�� The other authors have nothing to declare. All authors had full access to all of the data in the study selleck chemicals and take responsibility for the integrity of the data and the accuracy of the data analysis. Acknowledgments We thank Torsten Neilands and Kevin Delucchi for advice on statistical issues.
Despite progress in reducing cigarette smoking in the general U.S. population, smoking rates and related morbidity remain strikingly high among poor and underserved groups. One underserved group generally unreached by smoking cessation interventions is the 3 million persons annually experiencing homelessness in the United States. The cigarette smoking rate among the homeless remains an alarming 70% or greater (Wilder Foundation, 2004).

The leading causes of death among homeless persons are heart disease and cancer, both of which are tobacco related (Hwang, 2000; Hwang, Orav, O��Connell, Lebow, & Brennan, 1997). Because smoking cessation research usually excludes people without a regular place of residence, there is lack of evidence-based information about how to help homeless smokers quit smoking. Despite ample evidence that pharmacotherapy and counseling are effective for smoking cessation in the general population, to date, little is known about effective methods for smoking cessation among homeless populations. Because homeless individuals are faced with meeting basic survival needs such as finding food and shelter, many people may assume that smoking cessation is not a priority for the homeless and therefore ignore smoking as a health problem among the homeless.

However, findings from the few studies conducted in homeless populations do not support this assumption. A survey of 236 homeless adults from nine homeless service sites found a smoking prevalence rate of 69%. Of the smokers, 37% reported readiness to quit smoking within the next 6 months (Connor, Cook, Herbert, Neal, & Williams, 2002) and 72% had tried to quit at least once in the past year. The same study found that nicotine replacement alone or in combination with other treatments was the most preferred treatment (42.2%). Thus, there appears to be considerable interest in smoking cessation aided with medication among homeless smokers. Homeless smokers face multiple barriers to accessing and adhering to treatments (Teeter, 1999).

Furthermore, high rates of psychiatric and other substance abuse comorbid conditions (el-Guebaly, Cathcart, Currie, Brown, & Gloster, 2002) within homeless populations create additional challenges to cessation for homeless smokers. Cilengitide Adherence to smoking cessation treatment under these circumstances can be challenging. Within the general population, those who do adhere to recommended treatment usually achieve better cessation outcomes (Lam, Abdullah, Chan, & Hedley, 2005; Shiffman et al., 2002).