Using mHealth to investigate cancer inequities: The impact of discrimination on tobacco cessation among underserved populations

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PROJECT SUMMARY/ABSTRACT Cigarette smoking is a leading cause of morbidity and mortality in the U.S. Marginalized communities, such as Black/African Americans (B/AA) and sexual and gender minorities (SGM), experience increased risk for smoking-related cancers and unique social and contextual stressors that may hinder successful quitting. For example, B/AA and SGM experience pervasive minority stressors (e.g., stigmatization and discrimination) known to negatively impact mental health, health behaviors, and physical health outcomes. Although extensive research has linked perceived discrimination with current smoking behavior among B/AA and SGM, no studies have examined how discrimination impacts smoking cessation within these groups. Mobile health (mHealth) technologies such as ecological momentary assessment (EMA) and AutoSense – a suite of wearable physiological sensors – can provide real-time, real-world assessments of lived experiences during a quit attempt to predict smoking behavior and inform the development of adaptive interventions. The objective of the proposed research is to use mHealth approaches to advance current knowledge of the mechanisms by which minority stressors such as discrimination contribute to inequities in cancer risk among B/AA and SGM. Aim 1 will utilize data from a recently completed study to analyze pathways linking real-time, real-world experiences of discrimination and smoking lapse during a quit attempt among B/AA (N = 300). Aim 2 will utilize data from an ongoing study to elucidate pathways linking real-time, real-world experiences of discrimination and smoking lapse during a quit attempt among SGM, and further compare experiences of discrimination, associated intrapersonal experiences (e.g., stress, affect), and smoking lapse between SGM and non-SGM during a quit attempt (N = 375 [300 non-SGM + 75 SGM]). Key mechanisms hypothesized to mediate the temporal association between discrimination and smoking lapse are stress, negative affect, urge, and self- efficacy. This research will be conducted at Huntsman Cancer Institute, an NCI-Designated Cancer Center that offers an exceptionally supportive and collaborative training environment. The applicant’s comprehensive training plan, developed in conjunction with an expert mentoring team, will directly support the completion of the proposed research and complement the applicant’s prior training in cancer inequities research. Fellowship training goals focus on: 1) advanced statistical methods for analyzing intensive longitudinal data; 2) mHealth assessment and intervention approaches; 3) primary cancer prevention and smoking cessation; 4) health inequities and the social determinants of health; and 5) professional development, including grant writing, research dissemination, research ethics, and mentoring. The proposed research and training activities will provide the applicant with the necessary knowledge and skills needed to establish an independent and productive research program dedicated to eliminating cancer inequities across the cancer control continuum.