Feasibility and efficacy of tobacco treatment interventions for smokers with a history of homelessness.

Once informed consent is obtained and smoking status is confirmed by CO measurement using a PICO+ Bedfont Smokerlyzer (CO <5ppm indicates a non-smoker), participants will be enrolled on the 12 week treatment trial (with nicotine replacement therapy administration) with 3 monthly follow-up for 9 months. The trial stages are as follows: 1. Participants will attend an initial tobacco assessment at Common Ground with a tobacco treatment counsellor who will administer a number of research questionnaires. 2. Participants will return the following week for the first of 12 x ½ hour, weekly, counselling sessions at Common Ground, with the study counsellor, at which time nicotine replacement therapy (NRT) will be dispensed and motivational intervewing commenced. Participants will commence on 21mg x 24 hour transdermal nicotine patch and/or one of the oral forms of NRT of the participant’s choice. The starting dose and type of NRT will be determined by an assessment of the patient's nicotine dependency and CO level. The dose of NRT will be titrated up to a maximum of 42mg transdermal nicotine patch in response to symptoms of withdrawal and relapse. Flexible NRT dosing will be provided according to the patient profile and clinician advice, based on the participant’s severity of dependence and previous experiences in using NRT. 3. At each weekly treatment session participants’ self-reported smoking level will be assessed and verified by CO measurement, as will NRT use, nicotine withdrawal symptoms and mental health issues. NRT will be dispensed at each weekly treatment session for 12 weeks. Motivational counselling interventions will be used throughout the treatment protocol to enhance motivation and readiness to quit smoking. 4.After 12 weeks of treatment, the provision of free NRT will cease but participants will have the option of obtaining a script for nicotine patches for a further 12 weeks if needed. The script will be provided by their medical practitioner. 5. Face-to-face follow-up interviews will be conducted at 3 monthly intervals for a period of 9 months following termination or treatment completion. Follow-up will include biochemical verification of self-reported smoking status in expired CO measurement, administration of the research questionnaires and a review of participants' medical records. Written consent will be obtained for access to participants’ medical records.