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VeteransPhase 4NCT06966362

Varenicline for Smoking Reduction in Veterans Not Ready To Quit

A Phase 4 study testing Motivation-Phase Varenicline, Motivation-Phase Nicotine Mini-Lozenge and Cessation-Phase Combination Nicotine Replacement Therapy (NRT) in people with Veterans and Tobacco Use Disorder, run by VA Office of Research and Development at 4 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

In order to reduce the prevalence of cigarette smoking among Veterans, it is vital that healthcare providers offer effective tobacco treatment to all Veterans who smoke, including those not ready to make a quit attempt. Read more about this study

Who is it for?
Ages 21 years and older
Conditions the study is for
Veterans, Tobacco Use Disorder, Cigarette Smoking
What is being tested?
Motivation-Phase Varenicline, Motivation-Phase Nicotine Mini-Lozenge and Cessation-Phase Combination Nicotine Replacement Therapy (NRT)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
400 participants
Where
4 sitesUnited States
Study dates
17 Aug 2026to 28 Jun 2030
Phase
Phase 4
Are there results?
Not yet: the study is under way

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

  • Report smoking an average of 5 or more cigarettes daily for the previous 6 months
  • Not ready to set a quit date in the next 30 days but willing to cut down on their smoking
  • Able to read, write, and speak English
  • Be medically eligible to use study medications (nicotine replacement therapy (NRT) or varenicline)
  • If female, use an approved method of birth control while using study medication
  • Be a Veteran

Who cannot join

  • Unable to give informed, voluntary consent to participate
  • Current use of any pharmacotherapy for smoking cessation
  • Use of non-cigarette tobacco products as primary form of tobacco use
  • Incarceration

Trial locations and contacts

4 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Jessica M Cook, PhD contact

(608) 256-1901

Jessica.Cook2@va.gov

Elana G Brubaker, MSW BS contact

(608) 256-1901 ext. 17854

elana.brubaker@va.gov

United States4 sites, 3 recruiting
  • Durham VA Medical Center, Durham, NC

    Durham, North Carolina, 27705-3875

    Jean Beckham, PhD, jean.beckham@va.gov

    Recruiting
  • William S. Middleton Memorial Veterans Hospital, Madison, WI

    Madison, Wisconsin, 53705-2254

    Active, not recruiting
  • Minneapolis VA Health Care System, Minneapolis, MN

    Minneapolis, Minnesota, 55417-2309

    Patrick Hammett, PhD, patrick.hammett@va.gov

    Recruiting
  • VA San Diego Healthcare System, San Diego, CA

    San Diego, California, 92161-0002

    Neal Doran, PhD, neal.doran@va.gov

    Recruiting

Other trials in United States

About this study

Official title: Varenicline for Smoking Reduction in Veterans Unwilling to Quit

In order to reduce the prevalence of cigarette smoking among Veterans, it is vital that healthcare providers offer effective tobacco treatment to all Veterans who smoke, including those not ready to make a quit attempt. Smoking treatments currently available to Veterans who are not ready to quit are only weakly effective. This project will generate new knowledge about the effectiveness of a promising varenicline-based intervention designed to increase quit attempts and long-term abstinence in Veterans who are initially not ready to quit. This project has great potential to engage Veterans not ready to quit smoking in treatment that increases quit attempts and quitting success, thereby reducing morbidity and mortality caused by smoking in Veterans.

