Expanding population-level interventions to help more low-income smokers quit

摘要 许多低收入的美国人、少数民族和其他边缘化群体生活在信息时代， 恶劣的环境，不成比例地暴露在关于COVID-19的错误信息中，以及不信任医疗， 政府、科研机构和领导者。这些以及其他社会、文化和行为因素构成了 在大流行病中增加人群检测和疫苗接种的公共卫生努力面临重大障碍。 迫切需要进行有效的卫生宣传，以帮助应对这些挑战，并减少 COVID-19的影响。我们与四个州和全国范围内的2-1-1公司密切合作， 建议优先进行从受众分析到信息测试的快速循环研究 在NOSI中识别的人群。我们的方法建立在我们团队数十年来 一项旨在消除差距的健康传播研究计划，特别是经过验证的信息策略，如 文化价值观、差异框架和叙事，将应用于COVID-19背景。我们特别 将对43，000多个COVID-19测试查询进行多方法内容分析，以2-1-1（目标1），调查 和采访350个2-1-1呼叫者和电话接线员（目标2），并在随机A-B中开发和评估 在300名2-1-1呼叫者中测试新的COVID-19测试信息（目标3）。这些活动将 确定向弱势群体传达COVID-19检测的基本背景和内容， 将这些知识整合到经过验证的信息策略中，并确定它们对以下方面的兴趣和意图的影响： 测试和其他关键成果。我们与2-1- 1 s的合作关系是拟议研究的核心。的24 在NOSI中确定的优先人群中，2-1- 1服务于几乎所有人群中较高比例的呼叫者 与他们在美国人口中的比例相比，包括60-80%的种族或少数民族，40-55%的 家庭收入低于1万美元，四分之一的人没有完成高中学业。在COVID-19期间，36人中有2-1- 1人 各州共处理了964，286份COVID-19请求。这些第一手资料来自服务水平低下的美国人 关注或受COVID-19影响的人必须通知沟通工作，2-1-1的基础设施是 非常适合支持对有前途的方法进行快速测试。

ABSTRACT Many low-income Americans, racial and ethnic minorities, and other marginalized groups live in information- poor environments, disproportionately exposed to misinformation about COVID-19, and distrusting medical, government and scientific institutions and leaders. These and other social, cultural and behavioral factors pose significant obstacles to public health efforts to increase population testing and vaccination in a pandemic. Effective health communication is urgently needed to help counter these challenges and reduce disparities in COVID-19's impact. Working in close partnership with 2-1-1 helplines in four states and nationwide, we propose rapid-cycle research that moves from audience analysis to message testing among priority populations identified in the NOSI. Our approach builds on strong evidence from our team's decades-long program of health communication research to eliminate disparities, especially proven message tactics such as cultural values, disparity framing, and narratives, that will be applied to the COVID-19 context. Specifically, we will conduct a multi-method content analysis of 43,000+ COVID-19 testing inquiries to 2-1-1 (Aim 1), survey and interview 350 2-1-1 callers and phone operators (Aim 2), and develop and evaluate in randomized A-B testing new COVID-19 testing messages among 300 2-1-1 callers (Aim 3). Taken together, these activities will identify essential context and content for communicating about COVID-19 testing to vulnerable populations, integrate this knowledge into proven message tactics, and determine their impact on interest in and intention to be tested and other key outcomes. Our partnership with 2-1-1s is central to the proposed research. Of the 24 priority populations identified in the NOSI, 2-1-1s serve a higher proportion of callers from nearly every group compared to their proportion of the U.S. population, including 60-80% racial or ethnic minorities, 40-55% with household income below $10,000, and 1 in 4 not completing high school. During COVID-19, 2-1-1s in 36 states have fielded 964,286 COVID-19 requests. These first-hand accounts from underserved Americans concerned about or affected by COVID-19 must inform communication efforts, and the infrastructure of 2-1-1 is well suited to support rapid testing of promising approaches.