Multilevel intersectional stigma & empowerment: decreasing tobacco use among black & latine adult sexual and gender minorities

This Project Grant award, with a total funding amount of $957,600.00, was provided by the National Institute on Drug Abuse (NIDA) under the Drug Use and Addiction Research Programs (CFDA 93.279). The grant will be used by Drexel University to develop a novel framework for community-directed research approaches that seek to reduce intersectional and intergenerational inequities in commercial tobacco use among Black and Latinx adult sexual and gender minorities in Philadelphia. Key activities include: 1) using a community-driven systems dynamic modeling process to identify multilevel intersectional drivers of tobacco use and motivations; 2) evaluating how empowerment from direct policy engagement can disrupt tobacco use and motivations; 3) developing and assessing a new organizational-level metric of intersectional stigma; 4) identifying unique drivers of organizational empowerment to combat racial/ethnic inequities in tobacco use; and 5) collecting longitudinal qualitative data to understand racialized dimensions of medical mistrust within harm-reduction settings. The award period is from August 15, 2024 to October 10, 2024.

Abstract

/project summary the intersectional substance use & lived analysis (isla) lab, is dedicated to developing a novel framework for community-directed research approaches that seeks to reduce intersectional (race/ethnicity + sexual orientation) and intergenerational inequities in (commercial) tobacco use (TU) among black & latine young adult sexual and gender minorities (sgms). SGM adults experience heightened TU, with racial/ethnic sgms exhibiting elevated TU compared to their racial/ethnic heterosexual peers. Efforts to redress intersectional stigma is currently constrained in two significant ways: 1) overwhelming foci on individual-level measurement without identification of useful empowering strategies that mitigate individual-level stressors/harms and 2) lacking evidence illuminating how intersectional stigma constrains organizational capacity of community-based organizations (cbos) historically serving those experiencing harmful TU. Cbos serving racial/ethnic SGM adults with heightened TU behaviors, and whose leadership historically has been led by racial minorities (e.g., HIV/aids service organizations), have not experienced enhanced r & d growth capacity on PAR with cbos serving similar populations but with non-racially minoritized leadership. Such client-service provider racial disconcordance (r/d) has been linked to elevated mistrust, although such evidence within harm-reduction settings warrants greater clarity. We hypothesize that multilevel empowerment strategies (individual+organizational) is positively associated with decreases in TU/motivations among black & latine adult SGM philadelphians. The current project combines inventive community-directed design and measurement strategies to investigate multilevel influences of empowerment in mitigating the harms of TU among racial/ethnic SGM adults. Guided by a 13-member community advisory council, we will use a community-driven systems dynamic modeling process to identify significant multilevel intersectional drivers shaping TU/motivations among clients served by a bipoc queer/trans urban CBO (n=30). Second, we evaluate how empowerment, resulting from direct policy engagement, can disrupt TU/motivations among clients with smoking histories, using expanded notions of intergenerational familial composition germane collected via surveys. Third, we will develop/assess the psychometric properties of a new organizational-level metric of intersectional stigma (n=488). Fourth, we will identify unique drivers of organizational empowerment, augmenting the r & d environment, to uncover new strategies for combating racial/ethnic inequities in TU. Lastly, we collect longitudinal (t=4, 3-month intervals: 24 clients/16 providers) qualitative multilevel data to better understand racialized dimensions of medical mistrust within harm-reduction settings, uncovering strategies to improve challenges arising from client-provider r/d in harm-reduction settings. These five components synergistically contribute to the development of the first empirically measureable framework of successful community-directed tobacco harm reduction (THR) research; a framework needed to achieve multiple crosscutting issues outlined within nida's racial equity action plan.