PROJECT SUMMARY Polytobacco use, defined as concurrent use of more than one tobacco product including electronic nicotine delivery systems (ENDS), is rising and high in lesbian, gay, bisexual, and transgender (LGBT) young adults (YA). Between 22-40% of LGBT YA (vs 12-21% of non-LGBT YA) report past 30-day polytobacco use, and LGBT YA are less likely to perceive tobacco use as harmful. Low risk perceptions may reinforce tobacco use and widen existing disparities. The Food and Drug Administration (FDA) Center for Tobacco Products (CTP) is mandated educate the public about tobacco product risks, yet no evidence describes how to effectively frame anti- polytobacco risk communications. The proposed training objectives are for the applicant to develop advanced skills in health communication science; bio-behavioral methods, including psychophysiological measurement; and randomized controlled trials. These skills will be used to determine effective communication of polytobacco use risks to at-risk LGBT YA. This proposal directly supports the FDA’s mandate to educate the public by addressing the research priority area of Communications. While studies indicate that antitobacco communications can successfully increase public knowledge about tobacco use risks, there are limitations to the extant literature, as follows: (1) While strategies for effective risk communication are well-established, less is known about how to frame behavioral choices (e.g., total tobacco cessation vs switching to ENDS) to increase tobacco risk perceptions and intentions to quit in polytobacco users. (2) Antitobacco campaigns often leverage cultural targeting, a broadly supported but costly communications strategy, to increase at-risk population engagement. No studies have experimentally tested the effectiveness of LGBT culturally targeted vs non- targeted anti-tobacco messages. (3) Mobile multimedia messaging has been used to disseminate smoking cessation communications and may be feasible for distributing anti-polytobacco messages to LGBT YA, but this has not been investigated. Using formative and summative evaluation, the applicant will address these gaps with three Specific Aims: (1) Identify absolute and relative risk anti-polytobacco messages that effectively communicate polytobacco risks to YA; (2) Determine the effects of cultural targeting on LGBT YA polytobacco users’ attention to anti-polytobacco messages and perceived effectiveness; (3b) Assess the feasibility of delivering MMS anti-polytobacco messages developed in Aims 1 and 2 to LGBT YA via texting; and (3b) Estimate effect sizes of exposure to anti-polytobacco messages on risk perceptions and tobacco use over time. These aims support the National Cancer Institute’s (NCI) tobacco control research priority to reduce tobacco disparities by determining effective antitobacco message framing and cultural targeting to increase polytobacco risk perceptions and reduce tobacco use in an at-risk population, LGBT YA. Findings will provide public health officials, NCI, and the FDA CTP critical information about messages and digital media that may be leveraged in national health communications to reduce poly-tobacco use in at-risk populations.

PROJECT NARRATIVE Between 22-40% of lesbian, gay, bisexual, and transgender (LGBT) young adults are polytobacco users, meaning they concurrently use multiple nicotine and tobacco products, and low tobacco risk perceptions may be an influencing factor. The proposed study uses crowdsourced (Aim 1), in-laboratory (Aim 2), and Phase I randomized controlled trial (Aim 3) studies to determine effective message framing and targeting to communicate polytobacco use risk to LGBT young adult polytobacco users, and if exposure to anti-polytobacco communications delivered via text messaging reduces tobacco use in this population. Findings will provide public health officials, the National Cancer Institute, and the Food and Drug Administration critical information about optimal anti-polytobacco message framing and digital dissemination strategies that may be leveraged in national health communications.