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The University of Southampton
Public Policy|Southampton

Say no to smoking? Understanding the complexity of introducing smoking cessation programmes


A collaborative knowledge exchange research project bringing local authority commissioners and researchers together to explore perceptions relating to the commissioning of stopping smoking programmes within homelessness services. Alongside health benefits, the current cost of living crisis identifies understanding of the financial benefits of stopping smoking.

Homelessness is associated with higher levels of cardiac and respiratory problems (Hwang, 2001), poorer mental health, substance misuse (Aldridge et al., 2018) and low levels of support service attendance (Soar et al., 2020). Smoking has been described as the neglected addiction for homeless populations (Baggett et al., 2013). In homeless adult populations, smoking is estimated to be 78% (Homeless Link, 2019, September 19) in comparison to 14.7% in the general population (Office for National Statistics, 2019). A variety of smoking cessation interventions report abstinence rates of 4-45% (Carpenter et al., 2015; Segan et al., 2015). However, in the UK, smoking cessation support is not routinely offered and not all services address support for smoking cessation within their policies (Cox et al., 2022).

Given the current cost of living crisis, the financial benefits of smoking cessation may be particularly significant for the homelessness. A survey of tobacco smokers living in temporary accommodation in Australia found financial savings were an important perceived benefit of smoking cessation (Puljević et al., 2021). Following a campaign, 70.6% of participants reporting thoughts of quitting were associated with cost-savings in comparison to 30.6% who associated quitting with graphic health warnings (Puljević et al., 2021). In a survey of 306 homelessness service users in Boston, US, the mean tobacco expenditure over 30 days was 36% of an individual’s income (Baggett et al., 2016). The NHS estimate the cost of a 20 a day habit as costing £70 per week (NHS 24, 2022).

There may be an assumption that smoking cessation programmes are desirable within homeless services but there is evidence that some staff find smoking alongside service users a useful context for generating conversations, de-escalating challenging situations, and helping distressed service users to relax (Cox et al., 2022). Across 99 homeless centre staff, staff smoking rates were 23% and 62% of centres reported staff smoking with service users (Cox et al., 2022). However, the idea that smoking might increase staff effectiveness is ethically questionable, especially in light of the government legislation banning smoking in the workplace (Crown Copyright, n.d.). Alternative approaches to increasing engagement with service users and de-escalating situations could be explored.


To participate in a collaborative research project including the University of Southampton and Portsmouth City Council

To host an online community research knowledge exchange event with local authority, homelessness services, and researchers to discuss these findings and implications for practice, and to gain feedback from a wider group of stakeholders to shape the recommendations

To create a policy brief proposal by the end of March 2023 providing key information for the potential commissioning of smoking cessation programmes

To collect feedback on proposed policy brief and update in consultation with partners

To disseminate findings through peer-reviewed academic journals, research and practitioner networks, practitioner channels and publications, and through social media

Potential Impact

A collaborative co-produced piece of research with Portsmouth City Council partners potentially leading to further knowledge exchange and enterprise activities

Local authorities would be informed of the benefits and challenges of commissioning stop smoking programmes for homelessness services

Support to stop smoking programmes may be commissioned in local authorities leading to improved health and financial outcomes for individuals and services

People experiencing homelessness would understand the financial benefits of stopping smoking

Specific Outputs

A knowledge exchange event for researchers and practitioners to collaborate

A policy brief for local authorities concerning commissioning of stopping smoking programmes

An awareness campaign informing people experiencing homelessness of the financial benefits of stopping smoking (alongside the health benefits)

Sustainable Development Goals

SDG3 - Good Health and Well-Being;SDG1 - No Poverty;SDG10 - Reduced Inequalities ;SDG11 - Sustainable Cities and Communities.

Project Members

Project Lead: Rebecca Ward

Stephanie Barker

Jennifer Tarabay

Sophie Kecsmar,Portsmouth City Council

Katie Wood,Portsmouth City Council

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