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Cigarette Smoking BehaviorESHIFTNCT07897058

Project E-Shift: A Harm Reduction Intervention for Chronically Unhoused Smokers.

A study testing E-cigarette, Nicotine replacement therapy (patch, gum), both arms and CO-contingent financial incentives, both arms in people with Cigarette Smoking Behavior and E-Cigarette Use, run by Thomas Jefferson University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This pilot randomized trial tested whether switching to e-cigarettes, compared with standard nicotine replacement therapy (NRT; patch and gum), helped adults with a history of chronic homelessness stop smoking combustible cigarettes. Read more about this study

Who is it for?
Ages 21 years and older
Conditions the study is for
Cigarette Smoking Behavior, E-Cigarette Use
What is being tested?
E-cigarette, Nicotine replacement therapy (patch, gum), both arms and CO-contingent financial incentives, both arms
Could I receive a placebo?
No, everyone receives an active treatment
How many people
44 participants
Where
1 siteUnited States
Study dates
5 Aug 2025to 29 Jul 2026
Phase
Interventional
Are there results?
None posted in the registry

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

Who may be able to join

  • Individuals must meet all of the following inclusion criteria in order to be eligible to participate in the study:
  • Provide signed and dated informed consent form
  • Willing to comply with all study procedures and be available for the duration of the study.
  • Male or female aged 21 and above.
  • expired CO >6 ppm at screening
  • People of reproductive potential must not be pregnant nor trying to become pregnant.
  • Adequate literacy to complete self-administered study questionnaires, defined as a score ≥4 out of 7 on the Rapid Estimate of Adult Literacy in Medicine - Short Form (REALM-SF), corresponding to a 7th-grade reading level or higher

Who cannot join

  • An individual who meets any of the following criteria will be excluded from participation in this study:
  • Anyone who has trouble understanding the consent or with significant anxiety detected during the consent process will also be excluded.
  • Medical condition that precludes participation
  • Current use of THC-containing vaping products
  • Pregnancy or lactation
  • Known allergic reactions to components of the study product(s)
  • Anything that would place the individual at increased risk or preclude the individual's full compliance with or completion of the study.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Pathways to Housing

    Philadelphia, Pennsylvania, 19107

Other trials in United States

About this study

Official title: Project E-Shift: A Harm Reduction Intervention for Chronically Unhoused Smokers

This pilot randomized trial tested whether switching to e-cigarettes, compared with standard nicotine replacement therapy (NRT; patch and gum), helped adults with a history of chronic homelessness stop smoking combustible cigarettes. All participants received brief cessation counseling and incentives for carbon monoxide (CO)-verified abstinence from cigarettes during the first weeks after a scheduled switch date. Participants were followed for 12 weeks after switching, with a final follow-up at 24 weeks. The study also assessed feasibility (recruitment, retention, and visit attendance) and used interviews with participants and service-agency staff to understand acceptability and how a tobacco harm reduction program could fit into existing housing and clinic services.

Read the detailed description

This two-arm, parallel-group, open-label pilot randomized trial compared e-cigarette (EC) switching with nicotine replacement therapy (NRT) among adults who smoke cigarettes and have a history of chronic homelessness, recruited through Pathways to Housing PA and affiliated clinic services in Philadelphia [confirm sites]. Both arms received standard cessation counseling and financial incentives contingent on carbon monoxide (CO)-verified abstinence from combustible cigarettes during the early post-switch period. Because both arms received incentives, the trial compares EC with NRT in the presence of incentives and does not isolate the effect of incentives.

After consent and baseline assessment, participants were randomized 1:1 to EC plus financial incentives (EC+FI) or NRT plus financial incentives (NRT+FI). EC+FI participants received a pod-based device and a one-week practice supply of pods before a scheduled switch date one week after baseline. NRT+FI participants received nicotine patch and gum. At consent, all participants were counseled on e-cigarette or vaping use-associated lung injury (EVALI) and instructed not to use THC-containing, non-study, or modified vaping products.

