Smoking Cessation trials in Centres for the Homeless (SCeTCH)
Electronic cigarettes (EC) are electronic vaping devices that are handheld and produce for inhalation an aerosol formed by heating an e-liquid using a battery-powered heating coil.
EC are the most popular quit method used by smokers in the UK, and there is growing evidence for their effectiveness in clinical trials. EC may be a useful method of quitting for people who are heavily nicotine dependent as they are effective in delivering nicotine sometimes over and above Nicotine Replacement Therapy (NRT) products. To date, there is less evidence on how effective EC are for smoking cessation for people with pre-existing severe health and social needs. This evidence is needed to fully evaluate their public health and population impact.
In 2018 we ran a small four centre study offering EC or signposting to the stop smoking service to people accessing homeless services. We found people were willing to take part, staff at homeless centres were able to support the study, and we could collect data needed for a full trial. This full trial is now underway.
This study explores the effectiveness of EC versus usual care (UC) to people accessing homeless support services. At the current time, in these settings, UC involves a referral to a traditional NHS stop smoking service (SSS). SSS provide licensed NRT alongside behavioural support. While these methods are effective for many, for those with competing needs, this may not be enough. EC with effective nicotine delivery and ability to replicate some of the sensory aspects of smoking (e.g., hand to mouth action, deep inhalation) may enhance quit rates. Offering EC at a place which people who are experiencing homelessness are already seeking support, may also be advantageous.
The study aims to address the following questions:
- What is the effectiveness and cost-effectiveness of providing free EC starter kits to smokers accessing homeless centres compared with UC?
- How is the EC intervention implemented and how does organisational and geographic context influence implementation?
- What are the mechanisms through which the delivered intervention activities and participant interactions produce change in smoking behaviour?
- If the intervention is effective and cost-effective, what are the facilitators and barriers to successful implementation across Great Britain?
What are we doing?
Our study takes place in 32 homeless centres across five areas in Great Britain (GB): Scotland; Wales; London; South-East England and East England. Centres were supported by the provision of information about smoking and smoking cessation, and we introduced the study to centres service users.
Once people agreed to take part, we asked them to complete questionnaires asking about their smoking and health. They also breathed into a breathalyser which measures carbon monoxide (CO; a harmful chemical produced by smoking) which told us whether the person has recently smoked.
Those in the EC group were given an EC starter kit, 4 weeks supply of e-liquids and support to use it. Those in the UC group were given information and advice about stopping smoking and signposted to the local Stop Smoking Service (SSS). We saw everyone again at 4, 12 and 24 weeks to ask them about their quit attempts, current smoking, EC use, health, and CO level.
We also looked at how delivery of the intervention worked, and which parts of the intervention led to a change (if any) in participants’ smoking and if the interventions help people to stop smoking, we also spoke to key stakeholders.
Contact us
For further information, or an informal discussion about the project please contact Kirstie at soark@lsbu.ac.uk or Lynne at dawkinl3@lsbu.ac.uk.
You can also follow us on Twitter.
If you would like further information on the trial or would like to be added to our mailing list to receive updates on trial progress, trial findings and future dissemination and networking events, please contact our Trial manager Kirstie, on soark@lsbu.ac.uk.
Centre partners
The SCeTCH project is a partnership with 9 institutions: London South Bank University, University College London, University of East Anglia, University of Stirling, Cardiff University , Kings College London, Queen Mary University Londonhttps://www.qmul.ac.uk/wolfson/, University of Edinburgh, University of York. The project is funded by the National Institute of Health Research (NIHR).
Management Team
- Prof. Lynne Dawkins, Co Principal Investigator, London South Bank University
- Dr Sharon Cox, Co Principal Investigator, University College London
- Dr Kirstie Soar, Clinical Trial Manager, London South Bank University
- Prof. Caitlin Notley, Co-investigator (area lead), University of East Anglia
- Dr Rachel Brown, Co-investigator (area lead), Cardiff University
- Dr Allison Ford, Co-investigator (area lead), University of Stirling
- Bethany Gardner, Trial Administrator, London South Bank University
SCeTCH Team
- Dr Allan Tyler, Co-investigator, London South Bank University
- Janine Brierley, Research Associate, London South Bank University
- Charlotte Mair, Research Associate, London South Bank University
- Dr Emma Ward, Research Fellow, University of East Anglia
- Anna Varley, Research Associate, University of East Anglia
- Jessican Lennon, Research Associate, Cardiff University
- Amy Edwards, Research Associate, Cardiff University
- Lauren McMillan, Research Associate, Stirling University
- Danielle Mitchell, Research Associate, Stirling University
- Dr Francesca Pesola, Co-investigator, Queen Mary University London
- Dr Deborah Robson, Co-investigator, Kings College London
- Steve Parrott, Co-investigator, University of York
- Prof. Linda Bauld, Co-investigator, University of Edinburgh
- Prof. Peter Hajek, Collaborator, QMUL
- Matt Carlisle, PPI Co-investigator, Centrepoint
- Soar K, Cox S, Dawkins LE (2023) Lessons learnt from Project SCeTCH: a multi-centre cluster randomised controlled trial evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation in those accessing homeless services. Smoking Cessation and Health UK 2023.
