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.