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Tobacco Use DisorderNew HARTNCT07714200

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

A study testing Cognitive Behavioral Therapy for Smoking Cessation, Nicotine Replacement Therapy and Bupropion in people with Tobacco Use Disorder, run by VA Office of Research and Development at 1 site in United States.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial 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. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Tobacco Use Disorder
What is being tested?
Cognitive Behavioral Therapy for Smoking Cessation, Nicotine Replacement Therapy and Bupropion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
120 participants
Where
1 siteUnited States
Study dates
1 Mar 2027to 1 Sep 2030
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Are homeless
  • Smoke at least 5 cigarettes daily with CO indicating current smoking at time of screening assessment
  • Are willing to try to quit smoking in next 30 days

Who cannot join

  • Have uncontrolled psychotic symptoms
  • Have active substance dependence other than nicotine (participants in partial remission with at least one month sobriety will be included)
  • Have severely impaired hearing or speech

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

United States1 site
  • Durham VA Medical Center, Durham, NC

    Durham, North Carolina, 27705-3875

    Angela C Kirby, MS, 919-286-0411 ext. 7456, angela.kirby@va.gov

    Jean C Beckham, PhD

Other trials in United States

About this study

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.

Read the detailed description

Significance to VA: 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. While there are numerous challenges to smoking cessation among Veterans experiencing homelessness, four in five homeless smokers report interest in quitting. Innovation and Impact: The investigators recently developed and evaluated the effectiveness of a multi-component intervention called Abstinence Reinforcement Therapy (ART), which combined five sessions of telehealth-based cognitive-behavioral therapy, provision of smoking cessation aids, and four weeks of mobile contingency management (mCM). The investigators have added an additional CM period of eight weeks and opportunities for booster calls and repeated quit attempts, resulting in an intervention called ART+ to improve outcomes over time. The innovative use of web-based platform technology in the current proposal will remove numerous barriers that often prevent smokers experiencing homelessness from accessing high-quality, evidence-based care. There is tremendous inequity in smoking-related outcomes for VEH. The innovative use of mobile health technology in the current proposal will remove numerous barriers that often prevent Veterans who smoke and experience homelessness from accessing high- quality, evidence-based care. Specific Aims: Aim 1: Evaluate the comparative effectiveness of ART+ on bio-verified abstinence outcomes at three-, six-and 12-month follow-ups. The primary endpoint will be bioverified prolonged abstinence at the six-month follow-up. Aim 2: Assess the relative cost-effectiveness of ART+ to VA standard care smoking cessation on quality adjusted life years (QALY). Aim 3: Qualitatively evaluate implementation determinants of ART+ within Specialty Smoking Clinics and VA primary care for VEH programs. Methodology: 120 Veterans experiencing homelessness who smoke cigarettes will be randomly assigned to ART+ or to VA standard smoking cessation care. Self-reported and bioverified abstinence at six months are the primary outcomes. Cost-effectiveness analyses will be performed using QALY as the effectiveness measure. Rapid qualitative analytic methods will be used to evaluate implementation determinants of ART+ following enrollment of all study participants. Participants for the qualitative analysis will include clinicians and clinical support staff who provide care to Veterans experiencing homelessness, designated VA operations partners, and VA Tobacco Treatment Specialists. Purposive sampling will be used to identify potential participants and a structured interview guide based upon domains from the Consolidated Framework for Implementation Research (CFIR) will be administered. The investigators will use rapid qualitative analysis to answer the key qualitative research question: "What determinants will impact implementation of ART+?" The benefit of decreasing tobacco use (Aim 1) among VEH who smoke is tremendous as it will prevent significant morbidity and mortality. Moreover, if ART+ is shown to be cost effective (Aim 2) and implementation determinants are identified (Aim 3), the use of mobile phones as a platform to provide behavioral incentives has the potential to transform the delivery of smoking cessation care. Path to Translation/Implementation: Cost-effectiveness analysis (Aim 2) will help guide implementation decisions. Qualitative evaluation of the implementation determinants of ART+ within Specialty Smoking Clinics and VA primary care for VEH programs (Aim 3) will provide important information on effective implementation of ART+.

Being tested
Cognitive Behavioral Therapy for Smoking Cessation, Nicotine Replacement Therapy, Bupropion, Varenicline, Mobile Contingency Management
Keywords
Smoking, Veterans, Ill-Housed Persons
Medical subject headings
Tobacco Use Disorder, Smoking

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cognitive Behavioral Therapy for Smoking CessationBehavioural

    Also called CBT

    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.

  • Nicotine Replacement TherapyDrug

    Also called NRT, nicotine gum, nicotine lozenge, nicotine patch, NicoDerm, Nicorette

    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).

  • BupropionDrug

    Also called Zyban

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

  • VareniclineDrug

    Also called Chantix

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

  • Mobile Contingency ManagementBehavioural

    Also called mCM, CM

    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.

  • Clinic-Based Smoking Cessation CounselingBehavioural

    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.

