Abstract
BackgroundAdults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness.MethodsAdults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer).ResultsFrequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes.ConclusionsDuring a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study.
Highlights
Adults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population
During a time when combustible tobacco use is at an all-time low in the U.S general population, tobacco use remains common among people experiencing homelessness, with approximately three-quarters reporting current smoking [6]
The current study aims, in an exploratory fashion, to understand 1) trends of e-cigarette and dual e-cigarette and combustible cigarette use among adults experiencing homeless from 2015 to 2018, 2) the correlates of ecigarette use among participants in 2018, and 3) frequency of chronic health conditions by use trajectory in the 2018 sample
Summary
Adults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness. Combustible cigarette smoking, plays a significant role in widening health disparities between people experiencing homelessness and the general population. Less is known regarding electronic cigarette (e-cigarette) use among this population and the role it might play in widening or narrowing disparities. Pod-based e-cigarettes, such as JUUL, entered the U.S market in 2015 and have only accelerated the proliferation and popularity of e-cigarettes [7]
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