Compliance with ecological momentary assessment protocols in substance users: a meta-analysis

The effectiveness of a drink-counting and a breathalyser-coupled smartphone application for reduced heavy drinking among alcohol-dependent adults in Sweden: A randomised controlled trial

BACKGROUND AND AIMS

Studies using smartphone apps in treatment for alcohol dependence are lacking. This study aimed to test the consumption-reducing effects of using two app-based alcohol interventions as complement to treatment as usual (TAU).

DESIGN

Three-armed, parallel, randomised controlled trial.

SETTING

Specialised outpatient clinic within the Stockholm Centre for Dependency Disorders, Stockholm, Sweden.

PARTICIPANTS

162 alcohol-dependent adults (46% female), with no social problems or mental disorders, who had no other drug use, were included. Mean age was 50 years, and the majority were highly educated, employed and had not previously received any alcohol treatment.

INTERVENTIONS

Participants were randomised to (1) TAU+drink-counting app (Glasklart, n = 52), (2) TAU+app-coupled breathalyser (iBAC Pro, n = 58) or (3) TAU only (n = 52). TAU included four sessions of clinician-led psychological treatment based on motivational interviewing/cognitive behavioural therapy, combined with pharmacotherapy when requested, for 12 weeks.

MEASUREMENTS

The primary outcome was past 4-week heavy drinking days (HDD) at 26 weeks post-randomisation, adjusted for baseline HDD, and assessed by structured interviews using Timeline Followback. Secondary outcomes included weekly consumption, consumption patterns, phosphatidylethanol and dependence at 12 and 26 weeks. Analyses compared TAU+drink-counting app and TAU+breathalyser each with TAU alone.

FINDINGS

At 26 weeks, participants with TAU+breathalyser had statistically significantly lower HDD [incidence rate ratio (IRR) = 0.67, 95% confidence interval (CI) = 0.49, 0.91] compared with those with TAU alone. There was no evidence of any effects on HDD for those with TAU+drink-counting app, compared with TAU alone (IRR = 0.94, 95% CI = 0.70, 1.25) or of any other effects.

CONCLUSIONS

In Sweden, treatment as usual (TAU) for alcohol dependence combined with a smartphone application coupled with a breathalyser was more effective than TAU alone in reducing self-reported heavy drinking. There was no evidence that TAU combined with a smartphone application for drink-counting was more effective than TAU alone.

Affective reinforcement of simultaneous versus single use of alcohol and cannabis

BACKGROUND

Simultaneous alcohol and cannabis use is prevalent among adults who drink alcohol and is associated with more negative consequences than use of either substance alone. Understanding reinforcement processes that maintain simultaneous versus single-substance use will highlight intervention targets specific to this pattern of use. In individuals' daily lives, we tested whether simultaneous use moments are associated with more affectively reinforcing outcomes compared to single use moments.

METHODS

We used ecological momentary assessment with 6 +  daily reports for 14 days. Participants were 88 adults ages 18-44 who reported simultaneous use at least twice per week. Mean age was 25.22 years and participants were 60.2 % female. At each momentary survey, participants reported alcohol and cannabis use, affect, momentary coping and enhancement motives, and subjective appraisals of use.

RESULTS

Simultaneously using cannabis during alcohol-use moments attenuated the increase in negative affect that accompanied coping-motivated drinking (anxious mood b = -0.11, 95 % CI = [-0.19, -0.02], p = .016; depressed mood b = -0.14, 95 % CI = [-0.23, -0.05], p = .003). Simultaneously using cannabis during alcohol-use moments attenuated the positive association between enhancement drinking motives and subjective drinking-contingent pleasure (b = -0.34, 95 % CI = [-0.50, -0.18], p < .001).

CONCLUSIONS

Simultaneously using cannabis during alcohol-use moments altered the subjective effects of alcohol, whereas simultaneously consuming alcohol during cannabis-use moments did not alter the subjective effects of cannabis. Individuals may perceive that simultaneous cannabis use mitigates undesirable effects of coping-motivated drinking, thereby driving simultaneous use of cannabis alongside alcohol.

Readdressing the Ongoing Challenge of Missing Data in Youth Ecological Momentary Assessment Studies: Meta-Analysis Update

BACKGROUND

Ecological momentary assessment (EMA) is pivotal in longitudinal health research in youth, but potential bias associated with nonparticipation, omitted reports, or dropout threatens its clinical validity. Previous meta-analytic evidence is inconsistent regarding specific determinants of missing data.

OBJECTIVE

This meta-analysis aimed to update and expand upon previous research by examining key participation metrics-acceptance, compliance, and retention-in youth EMA studies. In addition, it sought to identify potential moderators among sample and design characteristics, with the goal of better understanding and mitigating the impact of missing data.

METHODS

We used a bibliographic database search to identify EMA studies involving children and adolescents published from 2001 to November 2023. Eligible studies used mobile-delivered EMA protocols in samples with an average age up to 18 years. We conducted separate meta-analyses for acceptance, compliance, and retention rates, and performed meta-regressions to address sample and design characteristics. Furthermore, we extracted and pooled sample-level effect sizes related to correlates of response compliance. Risk of publication bias was assessed using funnel plots, regression tests, and sensitivity analyses targeting inflated compliance rates.

