Alternative Tobacco Product Use and Smoking Cessation Among Homeless Youth in Los Angeles County

INTRODUCTION: Approximately 70% of homeless youth smoke cigarettes, but their use of alternative tobacco products (ATPs) is unknown. This paper reports on ATP use among past month smokers in Los Angeles County, including whether it differs by demographic characteristics, homelessness severity, past year quit attempts, and readiness to quit smoking. Given the growing popularity of e-cigarettes, we also report on perceptions of harm and reasons for using this product. METHODS: We surveyed 292 unaccompanied homeless youth who were randomly sampled from street sites. Participants smoked at least 100 cigarettes in lifetime and 1 cigarette in the past month. RESULTS: Seventy-two percent of youth reported past month ATP use (e-cigarettes = 51%; little cigars/cigarillos = 46%; hookah = 31%; other smokeless tobacco product = 24%; chewing tobacco/moist snuff = 19%). Current ATP use was unrelated to most demographic characteristics or having a past year quit attempt. However, youth who planned to quit smoking in the next 30 days were significantly less likely to report current use of hookahs, other smokeless tobacco products, or e-cigarettes. Among lifetime e-cigarette users, the most common reasons for use included not having to go outside to smoke (38%) and to deal with situations or places where they cannot smoke (36%); it was less common to report using e-cigarettes to quit smoking (17%–18%). DISCUSSION: Dual use of ATPs among homeless youth smokers is common, and more likely among those who have no immediate plans to quit smoking. Effective and easily disseminable strategies for reducing all forms of tobacco use among homeless youth are urgently needed.