Randomized Controlled Trial of a Text-Based Smokeless Tobacco Cessation Intervention for Rural and Medically Underserved Communities.

INTRODUCTION: Smokeless tobacco use remains prevalent in rural and medically underserved populations, leading to increased rates of tobacco-related cancers and chronic disease. While access to effective cessation programs is limited, text-based interventions may offer a delivery approach with broad reach. This two-armed randomized control trial (RCT) assessed the efficacy of #EnufSnuff.TXT, a text-based smokeless tobacco cessation intervention, in rural and medically underserved communities. AIMS AND METHODS: We conducted a two-arm RCT assessing #EnufSnuff.TXT, a text-based scheduled reduction intervention paired with text-based cessation support messages compared with the modified Enough Snuff intervention comprised of a cessation education booklet and bi-weekly motivational text messages. We recruited participants via social media and surveyed participants at 3 and 6 months post-randomization. The primary outcome was self-reported 7-day point prevalence abstinence at 6 months. RESULTS: We recruited and randomized 532 participants. At 3 months post-randomization, the quit rate was significantly higher in #EnufSnuff.TXT arm compared to the Enough Snuff arm for intent-to-treat (ITT) cases (29.2% vs. 19.0%, odd ratios [OR] = 1.75, p = .0066). The quit rate at 6 months post-randomization remained higher in #EnufSNuff.TXT compared to Enough Snuff for ITT cases (23.1% vs. 20.9%, OR = 1.14, p = .5384), although no longer significantly different. CONCLUSIONS: This is the first large-scale text-based cessation clinical trial for individuals in underserved areas who use smokeless tobacco. The #EnufSnuff.TXT intervention performed better in the short term; however, both interventions yielded similar quit rates at 6 months post-randomization. Future research should focus on improving long-term abstinence in the #EnufSNuff.TXT intervention. IMPLICATIONS: Text-based cessation approaches have the potential to increase access to cessation interventions in rural and medically underserved areas and reduce tobacco-related chronic disease morbidity and mortality. Our study shows short-term efficacy from the first-ever randomized controlled trial of a smokeless tobacco cessation intervention, #EnufSnuff.TXT, for rural and medically underserved residents in the United States. Our #EnufSnuff.TXT Intervention offers a scalable solution to reach and provide much-needed access to cessation interventions in medically underserved, rural communities in the United States. This work provides the foundation for further inquiry on augmented text-based approaches to increase cessation in this at-risk group. CLINICAL TRIALS REGISTRATION: A text-based Reduction Intervention for Smokeless Tobacco Cessation, NCT04315506.

Duke Scholars

Author Devon Noonan School of Nursing

Author Kathryn IIonka Pollak Population Health Sciences

Author Susan Gray Silva School of Nursing

Author Karen Scherr Family Medicine and Community Health, Family Medicine

Author Laura Jane Fish Family Medicine and Community Health, Prevention Research