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Three-quarters of homeless people smoke, a rate that is four times higher than the general population, according to Harvard University researchers. This population of smokers needs better access to smoking cessation help, they write in this week’s New England Journal of Medicine.

Homeless people seem to be dying of smoking-related causes at high rates, lead author Dr. Travis Baggett told HealthDay. For more than six years, he has tracked health issues in 28,000 homeless people in Boston.

Cheryl Healton, President and CEO of the public health advocacy group Legacy, said of homeless people, “They’ve sadly been a target of the tobacco industry. Over time, the tobacco epidemic has become more and more concentrated among those least in a position to pay for cessation services and access health care.”

Health care workers treating homeless people often don’t address their smoking, because they appear to have more urgent needs, such as finding food and shelter, Baggett said. “A chronic problem like smoking seems like it maybe shouldn’t be the most pressing issue at the forefront of what we’re tackling with them. I can certainly understand that.” He added, “As you take a step back and look at the public health implications and public health impact, what we’re finding is difficult to ignore.”

It is a mistake to assume homeless people don’t want to quit smoking, Baggett said. “The vast majority of homeless people, just like any other type of patient we see, they want to be healthy. They want to feel better.” Smoking can prevent homeless people from improving their lives, because they spend so much effort getting money for cigarettes, he noted.

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