Kudos to Devon Noonan, associate professor, and her entire team for the submission of her NIH R01 Administrative Supplement application entitled: “Development of a M-Health Smokeless Tobacco Cessation Intervention for Firefighters." This proposal requests funds for a one-year period with a start date of September 1, 2021.

Firefighters represent a high-risk group for cancer given both their occupational exposures and high rates of smokeless tobacco use. Smokeless tobacco (chew or dip) use is high among fire fighters with 10-18% of firefighters using compared to 3% in the general population. This use increases the risk for developing head and neck cancers; and prevalence of head and neck cancer among U.S. firefighters exceeds that in the general population. Our team has recently partnered with the Professional Firefighters and Paramedics of North Carolina (PFPNC). We are currently conducting an observational study on firefighters on cancer risk beliefs and behaviors. Preliminary results from this work indicate high rates of smokeless tobacco use (10% everyday users and 4% someday users), higher than the national and state averages (3% nationally and 8% in men in NC). Despite high rates of use, there has been little attempt to promote cessation. Given this need we have enrolled 12 firefighters in the EnufSnuff study to date. Initial reactions to the intervention are positive, however, delivery of a Scheduled Gradual Reduction Intervention to participants who work in shifts such as firefighters is problematic and may be a barrier to effective engagement with the program. Therefore, for this administrative supplement, we will conduct formative work with our partners to inform the development of a tailored, m-health smokeless tobacco cessation intervention for Firefighters. We will then test the feasibility, acceptability, and preliminary efficacy of this intervention, a culturally and occupationally relevant smokeless tobacco cessation intervention, compared to a usual care control (Enough Snuff booklet). If we meet feasibility and acceptability benchmarks, we will submit an R01 to test our intervention in a fully powered randomized controlled trial.