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

Citation

Dawkins L, Soar K, Pesola F, Ford A, Notley C, Brown R, Ward E, McMillan L, Robson D, Varley A, Mair C, Lennon J, Brierley J, Edwards A & Hajek P (2025) 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. BMC Medicine, 23, Art. No.: 394. https://doi.org/10.1186/s12916-025-04167-y

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-weeks’ 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). 7- 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. 7-day point prevalence abstinence rates suggest that cessation is possible, but more support may be needed to sustain this.

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

Journal
BMC Medicine: Volume 23

• Published Version