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.?
Evidence suggests that women may have more difficulty quitting smoking than men due to unique stressors related to the complex interplay between aspects of social identity (e.g., socioeconomic status, sexual orientation, race/ethnicity) and social determinants such as interpersonal experiences (e.g., discrimination), social/contextual factors (e.g., social support, neighborhood disadvantages) that may influence health behavior change. This research will extend a parent grant by using a novel methodological and conceptual framework called intersectionality and cutting-edge mobile health technology (i.e., ecological momentary assessment and AutoSense) to examine how multiple aspects of sociodemographic identity, context, and interpersonal experiences interact to shape health inequities in 834 understudied, underrepresented, and underreported women. These data will improve the identification of specific populations of women at disproportionate risk for tobacco and cancer inequities and can inform the development of targeted cancer prevention interventions.
