Exploring the uptake and use of electronic cigarettes provided to smokers accessing homeless centres: a four-centre cluster feasibility study

Journal article


Cox, S., Ford, A., Li, Ji., Best, C., Tyler, A., Robson, D., Bauld, L., Hajek, P., Uny, I., Parrott, S. and Dawkins, L. (2020). Exploring the uptake and use of electronic cigarettes provided to smokers accessing homeless centres: a four-centre cluster feasibility study. Journal of Public Health Research. 9 (7). https://doi.org/10.3310/phr09070
AuthorsCox, S., Ford, A., Li, Ji., Best, C., Tyler, A., Robson, D., Bauld, L., Hajek, P., Uny, I., Parrott, S. and Dawkins, L.
Abstract

Background
Smoking prevalence is extremely high in adults experiencing homelessness and there is little evidence regarding which cessation interventions work best. This study explored the feasibility of providing free e-cigarette (EC) starter kits to smokers accessing homeless centres in the UK

Objectives
Seven key objectives were examined to inform a future trial. 1: Assess willingness of smokers to participate in the study to estimate recruitment rates. 2: Assess participant retention in the intervention and control groups. 3: Examine the perceived value of the intervention, facilitators and barriers to engagement and influence of local context. 4: Assess service providers’ capacity to support the study and the type of information and training required. 5: Assess the potential efficacy of supplying free EC starter kits. 6: Explore the feasibility of collecting data on contact with health care services as an input to a main economic evaluation. 7: Estimate the cost of providing the intervention and usual care.

Design
A prospective cohort four-centre pragmatic cluster feasibility study with embedded qualitative process evaluation.

Setting
Four homeless centres. Two residential units in London, England. One day centre in Northampton, England. One day centre in Edinburgh, Scotland.

Intervention
Intervention arm: A single refillable EC was provided with e-liquid provided once a week for four weeks (choice of three flavours: fruit, menthol, tobacco and two nicotine strengths: 12mg/mL or 18mg/mL). Written information for EC use and support. Usual care arm: Written information on quitting smoking (adapted from NHS Choices) and signposting to the local stop smoking service (SSS).

Results
Fifty-two percent of eligible participants invited to take part in the study were successfully recruited (56% in the EC arm; 50.5% in the UC arm; total N=80). Retention rates were 75%, 63% and 59% respectively at 4, 12 and 24 weeks. The qualitative component found perceived value of the intervention was high. Barriers were participant’s personal difficulties and cannabis use. Facilitators were participants’ desire to change, free EC and social dynamics. Staff capacity to support the study was generally good. Carbon Monoxide (CO) validated sustained abstinence rates at 24 weeks were 6.25% (3/48) in the EC arm vs. 0/32 (0%) in the UC arm (intention to treat). Almost all participants present at follow-up visits completed measures needed for input into an economic evaluation although information about staff time to support UC could not be gathered. The cost of providing the EC intervention was estimated to be £114.42 per person. Estimated cost could not be completed for UC.

Limitations
Clusters could not be fully randomised due to lack of centre readiness. The originally specified recruitment target was not achieved and recruitment was particularly difficult in residential centres. Blinding was not possible for the measurement of outcomes. Staff time supporting UC could not be collected.

Conclusions
The study was associated with reasonable recruitment and retention rates and promising acceptability in the EC arm. Data required for full cost-effectiveness evaluation in the EC arm could be collected but some data was not available in the UC arm.

Future work: Future research should focus on several key issues to help design optimal studies and interventions with this population, including: which types of centres the intervention works best in; how best to retain participants in the study; how to help staff to deliver the intervention and how best to record staff treatment time given the demands on their time.

