Irene Glasser

Homelessness and Substance Misuse: A Tale of Two Cities

In this article we examine the relationship between alcohol and drug misuse among the literally homeless (those living out of doors and in emergency shelters) in Hartford, Connecticut and Providence, Rhode Island, two northeastern U.S. cities of comparable size. We worked with homeless advocacy organizations in both cities, using a point-in-time census (N = 1058) and random sample (N = 66) in Hartford, and a sampling of clients (N = 82) of six shelters serving residents of Providence (N = 82). We found substance misuse relevant in 47.2% of the homeless in Hartford and in 45.1% of the homeless in Providence. We conclude that there is a great need for substance treatment services inside shelters, soup kitchens, and day centers so that homeless individuals have an opportunity to engage in treatment within their own milieu.

Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives

Abstract We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation.

NICOTINE ANONYMOUS MAY BENEFIT NICOTINE-DEPENDENT INDIVIDUALS

Goodwin, Keyes, and Hasin1 note that despite the decrease in cigarette smoking in the United States, there is evidence that nicotine dependence has increased among cigarette users in recent birth cohorts, especially among women cigarette users living in poverty, and nicotine dependence has not been reduced significantly within the overall population. The authors further note that the heaviest users of other substances, such as alcohol and cocaine, are not expected to quit on their own, whereas those who are nicotine dependent find that smoking cessation treatment is often difficult to obtain. A bicyclist in the model greentown of Cuitiba, Brazil, safely crosses the town center in a designated bicycle lane. Photograph by Carlos Cazalis. Printed with permission of Corbis. In light of this I was surprised to discover the lack of attention to a potential source of help in smoking cessation, Nicotine Anonymous (NicA), which is a 12-step program for people who are nicotine dependent.2 I recently became aware of NicA through my homelessness research3 and in searching for smoking cessation for homeless populations who are underserved for nicotine dependence. NicA has existed since 1985, yet there has been a dearth of research attention to it,4–6 which I believe has contributed to its overall lack of visibility. As an anthropologist, I find this lack of interest and lack of referrals to NicA, which is free and could be easily accessible, culturally interesting. Further, there is some recent evidence that some heavy smokers are interested in approaches to cessation that include a spiritual dimension.7 I believe that NicA should have the benefit of outcome research, after which we may find it appropriate to add to the current smoking cessation choices.