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NIH grant 1IK2RD000469-01A1: Implementing an Evidence-Based Intervention for Tobacco Use with Homeless-Experienced Veterans
Institute: {'code': 'VA', 'abbreviation': 'VA', 'name': 'Veterans Affairs', 'admin_org_id': '12500964', 'admin_funding_url': ''}. PI: Taylor Harris. Award: $.
Start: 2026-10-01T00:00:00.
Significance to VA: Veterans experiencing homelessness have smoking rates averaging 70%, nearly five
times higher than the general population.1 Despite the availability of evidence-based treatments for tobacco use
within the Department of Veterans Affairs (VA), these Veterans cessation outcomes are poor, largely due to the
socioecological barriers to cessation they face while homeless.2 Permanent Supportive Housing (PSH), which
combines subsidized housing and supportive services for homeless populations, offers an opportunity to
improve tobacco cessation via increased stability and access to healthcare. However, homeless-experienced
Veterans (HEVs; i.e., formerly homeless Veterans) housed through Department of Housing and Urban
Development-VA Supportive Housing (HUD-VASH)– the VA’s PSH initiative – continue to smoke daily, with
many barriers to cessation persisting post-housing. Innovation and Impact: Contingency management
(CM) is an evidence-based intervention (EBI) that is among the most efficacious treatments for tobacco use.3–6
Drawing from operant conditioning, CM delivers monetary incentives upon the achievement of a target health
behavior, such as abstinent substance use.7 Implementing CM in HUD-VASH has the potential to significantly
improve the health of HEVs who smoke. Yet, to date, no behavioral interventions for tobacco cessation have
been implemented within VA or non-VA PSH settings. This Career Development Award (CDA) will fill this
critical gap in cessation care, by adapting, implementing, and evaluating a CM intervention for tobacco
smoking, tailored specifically to HEVs in HUD-VASH. Specific Aims: Guided by the Behavior Change Wheel
(BCW)8 for tailoring interventions and the Consolidated Framework for Implementation Research (CFIR),9 I
aim to: Aim 1. Adapt a CM intervention for tobacco use (referred to as “Pays to Quit”) for HEVs in HUD-VASH;
Aim 2. Implement Pays to Quit in HUD-VASH and examine its feasibility and acceptability, and preliminary
effectiveness measures; and Aim 3. Identify contextual factors that support or impede use of Pays to Quit in the
pilot trial context. Methodology: Aim 1. Community-engaged research (CEnR) methods10 and the BCW will
guide the co-production of the Pays to Quit protocol in collaboration with a Stakeholder Workgroup (i.e., a
community advisory board) comprised of CM experts, HUD-VASH leaders and providers, and HEV
“Champions”. Focus groups with HEVs who smoke tobacco (n=32) from participating HUD-VASH sites (i.e.,
PSH buildings; n=4) will inform co-production. Aim 2. In an uncontrolled pilot trial with two implementation
cohorts, four HUD-VASH sites (two adjacent sites/per cohort) will receive Pays to Quit, with Addiction
Therapist (ATs) delivering the intervention. The trial will enroll approximately 30 HEVs per cohort (total
N=60; 15 HEVs per building). Quantitative data from biochemically verified smoking status and smoking
behavior assessments will be used to preliminarily examine effectiveness outcome measures to inform a future
controlled trial. Quantitative retention and engagement data and qualitative data from interviews with HUD-
VASH staff and HEVs will inform feasibility (e.g., fit) and acceptability (e.g., compatibility, satisfaction). Aim 3.
Data from periodic reflections, which capture near-real-time implementation contextual information,
conducted with ATs, ethnographic observations of CM sessions, and Aim 2 qualitative interviews will be
integrated. The CFIR will guide evaluation of contextual factors that support or impede implementation of the
Pays to Quit intervention within HUD-VASH. Path to Translation/ Implementation: By tailoring Pays to
Quit to address the individual, social and environmental challenges that diminish HEVs’ successful cessation,
and determining the intervention’s feasibility and acceptability within the HUD-VASH context, findings can
inform equitable approaches to care for this vulnerable Veteran population and enhance its implementation in
future trials. This CDA will contribute to future trials, including a VA merit proposal to test Pays to Quit
implementation and effectiveness outcomes in a hybrid type-1 trial.document fetched 2026-10-24 02:46