Assessments occurred on the switch date, weekly at 1 through 4 weeks post-switch, and at 8, 10, and 12 weeks post-switch, with a final self-report follow-up at 24 weeks post-switch. Visits included self-report questionnaires on tobacco and nicotine product use, withdrawal symptoms, respiratory symptoms, and mental health, and expired CO measurement (through week 12). Abstinence-contingent incentives were available from the switch date through week 4 only; later visits were unincentivized to assess maintenance after incentive withdrawal. Study product was resupplied at each visit through week 8, with EC pods dosed to pre-switch cigarettes per day and used pods returned before resupply, and was then discontinued to assess unsupported continuation.

A subsample of participants and partner-agency staff completed semi-structured interviews on intervention acceptability and on integrating tobacco harm reduction into existing service workflows.

Being tested
E-cigarette, Nicotine replacement therapy (patch, gum), both arms, CO-contingent financial incentives, both arms, Cessation counseling
Keywords
cigarette, e-cigarette
Medical subject headings
Cigarette Smoking, Vaping

What participants receive

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

  • E-cigaretteOther

    Pod-based e-cigarette device [Vuse Alto, 5 % nicotine] given at baseline, with 3 pods for a 1-week practice period. Starting on switch day, participants receive weekly pod supplies in flavors of their choice, dosed to pre-switch cigarettes per day, through 8 weeks post-switch. Used pods are returned before resupply. One replacement device is provided if the device is lost or damaged.

  • Nicotine replacement therapy (patch, gum), both armsDrug

    Also called E-cigarette, EC arm

    Participants receive Nicotine Replacement Therapy (patch, gum)

  • CO-contingent financial incentives, both armsBehavioural

    CO-contingent financial incentives, both arms

  • Cessation counselingBehavioural

    Cessation counseling, all arms

Study groups in NCT07897058
Study groupRoleWhat they receive
NRT as Cigarette Product ReplacementActive comparatorEither participants receive NRT as cigarette product replacement
Receives: Drug: Nicotine replacement therapy (patch, gum), both arms; Behavioral: CO-contingent financial incentives, both arms; Behavioral: Cessation counseling
E-Cigarette as cigarette product replacementExperimentalParticipants receive E-Cigarette as cigarette product replacement
Receives: Other: E-cigarette; Drug: Nicotine replacement therapy (patch, gum), both arms; Behavioral: CO-contingent financial incentives, both arms; Behavioral: Cessation counseling

What is being measured

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

  1. Number of Participants With Carbon Monoxide (CO)-Verified Combustible Cigarette Abstinence

    Abstinence is defined as self-report of no combustible cigarette smoking in the past 7 days AND expired CO ≤6 parts per million (Vitalograph CO monitor). Reported by arm at each time point. Participants with missing data at a time point are counted as not abstinent (intention-to-treat).

    Measured: 4, 8, and 12 weeks post-switch

Secondary outcomes (6)
  1. Expired Carbon Monoxide (CO) Level

    Mean expired CO in parts per million, measured by Vitalograph CO monitor. Lower values indicate less recent combustible smoke exposure.

    Measured: Switch date (1 week post-baseline) and 1, 2, 3, 4, 8, 10, and 12 weeks post-switch

  2. Number of Days Smoking Combustible Cigarettes in the Past 7 Days

    Self-reported number of days (range 0-7) on which the participant smoked combustible cigarettes in the past 7 days. Higher values indicate more smoking.

    Measured: 1, 2, 3, 4, 8, 10, 12, and 24 weeks post-switch

  3. Number of Participants by Past-7-Day Product Use Category

    Mutually exclusive categories derived from self-report: e-cigarette use only, combustible cigarette use only, dual use, and no use of either product.

    Measured: 1, 2, 3, 4, 8, 10, 12, and 24 weeks post-switch

  4. Number of Participants With Self-Reported 7-Day Point-Prevalence Combustible Cigarette Abstinence

    Self-report of no combustible cigarette smoking in the past 7 days. CO verification was not performed at this visit.

