The Indirect Effect of Smoking Level in the Association Between Urban Stress and Readiness to Quit Smoking among Adults Experiencing Homelessness

Authors

Carol Wang, University of Texas MD Anderson Cancer CenterFollow
Tzu-An Chen, University of Houston - MainFollow
Maggie Britton, University of Texas MD Anderson Cancer CenterFollow
Michael S. Businelle PhD, University of Oklahoma Health SciencesFollow
Darla E. Kendzor PhD, University of Oklahoma Health SciencesFollow
Lorna McNeill, University of Texas M. D. Anderson Cancer CenterFollow
Lorraine R. Reitzel, University of Texas MD Anderson Cancer CenterFollow

Abstract

Over 70% of adults experiencing homelessness are cigarette smokers, a fivefold greater rate than in the general U.S. population. Consequently, tobacco-related conditions are the leading causes of disease and death for this group. Adults experiencing homelessness tend to seek shelter in urban areas. Thus, they not only experience the daily stressors of being homeless, but they may additionally experience unique or additive urban stressors (e.g., stress related to using public services, crime and violence, and/or cultural conflicts with others). For some smokers, stress is known to increase smoking rates and decrease readiness to quit smoking. Likewise, increased smoking rates alone may lead to a lower likelihood of making a quit attempt. The current study examined the potential mediating role of smoking level in the association of urban stress and quit readiness among adults experiencing homelessness (N = 411). Two multinomial logistic regression analyses revealed that urban stress was positively associated with smoking level (p = 0.02). The odds ratio for one-unit increase in stress was 1.047 (CI_.95:1.014, 1.082) for being a heavy vs. non-daily smoker. Furthermore, analyses revealed smoking level mediated the effect of stress on quit readiness (ab = -0.005, CI_.95:-0.010, -0.002]). Homeless smokers who report high levels of stress might smoke at higher levels, which could attenuate quit readiness.

Author ORCID Identifier

0000-0001-7808-1996

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Recommended Citation

Wang, Carol; Chen, Tzu-An; Britton, Maggie; Businelle, Michael S. PhD; Kendzor, Darla E. PhD; McNeill, Lorna; and Reitzel, Lorraine R. (2023) "The Indirect Effect of Smoking Level in the Association Between Urban Stress and Readiness to Quit Smoking among Adults Experiencing Homelessness," Health Behavior Research: Vol. 6: No. 1. https://doi.org/10.4148/2572-1836.1175