We were very pleased that Borrelli, Busch, and Dunsiger1 directed our attention to the needs of the mobility impaired community as one of the underserved populations with high rates of smoking and little targeting of culturally appropriate smoking cessation interventions.
As an anthropologist and sociologist who have long been researching and advocating on behalf of the homeless population, we have searched in vain for smoking cessation services for homeless individuals. The rate of smoking among homeless populations is estimated to be 73%2 and smoking greatly impacts their mortality and morbidity.3
When we recently asked a group of formerly homeless adults what they would do if they needed help in quitting smoking, their response was that they would “look on the bus for an advertisement for a study and join the study.” Joining a study is not the same as having access to a standard and effective smoking cessation program. This response highlights the dearth of accessible smoking cessation programs for homeless individuals. Further, when we inquired through the Health Department of Rhode Island for accessible smoking cessation programs, we discovered that there is only one smoking cessation professional who is funded to offer a free smoking cessation program to the uninsured and underinsured residents of Rhode Island.
In an excellent previous article regarding smoking cessation, Borrelli4 advocates for integrating smoking cessation services into the infrastructure of existing agencies. Having such programs within homeless service agencies would greatly increase access and would also have the advantage of making the interventions more culturally appropriate. However, smoking cessation programs are not available in the homeless service agencies with whom we work. Their ability to provide such programs would require outside assistance as the staff of these agencies are too stressed and focused on providing basic needs to homeless individuals to allow for the internal development of smoking cessation services.
We agree that researching culturally appropriate interventions is an excellent use of research funds. However, we recommend that the public health community also confront the reality of poor access to smoking cessation programs among underserved populations. This is a matter of social justice.
References
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