Read the detailed description

Evidence-based smoking cessation treatments can double smoking abstinence rates, yet these treatments are underused by the millions of Veterans who smoke. One reason for this is that the great majority of people who smoke are not ready to make a quit attempt when cessation treatment is offered (70-90%). An important public health goal is to increase engagement of people not ready to quit smoking in highly effective treatment that prepares them to make quit attempts and ultimately achieve abstinence (i.e., Motivation-phase treatment; MPT). MPT typically combines smoking reduction counseling with nicotine replacement therapy (NRT). Although offering NRT Motivation-phase treatment (NRT MPT) in healthcare settings increases the reach of tobacco treatment, such interventions only weakly affect long-term abstinence. It is vital that the investigators develop more effective MPTs that increase quit attempts and quitting success in people not ready to quit. Varenicline, the most effective single agent smoking cessation pharmacotherapy, holds great promise as an intervention for people who are not ready to make a quit attempt. The investigators propose that MPT will be markedly more effective if it involves the use of varenicline (vs. NRT) because it will more effectively reduce smoking reward, affective withdrawal, and tonic craving. Initial evidence suggests that varenicline increases quitting motivation in those not ready to quit, but the extant studies have not 1) directly evaluated varenicline effectiveness in this population and 2) compared varenicline MPT with NRT MPT, the current standard treatment for those not ready to make a quit attempt. The goal of this study is to evaluate whether varenicline MPT is especially effective and cost-effective relative to NRT MPT, in Veterans who are willing to reduce but not quit smoking. This study will compare the use of varenicline MPT vs. NRT MPT on: biochemically verified point-prevalence abstinence at 1 year (primary outcome), quit attempts, and cessation treatment use.

This study is a 2-group randomized controlled trial that will enroll 400 adults from three geographically diverse VA hospitals who smoke 5 cigarettes/day and do not want to quit smoking in the next 30 days but are willing to cut down. Participants will be randomized to one of two 12-week MPT groups: (1) varenicline, or (2) NRT (2 milligrams (mg) mini-lozenges). All participants will receive 5 phone counseling sessions focused on smoking reduction during the 12-week MPT. Any participants who decide to try quitting will receive smoking cessation treatment involving continued use of their assigned study medication and cessation counseling.

Being tested
Motivation-Phase Varenicline, Motivation-Phase Nicotine Mini-Lozenge, Cessation-Phase Combination Nicotine Replacement Therapy (NRT), Cessation-Phase Varenicline, Motivation-Phase Counseling
Keywords
Varenicline, Tobacco use disorder, Veterans, Quit attempts, Cigarette smoking, Motivation phase treatment, Nicotine replacement therapy, Smoking reduction, Smoking abstinence
Medical subject headings
Tobacco Use Disorder, Cigarette Smoking, Smoking Reduction

What participants receive

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

  • Motivation-Phase VareniclineDrug

    Also called Chantix

    Varenicline reduction dosing will start when participants initiate Motivation-phase treatment: 0.5 milligrams (mg) once daily for 3 days, increasing to 0.5mg twice daily for days 4 to 7, and then to the maintenance dose of 1mg twice daily for the duration of the 12-week reduction regimen.

  • Motivation-Phase Nicotine Mini-LozengeDrug

    Also called Nicorette

    NRT mini-lozenge reduction dosing will start when participants initiate Motivation-phase treatment: 2-milligrams (mg) mini-lozenges in place of cigarettes (5-15/day).

  • Cessation-Phase Combination Nicotine Replacement Therapy (NRT)Drug

    Also called Nicorette, Nicoderm

    Combination NRT (nicotine patch + nicotine mini-lozenge) cessation dosing will begin on the target quit day: if smoking >10 cigarettes/day = 8 weeks of 21-milligrams (mg), 2 weeks of 14-mg, and 2 weeks of 7-mg nicotine patches; if smoking 10 cigarettes/day = 10 weeks of 14-mg and 2 weeks of 7-mg nicotine patches. All participants will receive 2 or 4 mg mini-lozenge for the 12-week cessation period (9/day, 1 piece every 1-2/hours).

  • Cessation-Phase VareniclineDrug

    Also called Chantix

    Varenicline cessation dosing will start one week prior to their target quit date (TQD): 0.5 milligrams (mg) once daily for 3 days, increasing to 0.5mg twice daily for days 4 to 7, and then to the maintenance dose of 1mg twice daily for the remainder of the 12-week cessation regimen.

