Multilevel Intersectional Stigma & Empowerment: Decreasing Tobacco Use among Black & Latine Adult Sexual and Gender Minorities - Abstract/Project Summary The Intersectional Substance Use & Lived Analysis (ISLA) lab, is dedicated to developing a novel framework for community-directed research approaches that seeks to reduce intersectional (race/ethnicity + sexual orientation) and intergenerational inequities in (commercial) tobacco use (TU) among Black & Latine young adult sexual and gender minorities (SGMs). SGM adults experience heightened TU, with racial/ethnic SGMs exhibiting elevated TU compared to their racial/ethnic heterosexual peers. Efforts to redress intersectional stigma is currently constrained in two significant ways: 1) overwhelming foci on individual-level measurement without identification of useful empowering strategies that mitigate individual-level stressors/harms and 2) lacking evidence illuminating how intersectional stigma constrains organizational capacity of community-based organizations (CBOs) historically serving those experiencing harmful TU. CBOs serving racial/ethnic SGM adults with heightened TU behaviors, and whose leadership historically has been led by racial minorities (e.g., HIV/AIDS service organizations), have not experienced enhanced R&D growth capacity on par with CBOs serving similar populations but with non-racially minoritized leadership. Such client-service provider racial disconcordance (R/D) has been linked to elevated mistrust, although such evidence within harm-reduction settings warrants greater clarity. We hypothesize that multilevel empowerment strategies (individual+organizational) is positively associated with decreases in TU/motivations among Black & Latine adult SGM Philadelphians. The current project combines inventive community-directed design and measurement strategies to investigate multilevel influences of empowerment in mitigating the harms of TU among racial/ethnic SGM adults. Guided by a 13-member Community Advisory Council, we will use a community-driven systems dynamic modeling process to identify significant multilevel intersectional drivers shaping TU/motivations among clients served by a BIPOC queer/trans urban CBO (n=30). Second, we evaluate how empowerment, resulting from direct policy engagement, can disrupt TU/motivations among clients with smoking histories, using expanded notions of intergenerational familial composition germane collected via surveys. Third, we will develop/assess the psychometric properties of a new organizational-level metric of intersectional stigma (n=488). Fourth, we will identify unique drivers of organizational empowerment, augmenting the R&D environment, to uncover new strategies for combating racial/ethnic inequities in TU. Lastly, we collect longitudinal (t=4, 3-month intervals: 24 clients/16 providers) qualitative multilevel data to better understand racialized dimensions of medical mistrust within harm-reduction settings, uncovering strategies to improve challenges arising from client-provider R/D in harm-reduction settings. These five components synergistically contribute to the development of the first empirically measureable framework of successful community-directed tobacco harm reduction (THR) research; a framework needed to achieve multiple crosscutting issues outlined within NIDA's Racial Equity Action Plan.