RESULTS

We identified 285 samples, including 17,441 participants aged 5 to 17.96 years (mean age 14.22, SD 2.24 years; mean percentage of female participants 55.7%). Pooled estimates were 67.27% (k=88, 95% CI 62.39-71.96) for acceptance, 71.97% (k=216, 95% CI 69.83-74.11) for compliance, and 96.57% (k=169, 95% CI 95.42-97.56) for retention. Despite overall poor moderation of participation metrics, acceptance rates decreased as the number of EMA items increased (log-transformed b=-0.115, SE 0.036; 95% CI -0.185 to -0.045; P=.001; R2=19.98), compliance rates declined by 0.8% per year of publication (SE 0.25, 95% CI -1.3 to -0.3; P=.002; R2=4.17), and retention rates dropped with increasing study duration (log-transformed b=-0.061, SE 0.015; 95% CI -0.091 to 0.032; P<.001; R2=10.06). The benefits of monetary incentives on response compliance diminished as the proportion of female participants increased (b=-0.002, SE 0.001; 95% CI -0.003 to -0.001; P=.003; R2=9.47). Within-sample analyses showed a small but significant effect indicating higher compliance in girls compared to boys (k=25; g=0.18; 95% CI 0.06-0.31; P=.003), but no significant age-related effects were found (k=14; z score=0.05; 95% CI -0.01 to 0.16).

CONCLUSIONS

Despite a 5-fold increase in included effect sizes compared to the initial review, the variability in rates of missing data that one can expect based on specific sample and design characteristics remains substantial. The inconsistency in identifying robust moderators highlights the need for greater attention to missing data and its impact on study results. To eradicate any health-related bias in EMA studies, researchers should collectively increase transparent reporting practices, intensify primary methodological research, and involve participants' perspectives on missing data.

TRIAL REGISTRATION

PROSPERO CRD42022376948; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022376948.

Effects of E-cigarettes on Combustible Cigarette Smoking Among Adults With Opioid Use Disorder on Buprenorphine: Single Arm ERASER Pilot Trial

INTRODUCTION

People with opioid use disorder (OUD) on buprenorphine smoke at high rates and have low cessation rates, even with evidence-based medications. Electronic cigarettes (EC) are a promising harm reduction strategy for combusted cigarette (CC) smokers unable to quit. Unfortunately, people with OUD are underrepresented in EC research.

AIMS AND METHODS

A pilot study assessed the feasibility, acceptability, and preliminary effectiveness of EC as a harm reduction tool among CC smokers with OUD on buprenorphine (N = 30). Participants were provided with an EC and freebase nicotine liquid (6 mg/mL) with a choice of flavor and a brief training session. Research visits were scheduled in person at baseline, week 4, and week 8 (follow-up). Daily diary assessments were completed during the 4-week EC period.

RESULTS

Most visits (>74%) and 61.4% of daily diary assessments were completed. During the 4-week study period, 90% of participants used the EC at least one day, 66.7% used the EC for at least 16 days, and 43.3% used the EC every day. Significant reductions were observed between baseline and both weeks 4 and 8 in cigarettes smoked per day (CPDbaseline = 16.2[8.3], CPDweek4 = 9.6[9.3], CPDweek8 = 8.4[8.3]) carbon monoxide (CO) levels (CObaseline = 21.5[15.0], COweek4 = 16.9[9.6], COweek8 = 15.7[10.0]), and nicotine dependence measured using the Fagerström Test for Nicotine Dependence (FTNDbaseline = 5.4[2.5], FTNDweek4 = 4.2[2.6], FTNDweek8 = 4.4[2.6]), with all p-values < .05.

CONCLUSIONS

Implementing an EC protocol in outpatient maintenance treatment programs is feasible and acceptable. Preliminary results suggest that ECs may facilitate reductions in cigarettes per day, CO levels, and nicotine dependence. Future research should explore the effect of prolonged EC use on harm reduction and cessation milestones.

IMPLICATIONS

EC are a potentially promising harm reduction strategy for adult CC smokers with OUD on buprenorphine who are unable to quit using evidence-based medications. However, previous studies have largely overlooked people with OUD on buprenorphine with recent drug use. This study addresses this gap through a pilot trial investigating the feasibility, acceptability, and preliminary effects of EC on CC behavior. The brief and standardized nature of the protocol and its implementation in outpatient settings highlights its potential for widespread implementation in facilities providing care to people with OUD on buprenorphine.

Teens and opioids postsurgery (TOPS): protocol for a prospective observational study describing associations between sleep deficiency and opioid use following outpatient surgery in adolescents

INTRODUCTION

The opioid crisis is a significant burden on adolescent public health in the USA. Medical use of prescription opioids is a pathway via which adolescents transition to opioid misuse, opioid use disorder and overdose. More than half of all opioids prescribed to adolescents are for pain management following surgery. Yet, little is known about the critical period following surgery during which adolescents initiate opioid misuse or the modifiable mechanisms (such as sleep deficiency) contributing to this process. This prospective observational study will broaden our knowledge by examining associations between sleep deficiency and opioid use and misuse following surgery. We will also examine behavioural, psychological, family and social factors linking sleep deficiency with opioid use and misuse.

