Are Smokers More Likely to be Non-Compliant with their Medications? An Examination of Permanent Supportive Housing (PSH) Residents in Fort Worth, Texas

Purpose: People with a history of chronic homelessness are disproportionately more likely to smoke and have problems with medication compliance. Moreover, smoking and medication adherence are often related; people who smoke tend to have more trouble taking their medications. However, no studies to our knowledge have investigated this relationship among a group of formerly homeless individuals who have mental health symptoms. The current study utilized a sample of permanent supportive housing (PSH) residents in Ft. Worth, TX who were participating in a health coaching program. It was hypothesized that people who smoked would have more difficulties adhering to their medication regimens. Methods: Data were from m.chat, a technology-enhanced health coaching program for PSH residents with mental health symptoms. Data from November 2014 - March 2017, which consisted of 567 participants, were included. Baseline smoking status was determined by the following question: do you currently smoke cigarettes, or use other forms of tobacco? (yes vs. no). Medication adherence was identified using a modified Morisky Medication Adherence Scale, which categorized people as low vs. medium/high adherence. Covariates were selected based on prior literature and the information available in our data. Logistic regression was used for the analysis. Results: Medication adherence was similar between smokers and non-smokers (aOR: 0.78, 95% CI: 0.41, 1.49). However, drug abuse was significantly associated with medication adherence; people who reported consuming any illicit drug or abusing a prescription medication in the past 90 days had 73% lower odds (aOR: 0.27, 95% CI: 0.12, 0.65) of adhering to medications compared to those who reported no drug abuse. Alcohol consumption was significant in the unadjusted analysis, but was not significant after adjusting for other factors. Conclusions: Among a group of PSH residents with a history of homelessness, smokers and non-smokers had similar rates of medication adherence. Although smoking was not associated with medication adherence, other forms of substance use were related to a poorer medication adherence. This research highlights the role of illicit drug use in predicting medication adherence; programs that attempt to improve rates of medication adherence should take drug use into account as a key predictor of compliance.