in the smoking characteristics over time and examining the variability in the change in smoking characteristics by demographic characteristics and treatment group. Results Among the full sample, self-efficacy to refrain from smoking increased linearly over time, confidence to quit increased until the midpoint of treatment but subsequently decreased, and smoking urges decreased until the midpoint of treatment but subsequently increased. There were race differences in these trajectories. Racial minorities experienced significantly greater increases in self-efficacy to refrain from smoking than Whites and Blacks had higher confidence to quit than Whites. Conclusions White participants experienced less increase in self-efficacy to refrain from smoking and lower confidence to quit and therefore may be a good target for efforts to increase self-efficacy to quit as part of homeless-targeted smoking cessation interventions. Sustaining high confidence to quit and low smoking urges throughout treatment could be key to promoting higher cessation rates among the homeless.
Bibliographical noteFunding Information:
This work was supported by the National Institutes of Health [grant numbers R25CA163184 and R01HL081522 ] and the Veterans Affairs Advanced Fellowship in Clinical and Health Services Research through the Center for Chronic Disease Outcomes Research. The National Institutes of Health and Department of Veterans Affairs had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the National Institutes of Health or Department of Veterans Affairs.
- Growth curve modeling
- Self-efficacy to quit
- Smoking cessation
- Smoking urges