Kudos to Devon Noonan and her entire team for the submission of their NIH R01 application entitled: “Addressing Tobacco Use Disparities in Older Adults through a Mobile Phone Intervention: Project Wise”. This proposal requests funding for a 5 year period with a start date of July 1, 2017.

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. Most currently available interventions for older adults rely on a withdrawal management model of cessation including Nicotine Replacement Therapy (NRT) and counseling to manage withdrawal during cessation. These interventions do not sufficiently address all the needs of older adult smokers, who often have greater number of pack years, multiple failed quit attempts and smoking cues that have been engrained for decades. Scheduled Gradual Reduction (SGR), an intervention that addresses stimulus control, may be an effective intervention to help older smokers quit and has been minimally studied in this population. Delivering SGR interventions via text messaging is an innovative way to increase the reach of this cessation intervention in underserved populations. Therefore, we propose a randomized clinical trial to evaluate the efficacy of a stimulus control intervention (SGR intervention plus text-based support messages and NRT) vs. a typical withdrawal management intervention (text-based support messages and NRT) in decreasing tobacco use in older adults. The stimulus control group (N=248) will receive a five week SGR program, text-based support messages and Nicotine Replacement Therapy (NRT). The withdrawal avoidance group (N=248) will receive text-based support messages and NRT. The primary outcome will be biochemically-validated tobacco smoking cessation at 6 months. The secondary outcomes will explore the association of adherence and craving on biochemically validated tobacco cessation at 6 months and intervention implementation costs to inform future scalability. 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.