Novel use of mHealth data to identify states of vulnerability and receptivity to JITAIs

项目总结 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。边缘化 妇女(例如，种族/族裔、社会经济地位低，或者性和性别少数)可能更容易受到伤害 环境、社会和背景应激源，这些都是烟草戒断的重要障碍。至 提高对性和性别与健康行为和疾病的关系的基本认识 在预防方面，至关重要的是使用能够确定社会决定因素和 这些因素如何影响研究不足、代表性不足和 对女性的报道不足。交叉性假设社会身份彼此相互作用，并与 造成不平等的社会/背景因素。因此，交叉性对于将关注点从宽泛转移到 人口部分(例如，所有女性吸烟者)转移到具有交叉地位的群体，这可能会带来更大的 健康风险(例如，低收入种族/少数民族女性)。此外，交叉性既反映了 人与人之间和人内的流程。后者突出表明，复杂的因素(例如， 可能影响烟草使用的歧视、遇到有利于烟草的环境)是动态的 并且可以根据时间和上下文而改变。移动健康方法(MHealth)，如AutoSense、 生态瞬时评估(EMA)和全球定位系统(GPS)提供实时客观和 根据时间和背景对情绪和行为如何以及何时发生变化的主观评估。 MHealth的设计和交叉性框架结合在一起，可能会揭示动态和复杂的因素 它们相互作用，造成烟草使用不平等和癌症风险，研究不足、代表性不足和 被低估的女性。拟议的补编将延长母项目(U01CA229437，MPI：Nahum- 通过协调834年中7项密集的纵向mHealth戒烟研究的数据 多样化的妇女，这将为应用交叉性框架来理解 将妇女的边缘化地位与烟草失效和戒烟结果联系起来的机制。这些精美的- 粒化数据可以产生迄今为止最详细的交叉过程调查，包括复杂的 社会认同(社会经济地位、种族/族裔)、社会认同(如歧视)和背景方面之间的相互作用 因素(例如，社区劣势、暴露在有利于吸烟的环境中)，以及这些因素是否 调节交叉身份与失误和长期禁欲之间的联系。建议的研究是 旨在针对在未被研究的人群中对烟草使用的不平等和健康风险的理解方面的差距， 代表不足和报告不足的妇女亚群，直接符合第一个战略目标 妇女健康研究办公室，以“推进严谨的研究，以改善基础 了解性和性别以及其他关键因素如何影响健康和疾病。

PROJECT SUMMARY Tobacco is the leading cause of preventable death and disease and is linked to ~20 cancers. Marginalized women (e.g., racial/ethnic, low socioeconomic status, or sexual and gender minorities) may be more vulnerable to environmental, social, and contextual stressors that are significant barriers to tobacco abstinence. To improve the fundamental understanding of how sex and gender relate to health behaviors and disease prevention, it is critical to use approaches that can identify meaningful intersections of social determinants and how these shape experiences and health behaviors in subpopulations of understudied, underrepresented, and underreported of women. Intersectionality posits that social identities interact with one another and with social/contextual factors to create inequities. Thus, intersectionality is useful for shifting focus from broad sectors of the population (e.g., all female smokers) to groups with intersecting statuses that may confer greater health risk (e.g., low income racial/ethnic minority females). Moreover, intersectionality reflects both between- and within-person processes. The latter highlights that the complex factors (e.g., experiences of discrimination, encountering tobacco-facilitative environments) that may influence tobacco use are dynamic and may change depending on time and context. Mobile health methodology (mHealth), such as AutoSense, ecological momentary assessment (EMA), and global positioning system (GPS) provide real-time objective and subjective assessments of how and when emotions and behaviors change depending on time and context. Together, mHealth designs and an intersectionality framework may reveal the dynamic and complex factors that interact to contribute to inequities in tobacco use and cancer risk in understudied, underrepresented, and underreported women. The proposed supplement will extend the parent project (U01CA229437, MPI: Nahum- Shani, Wetter) by harmonizing data across 7 intensive longitudinal mHealth studies of tobacco cessation in 834 diverse women, which will provide adequate power for applying an intersectionality framework to understand mechanisms linking marginalized status among women to tobacco lapse and cessation outcomes. These fine- grained data can yield the most detailed investigation of intersectional process to-date, including the complex interplay between aspects of social identity (SES, race/ethnicity), social (e.g., discrimination) and contextual factors (e.g., neighborhood disadvantage, exposure to tobacco-facilitative environments), and whether these mediate the association of intersectional identities with lapse and long term abstinence. The proposed study is designed to target gaps in the understanding of inequities in tobacco use and health risk among understudied, underrepresented, and underreported subgroups of women and is directly in line with the first strategic goal of the Office of Research on Women's Health, to “advance rigorous research that will improve the fundamental understanding of how sex and gender, among other critical factors, influence health and disease.”