When he was sent to Vietnam in 1970, Travis Dorsey quickly picked up a smoking habit.
As the stress of being in a war zone took its toll, Dorsey found comfort in cigarettes.
"They started giving them to us with our meals, they called them C-rations, and the next thing you know I was buying them," Dorsey told the Fort Worth Star-Telegram. "I didn't drink. I didn't do drugs. The cigarette helped me deal with the stress during the day."
Life hasn't been easy for Dorsey since returning, and through it all he has continued to smoke.
Sixteen years ago, he was diagnosed with post-traumatic stress disorder and lost his job as an aircraft mechanic. Two years ago, his wife died from breast cancer, triggering a downward spiral.
"I tried to commit suicide here about three months ago," Dorsey said. "I ran off the cliff and tore up my truck. I was in the hospital about 2½ months."
Dorsey, 62, who is now staying at the Arlington Life Shelter, says he's beginning to turn his life around. He's resumed taking insulin for his diabetes, received counseling to cope with his wife's loss and found a church in Arlington where he feels at home.
And he's now looking at quitting smoking through a program started in November by Tarrant County Public Health at the Arlington Life Shelter.
"I know it's easier to quit now because I'm not under the stress I've been under the last two years," Dorsey said. "I'm laying down at night and I'm not afraid."
The county health department plans to eventually expand the program to other homeless shelters across Tarrant County, including the Patriot House, a shelter for homeless veterans.
"I wanted to reach an audience that wasn't already being reached," said Vanessa Ayala, a community health worker with the department. "We try to help them manage the stress from quitting smoking and understand the effects of nicotine withdrawal and dealing with weight gain."
Michael Businelle, an assistant professor at the University of Texas School of Public Health in Dallas, said more should be done to encourage those who are homeless to quit smoking.
Tobacco-related deaths in the U.S. are about 440,000 annually, which include deaths from secondhand smoke, according to the federal Centers for Disease Control and Prevention.
"These tobacco cessation services are generally not offered at homeless shelters while substance abuse programs are generally ubiquitous," Businelle said. "Smokers don't go and rob their neighbors or sell their VCRs for cigarettes like someone would do for crack, but smoking is responsible for way more deaths than drugs and alcohol combined."
Businelle helped conduct a study with several other researchers for publication in the American Journal of Public Health, comparing homeless smokers with economically disadvantaged smokers who have a home. The study, conducted from August 2011 to November 2012, found that the homeless smoking rate of 70 percent was twice that of those living in poverty (34.7 percent).
One of the challenges Businelle found was that homeless people were exposed to as many 40 smokers a day compared with three or four among those who are not homeless.
Those who run area shelters agree that efforts to curb smoking among homeless people are needed.
"The majority of the homeless population does smoke," said Toby Owen, executive director of the Presbyterian Night Shelter. "Offering programs would certainly be most beneficial but it's going to have to provide more than just going cold turkey."
In Businelle's study, 10 participants received small incentives - gift cards - and their carbon monoxide levels were tested to see whether they had actually quit. A larger group of 58 homeless people did not receive gift cards.
The quit rate four weeks after stopping smoking was 30 percent among the group that got gift cards versus 1.7 percent among those who didn't receive gift cards.
"The findings of this pilot study are important because smoking cessation interventions that have worked in the general population are not as effective in homeless smokers," Businelle said. "Offering small financial incentives for smoking cessation may be a novel way to have an impact on smoking in this vulnerable population."
Businelle has applied for a National Institutes of Health grant that would pay for a five-year study and is still waiting to see whether it gets approved. The most recent study didn't cover enough time to draw definitive conclusions. But Businelle said it is worth exploring because of the extensive costs associated with tobacco-related illnesses.
"The study is so small you can't really make any broad generalizations," Businelle said. "It is a pilot study that shows there is potential."
The Bridge homeless recovery center in Dallas has been offering smoking cessation classes and modified its courtyard this summer to include a nonsmoking area for those who want to quit. With a day shelter that brings in as many as 1,200 people daily, along with a transitional shelter and an emergency shelter, the Bridge is trying to find ways to reach as many people as possible, President and CEO Jay Dunn said.
"We're learning about the need for smoking cessation medication and brainstorming about how to make that more accessible," Dunn said.
At the Arlington Life Shelter, Dorsey can get nicotine replacement medication through the Veterans Administration Hospital in Dallas.
Another shelter resident, Dennis Bell, said he can get a prescription through the JPS Connection Program if he needs one.
"I don't know that I'll need the medication," Bell said. "I think I can do it with just the knowledge I've learned in the classes. That's my goal. Now if my body says otherwise, that's another thing."
Bell, 45, ended up at the Arlington Life Shelter after his home was foreclosed on and he went through a difficult divorce.
But he said he was receptive to quitting smoking after Ayala pointed out how much money it would save him.
"I knew some of the health issues but the cost of smoking wasn't something I had really thought about," Bell said. "It was good information."
Bell started smoking at 19 to fit in with his friends.
"To be honest with you, it was peer pressure," Bell said. "I guess I wanted to be in the cool crowd."
Karen Caston, director of shelter operations at the Arlington Life Shelter, said the classes can have an impact.
"They come here to become self-sufficient," Caston said. "Anything that helps their health, their mental state and their financial state, can't help but be a good thing."
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