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

项目摘要 烟草是可预防的死亡和疾病的主要原因，与约20种癌症有关。边缘化 女性（例如，种族/民族、社会经济地位低下或性和性别少数群体）可能更容易受到伤害 环境、社会和背景压力是戒烟的重要障碍。到 提高对性和性别如何与健康行为和疾病相关的基本认识 预防，关键是要使用能够确定社会决定因素的有意义的交叉点的方法， 这些因素如何影响研究不足、代表性不足和 被低估的女性。交叉性假设社会身份相互作用， 社会/背景因素造成不平等。因此，交叉性有助于将重点从广泛的 人口的部分（例如，所有女性吸烟者）与具有交叉地位的群体相比， 健康风险（例如，低收入种族/少数民族女性）。此外，交叉性反映了 人与人之间的过程。后者强调了复杂因素（例如，经验 歧视，遇到烟草促进环境）可能影响烟草使用是动态的 并且可以根据时间和上下文而改变。移动的健康方法（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 对情绪和行为如何以及何时根据时间和环境发生变化的主观评估。 移动健康设计和交叉性框架可以共同揭示动态和复杂的因素 这些因素相互作用，导致研究不足、代表性不足和 被低估的女性拟议补充将扩展母项目（U 01 CA 229437，MPI：Nahum- Shani，Wetter）通过协调834年7项关于戒烟的密集纵向移动健康研究的数据， 不同的妇女，这将提供足够的权力，适用一个跨部门的框架，以了解 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。这些美好的- 粒度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 社会身份（SES，种族/民族），社会（例如，歧视）和背景 因素（例如，邻里劣势，暴露于烟草促进环境），以及这些是否 调解交叉身份与失误和长期禁欲的关联。拟定研究 旨在针对未充分研究的人群在了解烟草使用不公平和健康风险方面的差距， 妇女代表性不足和报告不足的妇女亚群体，直接符合第一个战略目标， 妇女健康研究办公室，以“推进严格的研究，将改善基本的 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.”