    Measured: 24 weeks post-switch

  5. Number of Participants Maintaining CO-Verified Abstinence After Incentive Discontinuation

    Among participants with CO-verified combustible cigarette abstinence (self-report of no smoking in the past 7 days and expired CO ≤6 ppm) at week 4, the final incentivized visit, the number who remain CO-verified abstinent at unincentivized follow-up visits.

    Measured: 8, 10, and 12 weeks post-switch

  6. Number of Randomized Participants Retained at 12 Weeks

    Number of randomized participants who completed the 12-week post-switch assessment.

    Measured: 12 weeks post-switch

Timeline

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

  1. First posted27 Oct 2026
  2. Study start5 Aug 2025
  3. Primary completion12 May 2026
  4. Study completion29 Jul 2026

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
Model description
Half the participants will be given an e-cigarette device with charger and pods, they will also receive counseling, and NRT will be available to them upon request. The standard care group will receive nicotine replacement therapy which includes counseling and nicotine replacement products. Further, all participants will be able to earn financial incentives if they are abstinent from combustible cigarette smoking to encourage reduction of combustible cigarette use.
Masking
None (open label)
Enrolment
44 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07897058
Sponsor's protocol ID
45309
Acronym
ESHIFT
Status last verified
Oct 2026
First submitted
9 Oct 2026
Last updated
27 Oct 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Populations with experiences of homelessness are uniquely vulnerable.

Publications

  • Leavens ELS, Pebley K, Smith TT, Ahluwalia JS, Bello MS, Bold KW, Cantrell J, Carpenter MJ, Cioe PA, Felicione NJ, Havard A, Hawk LW Jr, Kaye JT, Klemperer EM, Kleykamp BA, Lindson N, McClure EA, McRobbie H, Murphy CM, Rigotti NA, Walker NK, Yang MJ, Rojewski AM, Johnson AL; Members of the Society for Research on Nicotine and Tobacco, Treatment Research Network, Harm Reduction Workgroup. Nicotine E-Cigarettes for Cigarette Smoking Cessation: Recommendations to US-Based Clinicians. JAMA. 2026 Sep 1;336(9):783-790. doi: 10.1001/jama.2026.13087.

    PubMed 42530900
  • 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.

    PubMed 39764385
  • Businelle MS, Ma P, Kendzor DE, Reitzel LR, Chen M, Lam CY, Bernstein I, Wetter DW. Predicting quit attempts among homeless smokers seeking cessation treatment: an ecological momentary assessment study. Nicotine Tob Res. 2014 Oct;16(10):1371-8. doi: 10.1093/ntr/ntu088. Epub 2014 Jun 3.

    PubMed 24893602
  • Wagener TL, Meier E, Hale JJ, Oliver ER, Warner ML, Driskill LM, Gillaspy SR, Siegel MB, Foster S. Pilot investigation of changes in readiness and confidence to quit smoking after E-cigarette experimentation and 1 week of use. Nicotine Tob Res. 2014 Jan;16(1):108-14. doi: 10.1093/ntr/ntt138. Epub 2013 Oct 23.

    PubMed 24154511
  • Reitzel LR, Kendzor DE, Nguyen N, Regan SD, Okuyemi KS, Castro Y, Wetter DW, Businelle MS. Shelter proximity and affect among homeless smokers making a quit attempt. Am J Health Behav. 2014 Mar;38(2):161-9. doi: 10.5993/AJHB.38.2.1.

    PubMed 24629545
  • Nguyen MA, Reitzel LR, Kendzor DE, Businelle MS. Perceived cessation treatment effectiveness, medication preferences, and barriers to quitting among light and moderate/heavy homeless smokers. Drug Alcohol Depend. 2015 Aug 1;153:341-5. doi: 10.1016/j.drugalcdep.2015.05.039. Epub 2015 Jun 6.

