Randomized Controlled Trial of Dyadic Financial Incentive Treatment for Dual Smoker Couples: Evaluation of Efficacy, Mechanisms, and Cost Effectiveness

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA- 24-032.” Couples where both members smoke (i.e. dual-smoker couples; DSCs) are highly prevalent and particularly unlikely to achieve abstinence. Within DSCs, little attention has been paid to understanding the

unique needs of sexual and/or gender minority (SGM) couples (i.e., couples with at least one individual identifying as SGM). Although SGM groups remain underrepresented in research, evidence strongly suggests they experience a disproportionate cancer burden, with tobacco being a leading cause of preventable disease

and death among SGM groups.7–12 SGM and non-SGM individuals share a similar desire to quit smoking27 and awareness of evidence-based cessation methods,28 thus motivation and knowledge barriers are not likely driving smoking disparities. SGM people have expressed a preference for SGM-tailored smoking cessation assistance, 29

which currently does not take a dyadic approach. Among individuals with SGM identities, there is variability in smoking behavior and cessation outcomes. Understanding the drivers of smoking behavior and barriers to cessation observed among SGM people within DSCs may improve cessation assistance for this group, thereby

improving cancer outcomes for individuals at the intersection of these hard-to-reach groups. In the context of parent trial R01CA275494, we propose understanding the unique factors that contribute to smoking behavior and cessation among SGM individuals in DSCs. Using quantitative methodology, we aim to

evaluate the heterogeneity of SGM DSCs regarding relationship dynamics, sexual orientation and gender identity (SOGI) stressors and strengths, broader social environmental factors, and cessation-related impulsivity in relation to smoking and cessation-related behaviors. Using qualitative methodology, we aim to understand

the unique smoking and cessation-related stressors, motives, and relationship dynamics experienced by SGM DSCs to inform measure development for future studies examining within-group heterogeneity. Finally, we will expand the recruitment of SGM couples for inclusion in the parent project. Individuals who identify as SGM and

have smoking partners will be invited to complete a survey in which we assess smoking and cessation-related behaviors as well as relationship dynamics, sexual and gender identity-related stressors and strengths, smoking-related impulsivity, and smoking behaviors. We will conduct one-on-one, semi-structured in-depth

interviews with a purposively sampled subset of these individuals to gather an understanding of the factors influencing current smoking, past quit attempts, and considerations of future quit attempts in SGMs in a DSC. These interviews will elicit rich discussion surrounding, barriers, facilitators, and relationship dynamics as an SGM-

identified person in a DSC. Following separate analyses of the quantitative and qualitative data, findings will be examined side-by-side in a convergence coding matrix. The findings are intended to develop culturally appropriate cessation interventions to better support the needs of SGM individuals with smoking partners.