Smoking cessation for people accessing homeless support centres (SCeTCH): comparing the provision of an e-cigarette versus usual care in a cluster randomised controlled trial in Great Britain
Lynne Dawkins,
Kirstie Soar,
Francesca Pesola,
Allison Ford,
Caitlin Notley,
Rachel Brown,
Emma Ward,
Lauren McMillan,
Debbie Robson,
Anna Varley,
Charlotte Mair,
Jessica Lennon,
Janine Brierley,
Amy Edwards,
Peter Hajek,
Allan Tyler,
Steve Parrott,
Jinshuo Li,
Linda Bauld,
Bethany Gardner,
Sharon Cox
Affiliations
Lynne Dawkins
Division of Psychology, School of Applied Science, London South Bank University
Kirstie Soar
Division of Psychology, School of Applied Science, London South Bank University
Francesca Pesola
Wolfson Institute of Population Health, Mary University of London
Allison Ford
Institute for Social Marketing, University of Stirling
Caitlin Notley
Norwich Medical School, Lifespan Health Research Centre, University of East Anglia
Rachel Brown
Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University
Emma Ward
Norwich Medical School, Lifespan Health Research Centre, University of East Anglia
Lauren McMillan
Institute for Social Marketing, University of Stirling
Debbie Robson
Department of Addiction Sciences, Institute of Psychiatry, King’s College London
Anna Varley
Norwich Medical School, Lifespan Health Research Centre, University of East Anglia
Charlotte Mair
Division of Psychology, School of Applied Science, London South Bank University
Jessica Lennon
Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University
Janine Brierley
Division of Psychology, School of Applied Science, London South Bank University
Amy Edwards
Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University
Peter Hajek
Wolfson Institute of Population Health, Mary University of London
Allan Tyler
Division of Psychology, School of Applied Science, London South Bank University
Steve Parrott
Department of Health Sciences, University of York
Jinshuo Li
Department of Health Sciences, University of York
Linda Bauld
College of Medicine and Veterinary Medicine, Usher Institute, University of Edinburgh
Bethany Gardner
Division of Psychology, School of Applied Science, London South Bank University
Sharon Cox
Department of Behavioural Science and Health, University College London
Abstract Background Smoking rates are exceptionally high among people experiencing homelessness. We aimed to test the effectiveness of an e-cigarette (EC) intervention designed to help people accessing homeless support services to stop smoking. Methods A two-arm cluster randomised controlled trial. We recruited 32 homeless centres (clusters) across Great Britain. Participants were aged 18 + and known by centre staff to smoke. Randomisation of clusters (1:1; using various block sizes) to EC or usual care (UC) was generated in Stata by the trial statistician, concealed from researchers. Participants in EC clusters received a refillable EC, 4-week supply of e-liquid, and a fact sheet. UC participants received very brief advice on smoking, a support leaflet, and signposting to the stop smoking service. Interventions were delivered by centre staff. The primary outcome was sustained abstinence from smoking from 2 weeks post-baseline through to 24 weeks, verified by carbon monoxide (CO) measurements below 8 ppm. Secondary outcomes included CO-verified 7-day point prevalence abstinence. Analysis was intention-to-treat. Results Between February 22, 2022, and June 22, 2023, 16 centres were randomised to EC (n = 239 participants) and 16 to UC (n = 238 participants). In UC, one participant died, and one withdrew consent. Final sample analysed: n = 239 (EC); n = 236 (UC). Sustained 24-week CO-validated smoking cessation rates were 5/239 (2.1%) with EC vs. 2/236 (0.8%) with UC (aRR: 2.43, 95%CI: 0.51–11.64). Seven-point prevalence abstinence was 15/239 (6.3%) in the EC arm vs. 5/236 (2.1%) in UC (aRR: 2.95, 95%CI: 1.05–8.29). Four adverse events were reported in the EC arm; three deemed EC-related and not serious; one serious and not EC-related. Conclusions EC did not support sustained smoking abstinence for 24 weeks. Seven-day point prevalence abstinence rates suggest that cessation is possible, but more support may be needed to sustain this. Trial registration The trial was preregistered on the ISTCTN registry #18566874. Registration date: 12/10/2021.
