Empowering Cessation ACS South Region

Phase 3RecruitingNCT06820034

University of Oklahoma400 enrolled

Overview

Sexual and/or gender minority (SGM) people face a disproportionate burden of cancer risk, and tobacco use is a key modifiable risk factor. SGM tobacco-related disparities are especially pronounced in places with high levels of stigma against SGM people. This community-engaged and remotely-delivered Research Scholar Grant project will evaluate an empowerment-based smoking cessation intervention tailored for SGM people in high-stigma places. In partnership with Freedom Oklahoma (OK) and a Community Advisory Board from Arkansas (AR) and Texas (TX) this projects aims to: (1) Adapt SGM-serving volunteer activities from the Oklahoma intervention pilot study for delivery in nearby states; (2) Test intervention efficacy among SGM adults in OK, AR, and TX; (3) Identify treatment mechanisms.

We will enroll 398 participants for the proposed RCT of the intervention. Randomization will occur prior to the onboarding meeting using screening survey responses. We will stratify by gender (cisgender man, cisgender woman, gender minority), sexual orientation (gay/lesbian, bisexual/pansexual/queer, all other sexual orientations), age (18-34 vs. ≥ 35 years old), and state of residence. In a 2-arm, 12-week randomized controlled trial (RCT) with follow-up at 26 weeks, N=398 SGM adults willing to quit smoking cigarettes will be randomized to a control arm (n=199) (i.e., remote cessation support via the National Cancer Institute's (NCI) smoking cessation app64 and mailed NRT64) or a treatment arm (n=199) that adds online SGM-serving volunteer activity participation (≥4 sessions) and a digital hub to foster social support across sites. All proposed activities will be conducted remotely (i.e., via phone/text, email, web-based platforms, a private Facebook group, and Zoom video chat) to maximize accessibility and scalability.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Interventions

Empowering Cessation for the ACS SouthOTHER

All participants (N=400) will receive remotely-delivered smoking cessation support comprised of the National Cancer Institute's (NCI) free smoking cessation app and 12 weeks of mailed over-the-counter NRT (nicotine patches, gum or lozenges).. While receiving smoking cessation support, participants in the intervention group (n=200) will also engage in SGM-serving online volunteer activities (≥4 weekly sessions lasting \~1.5 hours each), the protocols for which will be developed in Phase 1 to address the needs of OK, AR, and TX communities. Volunteer sessions will be facilitated by an SGM culturally-competent facilitator employed by the research team (i.e., community partner organizations will not run volunteer sessions). The intervention group will also be added to a digital hub (i.e., a private Reddit group) for 12 weeks to foster social support and exchange of ideas between participants/community partners across the three states.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 100 YearsHealthy volunteers:

Medical Language ↔ Plain English

Exclusion criteria: * Currently using other smoking cessation treatments. * Unable or unwilling to use Nicotine Replacement Therapy (NRT) * Serious psychological distress (i.e., score of 13 ≥ 18 on the Kessler Psychological Distress (PD) Scale-6 19) Inclusion criteria will be: 1. ≥ 18 years old 2. sexual and/or gender minority-identified (SGM) (see definition below) 3. living in Oklahoma, Texas, or Arkansas (verified by address) 4. a current cigarette smoker (see definition) 5. willing to quit smoking within 30 days of enrollment (see definition) 6. ability to read and speak English 'well' or 'very well' 7. ≥ weekly internet access 8. willing and able to participate in SGM-serving volunteer activities. 9. own a smartphone Sexual minority identity will be indicated by selecting any non-heterosexual response option(s) from: Heterosexual (Straight); Gay or Lesbian; Bisexual; Something else (please state)." Participants will indicate the sex assigned on their birth certificate (i.e., natal sex). Gender minority identity will be indicated by "Trans male/Trans man;" "Trans female/Trans woman;" "Gender queer/Gender non-conforming;" "Different identity (please state)" or a binary identity (male or female) non-concordant with natal sex. Current cigarette smoking will be indicated by ≥100 lifetime cigarettes and currently smoking cigarettes "every day" or "some days". High SGM stigma states are defined as the 22 states wherein ˂60% of the population 'thinks that homosexuality should be accepted'. High SGM stigma municipalities are defined as one of the 246 U.S. municipalities (out of the 496 scored from all U.S. states) that scored below the median (71) on the HRC Municipal Equality Index. Willingness to quit smoking will be assessed with a single item: "Are you willing to quit smoking cigarettes within 30 days after enrolling in this study? (yes/no)". To be classified as 'ready to quit smoking,' participants will report readiness to quit in the next 30 days and at least 1 past-year quit attempt (i.e., in the "Preparation" stage of change).