METHODS AND ANALYSIS

Adolescents (10-19 years) undergoing outpatient orthopaedic surgery, along with one parent, will be recruited from two paediatric hospitals, for a sample of 400 dyads. Adolescents will be assessed at six timepoints. Before surgery, participants will undergo comprehensive multimodal sleep assessments (sleep surveys and actigraphy). Participants will also report on previous substance use, pain intensity and psychosocial, family and social factors. Adolescents will then be closely monitored over the first 14 days following surgery using ecological momentary assessment methods to capture real-time, naturalistic, daily data on sleep, opioid use, pain and psychological factors (including mood, affect and subjective response to opioid use). Opioid use (total number of doses and duration) will be measured with an innovative electronic medication monitoring device following surgery. Follow-up assessments at 3 months, 6 months, 12 months and 24 months will track the development of opioid misuse over time. Our primary outcomes include opioid use during the immediate 14 days following surgery and the presence of opioid misuse at 24 months after surgery. Multilevel mediation models will determine associations between predictor variables and acute postsurgical opioid use. We will apply modern machine learning algorithms to develop and validate models predicting adolescent prescription opioid misuse at 24 months from surgery.

ETHICS AND DISSEMINATION

This study was approved by Advarra's Center for Institutional Review Board Intelligence (CIRBI) (Protocol 00072049), which serves as the single IRB of record for this multisite study.

Ecological momentary assessment study of same-hour polysubstance use among people who use opioids and additional substances

BACKGROUND

Polysubstance use is a defining feature of the opioid overdose epidemic in the United States today. Most quantitative studies of polysubstance use rely on 30-day retrospective measures. Understanding how drugs are co-used in shorter (daily and hourly) timeframes enhances our understanding of polysubstance-related overdose risk.

METHODS

We used ecological momentary assessment (EMA) to assess polysubstance in community-based sample of people who use drugs in Oakland, CA (N = 117). Participants provided data on substance use three times daily over 28 days, using a smartphone app. We created binary variables of same-day and same-hour polysubstance use and estimated its prevalence with mixed-effects logistic regression models.

RESULTS

The response rate to thrice-daily prompts was 64.6 %. The prevalence of same-day polysubstance use on any given day was 0.77 (95 % CI 0.73, 0.82), and the prevalence of same-hour polysubstance use was 0.71 (95 % CI 0.66, 0.76). Defined as the combination of opioids with stimulants, opioids with alcohol, opioids with benzodiazepines, or more than one opioid in the same hour, the probability of risky polysubstance use on a given day was 0.59 (95 % CI 0.52, 0.65). Excluding methadone from a treatment program, the probability of risky polysubstance use on a given day was 0.51 (95 % CI 0.44, 0.58).

CONCLUSIONS

Our findings highlight the importance of targeted prevention efforts addressing the diverse substance combinations that increase overdose risk. It is crucial to develop and test substance use treatment and overdose prevention strategies that address the complexities of polysubstance use, in partnership with people who use drugs.

Smartwatch-Based Ecological Momentary Assessment for High-Temporal-Density, Longitudinal Measurement of Alcohol Use (AlcoWatch): Feasibility Evaluation

BACKGROUND

Ecological momentary assessment methods have recently been adapted for use on smartwatches. One particular class of these methods, developed to minimize participant burden and maximize engagement and compliance, is referred to as microinteraction-based ecological momentary assessment (μEMA).

OBJECTIVE

This study explores the feasibility of using these smartwatch-based μEMA methods to capture longitudinal, high-temporal-density self-report data about alcohol consumption in a nonclinical population selected to represent high- and low-socioeconomic position (SEP) groups.

METHODS

A total of 32 participants from the Avon Longitudinal Study of Parents and Children (13 high and 19 low SEP) wore a smartwatch running a custom-developed μEMA app for 3 months between October 2019 and June 2020. Every day over a 12-week period, participants were asked 5 times a day about any alcoholic drinks they had consumed in the previous 2 hours, and the context in which they were consumed. They were also asked if they had missed recording any alcoholic drinks the day before. As a comparison, participants also completed fortnightly online diaries of alcohol consumed using the Timeline Followback (TLFB) method. At the end of the study, participants completed a semistructured interview about their experiences.

RESULTS

The compliance rate for all participants who started the study for the smartwatch μEMA method decreased from around 70% in week 1 to 45% in week 12, compared with the online TLFB method which was flatter at around 50% over the 12 weeks. The compliance for all participants still active for the smartwatch μEMA method was much flatter, around 70% for the whole 12 weeks, while for the online TLFB method, it varied between 50% and 80% over the same period. The completion rate for the smartwatch μEMA method varied around 80% across the 12 weeks. Within high- and low-SEP groups there was considerable variation in compliance and completion at each week of the study for both methods. However, almost all point estimates for both smartwatch μEMA and online TLFB indicated lower levels of engagement for low-SEP participants. All participants scored "experiences of using" the 2 methods equally highly, with "willingness to use again" slightly higher for smartwatch μEMA.

