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Novel Theoretical Models and Methods for Reducing Socioeconomic Disparities in Tobacco Use

Award Number: R21MD020448
ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2026
PERIOD OF PERFORMANCE END DATE: 02/29/2028

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Novel Theoretical Models and Methods for Reducing Socioeconomic Disparities in Tobacco Use - Although tobacco control interventions have reduced overall smoking prevalence, tobacco use remains a leading cause of preventable disease and death. There is a dynamic interplay of individual, social, and societal factors that underlie difficulty in smoking cessation, particularly for populations with low income or limited resources. Although smoking and smoking cessation behaviors are linked by complex feedback loops (i.e., a set of balancing and reinforcing causal feedback mechanisms) interacting at multiple levels, a more comprehensive understanding of these complex feedback mechanisms from a higher-level systems view is currently lacking. Towards reducing the prevalence of tobacco use, a promising and innovative approach is to identify stakeholder-informed targets of interventions (or leverage points) in multilevel feedback mechanisms driving the dynamics of smoking cessation. The goal of this R21 application is to identify and model multilevel intervention strategies that can be prioritized for addressing tobacco use and to develop a novel, multilevel adaptive intervention trial design that can identify the optimal order to target multilevel leverage points. Aim 1 is to identify key leverage points of intervention for reducing socioeconomic disparities in smoking. We will accomplish this using community-based system dynamics (CBSD) to develop an initial feedback theory of smoking and health-related social needs dynamics via key informant interviews and group model building. CBSD is an approach to group model building that directly involves communities in the process of conceptualizing, formulating, and analysis of system dynamics simulation models. Aim 2 is to develop a novel clinical trial design to test adaptive, multilevel interventions. Building on a framework for sequential, multiple assignment, randomized trials (SMARTs), we will design and develop the methodology to analyze clinical trial data that can be used to identify dynamic treatment regimens, or sequences of treatment that change adaptively based on response, for multilevel interventions. This project seeks to carry out conceptual work in parallel with methodological work to improve upon trial design and analysis that can inform advancements in clinical and translational science to reduce health disparities. The NIMHD has called for research on multilevel interventions to address health disparities, including through strengthening theoretical frameworks that can recognize the complex set of factors involved in multilevel change. By modeling the multilevel drivers of a significant health disparity issue, identifying leverage points for intervention, and addressing a gap in clinical trial design, the findings will cost-effectively inform the most optimal set of multilevel intervention targets that can be further examined and tested in a future study.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2027 ( Subtotal = $0 )
2027	2026	CASE WESTERN RESERVE UNIVERSITY	10900 EUCLID AVE	CLEVELAND	OH	44106	CUYAHOGA	USA	Minority Health and Health Disparities Research	000	1	10/8/2026	NEW	$0
														Subtotal = $0

Issue Date FY: 2026 ( Subtotal = $241,500 )
2026	2026	CASE WESTERN RESERVE UNIVERSITY	10900 EUCLID AVE	CLEVELAND	OH	44106	CUYAHOGA	USA	Minority Health and Health Disparities Research	000	1	8/31/2026	NEW	$241,500
														Subtotal = $241,500

Grand Total All Awards = $241,500

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Novel Theoretical Models and Methods for Reducing Socioeconomic Disparities in Tobacco Use

Award Number: R21MD020448

ORGANIZATION: NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2026

PERIOD OF PERFORMANCE END DATE: 02/29/2028

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