Kudos to Devon Noonan and her entire team for the submission of their NIH R21 application entitled: “The Effects of Cognitive Training on Self-Regulation, Executive Function and Smoking Cessation in Older Adults.” This proposal requests funding for a two-year period with a start date of July 1, 2018.

Adults aged 65 and older represent a vulnerable group for tobacco use, as they are at high risk for tobacco related and co-morbid illnesses. Cessation efforts and programs might be difficult among older adults given the role of impaired executive function, top down mental processes that are necessary for control of behavior. Executive function is critical to self-regulation of behavior, the Science of Behavior Change (SOBC) mechanism this proposal is targeting, that involves making a deliberate conscious effort to disrupt long-term habits and thus may play a role in successful smoking cessation. Approximately one-third of older adults have deficits in executive function, which may affect behavior change and impede the adoption of positive health behaviors. Although older adult smokers with executive function deficits have more difficulty in quitting smoking compared to those with higher executive function, the significance of executive function as a barrier to smoking cessation has been understudied in this population. We hypothesize that a cognitive training program provided to older adult smokers with mild to moderate executive function deficits as an adjunct to a smoking cessation intervention will result in greater reductions in smoking due to of improvements in executive function and self-regulation. Cognitive training comprises programs that use theoretically driven strategies and guided practice on various tasks reflecting specific cognitive functions. Cognitive training has been used to promote neuroplasticity, has been shown to be successful in improving executive function in older adults. Delivering the cognitive training via mobile phone has the potential to increase access, given over 50 percent of older adults have smartphones phones. The proposed exploratory randomized controlled trial (RCT) will evaluate the efficacy of a mobile cognitive training intervention with a mobile-based smoking cessation intervention program relative to a mobile active control in increasing executive function and self-regulation and decreasing tobacco use in older adults. The cognitive training intervention (N=75) will receive an eight-week cognitive training program, BrainHQ, plus text-based support messages and nicotine replacement therapy (NRT). The active control group (N=75) will receive eight weeks of an active control in place of cognitive training and text-based support messages and NRT. The primary smoking outcome will be biochemically-validated smoking cessation at 1-month post treatment. Executive function and self-regulation behavior will be examined as intermediate outcomes that mediate the intervention effects on smoking cessation. Validated SOBC assays will be used to assess self-regulation (Short Self-Regulation Questionnaire) and executive function components (adaptive Nback test and Stroop Test). Result of this study can be used to inform future development of tailored intervention strategies for smoking cessation that address executive function and self-regulation deficits among older adult smokers with the ultimate goal of decreasing cancer related morbidity and mortality in this at-risk group.