CLINICAL TRIAL article
Front. Public Health
Sec. Substance Use Disorders and Behavioral Addictions
#EnufSnuff.TXT-FirstResponder: A Pilot Randomized Controlled Trial of a Text Message Intervention for Smokeless Tobacco Cessation among First Responders
Provisionally accepted
Devon Noonan1,2*
Laura Fish2,3Susan Silva1Mariana DaCosta4
Leigh Ann Simmons5Norma Garcia Ortiz1
Courtney Swinkels1Daum Jung1Herb Severson6KI Pollak2,7- 1Duke University School of Nursing, Durham, United States
- 2Duke Cancer Institute, Durham, United States
- 3Duke University Department of Family Medicine and Community Health, Durham, United States
- 4Western Carolina University College of Health and Human Sciences, Cullowhee, United States
- 5University of California Davis Betty Irene Moore School of Nursing, Sacramento, United States
- 6Oregon Research Institute, Eugene, United States
- 7Duke University Department of Population Health Sciences, Durham, United States
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Abstract Introduction: First Responders are three times more likely to use smokeless tobacco than those in the general population and very few targeted cessation interventions are available. Methods: The #EnufSnuff.TXT First Responder text-based intervention (n=30), which includes an optional reduction component and tailored text-messages for cessation, was administered alongside the Enough Snuff Intervention (n=30), which includes a cessation booklet and general support texts. Both groups received a 4-week supply of 4mg Nicotine Replacement Therapy (NRT) lozenges to assist with cessation. We surveyed participants 30 days post-intervention initiation to assess feasibility, acceptability, and Smokeless TobaccoSLT cessation outcomes. A subset of participants participated in qualitative interviews to assess feedback on the intervention. Discussion/Conclusion: Feasibility: Feasibility benchmarks for recruitment, retention, and engagement were met. Both programs helped First Responders quit. The respective quit rate for #EnufSnuff.TXT-FR arm was higher compared to Enough Snuff was 40% vs 33% (OR=1.33, p=0.5925; RR=1.20, p=0.5935) for the intent-to-treat cases and 52% vs 44% (OR=1.41, p=0.5555; RR=1.20, p=0.5570) for the completers. A text-based cessation intervention was found to be feasible and represents a scalable intervention approach and both interventions produced high quit rates. Larger scale efficacy testing is warranted.
Keywords: Cessation intervention, First Responders (FRs), m-Health (Mobile Health), Smokeless Tobacco (SLT), Tobacco cessation
Received: 05 Sep 2025; Accepted: 05 Dec 2025.
Copyright: © 2025 Noonan, Fish, Silva, DaCosta, Simmons, Garcia Ortiz, Swinkels, Jung, Severson and Pollak. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Devon Noonan
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