Health-Related Quality of Life Among Homeless Smokers: Risk and Protective Factors of Latent Class Membership

Behav Med. Jan-Mar 2019;45(1):40-51. doi: 10.1080/08964289.2018.1447905. Epub 2018 May 14.


Health-related quality of life (HRQoL) is a multidimensional assessment of well-being and health status. Most work in this area assumes that HRQoL is a homogenous construct; however, it is possible HRQoL subgroups may exist. The purpose of the study was to characterize common classes of HRQoL among adult, homeless smokers, a particularly vulnerable group of the larger population, and to evaluate risk and protective factors of HRQoL class membership. Homeless smokers (N = 456; 65.1% male; Mage = 43.19 years [SD = 11.77]) completed self-report measures of sociodemographics, smoking characteristics, anxiety sensitivity, stress, social support, and the Center for Disease Control (CDC) four-item HRQoL measure. A latent class analysis was conducted for HRQoL. Multinomial regression models were used to simultaneously test correlates of class membership. A three-class solution, consisting of poor HRQoL, moderate HRQoL, and excellent HRQoL, demonstrated superior fit. Correlates of class membership included sex, age, lifetime months of being homeless, smoking characteristics, anxiety sensitivity, stress, and social support. The current findings provide novel evidence for three distinct classes of HRQoL among homeless smokers. Results suggest that older smokers with greater emotional distress, as evidenced by greater anxiety sensitivity, greater stress, and less social support, may be particularly vulnerable to poorer HRQoL.

Keywords: health related quality of life; homeless; latent class analysis; smokers; socioeconomically disadvantaged; tobacco use.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cigarette Smoking / psychology*
  • Female
  • Health Status
  • Homeless Persons / classification
  • Homeless Persons / psychology*
  • Humans
  • Intention
  • Male
  • Middle Aged
  • Motivation
  • Protective Factors
  • Quality of Life / psychology*
  • Risk Factors
  • Self Report
  • Smokers
  • Smoking / epidemiology
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Tobacco Products