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.
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
PublisherPAGEpress
ISSN2279-9028
Publication process dates
Accepted15 Dec 2020
Deposited16 Dec 2020
Accepted author manuscript
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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