Participants were chosen to reflect typical perspectives: they were recruited from common spaces where most participants gathered, almost all participants approached during recruitment agreed to participate, and service staff at recruitment sites helped identify participants who were representative of their clientele. For each of the eight venues, staff chose random days and time periods for recruitment. During the allotted time for recruitment at each of the eight study sites, staff screened clientele for eligibility and invited eligible participants to enroll into the study. All participants who were approached and were eligible were included in the study; we did not gather information on the total number of participants approached at each session. On each recruitment day, study staff reviewed the list of individuals recruited to ensure there were no duplicate records. On instances where there were duplicates, we retained only the first record for that participant. Staff administered a 20-minute questionnaire on a tablet computer. Participants who completed the questionnaire received a $15 gift card for their participation. All study procedures were approved by the University of California, San Francisco Committee on Human Research.We calculated the mean and standard deviations or median and interquartile range for continuous variables. We calculated proportions for categorical variables. We showed differences in demographics, cigarette smoking characteristics, patterns and frequency of use of flavored and unflavored ATPs, and perceptions of risk, addictiveness and harmfulness of ATPs between cigarette-only users and ATP users. We used logistic regression to examine the bivariate and multi-variable associations between ATP use and past-year quit attempts,cannabis grow indoor adjusting for covariates shown to be associated with quit attempts in prior studies with homeless adults including demographics, substance use disorders, depression, and cigarette use characteristics.

We conducted all analyses using Stata, Version 12.1 .Among participants, 34.5% were cigarette-only users and 65.5% were ATP users . Compared to ATP users, cigarette-only users were more likely to be older, White and American Indian/Alaska Native; ATP users were more likely to self-identify as Hispanic/Latinx. ATP users were more likely to report depressive symptoms, PTSD and past 30-days use of other substances compared to cigarette-only users. Compared to cigarette-only users, ATP users were more likely to report use of menthol cigarettes. ATP users reported high rates of use of cigars and bluntsin the past 30 days. In comparison, rates of use of e-cigarettes , smokeless tobacco , or tobacco pipe were low . ATP users were more likely to perceive cigars and blunts as addictive compared to cigarette-only users , and were more likely to perceive cigars and tobacco pipes as harmful compared to cigarette-only users . Cigarette-only and ATP users did not differ in their perception of risk of developing a smoking-related illness .In this study of current smokers who experienced homelessness, we found that 65.5% concurrently used an ATP. This estimate is similar to that reported in studies of adult homeless daily smokers in Oklahoma City, OK and Boston, MA , but higher than that reported among homeless adult smokers in Dallas, TX . Consistent with prior studies, we found that cigars, e-cigarettes, and blunts were the most commonly used ATP . Cigar use is common among individuals experiencing homelessness, perhaps due to their lower cost relative to cigarettes . Hispanic/Latinx participants were slightly more likely to report ATP use, in contrast to the general population where Hispanic/Latinx individuals have reported lower rates of use . ATP use is common among cigarette smokers experiencing homelessness, highlighting a need for providers to be aware of and screen for ATP use in this population. Contrary to our hypothesis and findings from a previous study , the use of ATP in the past 30 days was not associated with a past-year quit attempt.

We did not observe an association between ATP use and number of cigarettes smoked or time to first cigarette after waking, which are other metrics of nicotine dependence and predictors of quit attempts. These findings suggest that the frequency of ATP use or motivations of use may be more significant predictors of cigarette quit attempts than use of an ATP in the past 30-days. The type of ATP may also make a diference. Compared to other non-combustible tobacco products like cigars, which may carry equivalent risk to cigarettes, ecigarettes may be considered less risky and more likely to be used for cigarette quit attempts . However, we found no independent association between e-cigarettes and quit attempts in bivariate and multi-variable analysis. Amphetamine use in the past 30-days was associated with a lower odds of making a quit attempt after adjusting for other covariates. Our findings highlight a specific group of individuals who may have high levels of nicotine and co-ocurring substance use dependence that might pose challenges for cigarette smoking cessation. In contrast, hazardous alcohol use was associated with higher odds of past-year quitting. Our results are in contrast to previous studies that indicated that smoking cessation was significantly associated with fewer drinking days, fewer drinks consumed on drinking days, and lower odds of heavy drinking among individuals experiencing homelessness . Integrated efforts in treating tobacco and substance use might benefit this population. Consistent with previous studies , we found that ATP users had higher rates of mental health disorders and substance use in the past 30-days compared to cigarette-only users. Given high rates of smoking among individuals with mental health and substance use disorders , the use of ATP among this population may signal a need for higher levels of nicotine to allay symptoms from mental health and substance use conditions . Alternatively, ATP users may use other substances such as cannabis to reduce cravings to smoke, and may be more likely to attempt to quit smoking. While exploring these associations was beyond the scope of this study, our results highlight the need for studies to examine the underlying role of ATP use to curb substance use cravings and/or alleviate mental health symptoms or reduce the urge to smoke cigarettes among cigarette smokers experiencing homelessness.

