{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T12:16:09Z","timestamp":1780488969872,"version":"3.54.1"},"reference-count":68,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2019,4,1]],"date-time":"2019-04-01T00:00:00Z","timestamp":1554076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Abuse"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Background:<\/jats:italic>\n                    Smoking prevalence and mortality is 5 times higher for the chronically homeless versus general population. Unfortunately, traditional smoking cessation treatment does not optimally engage this population. In a preliminary study, smokers experiencing chronic homelessness suggested providers avoid giving advice to quit and instead use a more compassionate, nonjudgmental style to discuss a broader menu of patient-driven options, including safer nicotine use. Most had negative perceptions of smoking cessation medications; however, 76% expressed interest in a switchover to electronic nicotine delivery systems (ENDS).\n                    <jats:italic toggle=\"yes\">Methods:<\/jats:italic>\n                    Using a community-based participatory research approach, we codeveloped harm-reduction treatment for smoking (HaRT-S) together with people with lived experience of chronic homelessness and smoking and a community-based agency that serves them. In HaRT-S, interventionists embody a compassionate, advocacy-oriented \u201cheart-set\u201d and deliver manualized components: a) participant-led tracking of smoking-related outcomes, b) elicitation of harm-reduction goals and progress made toward them, c) discussion of relative risks of nicotine delivery systems, and d) distribution and instructions on use of safer nicotine products. We then conducted a single-arm, 14-week pilot of HaRT-S (\n                    <jats:italic toggle=\"yes\">N<\/jats:italic>\n                    \u2009=\u200944).\n                    <jats:italic toggle=\"yes\">Results:<\/jats:italic>\n                    Participants rated procedures \u201ctotally acceptable\/effective,\u201d which was reflected in 26% overrecruitment within a 4-month period and 70% retention at the 14-week follow-up. For each week in the study, participants experienced an 18% increase in odds of reporting 7-day, biochemically verified, point-prevalence abstinence. All participants reporting abstinence used ENDS. Participants evinced reductions in cigarette dependence (\u221245%), frequency (-29%), and intensity (\u221278%;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    s\u2009&lt;\u2009.05). Participants who used ENDS experienced an additional 44% reduction in smoking intensity and a 1.2-point reduction in dependence compared to participants who did not.\n                    <jats:italic toggle=\"yes\">Conclusions:<\/jats:italic>\n                    Harm-reduction counseling plus ENDS shows promise for smokers experiencing chronic homelessness. Randomized controlled trials are needed to establish the efficacy of this approach in decreasing smoking-related harm and improving health-related quality of life for this marginalized and disproportionately affected population.\n                  <\/jats:p>","DOI":"10.1080\/08897077.2019.1572049","type":"journal-article","created":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T10:45:26Z","timestamp":1553856326000},"page":"229-239","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Harm Reduction Treatment for Smoking (Hart-S): Findings from a Single-Arm Pilot Study with Smokers Experiencing Chronic Homelessness"],"prefix":"10.1177","volume":"40","author":[{"given":"Susan E.","family":"Collins","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lonnie A.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Washington State University West Campus, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joey","family":"Stanton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Mayberry","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"Ubay","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvi C.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Saxon","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"},{"name":"Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel K.","family":"Malone","sequence":"additional","affiliation":[{"name":"Downtown Emergency Service Center, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seema L.","family":"Clifasefi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kolawole","family":"Okuyemi","sequence":"additional","affiliation":[{"name":"University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The HaRT-S Community Advisory Board","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,4,1]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6544a2"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2010.03.024"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201100398"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.5.1719"},{"key":"e_1_3_5_6_2","first-page":"2629","article-title":"Risk factors for cardiovascular disease in homeless adults","volume":"111","author":"Lee TC","year":"2005","unstructured":"Lee TC, , Hanlon JG, , Ben-David J, . 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