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.
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