Using Ecological Momentary Assessment to Identify Common Smoking Situations Among Korean American Emerging Adults

The Use of Mobile-Based Ecological Momentary Assessment (mEMA) Methodology to Assess Dietary Intake, Food Consumption Behaviours and Context in Young People: A Systematic Review

Mobile-based ecological momentary assessment (mEMA) offers a novel method for dietary assessment and may reduce recall bias and participant burden. This review evaluated mEMA methodology and the feasibility, acceptability and validity as a dietary assessment method in young people. Five databases were searched from January 2008 to September 2021 for studies including healthy young people aged 16–30 years and used mEMA for obtaining dietary intake data, food consumption behaviours and/or contextual factors. Data on the method used to administer mEMA, compliance with recording and validation were extracted. A total of 46 articles from 39 independent studies were included, demonstrating a wide variation in mEMA methods. Signal-contingent prompting (timed notification to record throughout the day) was used in 26 studies, 9 used event-contingent (food consumption triggered recordings), while 4 used both. Monitoring periods varied and most studies reported a compliance rate of 80% or more. Two studies found mEMA to be burdensome and six reported mEMA as easy to use. Most studies (31/39) reported using previously validated questions. mEMA appears to be a feasible and acceptable methodology to assess dietary intake and food consumption in near real time.

Analyzing Trajectories of Acute Cigarette Reduction Post-Introduction of an E-Cigarette Using Ecological Momentary Assessment Data

Electronic cigarettes (ECs) may hold great potential for helping smokers transition off combustible cigarettes (CCs); however, little is known about the patterns that smokers follow when using an EC as a CC-substitute in order to ultimately reduce and quit smoking. Our primary aim in this study was to evaluate whether common patterns of CC use exist amongst individuals asked to substitute an EC for at least half of the CCs they would normally smoke. These patterns may elucidate the immediate switching and reduction behaviors of individuals using ECs as a reduction/cessation tool. This analysis uses data from a randomized controlled trial of 84 adult smokers assigned to receive either 4.5% nicotine or placebo (0% nicotine) EC. Participants were advised to use the EC to help them reach a 50% reduction in cigarettes-per-day (CPD) within 3 weeks. Longitudinal trajectory analysis was used to identify CPD reduction classes amongst the sample; participants clustered into four distinct, linear trajectories based on daily CC use during the 3-week intervention. Higher readiness to quit smoking, prior successful quit attempts, and lower baseline CC consumption were associated with assignment into "more successful" CC reduction classes. ECs may be a useful mechanism to promote CC reduction. This study demonstrates that a fine-grained trajectory approach can be applied to examine switching patterns in the critical first weeks of an attempt.

Correlates of tobacco use among Asian and Pacific Islander youth and young adults in the U.S.: A systematic review of the literature

Rates of tobacco product use, including the use of combustible and electronic cigarettes, remain high in youth and young adults within the U.S. Though a substantial body of work has examined risk factors associated with initiation and ongoing use of tobacco products, research on tobacco use and associated correlates among Asian and Pacific Islanders (APIs) has been more limited despite high rates in select API subgroups. This systematic review outlines recent research (2010-2020) on the correlates of tobacco use in APIs aged 9-29. To better understand determinants of tobacco use and identify gaps in the literature, we framed correlates based on the National Institute on Minority Health and Health Disparities (NIMHD) multidimensional research framework. Database and author-focused searches were conducted, followed by article abstract and full-text reviews, much of which were guided by a discrete set of inclusionary and exclusionary criteria related to tobacco use and youth/young adults. A total of 24 articles were included in this review. The majority of articles focused on individual-level correlates, with a high number of studies demonstrating association between behavioral and sociocultural factors and tobacco product use behavior. Interpersonal factors also made up a substantial portion of the literature, commonly focusing on peer, family, and social norms. Gaps related to the NIMHD model are addressed. Future research should examine biological and community/societal factors associated with API smoking to better understand unique correlates in this population and to inform tobacco prevention and intervention approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Motives for Substance Use in Daily Life: A Systematic Review of Studies Using Ecological Momentary Assessment

