E-Cigarettes May Have the Potential to Engage Homeless Populations

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Lindsey Stroud

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AVA Synopsis:


The study’s authors aimed to “assess the feasibility of supplying free e-cigarette starter kits” to smokers using homeless centers and “to estimate parameters to inform a possible future larger trial.”

The authors note that, similar to the United States, smoking prevalence is higher among disadvantaged populations and “smoking-related deaths are two to three times higher among disadvantaged groups.”

The authors sought to understand the willingness of smokers’ participation, retention rates, the success of e-cigarettes, the economics, and the “cost of providing the intervention and usual care.” Baseline measures consisted of various demographic and substance use information, including homeless status and history, cigarette history, severity of tobacco dependence and motivation to stop smoking, alcohol and drug use, mental health status, general health care and health status.

The authors used four homeless centers in Great Britain and non-randomly allocated centers to either a Usual Care arm, or the control group, and the E-cigarette arm, where participants received an e-cigarette started kit and four-week supply of e-liquid.

Just over half of invited persons participated, including consenting “to take part and completed baseline assessments.” Overall, the 24 week total participant retention rate was 59 percent, which favorably compares “with other smoking cessation studies” in disadvantaged populations, but “is likely to be an issue” when engaging with persons at homeless centers.

Electronic cigarettes “were well tolerated with high score for self-reported positive effects e.g. ‘pleasant’ and ‘tastes good.’” Further, the majority of users in the EC arm reported “that they still had, and were still using, the e-cigarette at the 24 week follow up,” and by the follow up, 31 percent reported having had purchased their own e-cigarette. Overall, three of 48 participants had CO-validated abstinence from combustible cigarettes in the electronic cigarette arm, compared to zero participants in the Usual Care arm.

The authors conclude that the study demonstrates “promising evidence and acceptability and efficacy of offering free [e-cigarette] starter kits to smokers accessing homeless” centers.

Implications:


Lower income persons disproportionately use combustible cigarette products. Although governmental agencies supply free quit smoking services, most rely on nicotine replacement therapy and other methods. Policymakers should be aware of the usefulness of e-cigarettes in helping homeless populations quit smoking, and provide such products in existing quit smoking programs.

Abstract


Smoking rates in the UK are at an all-time low but this masks considerable inequalities; prevalence amongst adults who are homeless remains four times higher than the national average. The objective of this trial was to assess the feasibility of supplying free e-cigarette starter kits to smokers accessing homeless centres and to estimate parameters to inform a possible future larger trial. In this feasibility cluster trial, four homeless centres in Great Britain were non-randomly allocated to either a Usual Care (UC) or E-Cigarette (EC) arm. Smokers attending the centres were recruited by staff. UC arm participants (N = 32) received advice to quit and signposting to the local Stop Smoking Service. EC arm participants (N = 48) received an EC starter kit and 4-weeks supply of e-liquid. Outcome measures were recruitment and retention rates, use of ECs, smoking cessation/reduction and completion of measures required for economic evaluation. Eighty (mean age 43 years; 65% male) of the 153 eligible participants who were invited to participate, were successfully recruited (52%) within a five-month period, and 47 (59%) of these were retained at 24 weeks. The EC intervention was well received with minimal negative effects and very few unintended consequences (e.g. lost, theft, adding illicit substances). In both study arm, depression and anxiety scores declined over the duration of the study. Substance dependence scores remained constant. Assuming those with missing follow up data were smoking, CO validated sustained abstinence at 24 weeks was 3/48 (6.25%) and 0/32 (0%) respectively for the EC and UC arms. Almost all participants present at follow-up visits completed data collection for healthcare service and health-related quality of life measures. Providing an e-cigarette starter kit to smokers experiencing homelessness was associated with reasonable recruitment and retention rates and promising evidence of effectiveness and cost-effectiveness.

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