Keywordse-cigarettes; smoking; tobacco; homeless; feasibility study
Year2020
JournalJournal of Public Health Research
Journal citation9 (7)
PublisherNational Institute for Health Research
ISSN2279-9028
Digital Object Identifier (DOI)https://doi.org/10.3310/phr09070
Publication dates
Print01 May 2021
Publication process dates
Accepted15 Dec 2020
Deposited16 Dec 2020
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Open
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Nodin, N, Peel, E, Tyler, A and Rivers, I (2015). The RaRE Research Report: LGB&T Mental Health - Risk and Resilience Explored. London PACE.
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.
Soar, K., Cox, S. and Dawkins, L. (2018). 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, Society for the Study of Addiction. Newcastle 07 - 08 Nov 2018 Society for the Study of Addiction.
Optics and Illusions of Street Drinking in East London: A thematic analysis
Tyler, A., Cox, S. and Moss, A. (2018). Optics and Illusions of Street Drinking in East London: A thematic analysis. SSA Annual Conference, Society for the Study of Addiction. Newcastle 07 - 08 Nov 2018
A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence
Ward, E, Cox, SA, Dawkins, LE, Jakes, S, Holland, R and Notley, C (2018). A Qualitative Exploration of the Role of Vape Shop Environments in Supporting Smoking Abstinence. International Journal of Environmental Research and Public Health. 15 (2), p. 297. https://doi.org/10.3390/ijerph15020297
Aspects of alcohol use disorder affecting social cognition as assessed using the Mini Social and Emotional Assessment (mini-SEA)
Cox, SA, Bertoux, M, Turner, JJD, Moss, AC, Locker, K and Riggs, K (2018). Aspects of alcohol use disorder affecting social cognition as assessed using the Mini Social and Emotional Assessment (mini-SEA). Drug and Alcohol Dependence. 187, pp. 165-170. https://doi.org/10.1016/j.drugalcdep.2018.03.004
'Real-world' compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure
Dawkins, LE, Cox, SA, Goniewicz, M, McRobbie, H, Kimber, CF, Doig, M and Kosmider, L (2018). 'Real-world' compensatory behaviour with low nicotine concentration e-liquid: subjective effects and nicotine, acrolein and formaldehyde exposure. Addiction. 113 (10), pp. 1874-1882. https://doi.org/10.1111/add.14271
The unique contribution of e-cigarettes for tobacco harm reduction in supporting smoking relapse prevention
Notley, C, Ward, E, Dawkins, LE and Holland, R (2018). The unique contribution of e-cigarettes for tobacco harm reduction in supporting smoking relapse prevention. Harm Reduction Journal. 15 (1). https://doi.org/10.1186/s12954-018-0237-7
Global and local perspectives on tobacco harm reduction: what are the issues and where do we go from here?
Cox, SA and Dawkins, LE (2018). Global and local perspectives on tobacco harm reduction: what are the issues and where do we go from here? Harm Reduction Journal. 15 (32). https://doi.org/10.1186/s12954-018-0239-5
Automatic visual-spatial perspective taking in alcohol-dependence: a study with happy emotional faces
Cox, SA, Maurage, P, O'Connor, R, Chandler, C and Riggs, K (2018). Automatic visual-spatial perspective taking in alcohol-dependence: a study with happy emotional faces. Drug and Alcohol Dependence. 190, pp. 42-45. https://doi.org/10.1016/j.drugalcdep.2018.05.025
LGBT people and suicidality in youth: A qualitative study of perceptions of risk and protective circumstances
Rivers, I, Gonzalez, C, Nodin, N, Peel, E and Tyler, A (2018). LGBT people and suicidality in youth: A qualitative study of perceptions of risk and protective circumstances. Social Science and Medicine. 212, pp. 1-8. https://doi.org/10.1016/j.socscimed.2018.06.040
A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness
Hickling, L, Perez-Iglesias, R, McNeil, A, Dawkins, LE, Moxham, J, Ruffell, T, Sendt, K-V and McQuire, P (2018). A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness. Psychological Medicine. 49 (6), pp. 1033-1040. https://doi.org/10.1017/S0033291718001782
Correction: Global and local perspectives on tobacco harm reduction: What are the issues and where do we go from here? [Harm Reduct J., 15, (2018) (32)] DOI: 10.1186/s12954-018-0239-5
