Kudos to Devon Noonan and her entire team for the submission of her NCI R01 application entitled: “Testing the Efficacy of Two Remotely Delivered Tobacco Cessation Interventions in Underserved Older Smokers." This proposal requests funding for a five-year period with a start date of April 1, 2021.

Approximately 3.8 million older adults currently smoke putting them at heighten risk for smoking related cancers, yet older adults have not been the target of most cessation initiatives. An even more high-risk group involves rural and medically underserved older adults who lack access to innovative cessation services and receive inconsistent cessation advice. Underserved older smokers face unique challenges to quitting: they tend to have higher nicotine dependence levels, multiple comorbidities, increased chronic disease risk, smoking habits that have been engrained for decades and often lack transportation that prevents them from accessing face-to-face treatment. The emergence of COVID-19 has further restricted the ability of older adults to access care through traditional face-to-face treatment. Few have tailored cessation interventions to the unique needs of older smokers and fewer have provided remote access to these services. Older smokers’ motivations for quitting are different than younger smokers, as older smokers are more motivated to quit when they receive provider advice to quit, when they have a greater realization of the health effects of smoking and when they are educated on how their smoking compromises their physical and mental health status. The team has designed an intervention strategy building on our previous work in delivering remote cessation interventions to address these motivations. They will determine if adding individualized, phone-based telehealth counseling delivered by a specially trained registered nurse to an intervention including cognitive behavioral therapy-based texting and combination NRT will lead to improved cessation outcomes among rural, and underserved older smokers. Therefore, they propose a two-arm randomized controlled trial in which they will randomize underserved older smokers (N=500) to receive either: 1. A tailored telehealth approach (n=250), (tailored phone-based telehealth counseling, NRT and CBT-based text-messages) compared to a texting only (n=250), (CBT-text-messages and NRT). They will collect data at baseline, three, six- and 12-months post-randomization. Secondary aims will examine the cost-effectiveness of the interventions and potential mediators and moderators of intervention effects. Results of this study can be disseminated broadly to help older smokers quit with the ultimate goal of increasing access to efficacious cessation interventions and eliminating cancer health disparities.