E-Cigarette switching and financial incentives to promote combustible cigarette cessation among adults accessing shelter services: A pilot study

Abstract

Background: Smoking prevalence among U.S. adults experiencing homelessness is ≥70 %. Interventions are needed to address persisting tobacco disparities.

Methods: Adults who smoked combustible cigarettes (CC) daily (N=60) were recruited from an urban day shelter and randomly assigned to an e-cigarette switching intervention with or without financial incentives for carbon monoxide (CO)-verified CC abstinence (EC vs. EC+FI). All participants received an e-cigarette device and nicotine pods during the first 4 weeks post-switch; and those in the EC+FI group also received escalating weekly incentives for CC abstinence during the same period. Key follow-ups were conducted at 4- and 8-weeks post-switch.

Results: Participants were predominantly male (75 %), 50 % were racially/ethnically minoritized, with an average age of 48.8 years. Descriptive analyses indicated that CC smoking abstinence rates among EC and EC+FI were 3.3 % vs. 13.3 % at 4 weeks (8.3 % overall) and 10.0 % vs. 13.3 % at 8 weeks (11.7 % overall) in the intent-to-treat analyses (missing considered smoking). Among those who completed follow-ups (51.7 % and 45.0 % at 4- and 8-weeks), CC abstinence rates in EC and EC+FI were 6.3 % vs. 26.7 % at 4 weeks (16.1 % overall) and 21.4 % vs. 30.8 % at 8 weeks (25.9 % overall). EC+FI participants reported fewer days of smoking, more days of e-cigarette use, and greater reductions in CO at 4-week follow-up. Most participants reported a high likelihood of switching to e-cigarettes (67.7 %).

Conclusion: E-cigarette switching with financial incentives for CC cessation is a promising approach to tobacco harm reduction among adults accessing shelter services. Refinements are needed to improve engagement.

Keywords: Combustible cigarette abstinence; E-cigarette switching; Financial incentives; Homelessness; Smoking cessation; Tobacco harm reduction.

Fig. 1

Carbon monoxide-verified combustible cigarette abstinence rates by intervention group. Note: The “intent-to-treat” groups had 30 participants each within the EC and EC+FI groups at 4- and 8-weeks post-switch. The “completers only” groups had 16 and 15 participants in the EC and EC+FI groups at 4 weeks post-switch, and 14 and 13 participants in the EC and EC+FI group at 8 weeks post-switch.

Fig. 2

Changes in CO (ppm) from baseline to 4-week (n=31) and 8-week (n=27) follow-up by intervention group. Note: The intervention groups had 16 and 15 participants each in the EC and EC+FI groups at 4 weeks post-switch, and 14 and 13 participants in the EC and EC+FI group at 8 weeks post-switch. Error bars represent the standard deviation of the mean change in CO.