Among both e-cigarette and cigar users and the general population, fruit flavored products had the highest appeal. This is consistent with a recent study that some adult e-cigarette users initiate use of these products because of their flavors . Studies are needed to examine whether flavored tobacco contributes to the initiation of ATP and/or smoking cessation among populations experiencing homelessness, especially in light of recent momentum to restrict these products. Almost all participants perceived cigarettes to be addictive and harmful, and cigarette only and ATP users did not differ in their perception of risk of developing a smoking-related illness. Most participants perceived cigars and e-cigarettes to be harmful or addictive. These findings have particular salience to the Food and Drug Administration’s regulatory authority, and suggest that efforts to inform the public of the harms associated with ATPs, specifically flavored ecigarettes, are reaching this population. Although ATP users perceived higher levels of addiction and harm from some tobacco products, including cigars and tobacco pipes,vertical farming supplies they also reported high rates of use of some of these products. These findings are consistent with those from a previous study where knowledge of risk was not associated with reduction in product use . Our study has several limitations. Our findings, which are intended to be representative of homeless adults seeking emergency shelter services in San Francisco, may not be generalizable to the general homeless population. The cross-sectional nature precludes us from evaluating a causal association between risk, harm, and addiction perceptions and smoking cessation behaviors. Longitudinal studies are needed to further explore these associations. Measurement error is possible given that tobacco use behaviors were self-reported and not biochemically verified. Residual confounders such as affects toward e-cigarettes and motivations for use of these products were not explored in this study and warrant further exploration.On the remains of an abandoned military base, a few minutes walk from the commercial and political center of Denmark, a village has arisen. Named Christiania after an ancient Viking monarch, this community of little more than a thousand was established thirty-five years ago as an alternative society. Amidst the 1960’s student revolts and critique of modern consumer culture, Christiania was formed as a space of expression and difference. The hope was to create a new society that would allow freedom from the constricting rules of the welfare state, and offer a counter-point and challenge to the homogeneity of Danish culture. Over the years, Christiania has become a key cultural icon in Danish society, recognized as a “social experiment” by the earlier Social Democratic governments and widely known as one of the oldest, most successful and politically active squatter communities in Europe. Christiania lies unobtrusively in the neighborhood of Christians haven, near Copenhagen’s famous walking street.

The enclave comes slowly into view, obscured by the surrounding multistory, grey apartment buildings and busy, car-filled streets. Among the dense rows of monotonous buildings is a surprisingly un-urban space; a vibrant, artistic, car-free and tree-filled village. Set-off from the busy bustle of the surrounding city streets, Christiania remains enclosed by a long colorful wall that separates it from the street. The encircling wall, a relic from the military past, is now a graffiti-filled space that provides running commentary on the current political situation in Denmark and abroad. At one of the few entrances, a gravel path leads away from the monotonous urban side streets towards the infamous Pusher Street; a city block of densely clustered booths illegally selling cannabis products, often joints rolled with different grades of marijuana, hashish blocks on paper plates, and the necessary paraphernalia to complete the smoking experience. Christiania is often represented in the media as a throwback, a place that is out-of-touch, lost in the hopes and dreams of the 1960’s. Once within Christiania, it is difficult to get oriented. There are no street signs and dirt pathways crisscross through the thousand-person community, and the various houses are not numbered. The noticeably formidable, large, grey military buildings dominate the community center. The functional austerity of the military barracks mixes with new age, pot-smoking, hippie style and vibrant hip-hop style graffiti covers the large buildings that once served as military housing and provided storage facilities. Over the past 35 years their functional austerity has been subverted. Some of the large buildings have been divided into communal houses, theaters, or transformed into work spaces such as the all-women smithy. A military base has been transformed into a living space. Christiania is a pastiche; hodge-podge, auto-constructed homes mix with brightly colored wagons that sit dispersed among three-story, massive grey barracks parodying the uniformity of the surrounding city space. Although only one-thousand people live in Christiania, it is also one of the most visited places in Denmark. The Danish Tourist Bureau estimates that several million people come to Christiania each year to see the famous “hippie” commune; purchase cannabis products or sit, enjoy and listen to music; jog on the surrounding canal embankments; or visit the many shops, and eat at the several restaurants and bars. “Pusher Street” is widely known as a tourist magnate, and is the most famous street in Christiania and is listed on tourist maps. The community also boasts a four-star restaurant called Loppen . Christianitter revel in their alterity and boast that their community is a special space, a needed counterpoint to the constricting rule-based limitations of the Danish welfare state and the homogeneity of the Danish culture. The emphasis on difference, and a resistance to incorporation is symbolically marked as you leave Christiania, a wooden arch hangs over the exit, carved in wood the sign proclaims: “You are now entering the European Union.” This paper discusses the connections between urban spaces, police violence, conflict and national identity. I use the case of Christiania, an illegal squatter community in Denmark, and focus on the twin projects of urban renewal and the policing of urban spaces. Christiania is a key cultural icon and widely known as one of the oldest, most successful and politically active squatter communities. It is also the most diverse and policed spaces in Copenhagen.In 2002 a new government, elected on a neoliberal agenda that promised significant reform of the welfare state, began plans to close the squatter community and to capitalize on its countercultural cache.