Engagement with healthcare system, tobacco use and cancer communication during COVID-19 in India - Administrative Supplement to Project LifeFirst SWASTH

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Project This Summary application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 21-033. Background: There are over one million deaths per year in India due to tobacco use, with high incidence among those from lower socioeconomic position (SEP). Our parent grant, LifeFirst SWASTH (R01 CA230355- 02), is addressing the need for evidence-based interventions in low-resource settings through task-shifting and developing brief tobacco cessation interventions in nongovernmental (NGO)-run health clinics, dental clinics, and tuberculosis clinics in Mumbai, India, to reach individuals of low SEP. However, the COVID-19 pandemic has created new challenges that have complicated the tobacco cessation environment, and may have led to changes in tobacco use and new barriers to cessation attempts. Key among these challenges are changes to access to health services, an increase in information and misinformation in the communication environment, and upheavals to mental and social wellbeing due to pandemic-related lockdowns and stress. The need to address these challenges is urgent due to the increased risk of severe COVID-19 in those who use tobacco. Goal: We will conduct a survey to explore the impacts of COVID-19 on health service delivery and help- seeking, cancer communication, and mental and social wellbeing. We will also examine the impact of these factors on tobacco use to inform any adaptations needed for our parent grant in its formative stages. Methods: This study will employ a cross-sectional survey that will gather data from 1200 participants in the same three setting types (although different locations) with the parent grant (NGO-run health clinics, dental clinics, and tuberculosis clinics) in greater Mumbai. The study is organized around three aims: Aim 1 will examine engagement with the healthcare system during COVID-19. Aim 2 will explore participants' cancer communication behaviors during the pandemic. Aim 3 will seek to understand the impact of COVID-19 on social and mental wellbeing. Throughout each aim, we will emphasize how these factors relate to tobacco use, and changes to tobacco use, during the pandemic period. Innovations and Impact: This study will address the dearth of knowledge on the impact of COVID-19 on low SEP individuals in India, particularly on how the pandemic may be associated with changes to their health service engagement, cancer communication behaviors, and mental and social wellbeing, and how these factors may impact tobacco use. This study represents a unique opportunity to gather data on how a pandemic impacts tobacco cessation interventions in low-resource settings, and to use this data to pivot our parent intervention to make it more responsive to the changing COVID-19 context.