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

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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.