Homelessness and smoking often go hand in hand. Studies have shown that homeless people are much more likely to smoke cigarettes than the general population. There are a variety of reasons for this phenomenon.
Addiction
One of the most obvious reasons that homeless people tend to smoke at high rates is addiction. Nicotine is an incredibly addictive drug that is very difficult to quit. Many homeless individuals start smoking at a young age and simply cannot kick the habit, even if they want to. Smoking provides a dopamine hit and brief reprieve from the stresses of homelessness.
Cigarettes are also relatively inexpensive and accessible. Even those with very limited funds can usually scrounge up enough change to buy a pack of cigarettes or some rolling tobacco. The accessibility and cheapness of cigarettes makes it easy for homeless people to feed their addiction.
Furthermore, overcoming addiction is exceedingly difficult when you are homeless. Having stable housing, a support system, access to treatment and cessation aids, and a routine conducive to quitting are all important factors in successfully quitting smoking. Most homeless people lack these key resources and structure in their lives. Kicking an addiction while living on the streets is a huge challenge.
Mental Health Issues
Mental illness and substance abuse disorders are common among the homeless population. Studies show high rates of mental health disorders like depression, PTSD, schizophrenia, and bipolar disorder among homeless individuals. There is a strong correlation between mental illness, trauma, substances abuse disorders and high smoking rates.
Those struggling with mental health challenges often use cigarettes as a way to self-medicate and cope with unpleasant symptoms like anxiety, depression, and insomnia. The mood enhancing and calming effects of nicotine provide temporary relief from psychological distress. Smoking becomes a sort of unhealthy coping mechanism for those with psychiatric issues living on the streets.
Boredom and Loneliness
Day-to-day life as a homeless person can be quite monotonous and socially isolating. Lots of time is spent wandering the streets alone, sitting in shelters, panhandling at busy intersections, waiting in lines at soup kitchens, etc. Cigarettes help pass the time and provide a brief social interaction when bumming a smoke from a fellow homeless person or stranger.
Smoking gives homeless individuals something to do to occupy their minds and hands. It provides a fleeting sense of purpose and stimulation when living an extremely purposeless and tedious existence. The act of smoking becomes a small pleasure to look forward to when experiencing intense boredom and loneliness.
Stress Relief
Homelessness is an incredibly stressful and precarious existence. Not knowing where you will sleep at night, having limited access to food, bathrooms, and other basic necessities takes a major toll. Being homeless also often means being exposed to violence, crime, harsh weather, hunger, and poor health.
Nicotine from smoking produces temporary feelings of relaxation and calmness. Lighting up provides a quick break from constantly worrying about finding your next meal or where to safely spend the night. Smoking a cigarette is like a minivacation from the perpetual stress of being homeless.
Social Acceptance
Within the homeless community, smoking is the norm. Those who do not smoke cigarettes are actually in the minority. If you spend most of your time in shelters, on the streets, or at encampments you are constantly surrounded by people who smoke.
To fit in and bond with fellow homeless individuals, many end up picking up the habit. Smoking becomes a way to gain social acceptance and connect with others who are in the same difficult predicament. The camaraderie and sense of belonging provided by sharing a smoke breaks down social barriers.
Something to Trade
Cigarettes are like currency among homeless populations. They have established value and can be traded for other goods or services. A pack of cigarettes may be exchanged for a meal, new socks, a place to sleep for the night, information about available services, etc.
Even nonsmokers will collect cigarettes to use for bartering purposes. Building a reserve of cigarettes gives homeless individuals something valuable to trade during times of need.
Lack of Health Care Access
Regular medical care is often hard to come by for the homeless. Without access to doctors, preventative health screenings, and counseling on smoking cessation, it is very difficult to address nicotine addiction.
Health problems caused by smoking tend to be a lower priority when you are homeless. More pressing needs like finding food, water and shelter have to come first. Therefore, smoking-related issues go untreated due to inadequate healthcare.
Homeless populations also have higher rates of substance abuse and mental health disorders, which negatively impact motivation and ability to quit smoking.
Targeted Advertising
Big tobacco companies have a long history of targeting advertisements and promotions at vulnerable low-income groups. Homeless individuals are directly exposed to this predatory marketing when smoking in public spaces.
Free sample giveaways at shelters and soup kitchens get new smokers hooked. Billboards for cheap cigarette brands are placed in locations frequented by the homeless. This strategic advertising normalizes and promotes smoking among the homeless.
Smoking Rates Among the Homeless
Many studies have shown significantly higher rates of smoking among homeless adults compared to the general population. For example:
- A 2004 study of over 9,000 homeless adults in Los Angeles found a smoking rate of 75% compared to 18% among all adults in California.
- A 1992 examination of homeless individuals in Dallas, Texas showed 82% were smokers.
- Research from 1996 of homeless persons in San Francisco indicated 73% smoked cigarettes.
The rates of smoking among homeless youth are similarly very high:
- A report on homeless youth in Los Angeles published in 2007 showed a smoking rate of 88%.
- In a Minnesota study of street youth from 1999, 97% identified as smokers.
While estimates vary between different locations and data collection methods, all evidence points to an extremely disproportionate smoking rate among America’s homeless.
Smoking-Related Health Risks
The high rate of tobacco use puts the homeless community at increased risk of:
| Lung cancer | Gum disease |
| COPD | Tooth decay |
| Emphysema | Tooth loss |
| Pulmonary disease | Poor wound healing |
| Heart disease | Cataracts |
| Stroke | Blindness |
Smoking worsens almost every health condition. This vulnerable population already has inadequate access to healthcare and struggles with higher rates of HIV, viral hepatitis, respiratory infections, tuberculosis, schizophrenia, and substance abuse disorders.
Tobacco use compounds these issues and contributes to the significantly reduced life expectancy of homeless people. Yet smoking rates remain high due to the powerful hold of nicotine addiction and the numerous pressure factors of homelessness.
Steps to Reduce Smoking Among the Homeless
Some initiatives that could help lower smoking rates in the homeless population include:
- Increased access to smoking cessation resources – nicotine patches, gum, counseling, quitlines, etc.
- Tobacco bans at homeless shelters
- Free annual health exams with smoking cessation advice
- Targeted public health campaigns
- Housing assistance programs
Holistic solutions that address root causes like mental illness, trauma, inadequate health care, boredom, and lack of purpose must also be part of long-term public policy changes. Simply scolding homeless people to quit smoking without alleviating underlying issues will not work.
Progress will only come through compassionate public health initiatives, advocacy, and improved government housing and healthcare assistance for America’s homeless population.
Conclusion
Homelessness and smoking are clearly strongly linked in the United States and elsewhere. Those without stable housing smoke at rates 2-3 times higher than the general public. Addiction, mental illness, social acceptance, lack of healthcare, and predatory marketing from Big Tobacco all enable this public health crisis.
More resources focused on tobacco cessation and broader social reforms are needed to protect this vulnerable community and uphold the human right to health and wellbeing.