Project 4: Culturally‐Tailored, Avatar‐Led mHealth Intervention to Aid Smoking Cessation Among Sexual and Gender Minority Young Adults in New Mexico

摘要 在新墨西哥州，性和性别少数（SGM）成年人的吸烟率是 更高的非SGM成年人，这表明现有的SGM相关的烟草使用差异将持续到2020年。 除非作出持续努力来解决这些问题，否则在可预见的未来，这些问题将无法得到解决。帮助青少年烟草 戒烟是SGM指导的烟草控制干预措施的一个关键部分，但很少有努力， 专门为这一人群开发量身定制的治疗方法。这是一个关键的差距，因为这是一个人口 他们获得和使用传统的戒烟治疗，包括咨询和药物治疗， 扶贫新墨西哥州（NM）的SGM年轻人可能会对烟草使用产生独特的影响， 除其身份的其他方面外，停止与其种族和SGM身份有关。一个 交叉关注对于制定干预措施以解决SGM中烟草使用率高的问题至关重要 年轻的成年人在新墨西哥州是可以接受的，可访问的，有效的。为了满足这些需求，我们 为SGM的年轻人改编了一个以化身为主导的数字接受和承诺治疗（ACT）计划 所有阶段的吸烟者都准备戒烟。这个计划（称为授权，酷儿，退出，和生活，或 EQQUAL）在一项单臂试点试验中显示出巨大的前景：93%的满意度和23%的生化- 确认退出率。在这项研究中，我们建议开发一个版本的程序，是文化定制， 在新墨西哥州的SGM年轻成人（EQM-NM）中进行了一项初步随机对照试验（n=120）， 初步评估EQR-NM相对于美国国家癌症研究所的可接受性和有效性 QuitGuide程序。我们假设，与QuitGuide相比，EQP-NM将显示出以下趋势： 更高的满意度、登录次数、生化确认的7天时点尼古丁和烟草患病率 禁欲和心理灵活性（即，ACT的基于理论的变化机制）。我们还将探索 戒烟准备、性取向、性别认同和拉丁裔种族作为治疗效果的调节因素。 本研究的意义在于：（1）研究对象为美国国立卫生研究院（NIH）定义的高烟草流行率的差异人群 在治疗研究中没有得到充分服务的用途;（2）它解决了SGM个体对计划的愿望 以易于扩展和访问的格式针对其独特的需求和挑战量身定制;（3）如果经过验证 有效的，EQW-NM将高度传播在线和通过SGM社区服务组织， NM.它也具有创新性：（1）它是第一个为SGM文化量身定制的自我指导数字戒烟治疗 年轻人在新墨西哥州，（2）目前没有其他的SGM定制的治疗在西班牙语，（3） 其新的治疗方法通过测试以下有效性来推进ACT戒烟科学： 处于准备退出的所有阶段的用户;以及（4）使用化身和交互式游戏作为参与 这些策略与现有的治疗方法有很大的不同。该项目将产生所需的所有试验数据 以支持R 01级项目，在全功率试验中测试EQP-NM的有效性。

ABSTRACT Smoking prevalence among sexual and gender minority (SGM) adults in New Mexico is more than twice as high as non-SGM adults, suggesting that existing SGM-related disparities in tobacco use will persist well into the foreseeable future unless sustained efforts are undertaken to address them. Helping young adult tobacco users to quit is a critical piece of SGM-directed tobacco control interventions, yet there have been few efforts to develop tailored treatments specifically for this population. This is a critical gap given that this is a population whose access to and use of traditional cessation treatments involving counseling and pharmacotherapy is poor. SGM young adults in New Mexico (NM) are likely to experience unique influences on tobacco use and cessation tied to both their ethnic and SGM identities, in addition to other aspects of their identity. An intersectional focus is critical for developing interventions to address high rates of tobacco use among SGM young adults in New Mexico that are acceptable, accessible, and effective. To address these needs, we have adapted an avatar-led, digital Acceptance and Commitment Therapy (ACT) program for SGM young adult smokers at all stages of readiness to quit. This program (called Empowered, Queer, Quitting, and Living, or EQQUAL) showed great promise in a single-arm pilot trial: 93% satisfaction and a 23% biochemically- confirmed quit rate. In this study, we propose to develop a version of the program that is culturally tailored to SGM young adults in New Mexico (EQQUAL-NM) and conduct a pilot randomized controlled trial (n=120) to preliminarily evaluate acceptability and efficacy of EQQUAL-NM relative to the National Cancer Institute’s QuitGuide program. We hypothesize that, compared with QuitGuide, EQQUAL-NM will show a trend toward greater satisfaction, number of logins, biochemically confirmed 7-day point prevalence nicotine and tobacco abstinence, and psychological flexibility (i.e., ACT’s theory-based change mechanism). We will also explore readiness to quit, sexual orientation, gender identity, and Latinx ethnicity as moderators of treatment effects. This project is significant: (1) it focuses on an NIH-defined disparities group with a high prevalence of tobacco use that has been underserved in treatment research; (2) it addresses SGM individuals’ desire for a program tailored to their unique needs and challenges in a readily scalable and accessible format; (3) if proven effective, EQQUAL-NM would be highly disseminable online and via SGM community-serving organizations in NM. It is also innovative: (1) it is the first self-guided digital cessation treatment culturally tailored for SGM young adults in New Mexico, (2) there are currently no other SGM-tailored treatments available in Spanish, (3) its novel treatment approach advances the science of ACT for tobacco cessation by testing effectiveness for users at all stages of readiness to quit; and, (4) use of avatars and interactive games as engagement strategies is substantially different than existing treatments. This project will generate all the pilot data needed to support an R01-level project testing the effectiveness of EQQUAL-NM in a fully-powered trial.