Document text
Principal Investigator: Arthur Durazo
Organization: UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
Fiscal Year: 2024
Award: $191,251
Funding agency: National Institute on Drug Abuse
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.
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