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

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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.