Abstinence Reinforcement Therapy for Veterans Who Smoke Tobacco and Are Experiencing Homelessness

Summary

Seventy to eighty percent of Veterans experiencing homelessness (VEH) smoke, which is four times the rate of the U.S. population and 2.5 times higher than among impoverished Americans. Smoking- related deaths among persons experiencing homelessness occur at double the rate seen among more stably housed people. The purpose of this study study is to evaluate the effectiveness of an intervention to help Veterans experiencing homelessness stop smoking. The intervention, called Abstinence Reinforcement Therapy + (ART+), includes telehealth-based counseling, smoking cessation aids, and mobile contingency management (mCM). mCM is an intervention in which participants are paid for smoking abstinence. 120 Veterans who smoke cigarettes and are experiencing homelessness will be randomly assigned to receive either ART+ or usual smoking cessation care. The primary outcome to be evaluated is the rate at which Veterans assigned to the ART+ condition report smoking abstinence and have their abstinence verified using salivary testing.

Conditions

• Tobacco Use Disorder

Interventions

BEHAVIORAL

Cognitive Behavioral Therapy for Smoking Cessation

Five core sessions of CBT plus up to four monthly booster sessions designed to help Veterans prepare to quit smoking, make a quit attempt, and prevent relapse to smoking.

DRUG

Nicotine Replacement Therapy

NRT is a group of over-the-counter medications designed to help users quit smoking. Standard of care often involves use of nicotine patch plus one rescue method (either gum or lozenge).

DRUG

Bupropion

Bupropion is an FDA-approved prescription smoking cessation aid. Participants will be prescribed 150-300 mg.

DRUG

Varenicline

Varenicline is an FDA-approved prescription smoking cessation aid. Participants will be 0.5 to 2 mg.

BEHAVIORAL

Mobile Contingency Management

Smoking abstinence will be intermittently reinforced. For each carbon monoxide (CO) reading that a participant provides that suggest smoking abstinence, the participant will earn spins on a virtual prize wheel that has financial prizes.

BEHAVIORAL

Clinic-Based Smoking Cessation Counseling

Participants assigned to the usual care condition may participate in group counseling for smoking cessation, which can also include use of phone-based smoking cessation resources such as a telephone quit line, a texting program, and a smoking cessation app.

Sponsors & Collaborators

• VA Office of Research and Development

  lead FED

Principal Investigators

• Jean C Beckham, PhD · Durham VA Medical Center, Durham, NC

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2027-03-01

Primary Completion

2030-03-01

Completion

2030-09-01

Countries

• United States

Study Locations