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Contingency Management for Smoking Cessation Among Adults Experiencing Homelessness: A Pilot Randomized Clinical
Dian Gu1,2, Deepalika Chakravarty3, Jordan Cuby4
1Division of General Internal Medicine, University of California, San Francisco.
JAMA Network Open
|August 11, 2026
Summary
Extended contingency management (CM) significantly increased smoking cessation rates in homeless adults. This financial incentive approach showed promising results for long-term smoking cessation in a vulnerable population.
Area of Science:
- Public Health
- Behavioral Science
- Addiction Medicine
Background:
- Smoking is highly prevalent among individuals experiencing homelessness, exceeding 70% of this population.
- Contingency management (CM) using financial incentives shows short-term success for smoking cessation, but extended interventions are understudied in this demographic.
Purpose of the Study:
- To evaluate the feasibility and preliminary efficacy of a 6-month extended CM intervention for smoking cessation among homeless adults.
- To determine if financial incentives can support sustained smoking cessation in this population.
Main Methods:
- A pilot parallel 2-group randomized clinical trial involving adults experiencing homelessness who smoke was conducted in San Francisco.
- Participants were randomized to either an extended CM group receiving escalating gift card incentives for verified abstinence or a control group receiving a fixed amount per visit.
- Follow-up was conducted for 6 months, with exploratory 52-week follow-up.
Main Results:
- The study included 83 participants (42 in CM, 41 in control).
- At 6 months, 7-day point prevalence abstinence (PPA) was 31.0% in the CM group versus 12.2% in the control group.
- Participants in the CM group had significantly higher odds of achieving 7-day PPA (adjusted odds ratio, 3.24; P=.04).
Conclusions:
- An extended CM intervention is feasible and associated with increased smoking cessation among adults experiencing homelessness.
- Extended CM appears to be a promising strategy for supporting smoking cessation in this population.
- Larger clinical trials are warranted to confirm the efficacy of extended CM interventions.
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