Estimating spatially varying health effects of wildland fire smoke using mobile health data.

Wildland fire smoke exposures are an increasing threat to public health, highlighting the need for studying the effects of protective behaviours on reducing health outcomes. Emerging smartphone applications provide unprecedented opportunities to deliver health risk communication messages to a large number of individuals in real-time and subsequently study the effectiveness, but also pose methodological challenges. Smoke Sense, a citizen science project, provides an interactive smartphone app platform for participants to engage with information about air quality, and ways to record their own health symptoms and actions taken to reduce smoke exposure. We propose a doubly robust estimator of the structural nested mean model that accounts for spatially and time-varying effects via a local estimating equation approach with geographical kernel weighting. Moreover, our analytical framework also handles informative missingness by inverse probability weighting of estimating functions. We evaluate the method using extensive simulation studies and apply it to Smoke Sense data to increase the knowledge base about the relationship between health preventive measures and health-related outcomes. Our results show that the protective behaviours' effects vary over space and time and find that protective behaviours have more significant effects on reducing health symptoms in the Southwest than the Northwest region of the U.S.