CONCLUSIONS

Our findings demonstrate the acceptability and potential utility of smartwatch μEMA methods for capturing data on alcohol consumption. These methods have the benefits of capturing higher-temporal-density longitudinal data on alcohol consumption, promoting greater participant engagement with less missing data, and potentially being less susceptible to recall errors than established methods such as TLFB. Future studies should explore the factors impacting participant attrition (the biggest reason for reduced engagement), latency issues, and the validity of alcohol data captured with these methods. The consistent pattern of lower engagement among low-SEP participants than high-SEP participants indicates that further work is warranted to explore the impact and causes of these differences.

Offshore Worker Compliance, Perceived Utility, Effectiveness, and Feasibility of Daily Fatigue Assessments over Four Weeks in the Gulf of Mexico

Occupational ApplicationsWe conducted a study on offshore drillships in the Gulf of Mexico that captured daily compliance rates with various fatigue assessments over four weeks-a Psychomotor Vigilance Task (PVT), actigraphy, physiological monitoring, and surveys. We obtained worker perceptions of these assessments' utility, effectiveness, and feasibility. Each fatigue assessment had a good overall compliance rate (>80%) over the four weeks but declined when the assessment was self-administered. Our interview findings revealed that actigraphy was the preferred means of monitoring their sleep to manage fatigue compared to physiological sensors. Workers also perceived PVT outcomes to be useful, but the duration (∼10 min) was the biggest barrier to continued use. From these findings, we generated research-to-practice recommendations on effective and sustainable fatigue assessments in offshore shiftwork: (1) periodic use of actigraphy watches to monitor sleep time and efficiency and (2) implementation of a short 3- or 5-min PVT on an electronic device.

Telephone Counseling and Messaging Guided by Mobile Profiling of Tobacco Users for Smoking Cessation: A Randomized Clinical Trial

Importance

Evidence-based pharmacotherapy and behavioral therapy could increase tobacco abstinence but are underused and require further investigation.

Objective

To evaluate the effectiveness of a novel mobile health (mHealth) profiling via ecological momentary assessment (EMA) in personalizing smoking cessation intervention for individuals who use tobacco with no intention to use smoking cessation services and medications.

Design, Setting, and Participants

A 2-arm, assessor-blind, individual-randomized clinical trial was conducted. With online recruitment through social media or email advertisement, 459 adults with daily tobacco use in Hong Kong were recruited from March 23, 2022, to January 4, 2023, with follow-up completed by July 4, 2023. Individuals who had not used smoking cessation services or medications in the preceding 7 days and had no intention to use these aids in the next month were included. Participants were randomized 1:1 to intervention (n = 231) or control (n = 228) groups.

Interventions

Both groups completed 5 EMAs daily for 7 days to report smoking behaviors and triggers. The intervention group additionally received nurse-led telephone counseling and 10-week instant messaging support guided by mHealth profiling from EMA.

Main Outcomes and Measures

Primary outcomes were biochemically validated tobacco abstinence and Incremental Behavior Change Toward Smoking Cessation (IBC-S) score at 3 months after EMA initiation. Secondary outcomes were biochemically validated tobacco abstinence and IBC-S status at 6 months, self-reported 7-day point prevalence, abstinence, and use of smoking cessation medications and services at 3 and 6 months after EMA initiation. Intention-to-treat analysis was used.

Results

The study included 459 participants (304 males [66.2%]) with a mean (SD) age of 36.7 (10.7) years. Biochemically validated tobacco abstinence rates were 8.2% in the intervention group and 3.5% in the control group (odds ratio [OR], 2.46; 95% CI, 1.06 to 5.75; P = .04) at 3-month follow-up. The corresponding rates at 6-month follow-up were 9.5% and 4.0% (OR, 2.56; 95% CI, 1.15-5.70; P = .02). The intervention group showed a greater increase in IBC-S scores from baseline to both 3-month (β = 1.03; 95% CI, 0.46-1.59; P < .001) and 6-month (β = 0.95; 95% CI, 0.37-1.53; P = .001) follow-ups.

Conclusions and Relevance

The findings of this randomized clinical trial suggest that telephone counseling and instant messaging support, guided by mHealth profiling, increased tobacco abstinence vs EMA alone. This intervention may be used to supplement conventional smoking cessation for individuals who use tobacco and are unwilling to use smoking cessation aids.

Trial Registration

ClinicalTrials.gov Identifier: NCT05212220.

Momentary mindfulness versus distraction coping messages to reduce cannabis craving among young adults: A microrandomized trial

OBJECTIVE

Rates of problematic cannabis use among young adults are high and increasing. Craving for cannabis varies throughout the day and is an important risk factor for cannabis use, yet no studies to date have tested interventions offered at the moment craving is experienced in the natural environment.

METHOD

This study used an efficient and innovative microrandomized trial design to test two distinct types of coping messages (mindfulness strategy vs. distraction strategy) offering brief coping strategies when moderate to severe craving was reported via ecological momentary assessment (EMA).

