Project RESIST: Increasing Resistance to Tobacco Marketing Among Young Adult Sexual Minority Women Using Inoculation Message Approaches

包括女同性恋者和双性恋者在内的青年成年性少数群体(SMW)的风险特别高，吸烟的几率比异性恋妇女高4.8倍；多达66万名青年SMW吸烟，并面临与吸烟有关的癌症和心肺疾病的风险增加。暴露于烟草行业营销、少数族裔压力源、酒精和药物使用以及社会决定因素是导致该人群吸烟行为增加的关键因素。禁烟运动利用接种信息(类似于疫苗)和文化定制(即LGBT形象、符号和语言)，在LGBT受众中提高对烟草营销影响的复原力。然而，针对文化定制的接种方法对年轻成人SMW的影响尚未得到检验。我们的长期目标是消除LGBTQ人群中与吸烟相关的健康差距。这项研究的目的是确定使用文化定制的接种方法来提高年轻成年SMW对烟草营销影响的复原力的效果，并获得利益相关者的关键投入，以支持以后的采用和实施。这些目标直接响应了PAR-18-559在癌症预防和控制方面的行为研究、针对烟草使用的干预措施的开发和测试以及旨在改变烟草使用的通信方面的优先事项。我们的中心假设是，文化定制的接种信息将比非定制的信息更有效，以提高对烟草营销的适应能力。这项工作的科学前提得到了1)在LGBTQ受众中促进针对烟草公司和吸烟的复原力的宣传活动的支持，2)我们的初步研究显示，与对照图像相比，年轻成年SMW对LGBTQ图像的相关性、有利态度和积极情绪更高，以及3)综合概念框架，该框架基于传播学、少数群体压力和SMW之间的复原力框架。我们的具体目标是：1)与主要利益攸关方合作，优化信息结构并收集试点数据，为未来的干预设计提供信息；2)评估针对文化定制的反吸烟信息对年轻成年SMW吸烟和戒烟意图的影响；3)评估接种信息类型、剂量和潜伏期对年轻成年SMW对烟草营销、吸烟和戒烟意图的适应能力的影响。我们将每年举行两次会议，进行快速周期反馈、现场试点测试和与关键线人的面谈，专家咨询委员会由LGBT组织领导人、性和性别少数群体健康调查人员、社区成员和国家机构(NCI、CDC和FDA)组成；使用定性研究方法进行信息开发和测试；以及随机调查实验。影响：这项研究的结果将为开发一种基于证据和文化定制的接种方法提供基础，以提高年轻成年SMW对烟草营销的适应能力，并满足未来采用者和实施者的需求。

Young adult sexual minority women (SMW), including lesbians and bisexuals, are at particularly high risk, with up to 4.8 times increased odds of cigarette smoking than heterosexual women; up to 660,000 young adult SMW smoke and are at increased risks of smoking-related cancers and cardiopulmonary illnesses. Exposure to tobacco industry marketing, minority stressors, alcohol and drug use and social determinants are key factors linked to increased smoking behavior in this population. Anti-smoking campaigns utilized inoculation messages (analogous to vaccines) and culturally-tailoring (i.e., LGBT imagery, symbols, and language) to promote resilience against tobacco marketing influences among LGBT audiences. However, the effects of culturally tailored inoculation approaches in young adult SMW have not yet been examined. Our long-term goal is to eliminate smoking-related health disparities among LGBTQ populations. The objectives of this study are to determine the effects of using a culturally-tailored inoculation approach to increase resilience to tobacco marketing influences among young adult SMW and obtain stakeholders’ critical inputs that support later adoption and implementation. These objectives are directly responsive to the priorities of PAR-18-559 for behavioral research in cancer prevention and control, development and testing of interventions addressing tobacco use, and communication aimed at altering tobacco use. Our central hypothesis is that culturally tailored inoculation messages will be more effective versus non-tailored messages to increase resilience to tobacco marketing. The scientific premise for this work is supported by 1) campaigns promoting resilience against tobacco companies and smoking among LGBTQ audiences, 2) our pilot study showing young adult SMW perceive higher relevance, favorable attitudes, and positive emotions toward LGBTQ imagery compared to control imagery, and 3) an integrative conceptual framework informed by communication science, minority stress and resilience framework among SMW. Our specific aims are: 1) Engage with key stakeholders to optimize message construction and collect pilot data to inform future intervention design, 2) Evaluate the effects of culturally tailored anti-smoking messages on young adult SMWs’ smoking and quitting intentions, and 3) Evaluate the effects of inoculation message type, dose, and latency on young adult SMWs’ resilience to tobacco marketing, smoking and quitting intentions. We will conduct twice-yearly meetings, rapid cycle feedback, field pilot testing, and key informant interviews with an Expert Advisory Committee comprising LGBT organization leaders, investigators in sexual and gender minority health, community members, and national agencies (NCI, CDC, and FDA); message development and testing using qualitative research methods; and randomized survey experiments. Impact: Findings from this study will provide the foundation to develop an evidence-based and culturally tailored inoculation approach to increase resilience to tobacco marketing among young adult SMW and that addresses the needs of future adopters and implementers.