The motivational model of substance use posits four motive subtypes (coping, enhancement, social, conformity) dynamically interact with contextual factors to impact decisions about substance use. Yet, prior studies assessing the motivational model have relied on between-person, cross-sectional evaluations of trait motives. We systematically reviewed ecological momentary assessments (EMA) studies (N=64) on motives for substance use to examine: methodological features of EMA studies examining the motivational model, support for the motivational model between and within individuals, and associations between trait motives and daily processes. Results of the reviewed studies provide equivocal support for the motivational model, and suggest that EMA measures and trait measures of motives might not reflect the same construct. The reviewed body of research indicates most studies have not examined the momentary and dynamic nature of the motivational model and more research is needed to inform interventions that address heterogeneous reasons for substance use in daily life.

In Lieu of Smoking: Are Smokers More Likely to Enact Certain Types of Implementation Intention Plans During a JIT Smoking Cessation?

BACKGROUND

To identify actionable and effective implementation intention (II) plans, we examined whether (a) IIs suggesting food or nicotine-based substitution strategies to help quit smoking cigarettes would be more likely to be enacted in real time, (b) IIs reminding participants to cognitively motivate themselves or engage in solitary activity would be more likely to be enacted than those suggesting seeking social support, and (c) II plan enactment based on the above strategies would be associated with reporting momentary lapse avoidance.

METHOD

A sample of 57 Asian American young adult (18-25 years) smokers participated in a 4-week, mobile-based smoking cessation intervention, implemented in a Just-In-Time framework. User-specified IIs were categorized into nature of activity (cognitively motivate themselves, engage in solitary activity, seek social support) and type of substitution strategy (food, nicotine, no substitution). Outcome variable was momentary enactment of the given II. Generalized mixed linear models were used for analyses.

RESULTS

IIs reminding participants to cognitively motivate themselves and/or engage in solitary activities were more likely to be enacted than IIs recommending seeking social support. IIs recommending nicotine-based substitution were more likely to be enacted than IIs that did not specify any substitution. IIs suggesting food-based substitution, however, were less likely to be enacted than those not suggesting a specific substitution. II plan enactment based on the above strategies was significantly associated with avoiding momentary lapses compared to when momentary lapses occurred.

CONCLUSION

Specifying II recommendations found to be helpful with avoiding lapses in a smoking cessation context, can increase chances of II enactment, and improve overall health intervention outcomes.

Cigarette Smoking in South Korea: A Narrative Review

Although the prevalence of cigarette smoking has declined in Western countries over the past few decades, a comparable decline among males has not been observed in Asian countries, especially in South Korea, where approximately 40%–50% of men and 4%–8% of women have been identified as smokers, and there is a pressing need to understand the background of cigarette smoking in these populations. The present study is a narrative review of the research literature on cigarette smoking in South Korea. First, we describe the social, economic, and cultural factors that impact cigarette smoking in South Korea. The paper also reviews the available peer-reviewed literature comprising observational studies and interventional studies, including randomized controlled trials. The extant literature on smoking in Korean Americans is also reviewed. Cigarette smoking in South Korea has been relatively understudied, and this review identifies priority areas for future research, including the use of mobile interventions.

Real-time predictors of smoking among sexual minority and heterosexual young adults: An ecological momentary assessment study

BACKGROUND

Sexual minority young adults have higher smoking rates than the general young adult population, but reasons for this disparity are poorly understood. The current study aimed to: 1) identify real-time predictors of smoking among sexual minority and heterosexual smokers and 2) examine between-group differences in these predictors.

METHODS

We conducted an ecological momentary assessment (EMA) study in the San Francisco Bay Area, California in 2016-2017. Data from 84 young adult smokers (44% identified as sexual minority, including 29 bisexual and 8 gay/lesbian) with 6498 EMA assessments were analyzed. Both internal and external predictors and interaction terms between each predictor and sexual group were examined using generalized estimating equation models.

RESULTS

Common correlates of smoking were found for both groups (e.g., craving, absence of smoking bans, presence of other smokers, outside location, and seeing triggers). Unique factors for sexual minority smokers were being at a bar (aOR = 1.75, 95% CI = 1.06-2.90) and the number of other smokers present (aOR = 1.12, 95%CI = 1.04-1.20), while the presence of a smoking family member reduced the odds of smoking in this group (aOR = 0.13, 95%CI = 0.02-0.85). In interaction models, the number of other smokers exerted a greater influence on sexual minority participants compared to their heterosexual counterparts (aOR = 1.10, 95%CI = 1.01-1.20), while craving (aOR = 0.84, 95%CI = 0.75-0.93) and presence of a smoking family member (aOR = 0.11, 95%CI = 0.01-0.82) had weaker influences.

CONCLUSIONS

Our study highlights unique situational factors associated with smoking among sexual minority young adults and differences in these factors by sexual identity. Future interventions targeting sexual minorities should address bar attendance and specific triggers.

Acceptability and compliance with a remote monitoring system to track smoking and abstinence among young smokers

BACKGROUND

Similar to adult smokers, quit attempts among younger smokers almost inevitably result in relapse. Unlike adults, less is known about the process of relapse in this younger age group. A technology-based remote monitoring system may allow for detailed and accurate characterization of smoking and abstinence and would help to improve cessation strategies.

OBJECTIVES

This study describes a mobile system that captures smoking using breath carbon monoxide (CO) and real-time self-reports of smoking behavior. Compliance, feasibility, acceptability, and accuracy of the system were measured during a quit attempt and subsequent monitoring period.

METHODS

The mobile application (My Mobile Monitor, M3) combined breath CO with ecological momentary assessment, delivered via smartphone. Participants (N = 16; 75% female) were daily smokers between the ages of 19 and 25, who used the app for 11 days during which they agreed to make a quit attempt. Acceptability, compliance, and abstinence were measured.

RESULTS

Participants averaged 22.3 ± 2.0 years old and smoked an average of 13.0 ± 6.1 cigarettes per day. Overall session compliance was 69% and during the quit attempt, 56% of participants abstained from smoking for at least 24 hours. Agreement between self-reported smoking compared to breath CO was generally high, when available for comparison, though underreporting of cigarettes was likely.

CONCLUSION

This study demonstrates feasibility of a remote monitoring app with younger smokers, though improvements to promote compliance are needed. Remote monitoring to detect smoking and abstinence represents a step forward in the improvement of cessation strategies, but user experience and personalization are vital.

Development of a Just-in-Time Adaptive Intervention for Smoking Cessation Among Korean American Emerging Adults

PURPOSE

Cigarette smoking is a preventable risk factor that contributes to unnecessary lung cancer burden among Korean Americans and there is limited research on effective smoking cessation strategies for this population. Smartphone-based smoking cessation apps that leverage just-in-time adaptive interventions (JITAIs) hold promise for smokers attempting to quit. However, little is known about how to develop and tailor a smoking cessation JITAI for Korean American emerging adult (KAEA) smokers.

METHOD

This paper documents the development process of MyQuit USC according to design guidelines for JITAI. Our development process builds on findings from a prior ecological momentary assessment study by using qualitative research methods. Semi-structured interviews and a focus group were conducted to inform which intervention options to offer and the decision rules that dictate their delivery.

RESULTS

Qualitative findings highlighted that (1) smoking episodes are highly context-driven and that (2) KAEA smokers believe they need personalized cessation strategies tailored to different contexts. Thus, MyQuit USC operates via decision rules that guide the delivery of personalized implementation intentions, which are contingent on dynamic factors, to be delivered "just in time" at user-scheduled, high-risk smoking situations.

CONCLUSION

Through an iterative design process, informed by quantitative and qualitative formative research, we developed a smoking cessation JITAI tailored specifically for KAEA smokers. Further testing is under way to optimize future versions of the app with the most effective intervention strategies and decision rules. MyQuit USC has the potential to provide cessation support in real-world settings, when KAEAs need them the most.