Study groups in NCT07714200
Study groupRoleWhat they receive
Abstinence Reinforcement Therapy +ExperimentalAbstinence Reinforcement Therapy +, or ART+, includes five sessions and several booster sessions of cognitive-behavioral therapy for smoking cessation, two forms of nicotine replacement therapy plus bupropion or varenicline, and mobile contingency management for smoking cessation.
Receives: Behavioral: Cognitive Behavioral Therapy for Smoking Cessation; Drug: Nicotine Replacement Therapy; Drug: Bupropion; Drug: Varenicline; Behavioral: Mobile Contingency Management
Standard Care ConditionActive comparatorStandard Care Condition will involve referral to local VA clinic-based smoking cessation care. This care often includes pharmacotherapy, counseling options, and/or use of a telephone-based, texting-based or app-based smoking cessation program.
Receives: Drug: Nicotine Replacement Therapy; Drug: Bupropion; Drug: Varenicline; Behavioral: Clinic-Based Smoking Cessation Counseling

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of participants whose self-report of prolonged smoking abstinence is bioverified

    Prolonged abstinence is defined as 30 days abstinent. For participants who are not using NRT/vapes/e-cigarettes at follow-up, abstinence will be based upon: 1) self-reported abstinence; 2) no biochemical samples indicating smoking (CO ≥ 5 ppm or cotinine ≥ 6 ng/mL); and 3) at least one sample indicating abstinence (CO < 5 ppm and/or cotinine < 6 ng/mL)

    Measured: 6-month follow-up, about six months after baseline

Secondary outcomes (13)
  1. Number of participants whose self-report of prolonged smoking abstinence is bioverified

    Prolonged abstinence is defined as 30 days abstinent. For participants who are not using NRT/vapes/e-cigarettes at follow-up, abstinence will be based upon: 1) self-reported abstinence; 2) no biochemical samples indicating smoking (CO ≥ 5 ppm or cotinine ≥ 6 ng/mL); and 3) at least one sample indicating abstinence (CO < 5 ppm and/or cotinine < 6 ng/mL)

    Measured: 3-month follow-up, about three months after baseline

  2. Number of participants whose self-report of prolonged smoking abstinence is bioverified

    Prolonged abstinence is defined as 30 days abstinent. For participants who are not using NRT/vapes/e-cigarettes at follow-up, abstinence will be based upon: 1) self-reported abstinence; 2) no biochemical samples indicating smoking (CO ≥ 5 ppm or cotinine ≥ 6 ng/mL); and 3) at least one sample indicating abstinence (CO < 5 ppm and/or cotinine < 6 ng/mL

    Measured: 12-month follow-up, about twelve months after baseline

  3. Number of participants who self-report 7-day point prevalence abstinence

    7-day point prevalence abstinence is defined as no smoking in the prior 7 days

    Measured: 3-month follow-up, about three months after baseline

  4. Number of participants who self-report 7-day point prevalence abstinence

    7-day point prevalence abstinence is defined as no smoking in the prior 7 days

    Measured: 6-month follow-up, about six months after baseline

  5. Number of participants who self-report 7-day point prevalence abstinence

    7-day point prevalence abstinence is defined as no smoking in the prior 7 days

    Measured: 12-month follow-up, about twelve months after baseline

  6. Number of participants who self-report 30-day point prevalence abstinence

    7-day point prevalence abstinence is defined as no smoking in the prior 30 days

    Measured: 3-month follow-up, about three months after baseline

  7. Number of participants who self-report 30-day point prevalence abstinence

    7-day point prevalence abstinence is defined as no smoking in the prior 30 days

    Measured: 6-month follow-up, about six months after baseline

  8. Number of participants who self-report 30-day point prevalence abstinence

    30-day point prevalence abstinence is defined as no smoking in the prior 30 days

    Measured: 12-month follow-up, about twelve months after baseline

  9. Number of participants who self-report early continuous abstinence

    Early continuous abstinence will be defined as reporting two weeks of continuous abstinence during the first four weeks after the quit day

    Measured: 3-month follow-up, about three months after baseline

  10. Incremental Cost-Effectiveness Ratio

    Measure of cost-effectiveness; costs as the numerator and effectiveness as measured by quality-adjusted life years (QALY) as the denominator.

    Measured: 12 months post quit, about 12 months after baseline

  11. Percentage of carbon monoxide reading completion by participants in ART+ intervention group

    Patient intervention utilization will be measured by the percentage of prompted carbon monoxide readings that participants in the ART+ condition complete during the treatment period.

    Measured: 3-month follow-up, about three months after baseline

  12. Number of behavioral cognitive-behavioral therapy (CBT) sessions completed by participants in ART+ intervention group

    Patient intervention utilization will be measured by the number of behavioral cognitive-behavioral therapy (CBT) sessions completed by participants in the ART+ condition during the treatment period

    Measured: 3-month follow-up, about three months after baseline

  13. Number of participants in ART+ intervention group who withdraw or are lost to contact during the treatment period

    Patient intervention utilization will be measured by the number of participants in ART+ intervention group who withdraw or are lost to contact during the treatment period.

    Measured: 3-month follow-up, about three months after baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Jul 2026
  2. Study start1 Mar 2027 (estimated)
  3. Primary completion1 Mar 2030 (estimated)
  4. Study completion1 Sep 2030 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07714200
Sponsor's protocol ID
HSR2-003-25M
Other IDs
1924743
Acronym
New HART
Status last verified
Jul 2026
First submitted
15 Jul 2026
Last updated
20 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Cognitive Behavioral Therapy for Smoking Cessation, Nicotine Replacement Therapy and Bupropion in people with Tobacco Use Disorder, run by VA Office of Research and Development at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 20 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Angela C Kirby, MS ((919) 286-0411 ext. 7456, angela.kirby@va.gov), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of participants whose self-report of prolonged smoking abstinence is bioverified (time frame: 6-month follow-up, about six months after baseline). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Jul 2026; AzTrials last refreshed its copy on 8 Nov 2026.

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