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，与大约20种癌症有关。 边缘化人群的烟草使用下降率低于较富裕人群 组大多数关于烟草不平等的研究都基于一个单一的属性来研究差异， 种族/民族，但这忽略了群体内的异质性，以及一个人的身份的多个方面， 他们的种族/民族、社会经济地位（SES）或性别可能相互作用，塑造生活经历和健康 行为。交叉性假定，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导致不平等。这个框架对于转换 将重点从广泛的人口部门转移到健康风险过大的群体。移动的健康 方法（mHealth），如AutoSense和生态瞬时评估（EMA），提供实时 客观和主观评估情绪和行为如何以及何时随时间变化， 环境，并可以为受影响不成比例的人口提供及时的适应性干预措施 烟草使用。本提案的目的是推进实用程序的方法和内容知识 交叉性研究有助于烟草的心理社会，行为和背景因素 使用和癌症不平等。培训目标包括烟草使用和健康不公平，移动健康 方法，先进的统计学和专业发展。 K99阶段将在亨茨曼癌症研究所进行，重点是烟草使用和 行为改变的机制（例如，压力，影响，自我效能）在交叉组使用现有的 主要导师大卫维特博士的EMA和AutoSense数据，他是mHealth，健康 不平等，以及针对烟草行为改变的干预措施。与共同导师Benjamin Haaland一起培训 在先进的统计学，博士Inbal 'Billie' Nahum-Shani在行为理论和适应性的发展 干预措施，以及定量交叉性研究中的Nicole Else-Quest博士将为培训做出贡献 目标. R 00阶段将包括一项新的交叉性研究，使用AutoSense和EMA进行调查 交叉身份与压力，负面影响，自我效能和烟草使用的实时动态， 实时的这项工作是创新的，因为迄今为止还没有研究使用 交叉性框架，也没有任何研究将这一框架与使用尖端技术相结合。 AutoSense和EMA等技术来实时调查烟草使用的不公平性。这项工作可以直接 针对特定社会人口群体烟草使用行为的有针对性的干预措施 交叉点，赋予不公平的癌症风险，并直接解决NCI的使命进行， 支持癌症研究，以推进科学知识，帮助所有人活得更长，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.