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Randomized Controlled Trial
. 2025 Jul 1;23(1):394.
doi: 10.1186/s12916-025-04167-y.

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  1 , Kirstie Soar  1 , Francesca Pesola  2 , Allison Ford  3 , Caitlin Notley  4 , Rachel Brown  5 , Emma Ward  4 , Lauren McMillan  3 , Debbie Robson  6 , Anna Varley  4 , Charlotte Mair  1 , Jessica Lennon  5 , Janine Brierley  1 , Amy Edwards  5 , Peter Hajek  2 , Allan Tyler  1 , Steve Parrott  7 , Jinshuo Li  7 , Linda Bauld  8 , Bethany Gardner  1 , Sharon Cox  9
Affiliations
Randomized Controlled Trial

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 et al. BMC Med. .

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.

Keywords: Abstinence; Cluster randomised controlled trial; E-cigarettes; Health inequalities; Homelessness; Smoking cessation; Smoking reduction; Tobacco harm reduction.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was granted by London Southbank University (LSBU) ethics committee: ETH2021-0176. The researcher obtained participant consent to (a) take part in the study, (b) be contacted regarding participation in a process evaluation interview, (c) share their anonymised data, and (d) be contacted long term (up to 2 years). Consent for publication: Not applicable. Competing interests: FP, AF, RB, EW, LM, DR, AV, CM, JL, JB, AE, PH, AT, SP, JL, BG and SC declare no competing interests. LD has acted as a paid consultant for Johnson & Johnson who manufacturer smoking cessation medications. KS has acted as a paid consultant for ThriveTribe who deliver stop smoking services and Pharmastrat Ltd a healthcare consulting company who deliver stop smoking services. CN has received an honorarium from Vox Media for filming a 'nicotine explainer' on the role of nicotine in addiction. LB is seconded part time to Scottish Government as their Chief Social Policy Adviser and in that role serve as Senior Responsible Officer for the Place and Wellbeing Programme.

Figures

Fig. 1
Fig. 1
SCeTCH CONSORT
See this image and copyright information in PMC

References

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