RESULTS

Young adults who regularly use cannabis (N = 53) were readily engaged in this 4-week intervention, and EMA completion was high throughout, demonstrating excellent feasibility of this approach. However, results indicated that coping messages did not reduce craving at the next EMA relative to control (thank you) messages, with no significant change in efficacy over time. Furthermore, exploratory analyses found that neither mindfulness nor distraction resulted in reduced craving relative to the control message.

CONCLUSIONS

Despite this outcome, this method of testing digital interventions targeting momentary risks for substance use such as craving holds promise for rapidly and efficiently screening a wide variety of intervention strategies for inclusion in future just-in-time adaptive interventions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Examining Trajectories of Momentary Affect Surrounding NSSI and Alcohol Use: A Network Analysis and Bayesian Approach

OBJECTIVES

This study aimed to identify specific affective antecedents of non-suicidal self-injury (NSSI) and alcohol use, and to examine affective trajectories before and after these behaviors.

METHOD

Fifty-six undergraduates (71% female, 25% non-White, 20.2 ± 1.3 years old) meeting criteria for probable alcohol or substance use disorder participated in 28-days of ecological momentary assessment, completing four daily surveys assessing affect, self-punishment cognitions, and engagement in NSSI and alcohol use. Contemporaneous and time-lagged graphical vector autoregressive (GVAR) models were used to examine affect dynamics surrounding NSSI and alcohol use. Zero-inflated Bayesian binomial regression was used to investigate the relationship between momentary affect and likelihood of engaging in either NSSI or alcohol at the next prompt. Multilevel modeling was used to examine trajectories of affective states pre- and post-engagement in NSSI and alcohol use.

RESULTS

GVAR models revealed significant relationships between jitteriness and being afraid with next timepoint NSSI, and excitement with next timepoint alcohol use. Bayesian regression with horseshoe priors identified self-punishment and loneliness as predictors of NSSI. Moreover, Bayesian regression revealed that excitement predicted alcohol use among those without alcohol use disorder (AUD), while belongingness predicted alcohol use among those with AUD. Multilevel models revealed self-punishment and loneliness followed a negative quadratic trajectory around NSSI events. Excitement and belongingness did not relate to slopes of time.

CONCLUSIONS

The findings suggest NSSI is used to reduce negative emotional states, whereas alcohol consumption initially enhances positive emotional states in individuals without an AUD and may be used to increase belongingness in those with an AUD.

Within-person affect dynamics among individuals in residential treatment for opioid use disorder: An ecological momentary assessment study

Ecological momentary assessment is increasingly leveraged to better understand affective processes underlying substance use disorder treatment and recovery. Research in this area has yielded novel insights into the roles of mean levels of positive affect (PA) and negative affect (NA) in precipitating drug craving and substance use in daily life. Little of the extant substance use disorder treatment research, however, considers dynamic patterns of PA and NA, separately or in relation to one another, or how such patterns may differ from those observed among nonclinical samples. The current ecological momentary assessment study examined between-person differences in within-person affect dynamics-including intensity, variability, instability, inertia, polarity, and spillover-among patients in residential treatment (n = 73) for opioid use disorder (OUD), both collectively and separately according to posttreatment relapse status, relative to a demographically similar nonclinical comparison group (n = 37). The results revealed no group differences in PA dynamics. The OUD group did, however, report higher average NA intensity and within-day variability relative to the comparison group. Furthermore, relative to the comparison group, OUD patients who relapsed within 120 days posttreatment exhibited greater linear declines in NA intensity across days, whereas OUD patients who did not relapse demonstrated weaker affect polarity (i.e., the within-person correlation between PA and NA). Although PA dynamics alone did not differ between groups, weaker affect polarity differentiated OUD patients who avoided relapse from the comparison group. The capacity to experience PA separately from fluctuations in NA may reflect an adaptive tendency that could reduce vulnerability to relapse among individuals in OUD treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Understanding Compliance Rates in Suicide Research During the Post-Discharge Period

INTRODUCTION

The period following discharge from psychiatric hospitalization is one of particularly elevated suicide risk. It is essential to better understand risk factors for suicide during this period; however, retention and compliance in longitudinal research can be a challenge with high-risk populations.

METHODS

We examined compliance rates in the six-month period following psychiatric hospital discharge among 174 adults (149 psychiatric patients and 25 healthy controls) across three data collection methods: ecological momentary assessment (EMA), weekly clinical assessment phone calls, and clinical follow-up assessments at two- and six-months post-discharge. We examined whether clinical and demographic characteristics influenced compliance rates.

RESULTS

Results suggested low rates of EMA compliance, but strong rates of completion of weekly phone calls and follow-up assessments. Compared to psychiatric patients, healthy controls completed more EMA and weekly phone calls, but not follow-up assessments. Participants who met current diagnostic criteria for a major depressive episode and who scored above the clinical threshold for borderline personality disorder symptoms had lower EMA compliance rates.

CONCLUSIONS

These findings have important implications for strategies to improve patient engagement in research during this high-risk period.

