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

Narges Neyazi; Deepalika Chakravarty; Fan Xia; Mark R Hawes; Wendy Max; Margot Kushel; Maya Vijayaraghavan

doi:10.1016/j.abrep.2026.100686

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

Addict Behav Rep. 2026 Mar 10:23:100686. doi: 10.1016/j.abrep.2026.100686. eCollection 2026 Jun.

Authors

Narges Neyazi¹, Deepalika Chakravarty², Fan Xia³, Mark R Hawes¹, Wendy Max^{4

5}, Margot Kushel⁶, Maya Vijayaraghavan^{1

7

8}

Affiliations

¹ Center for Tobacco Control Research and Education, University of California, San Francisco, CA, USA.
² Center for AIDS Prevention Studies, Division of Prevention Science, University of California, San Francisco, CA, USA.
³ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
⁴ Department of Social and Behavioral Sciences, University of California, Max, San Francisco, CA, USA.
⁵ Institute for Health & Aging, University of California, San Francisco, CA, USA.
⁶ Division of Health Equity and Society, University of California, San Francisco, CA, USA.
⁷ Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, CA, USA.
⁸ UCSF Division of General Internal Medicine, University of California, San Francisco, CA, USA.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Attitudes towards smoke-free policies; Cannabis use; Permanent Supportive Housing; Substance use; Tobacco and cannabis co-use; Tobacco use.