Virtual avatar counseling plus community health worker support to help older adults quit smoking

C-Raven: Pilot RCT of an Avatar-delivered Computerized Intervention for Tobacco Cessation With Community Health Worker Linkage to Lung Cancer Screening in Baltimore City (FY26)

This pilot will try a virtual avatar counseling program combined with community health worker support and nicotine replacement to see if it helps people 50 and older who smoke cut down or quit compared with a waitlist.

Quick facts

• Phase: PHASE4
• Study type: Interventional
• Enrollment: 30 (estimated)
• Ages: 50 Years and up
• Sex: All
• Sponsor: Johns Hopkins University (other)
• Locations: 1 site (Baltimore, Maryland)
• Trial ID: NCT07220356 on ClinicalTrials.gov

What this trial studies

This is a pilot randomized controlled trial at a residency clinic in Baltimore enrolling 30 people who smoke and are age 50 or older. Participants will be randomized to an avatar-delivered computerized cessation program augmented with community health worker (CHW) support, navigation to lung cancer screening, and nicotine replacement versus a waitlist control. Outcomes include feasibility of recruitment, engagement and completion of the intervention, and short-term smoking cessation measured at baseline, 1, 3, and 6 months. The team will also conduct interviews with a subset of participants to collect qualitative data on acceptability and will use findings to iteratively improve the intervention.

Who should consider this trial

Good fit: Ideal candidates are English-speaking adults aged 50 or older who currently smoke (have smoked >100 cigarettes lifetime), are considering quitting, plan to remain in the local area for at least six months, and have no contraindication to nicotine replacement or major cognitive/psychiatric impairment.

Not a fit: People who are not English speakers, have contraindications to nicotine replacement, have severe cognitive or psychiatric impairment or hearing loss, or are already enrolled in a formal cessation program are unlikely to benefit from this pilot intervention.

Why it matters

Potential benefit: If successful, this approach could increase quit rates and more reliably connect high-risk smokers to lung cancer screening using a scalable virtual counseling plus CHW navigation model.

How similar studies have performed: Digital counseling tools and community health worker–supported cessation programs have shown some promise in prior work, but the specific avatar-delivered plus CHW combination in an older clinic population is largely untested and being explored at pilot scale.

Eligibility criteria

Inclusion Criteria:

* Age 50 or older
* Current tobacco use with \>100 cigarettes smoked in the participant's lifetime
* Considering smoking cessation
* Planning to remain in local area for at least 6 months
* English speaking (intervention currently in English only)

Exclusion Criteria:

* Contraindication to nicotine replacement therapy
* Current engagement in formal smoking cessation program
* Major cognitive or psychiatric impairment
* Severe hearing impairment
* Investigator discretion

Where this trial is running

Baltimore, Maryland

• Johns Hopkins University School of Medicine — Baltimore, Maryland, United States (RECRUITING)

Study contacts

• Principal investigator: Alejandra Ellison-Barnes, MD — Johns Hopkins School of Medicine
• Study coordinator: Alejandra Ellison-Barnes, MD

Conditions: Tobacco Dependence