Outcomes

Primary Outcomes

Biochemically-verified 7-day Point Prevalence Abstinence (PPA) at 26 weeks

Self-reported smoking cessation abstinence will be biochemically verified with the iCOQuit Smokerlyzer expired carbon monoxide device 26 weeks after the participant's quit smoking date.

Time frame: 26 weeks post-quit-date

Secondary Outcomes

Social Support

Patient-Reported Outcomes Measurement Information System (PROMIS) emotional support scale. 5-point Likert scale; Strongly disagree = least support ... Strongly agree = most support

Time frame: Week 0; Week 12

Smoking intensity

-Smoking intensity will be assessed by past-week smoking days and past-week cigarettes per smoking day. Greater number of smoking days and great number of cigarettes per day = greater smoking intensity

Time frame: Week 0, Week 12, Week 26

Adaptive coping with minority stress

Brief- Coping Orientation to Problems Experienced Inventory (COPE) \[adapted\] 5-point Likert scale; Strongly disagree to Strongly agree. Higher score = more coping

Time frame: Week 0; Week 12

Self-efficacy

-Self-Efficacy Scale/Confidence (SESC) Scale of 10 Very confident to 1 not at all confident. Higher score = greater self-efficacy to quit smoking

Time frame: Week 0, Week 12, Week 26

Motivation to quit smoking

-Motivation to change (Stages of Change \[SoC\] scale) 0 (Not at all ready)-----------------------10 (Extremely ready/already quit) Higher score = more motivation to quit smoking

Time frame: Week 0, Week 12, Week 26

Internalized transphobia

Gender Minority Stress and Resilience: Internalized transphobia subscale 5-point Likert scale; Strongly disagree to Strongly agree Higher score = greater internalized transphobia

Time frame: Week 0; Week 12

Prosociality

Well-Being in Prosociality \[Chi K, Almeida DM, Charles ST, et al. Daily prosocial activities and well-being: Age moderation in two national studies. Psychology and Aging 2021;36(1):83.\] 5-point Likert Scale: Strongly agree to Strongly disagree Higher score indicates greater prosociality

Time frame: Week 0; Week 12

Nicotine Replacement Therapy (NRT) Adherence

Medication Adherence Questionnaire (MAQ) Yes=0; No=1; higher score = greater adherence

Time frame: Weeks 1, 3, 5, 7, 9, 11

Smoking cessation app engagement

Self-report of number of times per day participant opened app, on average, over the past week. Greater number of times opened = greater engagement

Time frame: Weeks 3, 5, 7, 9, 11

Intervention satisfaction

Validated measures of intervention feasibility, acceptability, and appropriateness (Weiner et al, 2017) 5 point ordinal scale from "completely disagree=0" to "completely agree=4"; higher score = greater intervention satisfaction

Time frame: Weeks 3, 5, 7, 9, 12

Sexual Orientation Identity Pride

Lesbian, Gay, and Bisexual Identity Scales: Identity Concealment Motivation subscale; Internalized Homonegativity; Identity Acceptance Concerns 6-point scale: 1=Disagree strongly... 6=Strongly agree Higher score = greater identity concerns

Time frame: Week 0, Week 12

Gender identity and expression pride

Gender Minority Stress and Resilience: Gender Identity \& Expression Pride subscale 5-point Likert scale; Strongly disagree to Strongly agree Higher score = greater gender identity and expression pride

Time frame: Week 0, Week 12

Empowering Cessation ACS South Region

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts