Dr Sharon Cox, Prof. Lynne Dawkins
Prof. Linda Bauld, Dr Rachel Brown, Dr Allison Ford, Prof. Caitlin Notley, Mr Steve Parrott, Dr Francesca Pesola, Dr Deborah Robson, Dr Allan Tyler
Smoking is extremely common among adults experiencing homelessness but there is lack of evidence for treatment efficacy. Smoking prevalence rates amongst people experiencing homelessness range between 57% and 82%, making it three to four times higher than the national UK average of 14.1%. Smoking is a leading cause of death in people aged 45 and over who are homeless, and the second leading cause of death in adults under this age. There is an urgent public health need to improve the lives of people experiencing homelessness and reducing the burden of smoking would significantly advance this. E-cigarettes are an effective quit aid, but they have not been widely tested in smokers with complex health and social needs. Here we build on our cluster feasibility trial and evaluate the offer of an e-cigarette or usual care to smokers accessing a homeless centre.
To explore the feasibility of offering EC to adult smokers accessing homeless services a cluster feasibility trial was previously conducted in four centres, three were in England and one was in Scotland. In this trial, two clusters were assigned to offer participants usual care (UC) which consisted of the standard offer of referral to the local stop smoking service (SSS) and two clusters offered participants a free EC starter pack, which consisted of one refillable battery-operated EC device and e-liquid was provided once per week for 4-weeks. Building on our feasibility study, here we aim to conduct a two-arm multi-centre cluster randomised controlled trial (cRCT).
A multi-centre cRCT with internal pilot, with 1:1 cluster randomisation to either an offer of an EC starter kit (including e-liquid) (intervention, n=16 clusters) or UC comprising very brief advice to quit and signposting to the local SSS (control, n=16 clusters). The study will take place in 32 homeless day centres across five areas of GB: London (n=8), South-East England(n=6), East-Anglia (n=6), Wales and Southwest (n=6) and Scotland (n=6). The centres will be homeless centres, offering a range of support during day-time hours, but do not offer sleeping accommodation or residency as their exclusive provision. Centres will be recruited into the trial over a 16-month period. Participants are people who smoke who are experiencing homelessness in GB, defined here as adults without secure or long-term accommodation and accessing one of the homeless centres in this study.
Further information and publications
Evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation when offered to smokers at homeless centres: Protocol for a multi-centre cluster randomised controlled trial in Great Britain Cox, S., Bauld, L., Brown, R., Carlise, M., Ford, A., Hajek, P., et al. Addiction (2022)
Full protocol available at: https://fundingawards.nihr.ac.uk/award/NIHR132158
This study is funded by the National Institute for Health Research (NIHR) PHR programme (PHR Reference Number: NIHR132158). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.