Developing An Empowerment Theory-Based Smoking Cessation Intervention for Sexual and/or Gender Minority People with Community Partners - PROJECT SUMMARY/ABSTRACT 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 sexual and/or gender minority (SGM) people living in high-stigma places. 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-related inequities among SGM people persist, especially in places with high SGM stigma. Tobacco is a leading cause of preventable disease and death among SGM individuals, ≥35% of whom live in places with high structural stigma. High-stigma (versus lower-stigma) places have more negative aggregate attitudes about SGM people, weaker policy protections, and are more likely to expose SGM people to minority stressors and lack SGM community participation outlets. Existing SGM-tailored smoking cessation interventions overwhelmingly focus on within-person processes of behavior change rather than the adverse sociopolitical factors driving SGM smoking inequities and the unique challenges of being SGM in high-stigma places. Our innovative approach, grounded in Empowerment Theory (ET), posits that when SGM people in high-stigma environments participate in SGM-serving volunteer activities that empower their communities, they may also experience cognitive and behavioral changes that support smoking cessation (i.e., social support, minority stress coping, SGM identity pride, prosociality). ET-informed health behavior change approaches have worked for SGM HIV prevention and youth tobacco interventions, suggesting that ET may also enhance SGM-tailored smoking cessation. Our pretest of ECHO in Oklahoma (OK; N=20) demonstrated the feasibility and acceptability of an additive intervention design wherein SGM people received remotely-delivered standard smoking cessation support and did SGM-serving volunteer activities. Building on this work, we propose to: (Aim 1/Phase 1) Prioritize key factors that support SGM smoking cessation success using ecological momentary assessment (EMA) of active smoking cessation quit attempts with n=60 nationally-recruited SGM adults in high stigma places; (Aim 2/Phase 2) Use a rapid, iterative design process with our SGM-serving community partners in two high stigma sites (OK and the San Joaquin Valley (SJV), California) to develop volunteer activity protocols likely to maximize factors supporting SGM cessation success with n=12 SGM adults ready to quit smoking; and (Aim 3/Phase 3) Use the volunteer activity protocols developed in Aim 2 to conduct a randomized controlled trial (RCT) of the ECHO intervention with our community partners and n=50 SGM adults ready to quit smoking in OK and the SJV. Conducted remotely to increase scalability and accessibility, this project lays the ground work of a future R01 application for a fully-powered, multi-site RCT of ECHO in high-stigma sites around the country.
