Noonan Submits NIH R01 Application

Kudos to Devon Noonan, associate professor, and her entire team for the resubmission of her NIH R01 application entitled “Addressing Tobacco Cessation in Rural and Medically Underserved Older Smokers using a Text-based Intervention: Project Wise." This proposal requests funding for a five-year period with a start date of Dec. 1, 2019.

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 the strong habitual component of smoking, may be an effective intervention to help older smokers quit and has been minimally studied in this population. SGR involves gradually tapering smoking through lengthening cigarette intervals based on an individually tailored schedule. SGR helps older smokers learn to refrain from smoking cigarettes that are habitual in response to environmental cues by following the schedule and gradually reducing their cigarette use. 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 SGR Intervention vs. control intervention in decreasing tobacco use in older adults. The SGR group (N=270) will receive an eight-week SGR program, text-based support messages and Nicotine Replacement Therapy (NRT). The control group (N=270) will receive the National Cancer Institute Clear Horizons Cessation Booklet and attention control text messages focusing on general wellness. The primary outcome will be biochemically-validated tobacco smoking cessation at 6 months. The secondary outcomes will explore the association of withdrawal, smoking restraint and situational temptations on biochemically validated tobacco cessation at 6 months. 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.