Cross-Platform Ecological Momentary Assessment App (JTrack-EMA+): Development and Usability Study

BACKGROUND

Traditional in-clinic methods of collecting self-reported information are costly, time-consuming, subjective, and often limited in the quality and quantity of observation. However, smartphone-based ecological momentary assessments (EMAs) provide complementary information to in-clinic visits by collecting real-time, frequent, and longitudinal data that are ecologically valid. While these methods are promising, they are often prone to various technical obstacles. However, despite the potential of smartphone-based EMAs, they face technical obstacles that impact adaptability, availability, and interoperability across devices and operating systems. Deficiencies in these areas can contribute to selection bias by excluding participants with unsupported devices or limited digital literacy, increase development and maintenance costs, and extend deployment timelines. Moreover, these limitations not only impede the configurability of existing solutions but also hinder their adoption for addressing diverse clinical challenges.

OBJECTIVE

The primary aim of this research was to develop a cross-platform EMA app that ensures a uniform user experience and core features across various operating systems. Emphasis was placed on maximizing the integration and adaptability to various study designs, all while maintaining strict adherence to security and privacy protocols. JTrack-EMA+ was designed and implemented per the FAIR (findable, accessible, interpretable, and reusable) principles in both its architecture and data management layers, thereby reducing the burden of integration for clinicians and researchers.

METHODS

JTrack-EMA+ was built using the Flutter framework, enabling it to run seamlessly across different platforms. This platform comprises two main components. JDash (Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour [INM-7]) is an online management tool created using Python (Python Software Foundation) with the Django (Django Software Foundation) framework. This online dashboard offers comprehensive study management tools, including assessment design, user administration, data quality control, and a reminder casting center. The JTrack-EMA+ app supports a wide range of question types, allowing flexibility in assessment design. It also has configurable assessment logic and the ability to include supplementary materials for a richer user experience. It strongly commits to security and privacy and complies with the General Data Protection Regulations to safeguard user data and ensure confidentiality.

RESULTS

We investigated our platform in a pilot study with 480 days of follow-up to assess participants' compliance. The 6-month average compliance was 49.3%, significantly declining (P=.004) from 66.7% in the first month to 42% in the sixth month.

CONCLUSIONS

The JTrack-EMA+ platform prioritizes platform-independent architecture, providing an easy entry point for clinical researchers to deploy EMA in their respective clinical studies. Remote and home-based assessments of EMA using this platform can provide valuable insights into patients' daily lives, particularly in a population with limited mobility or inconsistent access to health care services.

Do delayed responses introduce bias in ecological momentary assessment? Evidence from comparisons between self-reported and objective physical activity

Introduction

Delayed responses are a common yet often overlooked aspect of participant compliance in ecological momentary assessment (EMA) research. This study investigated whether response delays introduce selection bias in the moments captured by EMA.

Methods

Participants (n = 339) self-reported their physical activity behaviors using EMA five times a day over 7 days while wearing a continuous physical activity monitor. The continuous activity monitor data provided an objective reference value to evaluate potential biases in delayed EMA self-reports.

Results

Results showed that participants were significantly more likely to delay EMA responses when they were prompted during higher levels of physical activity, and they subsequently reduced their activity levels, postponing their response until they were in a significantly less active state. There was no significant evidence that response delays systematically biased the levels of EMA reported activities, although delayed responses were associated with significantly more random errors in EMA reports (with small effect sizes).

Discussion

The results suggest that respondents self-select the moments for answering EMA surveys based on their current activity levels, but brief response delays do not translate into marked reductions in the quality of EMA data.

Affective dynamics surrounding craving, non-heavy alcohol use and binge drinking in female patients with alcohol use disorder and controls: An experience sampling method study

BACKGROUND AND AIMS

Studies show that higher levels of positive affect (PA) and lower levels of negative affect (NA) are related to craving and alcohol consumption at a daily level in men, but little is known on these associations at a momentary level, and whether they are present in women. This study measured the dynamics of within-person NA and PA surrounding craving, non-heavy alcohol use and binge drinking in women with alcohol use disorder (AUD) and female controls without AUD.

METHODS

53 female patients with AUD and 75 female controls, all recruited in Belgium, were included in an experience sampling study where they reported on momentary NA, PA, craving and alcohol use in daily life over a period of 12 months. Assessments occurred eight times a day on Thursdays, Fridays and Saturdays in seven bursts of three weeks.

