Grant: Project Grant

Tobacco is the most preventable cause of disease and death in Canada. Although the tobacco use rate has substantially reduced in the general population, significant differences exist between sub-populations in Canada, e.g. Ottawa's highly vulnerable homeless or at-risk for homelessness population has ~100% tobacco use rate relative to 9-18% in the general Canadian population. This stark inequity in tobacco use translates into devastating healthcare outcomes such as a disproportionate amount of cancer, stroke, heart disease and death. Canadians who are homeless or at-risk for homelessness die 25 yrs earlier than housed Canadians, mostly due to tobacco. In order to tackle this inequity we urgently need novel approaches. Despite commonly held dogma that drug using people don't want to quit smoking, many studies have demonstrated that they are in fact interested in quitting. Moreover, the pragmatic peer-led community-based participatory action approach used in PROMPT has demonstrated that tobacco dependence strategies can be implemented with great success. The majority of PROMPT participants reduced/quit tobacco use, in addition to reducing/quitting other drug use. Importantly, PROMPT has demonstrated that it is possible to gain the trust and engagement of marginalized populations and create a low-threshold safe and non-judgemental space to conduct community-based projects. The proposed project aims to improve overall quality of life of this population with a holistic approach, using tobacco dependence management as a gateway. The project will use the same participatory approach operationalized in PROMPT including community peer researchers with lived experience. The investigators believe that the cost-effective community-based framework of the proposed trial will serve as a template for other community-based interventions and treatments for chronic diseases such as obesity and diabetes. The holistic approach could be used as a response to the growing opioid use cri