Cox, S and Dawkins, L (2018). Correction: Global and local perspectives on tobacco harm reduction: What are the issues and where do we go from here? [Harm Reduct J., 15, (2018) (32)] DOI: 10.1186/s12954-018-0239-5. Harm Reduction Journal. 15 (1), p. 37. https://doi.org/doi.org/10.1186/s12954-018-0242-x
Nicotine absorption from e-cigarettes over 12 months
Soar, K, Kimber, CF, McRobbie, H and Dawkins, LE (2018). Nicotine absorption from e-cigarettes over 12 months. Addictive Behaviors. 91, pp. 102-105. https://doi.org/10.1016/j.addbeh.2018.07.019
Messages matter: The Tobacco Products Directive nicotine addiction health warning versus an alternative relative risk message on smokers' willingness to use and purchase an electronic cigarette
Cox, S, Frings, D., Ahmed, R and Dawkins, L. (2018). Messages matter: The Tobacco Products Directive nicotine addiction health warning versus an alternative relative risk message on smokers' willingness to use and purchase an electronic cigarette. Addictive Behaviors Reports. 8, pp. 136-139. https://doi.org/10.1016/j.abrep.2018.09.006
The effects of the European E-cigarette health warning and comparative health messages on non-smokers' and smokers' risk perceptions and behavioural intentions: study protocol
Kimber, C, Frings, D, Cox, S, Albery, I and Dawkins, L (2018). The effects of the European E-cigarette health warning and comparative health messages on non-smokers' and smokers' risk perceptions and behavioural intentions: study protocol. BMC Public Health. 18 (1259). https://doi.org/10.1186/s12889-018-6161-7
Vaping as an alternative to smoking relapse following brief lapse
Notley, C, Ward, E, Dawkins, L, Holland, R and Jakes, S (2018). Vaping as an alternative to smoking relapse following brief lapse. Drug and Alcohol Review. 38 (1), pp. 68-75. https://doi.org/10.1111/dar.12876
Helping you helps me: Giving and receiving social support in recovery groups for problem gamblers
Hutchison, P, Cox, S and Frings, DJ (2018). Helping you helps me: Giving and receiving social support in recovery groups for problem gamblers. Group Dynamics: Theory, Research, and Practice. 22 (4), pp. 187-199. https://doi.org/10.1037/gdn0000090
Response to Campbell et al., (2018) - Health risk perceptions and reasons for use of tobacco products among clients in addictions treatment
Cox, S and Notley, C (2018). Response to Campbell et al., (2018) - Health risk perceptions and reasons for use of tobacco products among clients in addictions treatment. Addictive Behaviors. 90, pp. 378-379. https://doi.org/10.1016/j.addbeh.2018.11.047
An exploration into “do-it-yourself” (DIY) e-liquid mixing: Users' motivations, practices and product laboratory analysis
Cox, S, Dawkins, L, Leigh, N, Choo, E, Vanderbush, T and Goniewicz, M (2018). An exploration into “do-it-yourself” (DIY) e-liquid mixing: Users' motivations, practices and product laboratory analysis. Addictive Behaviors Reports. 9, p. 100151. https://doi.org/10.1016/j.abrep.2018.100151
Changing Behaviour: Electronic Cigarettes
Dawkins, LE and McRobbie, H (2017). Changing Behaviour: Electronic Cigarettes. British Psychological Society.
Sex Work
Tyler, A. (2017). Sex Work. in: Vossler, A., Harvard, C., Pike, G., Barker, M-J. and Raabe, B. (ed.) Mad or Bad? A Critical Approach to Counselling and Forensic Psychology London Sage.
Nicotine and e-cigarettes: Rethinking addiction in the context of reduced harm.
Cox, SA and Jakes, S (2017). Nicotine and e-cigarettes: Rethinking addiction in the context of reduced harm. International Journal of Drug Policy. 44, pp. 84-85. https://doi.org/10.1016/j.drugpo.2017.03.009
Compensatory puffing with lower nicotine concentration e-liquids increases carbonyl exposure in e-cigarette aerosols
Dawkins, LE, Kosmider, L, Kimber, C., Kurek, J and Corcoran, O (2017). Compensatory puffing with lower nicotine concentration e-liquids increases carbonyl exposure in e-cigarette aerosols. Nicotine and Tobacco Research (OUP). 20 (8), p. 998=1003. https://doi.org/10.1093/ntr/ntx162
Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack
Heidebrecht, F, MacLeod, MB and Dawkins, LE (2017). Predictors of heroin abstinence in opiate substitution therapy in heroin-only users and dual users of heroin and crack. Addictive Behaviors. https://doi.org/https://doi.org/10.1016/j.addbeh.2017.10.013
