E-Cigarettes and Financial Incentives to Promote Tobacco Harm Reduction Among Adults Accessing Shelter Services (EXCHANGE)

A Needs Survey of Urban Day Shelter Users and Preliminary Evaluation of Alternative Approaches to Combustible Cigarette Cessation: The Exchange Project

This randomized controlled trial evaluated the feasibility and potential efficacy of 1) e-cigarette switching (EC) or 2) e-cigarette switching + financial incentives for combustible cigarette cessation (EC+FI)

Study Overview

• Status: Completed
• Conditions: Cigarette Smoking
• Intervention / Treatment: Behavioral: E-cigarette Switching; Behavioral: Financial Incentives

Detailed Description

The current study examined the feasibility of e-cigarette switching and financial incentives contingent on combustible cigarette abstinence to promote combustible cigarette cessation among urban day shelter guests (N=60). A total of 60 adults who accessed the Homeless Alliance day shelter in Oklahoma City, OK were randomly assigned to 1 of 2 groups and followed weekly from 1 week prior to a scheduled EC switch date through 4 weeks post-switch date, with a final 8-week post-switch follow-up. The intervention groups were: 1) e-cigarette switching (EC) or 2) EC switching + small financial incentives for carbon monoxide (CO) verified combustible cigarette abstinence (FI + EC). The primary outcomes were self-reported combustible cigarette abstinence over the previous 7 days with carbon monoxide (CO)-verification at 4- and 8- weeks follow-up. Secondary outcomes included changes in CO from baseline, days of combustible cigarette smoking, and continued e-cigarette use. Other feasibility outcomes included study retention and perceptions of the intervention.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Oklahoma
    • Oklahoma City, Oklahoma, United States, 73106
      • Homeless Alliance

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

1. ≥21 years of age
2. Expired CO level ≥8 ppm suggestive of current smoking
3. reported smoking ≥5 cigarettes per day
4. Willing and able to attend 8 study visits over a 10-week period
5. Interested in switching from CCs to ECs
6. Willing to abstain from smoking cannabis for the duration of the study
7. Able to speak and understand English
8. Demonstrated >6th grade English literacy by earning a score ≥4 on the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF),
9. Able to read a 3-sentence selection from the consent form
10. Not pregnant, breastfeeding, or planning to become pregnant.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: E-Cigarette Switching (EC); Participants were provided with an e-cigarette device and nicotine pods and advised to completely switch from combustible cigarettes to e-cigarettes. Although participants in the EC group did not earn incentives for combustible cigarette abstinence, they were yoked with a participant in the EC+FI group (described below), and they earned the same weekly incentive amount as their counterpart earned for combustible cigarette abstinence credited to a reloadable study credit card.	Behavioral: E-cigarette Switching; Participants provided with e-cigarette device and nicotine pods and advised to switch from combustible cigarettes to e-cigarettes.; Other Names: EC
Experimental: E-Cigarette Switching + Financial Incentives (EC+FI); Participants assigned to the EC+FI group received ECs and pods and were instructed to switch from combustible cigarettes to e-cigarettes as described above for the EC group. Participants also earned escalating financial incentives for self-reported and carbon-monoxide-verified combustible cigarette abstinence via credits to a reloadable study credit card. Participants who reported combustible cigarette use and/or had a CO level >6 ppm did not earn incentives that week, but could earn incentives at the next visit with the incentive value reset to the starting value.	Behavioral: E-cigarette Switching; Participants provided with e-cigarette device and nicotine pods and advised to switch from combustible cigarettes to e-cigarettes.; Other Names: EC; Behavioral: Financial Incentives; Participants earned incentives for carbon monoxide-verified combustible cigarette abstinence.; Other Names: FI

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Combustible Cigarette Cessation	Self-reported and Carbon monoxide-verified (<=6 ppm) combustible cigarette smoking abstinence during the previous 7 days (missing = smoking)	4 weeks post-switch date
Combustible Cigarette Cessation	Self-reported and Carbon monoxide-verified (<=6 ppm) combustible cigarette smoking abstinence during the previous 7 days (missing = smoking)	8 weeks post-quit/switch date

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Combustible Cigarette Cessation (Complete Case Analysis)	Self-reported and Carbon monoxide-verified (<=6 ppm) combustible cigarette smoking abstinence during the previous 7 days (missing excluded)	4 weeks post-switch
Combustible Cigarette Cessation (Complete Case Analysis)	Self-reported and Carbon monoxide-verified (<=6 ppm) combustible cigarette smoking abstinence during the previous 7 days (missing excluded)	8 weeks post-switch
Expired Carbon Monoxide (CO), Parts Per Million (Ppm), Change From Baseline	Change in expired CO (ppm) from baseline to 4 weeks post-switch-date.	4 weeks post-switch
Expired Carbon Monoxide (CO), Parts Per Million (Ppm), Change From Baseline	Change in expired CO (ppm) from baseline to 8 weeks post-switch-date	8 week post-switch
Days of Combustible Cigarette Smoking, Past 7 Days	The total number of days of combustible cigarette smoking during the past week	4 weeks post-switch
Days of Combustible Cigarette Smoking, Past 7 Days	The total number of days of combustible cigarette smoking during the past 7 days	8 weeks post-switch
Days of E-cigarette Use, Past 7 Days	The total number of days where e-cigarettes were used during the past 7 days	4 weeks post-switch
Days of E-cigarette Use, Past 7 Days	The total number of days on which E-cigarettes were used during the past 7 days	8 weeks post-switch
Follow-Up Completion	The number of participants who completed the smoking status follow-up assessment.	4 weeks post-switch
Follow-Up Completion	The number of participants who completed the smoking status follow-up assessment	8 weeks post-switch

Collaborators and Investigators

• Sponsor: University of Oklahoma
• Investigators: Principal Investigator: Darla E. Kendzor, PhD, University of Oklahoma

Publications and helpful links

General Publications

• Boozary LK, Frank-Pearce SG, Alexander AC, Sifat MS, Kurien J, Waring JJC, Ehlke SJ, Businelle MS, Ahluwalia JS, Kendzor DE. Tobacco use characteristics, treatment preferences, and motivation to quit among adults accessing a day shelter in Oklahoma City. Drug Alcohol Depend Rep. 2022 Nov 5;5:100117. doi: 10.1016/j.dadr.2022.100117. eCollection 2022 Dec.
• Sifat MS, Alexander AC, Businelle MS, Frank-Pearce SG, Boozary LK, Wagener TL, Ahluwalia JS, Kendzor DE. E-Cigarette switching and financial incentives to promote combustible cigarette cessation among adults accessing shelter services: A pilot study. Drug Alcohol Depend Rep. 2024 Nov 6;13:100295. doi: 10.1016/j.dadr.2024.100295. eCollection 2024 Dec.

Study record dates

Study Major Dates

• Study Start (Actual): September 14, 2022
• Primary Completion (Actual): March 1, 2023
• Study Completion (Actual): March 1, 2023

Study Registration Dates

• First Submitted: November 13, 2018
• First Submitted That Met QC Criteria: November 13, 2018
• First Posted (Actual): November 16, 2018

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 7, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: Smoking cessation; Homelessness; Contingency management; Financial incentives; E-cigarettes
• Other Study ID Numbers: 10124

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes