Developing an Empowerment Theory-Based Smoking Cessation Intervention for People with High Levels of Social Stress - This multi-phased, community-engaged R34 proposal was developed with community partners to (1) inform, (2) develop, and (3) pilot test protocol for ECHO (Empowering Our Community & Health Outcomes), a smoking cessation intervention tailored for people experiencing high levels of social stress, an established risk factor for nicotine dependence and cessation relapse. The proposed work qualifies as “Stage I (treatment generation, refinement)” in “the development and testing of behavioral and integrative treatments for substance use and dependence” as per PAR- 22-183. Tobacco use is still a leading preventable cause of disease and death in the U.S. and current cessation treatments have limited success; two-thirds relapse within 6 months of a quit attempt. Existing smoking cessation interventions overwhelmingly focus on within-person processes of behavior change rather than addressing key socioenvironmental factors of cessation success. Our innovative approach, grounded in Empowerment Theory (ET), posits that when people participate in community-serving volunteer activities while making a quit smoking attempt, they may also experience cognitive and behavioral improvements (i.e., enhanced stress coping, social support, self-worth, prosociality) that ameliorate socioenvironmental stressors, thereby increasing cessation success. ET-informed health behavior change approaches have worked for infectious disease prevention and youth tobacco interventions, suggesting that ET may also enhance smoking cessation for people with high levels of social stress. Our pretest of ECHO in Oklahoma (OK; N=20) demonstrated strong feasibility and acceptability for an additive intervention design wherein participants received remotely-delivered standard smoking cessation assistance and did volunteer activities. Building on this work, we propose to: (Aim 1/Phase 1) Prioritize key factors that support smoking cessation success among people with high levels of social stress using ecological momentary assessment (EMA) of active smoking cessation quit attempts with n=60 nationally-recruited adults; (Aim 2/Phase 2) Use a rapid, iterative design process with our community partners in OK and the San Joaquin Valley (SJV), California to develop volunteer activity protocols likely to maximize factors supporting cessation success with n=12 adults with high levels of social stress who are ready to quit smoking; and (Aim 3/Phase 3) Use the volunteer activity protocols developed in Aim 2 to conduct a pilot randomized controlled trial (RCT) of the ECHO intervention with our community partners and n=50 adults with high levels of social stress who are ready to quit smoking in OK and the SJV. Conducted remotely to increase scalability and accessibility, this project lays the groundwork of a future R01 application for a fully-powered, multi-site RCT of ECHO to improve cessation outcomes across the country.