E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure
Cox, S., Kośmider, L., McRobbie, H., Goniewicz, M., Kimber, C., Doig, M. and Dawkins, L. (2016). E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure. BMC Public Health. 16 (1). https://doi.org/DOI:10.1186/s12889-016-3653-1
Alcohol Gel Ingestion Among Homeless Eastern and Central Europeans in London: Assessing the Effects on Cognitive Functioning and Psychological Health
Dawkins, LE, Soar, K and Papaioannou, G (2016). Alcohol Gel Ingestion Among Homeless Eastern and Central Europeans in London: Assessing the Effects on Cognitive Functioning and Psychological Health. Substance Use and Misuse. https://doi.org/10.3109/10826084.2016.1168441
Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects
Dawkins, LE, Kimber, C., Doig, M, Feyerabend, C and Corcoran, O (2016). Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects. Psychopharmacology. 233 (15), pp. 2933-2941. https://doi.org/10.1007/s00213-016-4338-2
The effect of alcohol dependence on automatic visuo-spatial perspective taking
Cox, S, Chandler, C, Simpson, A and Riggs, K (2016). The effect of alcohol dependence on automatic visuo-spatial perspective taking. Drug and Alcohol Dependence. 166, pp. 21-25. https://doi.org/10.1016/j.drugalcdep.2016.06.007
E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure (study protocol)
Dawkins, LE, Cox, SA, Kosmider, L, McRobbie, H, Goniewicz, M, Kimber, CF and Doig, M (2016). E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure (study protocol). BMC Public Health. 16. https://doi.org/10.1186/s12889-016-3653-1
Adolescent awareness and use of electronic cigarettes: A review of emerging trends and findings
Dawkins, LE, Greenhill, R, Notley, C, Finn, M and Turner, J (2016). Adolescent awareness and use of electronic cigarettes: A review of emerging trends and findings. Journal of Adolescent Health. 59 (6), pp. 612-619. https://doi.org/10.1016/j.jadohealth.2016.08.005
Recreational cocaine use is associated with attenuated latent inhibition
Soar, K., Dawkins, L., Page, F. and Woolridge, J. (2015). Recreational cocaine use is associated with attenuated latent inhibition. Addictive Behaviors. 50 (34-39). https://doi.org/10.1016/j.addbeh.2015.06.010
The effects of e-cigarette visual appearance on craving and withdrawal symptoms in abstinent smokers
Dawkins, L., Munafo, M., Christoforou, G., Olumegbon, N. and Soar, K. (2015). The effects of e-cigarette visual appearance on craving and withdrawal symptoms in abstinent smokers. Psychology of Addictive Behaviors. 30 (1), pp. 101-105. https://doi.org/10.1037/adb0000112
M$M@Gaydar - Queering the Social Network
Tyler, A. (2015). M$M@Gaydar - Queering the Social Network. in: M. Laing, K. Pilcher & N. Smith (ed.) Queer Sex Work Routledge (Taylor & Francis Group). pp. 140-150
Acute electronic cigarette use: nicotine delivery and subjective effects in regular users
Dawkins, L. and Corcoran, O. (2014). Acute electronic cigarette use: nicotine delivery and subjective effects in regular users. Psychopharmacology. 231 (2), pp. 401-407. https://doi.org/10.1007/s00213-013-3249-8
First‐ versus second‐generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptoms
Dawkins, L., Kimber, C., Puwanesarasa, Y. and Soar, K. (2014). First‐ versus second‐generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptoms. Addiction. 110 (4), pp. 669-677. https://doi.org/10.1111/add.12807
Water consumption, not expectancies about water consumption, affects cognitive performance in adults
Edmonds, C.J., Crombie, R., Baillieux, H., Gardner, M.R. and Dawkins, L. (2013). Water consumption, not expectancies about water consumption, affects cognitive performance in adults. Appetite. 60, pp. 148-153. https://doi.org/10.1016/j.appet.2012.10.016
Vaping? profiles and preferences: an online survey of electronic cigarette users
Dawkins, L. (2013). Vaping? profiles and preferences: an online survey of electronic cigarette users. UEL Research and Knowledge Exchange Conference 2013. London 26 Jun 2013 University of East London.
Neuropsychological effects associated with recreational cocaine use
Soar, K., Mason, C., Potton, A. and Dawkins, L. (2012). Neuropsychological effects associated with recreational cocaine use. Psychopharmacology. 222, pp. 633-643. https://doi.org/10.1007/s00213-012-2666-4
