Summary Climate change is an urgent public health threat, and climate-related health risks disproportionately impact vulnerable populations. Public health agencies have underscored the need to develop scalable and innovative health-equity centered, multi-level interventions that offer tools and resources to 1) raise awareness of the inextricable link between climate change and health and 2) support mitigation strategies to minimize the potential health hazards and impacts of climate change. To date, digital climate change communications have been limited to one-directional, one size-fits all messaging based on a single theoretical approach (i.e., framing). This Phase I SBIR will explore the acceptability and effects of an innovative solution: Beat Extreme ─ an interactive text messaging program that leverages insights from behavior change science and integrates data from the National Weather Service to engage a broad spectrum of users with varying levels of concern about climate change and tailor the user experience. Beat Extreme will 1) provide information on current climate- related and environmental risks (e.g., high temperatures, air quality alerts, asthma triggers etc.) that might adversely affect a user’s current health conditions; 2) link users to local zip-code matched resources to mitigate their specific risk (e.g., cooling centers, hurricane shelters); 3) implement a full range of best practices in tailored health behavior change communications to personalize ongoing communications regarding the link between human actions and extreme weather based on the user’s level of concern about and belief in climate change; and 4) provide customized actionable tips for addressing climate change to promote climate efficacy at the individual, community, and policy/advocacy level based on the user’s level of motivation. Developed in collaboration with community members, 2 community health experts, and 8 climate change experts, Beat Extreme will achieve sustained engagement and impact by hyper-personalizing the user experience and seamlessly integrating actionable insights from multiple theories of behavior change and communication frameworks. Extensive end user and expert input will ensure Beat Extreme is designed for rapid dissemination. Potential end users (n=12 community members aged 18 and older) will be recruited via community and social media ads. Formative qualitative data from interviews will be combined with input from experts to develop a journey map and prototype of Beat Extreme. Iterative usability testing (n=12) will allow the prototype to be refined before 120 community members are recruited to participate in a 30-day pilot test. Pilot participants will provide quantitative and qualitative data, and engagement and acceptability data will be examined. Pre-post comparisons of response efficacy will provide preliminary data on the effects of the program. The results will inform program modifications for a Phase II effectiveness trial that will provide the impetus for commercialization of a cost-effective, evidence-based, interactive text messaging solution that can address climate change on a population basis and, in particular, in vulnerable communities.

Relevance: Given that climate change is an existential public health threat and the health impacts of climate-related risks disproportionately affect vulnerable populations, there is an urgent need to develop scalable and innovative equity-centered tools and resources to raise awareness of the inextricable link between climate change and health and to support mitigation strategies to minimize its potential health hazards and impacts. The proposed study will develop and test Beat Extreme, a cost-effective, tailored interactive text messaging programs for vulnerable communities that will 1) provide information on current environmental risks or extreme weather events that might adversely affect a user’s current health conditions; 2) link users to local zip-code matched resources to mitigate their specific risk; 3) implement a full range of best practices in tailored health behavior change communications to personalize communications regarding the link between human actions and extreme weather based on the user’s level of concern about and belief in climate change; and 4) provide customized actionable tips for addressing climate change to promote climate efficacy at the individual, community, and policy/advocacy level based on the user’s level of motivation. Providing dynamically tailored behavior change messages via a ubiquitous, low-cost communication channel to address the intersectionality of climate change and inequities has the potential to advance readiness to engage in key climate change mitigation behaviors and – among those who are facing climate- related extreme weather events – increased readiness to access supportive local resources.