Using mHealth to investigate intersectionality and health behaviors: Implications for conceptual models and cancer prevention interventions for marginalized populations

项目概要/摘要 烟草是可预防的死亡和疾病的主要原因，并与大约 20 种癌症有关。 与更有特权的人群相比，边缘化人群的烟草使用下降率较低 组。大多数关于烟草不平等的研究都考察了基于单一属性的差异，例如 种族/民族，但这忽略了群体内的异质性以及一个人身份的多个方面如何 他们的种族/民族、社会经济地位 (SES) 或性别可能会相互作用，影响生活经历和健康 行为。交叉性假设身份的多个方面之间的相互联系及其 与社会和背景因素的相互作用可能会导致不平等。这个框架对于转移很有用 重点从广大人群转向健康风险不成比例的群体。移动健康 AutoSense 和生态瞬时评估 (EMA) 等方法论 (mHealth) 提供实时 对情绪和行为如何以及何时随着时间和时间而变化的客观和主观评估 并可以为受此影响不成比例的人群提供及时的适应性干预措施 烟草的使用。该提案的目的是提高实用程序的方法和内容知识 用于检查导致烟草的社会心理、行为和背景因素的交叉性 使用和癌症不平等。培训目标包括烟草使用和健康不平等、移动医疗 方法论、高级统计和专业发展。 K99 阶段将在亨斯曼癌症研究所进行，重点关注烟草使用和 使用现有的交叉群体行为改变机制（例如压力、情感、自我效能） 主要导师 David Wetter 博士的 EMA 和 AutoSense 数据，David Wetter 博士是 mHealth、健康领域的专家 不平等以及针对烟草行为改变的干预措施。与联合导师本杰明·哈兰德一起训练 在高级统计学方面，Inbal ‘Billie’ Nahum-Shani 博士在行为理论和适应性发展方面 Nicole Else-Quest 博士在定量交叉性研究方面的干预措施将有助于培训 目标。 R00 阶段将包括一项新颖的交叉性研究，使用 AutoSense 和 EMA 来调查 交叉身份与压力、负面情绪、自我效能和烟草使用的实时动态 实时。这项工作具有创新性，因为迄今为止还没有研究使用一种方法来检验烟草使用的不公平性。 交叉性框架，也没有任何研究将该框架与尖端技术的使用相结合 AutoSense 和 EMA 等技术可实时调查烟草使用的不平等情况。这个作品可以直接 为特定社会人口群体中针对烟草使用行为的定制干预措施提供信息 带来不公平癌症风险的交叉点，并直接解决 NCI 的使命：开展和 支持癌症研究，以推进科学知识并帮助所有人活得更长久、更健康。

PROJECT SUMMARY/ABSTRACT Tobacco is the leading cause of preventable death and disease and is linked to approximately 20 cancers. The rate of decline of tobacco use has been lower for marginalized populations compared to more privileged groups. Most research on tobacco inequities has examined differences based on a single attribute like race/ethnicity, yet this ignores heterogeneity within groups and how multiple aspects of a person’s identity like their race/ethnicity, socioeconomic status (SES), or gender may interact to shape lived experiences and health behaviors. Intersectionality posits that interconnections among multiple aspects of identity and their interaction with social, and contextual factors can contribute to inequities. This framework is useful for shifting focus from broad sectors of the population to groups with disproportionate health risk. Mobile health methodology (mHealth), such as AutoSense and ecological momentary assessment (EMA), provide real-time objective and subjective assessments of how and when emotions and behaviors change depending on time and context and can inform just-in-time adaptive interventions for populations disproportionately affected by tobacco use. The objective of this proposal is to advance methodological and content knowledge of the utility of intersectionality for examining psychosocial, behavioral, and contextual factors that contribute to tobacco use and cancer inequities. Training goals incorporate tobacco use and health inequities, mHealth methodology, advanced statistics, and professional development. The K99 phase will take place at the Huntsman Cancer Institute and focuses on tobacco use and mechanisms of behavior change (e.g., stress, affect, self-efficacy) in intersectional groups using the existing EMA and AutoSense data of the primary mentor, Dr. David Wetter, who is an expert in mHealth, health inequities, and interventions targeting tobacco behavior change. Training with co-mentors Benjamin Haaland in advanced statistics, Dr. Inbal ‘Billie’ Nahum-Shani in behavioral theory and the development of adaptive interventions, and Dr. Nicole Else-Quest in quantitative intersectionality research will contribute to training goals. The R00 phase will consist of a novel intersectionality study using AutoSense and EMA to investigate the real-time dynamics of intersectional identities with stress, negative affect, self-efficacy, and tobacco use in real-time. This work is innovative because no studies to-date have examined tobacco use inequities using an intersectionality framework, nor have any studies combined this framework with the use of cutting-edge technology like AutoSense and EMA to investigate tobacco use inequities in real-time. This work can directly inform tailored interventions targeting tobacco use behaviors among populations at specific sociodemographic intersections that confer inequitable cancer risk and directly addresses the NCI’s mission to conduct and support cancer research to advance scientific knowledge and help all people live longer, healthier lives.