- Soar K, Mair C, Cox S, Dawkins LE (2023) Square pegs, round holes: issues and considerations of running a cluster randomised control trials in people experiencing homelessness. SRNT-e Annual Conference, Sept 2023.
- McMillan L , Mair C, Soar K, Ford A (2023) Barriers and facilitators to delivering a usual care smoking intervention as part of a cRCT based in services for people experiencing homelessness: researcher observations. SRNTe. September 2023.
- Soar K, Brierley J, Gardner B, Mair C (2023) Smoking Cessation in those experiencing homelessness in GB: e-cigarette provision versus usual care. CRN South London Research Forum, 2023. First prize in the Under-served communities and health inequalities poster competition - awarded £5000 to continue EDI work on the project.
- Varley A, McMillan L, Ford A, Ward E (2022) A qualitative exploration of homeless smokers and the services they receive: contextual factors. French National Cancer Institute, E-cigarette Conference, December 2022.
- Soar K, Cox S, Dawkins LE (2022) A multi-centre cluster randomised controlled trial evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation when offered to smokers accessing homeless services: methodological challenges and experiences of collaboration. SSA Annual Conference 2022. November 2022
- Dawkins LE, Cox S (2022) Evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation when offered to smokers at homeless centres: A multi-centre cluster-randomized controlled trial in Great Britain. CRUK E-cigarette Forum. October 2022
- Soar K, Mair, C, Dawkins LE, Bauld L, Brown R, Lennon J, Ford A, McMillan L, Hajek P, Li J, Parrott S, Notley C, Ward E, Varley A. Robson D, Pesola F, Tyler A, Carlisle M, Tyler A, Cox S. (2022) Effects of e-cigarettes vs usual care for smoking cessation when offered at homeless centres: Protocol for a cluster randomised controlled trial. LNNM Conference 2022. 1st April 2022. Poster presentation and prize winner
- NIHR Project Page: Effects of e-cigarettes vs usual care for smoking cessation when offered at homeless centres: A cluster randomised controlled trial - NIHR Funding and Awards
- Let’s Talk E-cigarettes: University of Oxford. http://podcasts.ox.ac.uk/episode-12-dr-sharon-cox
- Lennon J (2022) Could free e-cigarettes help people experiencing homelessness to quit smoking? DECIPHer Blog https://decipher.uk.net/could-free-e-cigarettes-help-people-experiencing-homelessness-to-quit-smoking/
- Cox S, Bauld L, Brown R, Carlisle M, Ford A, Hajek P, Li J, Notley C, Parrott S, Pesola F, Robson D, Soar K, Tyler A, Ward E, Dawkins L (2021) Evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation when offered to smokers at homeless centres: protocol for a multi-centre cluster-randomized controlled trial in Great Britain. Addiction, https://doi.org/10.1111/add.15851
- Cox S, Ford A, Li J, Best C, Tyler A, Robson DJ, et al. (2021): Exploring the uptake and use of electronic cigarettes provided to smokers accessing homeless centres: a four-centre cluster feasibility trial. Public Health Res 9(7) https://www.journalslibrary.nihr.ac.uk/phr/phr09070/#/abstract
- June 2021: £1.7million grant funds world-first LSBU e-cigarette trial to help homeless quit smoking
- Dawkins LE, Bauld L, Ford A, Robson D, Hajek P, Parrott S, Bes C, Li J, Tyler A, Uny I, Cox S (2020): A cluster feasibility trial to explore the uptake and use of e-cigarettes versus usual care offered to smokers attending homeless centres in Great Britain. PLoS One https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240968