The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition
Dawkins, L., Turner, J.J.D., Hasna, S. and Soar, K. (2012). The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition. Addictive Behaviors. 37, pp. 970-973. https://doi.org/10.1016/j.addbeh.2012.03.004
Investigating the impact of nicotine on executive functions using a novel virtual reality assessment
Jansari, A.S., Froggatt, D., Edginton, T. and Dawkins, L. (2012). Investigating the impact of nicotine on executive functions using a novel virtual reality assessment. Addiction. 108, pp. 977-984.
Nicotine derived from the electronic cigarette improves time-based prospective memory in abstinent smokers
Dawkins, L., Turner, J.J.D. and Crowe, E. (2012). Nicotine derived from the electronic cigarette improves time-based prospective memory in abstinent smokers. Psychopharmacology. 227, pp. 377-384.
Effects of nicotine and alcohol on affective responses to emotionally toned film clips
Dawkins, L. and Powell, J (2011). Effects of nicotine and alcohol on affective responses to emotionally toned film clips. Psychopharmacology. 216, pp. 197-205. https://doi.org/10.1007/s00213-011-2197-4
Expectation of having consumed caffeine can improve performance and mood
Dawkins, L., Shahzad, F.-Z., Ahmed, S.S and Edmonds, C.J. (2011). Expectation of having consumed caffeine can improve performance and mood. Appetite. 57, pp. 597-600. https://doi.org/10.1016/j.appet.2011.07.011
Relapse to smoking during unaided cessation: clinical, cognitive, and motivational predictors
Powell, J.H., Dawkins, L., West, R., Powell, J.F. and Pickering, A. (2010). Relapse to smoking during unaided cessation: clinical, cognitive, and motivational predictors. Psychopharmacology. 212, pp. 537-549. https://doi.org/10.1007/s00213-010-1975-8
Patterns of change in withdrawal symptoms, desire to smoke, reward motivation and response inhibition across 3 months of smoking abstinence
Dawkins, L., Powell, J.H., Pickering, A., Powell, J. and West, R. (2009). Patterns of change in withdrawal symptoms, desire to smoke, reward motivation and response inhibition across 3 months of smoking abstinence. Addiction. 104, pp. 850-858. https://doi.org/10.1111/j.1360-0443.2009.02522.x
The effects of cigarette smoking and abstinence on auditory verbal learning
Soar, K., Dawkins, L., Begum, H. and Parrott, A.C. (2008). The effects of cigarette smoking and abstinence on auditory verbal learning. Human Psychopharmacology: Clinical and Experimental. 23, pp. 621-627. https://doi.org/10.1002/hup.968
The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips
Dawkins, L., Acaster, S. and Powell, J.H. (2007). The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips. Addictive Behaviors. 32, pp. 425-431. https://doi.org/10.1016/j.addbeh.2006.05.010
A double-blind placebo controlled experimental study of nicotine: II - Effects on response inhibition and executive functioning
Dawkins, L., Powell, J.H., West, R., Powell, J. and Pickering, A. (2007). A double-blind placebo controlled experimental study of nicotine: II - Effects on response inhibition and executive functioning. Psychopharmacology. 190, pp. 457-467. https://doi.org/10.1007/s00213-006-0634-6
A double-blind placebo controlled experimental study of nicotine: I - Effects on incentive motivation
Dawkins, L., Powell, J.H., West, R., Powell, J. and Pickering, A. (2006). A double-blind placebo controlled experimental study of nicotine: I - Effects on incentive motivation. Psychopharmacology. 189, pp. 355-367. https://doi.org/10.1007/s00213-006-0588-8
Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation
Powell, J.H., Pickering, A.D., Dawkins, L., West, R. and Powell, J.F. (2004). Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation. Addictive Behaviors. 29, pp. 1407-1426. https://doi.org/10.1016/j.addbeh.2004.06.006
Smoking, reward responsiveness, and response inhibition: tests of an incentive motivational model
Powell, J.H., Dawkins, L. and Davis, R.E. (2002). Smoking, reward responsiveness, and response inhibition: tests of an incentive motivational model. Biological Psychiatry. 51, pp. 151-163. https://doi.org/10.1016/S0006-3223(01)01208-2