RESULTS

Within-person NA at a previous assessment (t-1) predicted craving at the current assessment (t0) in patients with AUD in a positive linear [β = 0.043; 95% confidence interval (CI) = 0.002, 0.057; P = 0.041] and quadratic fashion (β = 0.034; CI = 0.011, 0.057; P = 0.004). Within-person PA at t-1 predicted craving at t0 in patients with AUD with a positive quadratic relation (β = 0.042; CI = 0.08, 0.065; P < 0.001). Within-person NA at t-1 negatively predicted non-heavy alcohol use at t0 in a linear fashion in controls (β = -0.495; CI = -0.677, -0.312; P < 0.001) and patients with AUD (β = -0.276; CI = -0.421, -0.132; P < 0.001). Within-person PA at t-1 significantly predicted non-heavy alcohol use at t0 with a positive linear term (β = 0.470; CI = 0.329, 0.610; P < 0.001) in controls, but with a positive linear term (β = 0.399; CI = 0.260, 0.454; P < 0.001) and a positive quadratic term (β = 0.203; CI = 0.060, 0.347; P = 0.003) in patients with AUD. Within-person NA at t-1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (β = 0.236; CI = 0.060, 0.412; P = 0.008), but not for controls. Within-person PA at t-1 predicted binge drinking at t0 in patients with AUD with a significant quadratic term (β = 0.378; CI = 0.215, 0.542; P < 0.001), and this was also the case for controls (β = 0.487; CI = 0.158, 0.770; P < 0.001). Non-heavy alcohol use at t0 predicted lower levels of NA at t+1 in both patients with AUD (β = -0.161; SE = 0.044; CI = -0.248, 0.074; P = 0.001) and controls (β = -0.114; CI = -0.198, -0.029; P = 0.010). Non-heavy alcohol use at t0 also predicted higher levels of PA at t+1 in both patients with AUD (β = 0.181; CI = 0.088, 0.274; P < 0.001) and controls (β = 0.189; CI = 0.101, 0.278; P < 0.001).

CONCLUSIONS

The momentary relation between affect and craving or alcohol use seems to be non-linear in female patients with alcohol use disorder, whereby a worse mood predicts subsequent alcohol use, though more for binge drinking than for non-heavy alcohol use.

Development and Initial Validation of a Momentary Cannabis Craving Scale Within a Homogeneous Sample of U.S. Emerging Adults

Given the popularity and ease of single-item craving assessments, we developed a multi-item measure and compared it to common single-item assessments in an ecological momentary assessment (EMA) context. Two weeks of EMA data were collected from 48 emerging adults (56.25% female, 85.42% White) who frequently used cannabis. Eight craving items were administered, and multilevel factor analyses were used to identify the best fitting model. The resulting scale's factors represented purposefulness/general desire and emotionality/negative affect craving. Convergent validity was examined using measures of craving, cannabis use disorder symptoms, frequency of use, cannabis cue reactivity, cannabis use, negative affect, and impulsivity. The scale factors were associated with cue-reactivity craving, negative affect, impulsivity, and subfactors of existing craving measures. For researchers interested in using a single item to capture craving, one item performed particularly well. However, the new scale may provide a more nuanced assessment of mechanisms underlying craving.

An Ecological Momentary Assessment Approach of Environmental Triggers in the Role of Daily Affect, Rumination, and Movement Patterns in Early Alcohol Use Among Healthy Adolescents: Exploratory Study

BACKGROUND

Adolescence is a period characterized by an increased susceptibility to developing risky alcohol consumption habits. This susceptibility can be influenced by social and situational factors encountered in daily life, which, in conjunction with emotions and thoughts, contribute to behavioral patterns related to alcohol use even in the early stages of alcohol experimentation, when initial experiences with alcohol are formed, and regular consumption is still evolving.

OBJECTIVE

This study aimed to examine the association between detailed behavioral and movement patterns, along with emotional and cognitive factors, and the early onset of alcohol use in the everyday lives of adolescents.

METHODS

A total of 65 healthy adolescents (33 male, twenty-nine 14-year-olds, and thirty-six 16-year-olds) underwent mobile-based ecological momentary assessments on alcohol (once a day at 9 AM, assessing alcohol use the day before), positive and negative affect, craving, rumination, and social context (6 prompts/day at 9 AM, 11 AM, 2 PM, 4 PM, 6 PM and 8 PM), type of day (weekdays or weekends, with weekend including Fridays, Saturdays, and Sundays), and using geospatial measures (specifically roaming entropy and number and type of trigger points for alcohol use met) over 14 days. After adjusting for a compliance rate of at least 50%, 52 participants (26 male and twenty-four 14-year-olds) were included in the analyses.

RESULTS

Generalized linear multilevel models revealed that higher positive affect (b=0.685, P=.007), higher rumination (b=0.586, P=.02), and a larger movement radius (roaming entropy) (b=8.126, P=.02) were positively associated with alcohol use on the same day. However, social context (b=-0.076, P=.90), negative affect (b=-0.077, P=.80), or potential trigger points (all P>.05) did not show significant associations. Alcohol use varied depending on the type of day, with more alcohol use on weekends (b=1.082, P<.001) and age (t50=-2.910, P=.005), with 16-year-olds (mean 1.61, SD 1.66) reporting more days of alcohol consumption than 14-year-olds (mean 0.548, SD 0.72).

CONCLUSIONS

Our findings support previously identified factors as significant contributors to very early and low levels of alcohol consumption through fine-grained analysis of daily behaviors. These factors include positive affect, rumination, weekend days, and age. In addition, we emphasize that exploratory environmental movement behavior (roaming entropy) is also significantly associated with adolescent alcohol use, highlighting its importance as an additional factor.

