{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:05:08Z","timestamp":1784030708278,"version":"3.55.0"},"reference-count":35,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001921","name":"Public Health Research programme","doi-asserted-by":"publisher","award":["NIHR132158"],"award-info":[{"award-number":["NIHR132158"]}],"id":[{"id":"10.13039\/501100001921","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec id=\"abs1-1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Smoking rates are up to four times higher among people experiencing homelessness compared to the housed population and how to support them to quit is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-2\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To test the effectiveness and cost-effectiveness of providing e-cigarettes to people accessing homeless support services to stop smoking. To explore implementation fidelity, contextual influences and mechanisms of change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-3\">\n                    <jats:title>Trial design<\/jats:title>\n                    <jats:p>A two-arm cluster randomised controlled trial with cost-effectiveness and mixed-methods process evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-4\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Setting and participants: Thirty-two homeless centres (clusters) across Great Britain. Participants were aged 18+ years and known by centre staff to smoke. Sixteen staff and 31 participants in electronic cigarette centres completed qualitative interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-5\">\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Clusters were randomised (1\u2005:\u20051) to electronic cigarettes or usual care prior to staff training. Electronic cigarette participants received a refillable electronic cigarette, 4 weeks\u2019 supply of e-liquid and a fact sheet. Usual care participants received very brief advice on smoking, a support leaflet and signposting to Stop Smoking Service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-6\">\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Primary outcome: Carbon-monoxide-verified sustained smoking abstinence from 2 weeks post baseline to 24 weeks.<\/jats:p>\n                    <jats:p>Secondary outcomes: Carbon-monoxide-verified 7-day point prevalence abstinence, &lt;\u200550% smoking reduction, intervention costs, quality-adjusted life-years, implementation fidelity and mechanisms of change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-7\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixteen centres were randomised to electronic cigarettes (\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u2005239 participants) and 16 to usual care (\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u2005238 participants). In usual care, one participant died, and one withdrew consent. Final sample analysed:\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u2005239 (electronic cigarette);\n                      <jats:italic>n<\/jats:italic>\n                      \u2005=\u2005236 (usual care). Sustained 24-week carbon-monoxide-verified smoking cessation rates were 5\/239 (2.1%) with electronic cigarettes versus 2\/236 (0.8%) with usual care (adjusted risk ratio 2.43, 95% confidence interval 0.51 to 11.64); 7-day point prevalence abstinence at 24 weeks was 15\/239 (6.3%) with electronic cigarettes versus 5\/236 (2.1%) with usual care (adjusted risk ratio 2.95, 95% confidence interval 1.05 to 8.29). Smoking reduction (&lt;\u200550%) at 24 weeks was 83\/239 (34.7%) with electronic cigarettes versus 40\/236 (17%) with usual care (adjusted risk ratio 2.02, 95% confidence interval 1.44 to 2.84). Four adverse events were reported in the electronic cigarette arm; three electronic cigarette-related and not serious; one serious and not electronic cigarette-related.\n                    <\/jats:p>\n                    <jats:p>Mean per participant intervention costs were \u00a392 (standard error \u00a30) for electronic cigarettes and \u00a350 (standard error \u00a30) for usual care. Mean total costs were \u00a33859 (standard error \u00a3441) versus \u00a32716 (standard error \u00a3386) in electronic cigarette and usual care groups, respectively. Quality-adjusted life-years were estimated at 0.303 (standard error 0.008) for electronic cigarettes and 0.295 (standard error 0.010) for usual care. From National Health Service and Personal Social Services perspective, the electronic cigarette arm was \u00a31267 (95% confidence interval \u00a3219 to \u00a32347) more costly and yielded 0.007 (95% confidence interval \u22120.016 to 0.033) more quality-adjusted life-years than usual care. The incremental cost-effectiveness ratio was \u00a3181,000 per quality-adjusted life-year gain.<\/jats:p>\n                    <jats:p>Electronic cigarette intervention was delivered with high fidelity with no variation by centre size or location, although staff capacity and resourcing were barriers to implementation. Quit enablers included high capability to use electronic cigarettes, support from friends\/family and increased motivation following smoking reduction. Barriers included lack of satisfaction with electronic cigarettes compared with smoking, a strong smoking culture at centres and staff deprioritising tobacco-related harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-8\">\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>Low quit rates resulted in insufficient power to detect an effect on the primary effectiveness and cost-effectiveness outcomes, leading to uncertainty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-9\">\n                    <jats:title>Conclusions and future work<\/jats:title>\n                    <jats:p>Electronic cigarettes showed no effectiveness for 24 weeks\u2019 sustained smoking abstinence; 7-day point prevalence abstinence and smoking reduction were possible, and staff can support the intervention. Longer-term and potentially different types of support and systems change are needed to support sustained abstinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-10\">\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR132158.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3310\/gjld1918","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T12:22:19Z","timestamp":1758198139000},"page":"1-33","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of e-cigarettes vs usual care for smoking cessation when offered at homeless centres: the SCeTCH cRCT 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