Dr Cox Talks About Her Trial

Posted 20th January 2022 by Dave Cross
Dr Sharon Cox has spoken to the Society for the Study of Addictions on a podcast about her trial looking at helping people experiencing homelessness to switch to vaping. Dr Cox works in the Department of Behavioural Science at University College London and spoke with Rob Calder in the Addiction journal newsroom.

The monthly podcast summarises the latest news from across the addictions sector. A lot of Sharon’s recent work has been to deliver smoking cessation solutions to people experiencing homelessness.

She explained the importance of her work: “People who are homeless, and I use this in its broadest term to cover people who are rough sleeping to sofa surfers and in temporary accommodation, these people experience some of the worse health inequalities; rates of respiratory illnesses are exceptionally high, other types of preventable illness and disease are also exceptionally high – and tobacco smoking really does contribute to these health inequalities.

So, we see that rates of COPD are exceptionally high in this group, 14 times higher than the usual UK population. From large cohort studies in the US, tobacco co-related cancers (cancers of the trachea, bronchus and the lung) are the second biggest killer in adults experiencing homelessness over the age of 45, and the second biggest killer in adults under this age.

As well as knowing how smoking impacts health, we know that it impacts people’s mental health, it impacts their wellbeing, and it also has huge financial implications with up to a third of people’s low incomes going on their tobacco. So, there’s a lot to be gained if people can quit smoking but unfortunately we have this situation in the UK where, almost the more health a social needs you have the less likely your smoking is to be addressed. It’s seen by health practitioners as ‘the last comfort’, the last pleasure.”

This then is what Doctor Cox’s work is trying to tackle and part of this now involves trying to encourage people experiencing homelessness to switch from smoking to vaping.


Her team is running the world’s first randomised control trial to test if vaping works for this group of people, comparing being given a starter kit to usual care (a referral to the stop smoking service).

We don’t know is e-cigarettes will be effective,” Dr Cox says. “Other studies in other clinical groups and in the usual smoking population have shown that e-cigarettes are effective, but we don’t know in this group and there are many challenges.

Why e-cigarettes may have a benefit in this group is because when they are offered in a homeless centre, a centre that is already well versed in delivering harm reduction, staff seem to ‘get it’, they seem to understand where an e-cigarette sits within the interventions that they’re already offering.

Just as you would give out injecting equipment or methadone, an e-cigarette is like this. It is taking away the more harmful behaviour, or trying to eliminate or reduce it, and replace it with something that is ultimately much safer, a safer way of using a substance, and that is using a clean form of nicotine without the harmful products of combustion.”

The full podcast is linked below.



Photo by CoWomen on Unsplash

 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, motorbikes, and dog walker
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