TRANSforma Tu Salud Dejando de Fumar: Advancing smoking cessation among transgender individuals

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PROJECT SUMMARY Mobile health (mHealth) interventions are a promising modality for overcoming barriers and providing culturally appropriate treatment among transgender individuals. mHealth interventions may be appropriate among transgender individuals, as emergent evidence suggests that virtual spaces are used to access gender affirming support and resources. Moreover, mHealth interventions may enable authentic self-expression among transgender individuals, which is not always possible offline. Over the past 7 years, our team has developed Decídetexto, a culturally accommodated smoking cessation text messaging intervention for U.S. Latino smokers. Decídetexto has been expanded to different Latin American countries/regions (e.g., Mexico and Puerto Rico), and has been adapted to different populations (e.g., U.S. Latino smokers living with HIV). A recently completed randomized controlled trial (RCT) with U.S. Latino smokers (n=457) demonstrated that U.S. Latinos receiving the Decídetexto intervention were significantly more likely than those receiving standard of care (smoking cessation printed materials) to be smoking abstinent at Month 6 (34.1% vs 20.6%; p<0.001). Despite the proven effectiveness of Decídetexto among U.S. Latinos, we have identified that this intervention does not adequately address unique barriers to smoking cessation encountered by transgender individuals (e.g., low social support, gender dysphoria as a stressor, need for gender affirming medical procedures). We propose to integrate our expertise in mHealth, smoking cessation, transgender health care, community-based participatory research, and cultural accommodation to develop, pilot test (R21), and then formally evaluate (R33) TRANSformá Tu Salud Dejando de Fumar (Spanish for “TRANSform Your Health by Quitting Smoking”) – a culturally accommodated smoking cessation intervention for transgender individuals. TRANSformá Tu Salud Dejando de Fumar will consist of 1) a 12-week WhatsApp-based program that facilitates longitudinal and bidirectional multimedia-based (i.e., text, image, video, and audio) dialogue with participants, and 2) integration with an e-Pharmacy to access nicotine replacement therapy (NRT) at no cost. R21 Aim 1: Develop TRANSformá Tu Salud Dejando de Fumar, a culturally accommodated smoking cessation intervention for transgender individuals. R21 Aim 2: Assess the feasibility, acceptability, and preliminary impact of TRANSformá Tu Salud Dejando de Fumar among transgender individuals. R33 Aim 1: Assess the efficacy of TRANSformá Tu Salud Dejando de Fumar compared to standard of care on smoking abstinence at Month 6 among transgender individuals. R21-R33 Capacity building. We will build capacity for mHealth behavioral research through the engagement of early career investigators in mentored activities and through academic partnerships between the U.S. and Argentina.