Homeless, but not Hopeless: Targeting Smokers in Bronx Family Shelters

Melody Corporan was living with her three daughters in the HELP USA family shelter in the Bronx when the cravings started to kick in. She had quit smoking cigarettes cold turkey two years prior when she found out she was pregnant with her youngest. But the day-to-day stress was getting to her and she found herself fighting old demons.

“I knew it was a waste of time and money,” Corporan said. “I knew it wasn’t going to solve any of my problems, but when everyone else is smoking, it’s hard. You start to get those urges.” She saw fliers posted around the shelter for help for people looking to quit, so she decided to check it out. “I needed the support. Sometimes it really helps to talk to people. It can be a real stress breaker, and I thought maybe I can help other people out with some pointers too,” she said.

In 2006, the Children’s Health Fund (CHF), New York Children’s Health Project Smoking Cessation Program, launched an ambitious pilot program in two Bronx family shelters. CHF studies showed that roughly 38% of the shelter residents 11 years and older and 40% of the shelter residents 18 years and older smoked cigarettes, nearly twice the smoking rate in New York City (NYC). Anecdotally, Corporan said she felt the number was closer to 80%. Shelter residents comprise a segment of the population with compromised health, and CHF physicians saw a critical need but didn’t have the time, money, or momentum to do anything about it. Now, after a grant from the American Legacy Foundation, CHF tracks tobacco use and physicians like Tanesha Lawrence are trained to intervene.

"We realized that there seemed to be a high rate of tobacco use among our clients, and a lot of their health problems are worsened by tobacco use,” said project director Dr. Tanesha Lawrence.

“Even in a population under as much stress and pressure as homeless families, we've found that many people want to quit,” said Jo Applebaum, co-director of the smoking cessation program.  “They know it's unhealthy for themselves and their children, and it's expensive. We've also benefitted from the powerful anti-smoking campaign produced by the NYC health department. The message about the effects of smoking is everywhere these days.”

Dr. Lawrence and Ms. Applebaum quickly recognized the tremendous stress this population is under. “They are first concerned with the basic necessities: food, shelter, and clothing, and you have to work way down that set of priorities to get to quitting smoking,” said Dr. Lawrence. “Many of these folks going smoke-free is low on the totem pole, but still that is our mission.”

The goal of the project was to provide information and access to people who might otherwise think that quitting just wasn't a possibility for them at this point in their lives. “The workshops we did helped people articulate all the reasons to quit, gave them strategies to quit and to manage stress in healthier ways, and provided support and encouragement. Most former smokers made 8-12 quit attempts  before they actually quit successfully, so we let people know that it's hard and to try, try again,” said Applebaum.

The New York Children’s Health Project Smoking Cessation Team led two cycles of four weeks of counseling and education at one shelter, and three cycles of four weeks at another. Topics covered included: the chemical composition of a cigarette, the long term and short term health effects of smoking, stress management, nutrition, and strategies for behavior change, including nicotine replacement therapy.

“A big key is encouraging healthy ways to reduce stress to replace smoking,” said Dr. Lawrence. “We are in a position to introduce them to a healthier way of living. Many of them will tell us that they didn’t really know about the dangers of secondhand smoke. Everybody knows about lung cancer, but many don’t know about the whole range of cancers and health impacts. We were able to plant the seed.”

Dr. Lawrence collected cell phone numbers and phone numbers of friends and family members to follow up with the participants four to six weeks after the meetings. She found that a large amount of people had cut down.

The CHF initiative found a readiness and a desire within the target population to quit smoking as well as a readiness for residents to support each other in their attempts to quit. “It always helps to be with people going through the same problems, to share ideas and encourage each other,” said Applebaum. “We even had smokers come to the group sessions with friends who weren't smokers--one woman was literally flanked by her friends who were there to help.”

After the 5 support group sessions, 64% of the 14 participants who had some sort of follow-up assessment reduced the number of cigarettes they smoked per day.  Overall, based on the 45 participants who participated in these groups, 20% reduced their amount of cigarette use and 7% quit smoking all together.  “These people did change their habits. Most have children and made an effort to not expose their families to secondhand smoke,” said Dr. Lawrence.

Corporan credits the CHF program with bolstering her resolve in a difficult environment. “Shelters are stressful places, and it can bring on even more than just cigarettes,” she said. “People say they smoke for relaxation, but that stress is still there. I chose to deal with it directly.” These days Corporan remains quit and lives with her daughters in her own apartment in Queens.

“My baby daughter likes to climb all over me and she doesn’t like that smell. I like her hugs and kisses better than I like the smoke, and I’d rather her be with me than have her running away.”