    PubMed 26072221
  • Kish DH, Reitzel LR, Kendzor DE, Okamoto H, Businelle MS. Characterizing Concurrent Tobacco Product Use Among Homeless Cigarette Smokers. Nicotine Tob Res. 2015 Sep;17(9):1156-60. doi: 10.1093/ntr/ntu230. Epub 2014 Oct 30.

    PubMed 25358660
  • Kendzor DE, Reitzel LR, Businelle MS. Characterizing Stressors and Modifiable Health Risk Factors Among Homeless Smokers: An Exploratory Pilot Study. Health Educ Behav. 2015 Oct;42(5):642-7. doi: 10.1177/1090198114565664. Epub 2015 Jan 23.

    PubMed 25616410
  • Kendzor DE, Allicock M, Businelle MS, Sandon LF, Gabriel KP, Frank SG. Evaluation of a Shelter-Based Diet and Physical Activity Intervention for Homeless Adults. J Phys Act Health. 2017 Feb;14(2):88-97. doi: 10.1123/jpah.2016-0343. Epub 2016 Oct 24.

    PubMed 27775471
  • Hajek P, Etter JF, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. 2014 Nov;109(11):1801-10. doi: 10.1111/add.12659. Epub 2014 Jul 31.

    PubMed 25078252
  • Wagener TL, Floyd EL, Stepanov I, Driskill LM, Frank SG, Meier E, Leavens EL, Tackett AP, Molina N, Queimado L. Have combustible cigarettes met their match? The nicotine delivery profiles and harmful constituent exposures of second-generation and third-generation electronic cigarette users. Tob Control. 2017 Mar;26(e1):e23-e28. doi: 10.1136/tobaccocontrol-2016-053041. Epub 2016 Oct 11.

    PubMed 27729564
  • Kotz D, West R. Explaining the social gradient in smoking cessation: it's not in the trying, but in the succeeding. Tob Control. 2009 Feb;18(1):43-6. doi: 10.1136/tc.2008.025981. Epub 2008 Oct 20.

    PubMed 18936053
  • Kendzor DE, Reitzel LR, Mazas CA, Cofta-Woerpel LM, Cao Y, Ji L, Costello TJ, Vidrine JI, Businelle MS, Li Y, Castro Y, Ahluwalia JS, Cinciripini PM, Wetter DW. Individual- and area-level unemployment influence smoking cessation among African Americans participating in a randomized clinical trial. Soc Sci Med. 2012 May;74(9):1394-401. doi: 10.1016/j.socscimed.2012.01.013. Epub 2012 Feb 23.

    PubMed 22405506
  • Kendzor DE, Businelle MS, Costello TJ, Castro Y, Reitzel LR, Cofta-Woerpel LM, Li Y, Mazas CA, Vidrine JI, Cinciripini PM, Greisinger AJ, Wetter DW. Financial strain and smoking cessation among racially/ethnically diverse smokers. Am J Public Health. 2010 Apr;100(4):702-6. doi: 10.2105/AJPH.2009.172676. Epub 2010 Feb 18.

    PubMed 20167886
  • Baggett TP, Rigotti NA. Cigarette smoking and advice to quit in a national sample of homeless adults. Am J Prev Med. 2010 Aug;39(2):164-72. doi: 10.1016/j.amepre.2010.03.024.

    PubMed 20621264

Questions about this trial

What is this clinical trial studying?

A study testing E-cigarette, Nicotine replacement therapy (patch, gum), both arms and CO-contingent financial incentives, both arms in people with Cigarette Smoking Behavior and E-Cigarette Use, run by Thomas Jefferson University 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 7 inclusion and 7 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: finished, as of the sponsor's last update on 27 Oct 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants With Carbon Monoxide (CO)-Verified Combustible Cigarette Abstinence (time frame: 4, 8, and 12 weeks post-switch). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07897058, which also lists 17 linked publications.

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 27 Oct 2026.

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