# Attitudes toward tobacco-free and cannabis-free policies among residents in permanent supportive housing who use tobacco, cannabis, and other substances

## TL;DR

Residents in supportive housing who use tobacco and cannabis often have negative attitudes toward smoke-free policies, especially if they use other substances like cocaine.

## Contribution

This study identifies how substance use patterns influence attitudes toward tobacco-free and cannabis-free policies in supportive housing.

## Key findings

- Heavy co-users of tobacco and cannabis had less favorable attitudes toward smoke-free policies.
- Cocaine use was linked to less favorable attitudes toward tobacco-free policies.
- Over half of tobacco and cannabis co-users also used other substances in the past 30 days.

## Abstract

•Two-thirds of study participants in permanent supportive housing (PSH) co-used tobacco and cannabis.•Over half of the tobacco and cannabis co-users reported past-30-day other substance use.•Heavy tobacco and heavy cannabis co-users had less favorable attitudes toward smoke-free policies.•Past 30-day cocaine use was associated with less favorable attitudes toward tobacco-free policies.•Interventions that address tobacco and cannabis co-use and other substance use are needed.

Two-thirds of study participants in permanent supportive housing (PSH) co-used tobacco and cannabis.

Over half of the tobacco and cannabis co-users reported past-30-day other substance use.

Heavy tobacco and heavy cannabis co-users had less favorable attitudes toward smoke-free policies.

Past 30-day cocaine use was associated with less favorable attitudes toward tobacco-free policies.

Interventions that address tobacco and cannabis co-use and other substance use are needed.

Over 60% of permanent supportive housing (PSH) residents smoke cigarettes, and over 50% use cannabis. Co-use of tobacco and cannabis may be linked with other substance use. We explored attitudes toward tobacco-free and cannabis-free policies among PSH residents who smoked cigarettes, co-used tobacco and cannabis, or other substances.

Between 2022 and 2024, we recruited 400 PSH residents who smoked cigarettes into a cluster-randomized clinical trial (RCT) of a smoke-free home intervention. Using baseline data from the RCT, we created scores reflecting attitudes toward tobacco-free and cannabis-free policies (higher scores reflect more favorable attitudes). We used linear mixed models to examine multivariable associations of these attitudes with predisposing, enabling, and need factors, as well as with intensity of tobacco and cannabis co-use.

Participants’ mean age was 54.5 years, 62.7% were male, and 41.8% identified as Black or African American. Of the participants, 64.3% used cannabis, 31.5% used amphetamines, and 27.3% used cocaine in the past 30 days. Cocaine use in the past 30 days was associated with less favorable attitudes toward tobacco-free policies (adjusted β: −0.20, 95% CI: −0.37, −0.04). Compared to light co-users of tobacco and cannabis, heavy co-users of tobacco and cannabis had less favorable attitudes toward tobacco-free policies (adjusted β:-0.32, 95% CI: −0.56, −0.07) and cannabis-free policies (adjusted β:-0.58; 95% CI: −0.82,-0.35).

Interventions that address the intensity of tobacco and cannabis co-use, the high levels of indoor co-use of tobacco and cannabis, and co-occurring substance use may increase favorable attitudes towards smoke-free policies in PSH.