Geographically-Explicit Ecological Momentary Assessment Protocol to Assess the Linkages Between Intersectional Discrimination and CVD Risk Among Sexual and Gender Minorities

Young adulthood is increasingly marked by the early onset of chronic conditions, such as systemic inflammation, compared with previous generations. A primary contributor to this trend is engagement in harmful cardiometabolic health behaviors (CHB), including physical inactivity, dysregulated sleep, smoking, and alcohol use. Stress is a key driver of these behaviors, yet research has not fully captured how stress shapes CHB in ways that reflect the lived experiences of young adults. To address this gap, we propose an innovative approach that integrates geographically explicit ecological momentary assessment (GEMA) with qualitative mapping to examine the contextual features of stress, protective social factors, and CHB among young adults. Qualitative mapping combines GPS and EMA activity data with in-depth interviews, allowing participants to describe their thoughts, feelings, and experiences within the mapped locations. This method is critically important because exposures to stress vary by geographic space and are appraised differently depending on contextual factors such as purpose of the space (for example home, work, or school), perceived safety, and time spent there. Our overarching goal is to elucidate the complex relationships between environmental and interpersonal experiences of stress and CHB among diverse young adults. Specifically, this study will (1) examine how daily experiences of stress and CHB differ across levels of structural inequality, measured through integrated GPS and census data, (2) assess how protective social factors such as social cohesion and community relationships buffer the negative impact of stress on CHB, and (3) explore context-specific risks and protective factors associated with CHB across racial and ethnic groups of young adults using the GEMA methodology. By capturing stress in real time and situating these experiences within their geographic and social contexts, this study offers a highly innovative and ecologically valid approach. Findings will provide critical insights to inform the development of tailored CHB prevention interventions for diverse young adults, including future Just in Time adaptive interventions designed to reduce health disparities.