Expanding population-level interventions to help more low-income smokers quit

ABSTRACTMany low-income Americans, racial and ethnic minorities, and other marginalized groups live in information-poor environments, disproportionately exposed to misinformation about COVID-19, and distrusting medical,government and scientific institutions and leaders. These and other social, cultural and behavioral factors posesignificant obstacles to public health efforts to increase population testing and vaccination in a pandemic.Effective health communication is urgently needed to help counter these challenges and reduce disparities inCOVID-19's impact. Working in close partnership with 2-1-1 helplines in four states and nationwide, wepropose rapid-cycle research that moves from audience analysis to message testing among prioritypopulations identified in the NOSI. Our approach builds on strong evidence from our team's decades-longprogram of health communication research to eliminate disparities, especially proven message tactics such ascultural values, disparity framing, and narratives, that will be applied to the COVID-19 context. Specifically, wewill conduct a multi-method content analysis of 43,000+ COVID-19 testing inquiries to 2-1-1 (Aim 1), surveyand interview 350 2-1-1 callers and phone operators (Aim 2), and develop and evaluate in randomized A-Btesting new COVID-19 testing messages among 300 2-1-1 callers (Aim 3). Taken together, these activities willidentify essential context and content for communicating about COVID-19 testing to vulnerable populations,integrate this knowledge into proven message tactics, and determine their impact on interest in and intention tobe tested and other key outcomes. Our partnership with 2-1-1s is central to the proposed research. Of the 24priority populations identified in the NOSI, 2-1-1s serve a higher proportion of callers from nearly every groupcompared to their proportion of the U.S. population, including 60-80% racial or ethnic minorities, 40-55% withhousehold income below $10,000, and 1 in 4 not completing high school. During COVID-19, 2-1-1s in 36states have fielded 964,286 COVID-19 requests. These first-hand accounts from underserved Americansconcerned about or affected by COVID-19 must inform communication efforts, and the infrastructure of 2-1-1 iswell suited to support rapid testing of promising approaches.