Smokeless tobacco (chew or dip) use remains prevalent in rural and medically underserved populations, leading to increased rates of tobacco-related cancers and chronic disease. Yet, underserved tobacco users who want to quit have access to few innovative interventions. This is a significant missed opportunity to address health disparities in this group. Scheduled Gradual Reduction (SGR) may be an effective intervention to help smokeless tobacco users quit. SGR addresses common cessation challenges faced by smokeless tobacco users including the strong cue-based component of use and strong withdrawal symptoms. The SGR method been minimally studied in this population of tobacco users and represents an innovative new direction in the field. SGR involves gradually tapering smokeless tobacco use through lengthening use intervals based on an individually tailored schedule. SGR helps smokeless tobacco users learn to refrain from chew/dips that are in environmental cues by following the schedule and gradually reducing their 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 (SGR intervention plus text-based support messages) vs. control intervention (text-based support messages) in decreasing smokeless tobacco use. The SGR group (N=250) will receive a six-week SGR program and text-based support messages. The control group (N=250) will receive text-based support messages. The primary outcome will be self-report smokeless tobacco cessation at 6 months. We will also test the efficacy of the text-based SGR intervention compared to support messages only on changes in withdrawal, craving, self-regulation and restraint across the 6-month period and explore whether changes in withdrawal, craving, self-regulation and restraint mediate intervention effects on self- reported cessation at 6 months post-intervention. Results of this study can be disseminated broadly to help smokeless tobacco users quit with the ultimate goal of increasing access to efficacious cessation interventions and eliminating cancer health disparities.
Available interventions for smokeless tobacco cessation have not targeted those most at risk and have not been easily disseminated too hard to reach populations. The proposed research will efficacy of a Scheduled Gradual Reduction intervention via SMS text messaging paired with text-based counseling messages. The results of this study can be easily disseminated to rural and medically underserved smokeless tobacco users to aid in cessation, thus helping to decrease tobacco related health disparities.
