Background and challenges to implementation:
World-wide shelter users have an alarmingly high smoking prevalence; more than 70% of homeless people smoke. The burden of tobacco related diseases as cancer, heart disease and chronic obstructive disease is very high in this population. The aim of this study was to develop systematic smoking cessation activities in the shelters of Copenhagen, Denmark and thereby improve the health of shelter users.

Intervention or response:
All available (n=13) shelters in Copenhagen were included. There was a development/test period and a period with implementation of the revised intervention. Shelter-staff completed a questionnaire at up-start meetings. Municipal smoking cessation counsellors were trained to work with shelter users. Three types of smoking cessation activities were developed -these should be tailored, flexible and on-site.

Results and lessons learnt:
The mean smoking prevalence was 79% among users of shelters. The level of smoking control in shelters varied and only two shelters had smoking cessation activities at baseline. All shelters implemented at least two out of three offered smoking cessation activities (1. participation in a house-meeting 2. quit smoking café with individual counselling, and 3. tailored group-based smoking cessation with free nicotine replacement therapy). All but one shelter implemented the group-based intervention: approx. 13% of smokers signed up and 26% of those who signed up were abstinent after approx. 12 weeks, as confirmed by staff.

Conclusions and key recommendations:
Smoking cessation activities in shelters are wanted by staff and users, they are feasible and even very vulnerable persons are able to quit. Based on experiences from all shelters in the Capital of Denmark, we propose a systematic approach for future smoking cessation initiatives, where the smoking activities should be driven by the municipality, be pro-active, on-site, tailored and flexible, and the smoking cessation counsellors should be trained to work with the target group.