  • Motivation-Phase CounselingBehavioural

    All participants receive motivation-phase counseling. Motivation-phase counseling involves 5, 10-15-minute counseling calls. The counselor will work with participants on smoking control skills selected by the participant, such as avoidance of smoking cues, reducing smoking heaviness/contexts, developing urge coping skills, or finding support from friends and family. Counseling will emphasize setting realistic and achievable smoking control goals. Counseling will also emphasize competence and self-efficacy, which will be linked to success in smoking control.

  • Cessation-Phase CounselingBehavioural

    All participants who enter cessation treatment will be offered 4, 10-15-minute counseling calls. The first counseling session involves pre-quit preparation, and can occur any time before the target quit day. The other 3 counseling calls will be scheduled for 1 day, 1 week, and 4 weeks after the target quit date. Cessation counseling will be based on treatment guidelines and will review instructions for when to start cessation medication, the timing of the quit day (relative to medication start), and medication adherence. Counseling will involve problem solving and skill development.

Study groups in NCT06966362
Study groupRoleWhat they receive
Motivation-Phase VareniclineExperimentalVarenicline use during pre-quit phase of smoking treatment for participants who are interested in cutting down on their smoking.
Receives: Drug: Motivation-Phase Varenicline; Drug: Cessation-Phase Varenicline; Behavioral: Motivation-Phase Counseling; Behavioral: Cessation-Phase Counseling
Motivation-Phase Nicotine Mini-LozengeActive comparatorNRT mini-lozenge use during pre-quit phase of smoking treatment for participants who are interested in cutting down on their smoking.
Receives: Drug: Motivation-Phase Nicotine Mini-Lozenge; Drug: Cessation-Phase Combination Nicotine Replacement Therapy (NRT); Behavioral: Motivation-Phase Counseling; Behavioral: Cessation-Phase Counseling

What is being measured

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

  1. 7-day point prevalence abstinence

    Participants who report 7-day point-prevalence abstinence from cigarettes at the 6 month follow-up will mailed a saliva collection kit that will test cotinine and anabasine to validate self-reported abstinence from combusted tobacco.

    Measured: 6 months post-study entry

Secondary outcomes (3)
  1. Making a quit attempt lasting 24 hours

    Making a quit attempt lasting at least 24 hours by 6 and 12 months; coded as binary (0 or 1).

    Measured: 6 and 12 months post-study entry

  2. Cessation treatment entry

    Entering cessation treatment; coded as binary (0 or 1)

    Measured: 6 months post-study entry

  3. Biochemically confirmed 7-day point-prevalence abstinence

    Participants who report 7-day point-prevalence abstinence from cigarettes at the 12 month follow-up will mailed a saliva collection kit that will test cotinine and anabasine to validate self-reported abstinence from combusted tobacco.

    Measured: 12 months post-study entry

Timeline

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

  1. First posted11 May 2025
  2. Study start17 Aug 2026
  3. Primary completion28 Jun 2030 (estimated)
  4. Study completion28 Jun 2030 (estimated)

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 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Participants will be randomized to one of two 12-week Motivation-phase treatment groups: (1) varenicline, or (2) NRT (2 mg mini-lozenges).
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
400 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06966362
Sponsor's protocol ID
NURA-007-24F
Status last verified
Aug 2026
First submitted
2 May 2025
Last updated
31 Aug 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No: Deidentified dataset will be shared upon request.

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Motivation-Phase Varenicline, Motivation-Phase Nicotine Mini-Lozenge and Cessation-Phase Combination Nicotine Replacement Therapy (NRT) in people with Veterans and Tobacco Use Disorder, run by VA Office of Research and Development at 4 sites 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 6 inclusion and 4 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: looking for participants now, as of the sponsor's last update on 31 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites 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.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Jessica M Cook, PhD ((608) 256-1901, Jessica.Cook2@va.gov), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

7-day point prevalence abstinence (time frame: 6 months post-study entry). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 31 Aug 2026.

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