Intersectionality in Intervention Development: Insights From Formative Work on a Tailored Tobacco Cessation Program for LGBTQIA+ Young Adults.

Tailored tobacco cessation interventions focusing on minoritized communities are proliferating, but the extent to which these interventions address the needs of individuals with multiple minoritized social identities is unclear. We developed Empowered, Queer, Quitting, and Living (EQQUAL), an avatar-led digital smoking cessation intervention tailored for lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (LGBTQIA+) young adults based on acceptance and commitment therapy (ACT), via a multistage user-centered design process. The purpose was to evaluate feedback from EQQUAL development activities using an intersectional lens. Intersectionality is a paradigm created by Kimberlé Crenshaw illustrating the multiple social identities each person possesses along with the marginalization of these different social identities. We conducted a rapid deductive content analysis focused on intersectional design gaps using interviewer notes from user testing (n = 7), a diary study (n = 8), and treatment satisfaction responses from a single-arm trial of the EQQUAL intervention (n = 22). Feedback related to intersectional design fell under three broad themes: (a) inadequate representativeness of the avatar, (2) inadequate representativeness within the program broadly, and (3) non-inclusive ACT intervention content. Feedback on inclusiveness included reference to socioeconomic status, race/ethnicity, religious/cultural affiliation, and ability/disability. Although we previously found that EQQUAL was highly acceptable and showed promise in terms of efficacy in a single-arm pilot trial, we identified several gaps in intersectional design as the iterative intervention development proceeded. Because intersectional design is a critical part of developing interventions with a health equity focus, applying standardized procedures for intersectional design and analysis could improve intervention design and better address tobacco cessation treatment needs of individuals who may experience multiple forms of marginalization.

Effectiveness of mindfulness-based stress reduction in a community sample over 2 years.

BACKGROUND: Although numerous studies have demonstrated that mindfulness-based stress reduction (MBSR) improves clinical and nonclinical outcomes, few studies have followed MBSR participants for >12 months, and few have analyzed post-intervention home practice. METHODS: We followed a community sample of 247 self-referred adults for 2 years after completion of an 8-week MBSR program. Dependent variables, including self-reported anxiety, depression, perceived wellness, mindfulness, and duration and frequency of continued home practice, were measured before and after the program and every 6 months after. RESULTS: Participants reported significantly improved symptoms of depression and anxiety, increased perceived wellness, and increased mindfulness after the 8-week intervention compared with preintervention reports. These improvements persisted for 2 years. Correlations between post-intervention home practice and mindfulness indicated that individuals who continued to practice developed greater mindfulness, which was associated with improved mental health and wellness. CONCLUSIONS: Participants who completed the MBSR program reported significant improvements in anxiety, depression, perceived wellness, and mindfulness during the program.