Investigating dynamics in attentive and inattentive responding together with their contextual correlates using a novel mixture IRT model for intensive longitudinal data

In ecological momentary assessment (EMA), respondents answer brief questionnaires about their current behaviours or experiences several times per day across multiple days. The frequent measurement enables a thorough grasp of the dynamics inherent in psychological constructs, but it also increases respondent burden. To lower this burden, respondents may engage in careless and insufficient effort responding (C/IER), leaving data contaminated with responses that do not reflect what researchers want to measure. We introduce a novel approach to investigating C/IER in EMA data. Our approach combines a confirmatory mixture item response theory model separating C/IER from attentive behaviour with latent Markov factor analysis. This enables gauging the occurrence of C/IER and studying transitions among states of different response behaviours including their contextual correlates. The approach can be implemented using R packages. An empirical application showcases the approach's efficacy in pinpointing C/IER instances and gaining insights into their underlying causes. We showcase that the approach identifies various C/IER response patterns but requires heterogeneous and negatively worded items to detect straightlining. In a simulation investigating robustness against unaccounted for changes in measurement models underlying attentive responses, the approach proved robust against heterogeneity in loading patterns but not against heterogeneity in factor structures. Extensions to accommodate the latter are discussed.

Impact of Providing a Personalized Data Dashboard on Ecological Momentary Assessment Compliance Among College Students Who Use Substances: Pilot Microrandomized Trial

BACKGROUND

The landscape of substance use behavior among young adults has observed rapid changes over time. Intensive longitudinal designs are ideal for examining and intervening in substance use behavior in real time but rely on high participant compliance in the study protocol, representing a significant challenge for researchers.

OBJECTIVE

This study aimed to evaluate the effect of including a personalized data dashboard (DD) in a text-based survey prompt on study compliance outcomes among college students participating in a 21-day ecological momentary assessment (EMA) study.

METHODS

Participants (N=91; 61/91, 67% female and 84/91, 92% White) were college students who engaged in recent alcohol and cannabis use. Participants were randomized to either complete a 21-day EMA protocol with 4 prompts/d (EMA Group) or complete the same EMA protocol with 1 personalized message and a DD indicating multiple metrics of progress in the study, delivered at 1 randomly selected prompt/d (EMA+DD Group) via a microrandomized design. Study compliance, completion time, self-reported protocol experiences, and qualitative responses were assessed for both groups.

RESULTS

Levels of compliance were similar across groups. Participants in the EMA+DD Group had overall faster completion times, with significant week-level differences in weeks 2 and 3 of the study (P=.047 and P=.03, respectively). Although nonsignificant, small-to-medium effect sizes were observed when comparing the groups in terms of compensation level (P=.08; Cohen w=0.19) and perceived burden (P=.09; Cohen d=-0.36). Qualitative findings revealed that EMA+DD participants perceived that seeing their progress facilitated engagement. Within the EMA+DD Group, providing a DD at the moment level did not significantly impact participants' likelihood of completing the EMA or completion time at that particular prompt (all P>.05), with the exception of the first prompt of the day (P=.01 and P<.001).

CONCLUSIONS

Providing a DD may be useful to increase engagement, particularly for researchers aiming to assess health behaviors shortly after a survey prompt is deployed to participants' mobile devices.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/57664.

Ecological momentary assessment in prolonged grief research: Feasibility, acceptability, and measurement reactivity

Ecological momentary assessment (EMA) is a method of data collection that entails prompting individuals to report their experiences (e.g., thoughts, feelings, and behaviors) in real time over the course of their day-to-day lives. By providing rich information about how these experiences unfold over time within an individual, EMA has the potential to substantially advance our understanding of grief. However, there is uncertainty about how bereaved adults will respond to EMA, especially among those with high prolonged grief symptom severity. Accordingly, we evaluated the feasibility and acceptability of an EMA protocol in bereaved adults with low and high prolonged grief severity. Participants completed six 12-item EMA surveys per day on their smartphones for 17 days. Adherence was high (mean survey completion = 90%, median = 96%), and only 6% of participants withdrew. Adherence remained high in those with high prolonged grief symptom severity (mean = 86%; median = 96%). On average, participants reported agreement that survey frequency and length were acceptable. There was no evidence for systematic worsening of symptoms during EMA data collection. Together, these findings suggest that EMA is feasible, acceptable, and safe for bereaved adults, including those with high prolonged grief symptom severity.

Predictors of participant compliance with ecological momentary assessment among individuals with chronic pain who are using cannabis and opioids

Background

Cannabis may be an alternative or adjunct to opioid therapy for chronic pain. However, there are limited data on patterns of opioid medication and medical cannabis use. The current study investigated the feasibility of using Ecological Momentary Assessment (EMA) to assess patterns of prescription opioids and medical cannabis among individuals experiencing chronic pain.

Method

The study included 133 participants recruited online. Participants were 42.6 (SD = 13.9) years old on average and the majority were men (57.9 %) and Non-Hispanic White (63.2 %). Participants completed a baseline assessment, followed by 30 days of EMA data collection with four randomly prompted past-hour surveys and one daily diary per day, and a follow-up survey that assessed perceived EMA burden. Simple and multivariable linear regression models were estimated to investigate participant predictors of the proportion of EMA surveys completed (past-hour surveys and daily diaries in separate models).

Results

Compliance rates for EMA prompts were 89.7 % for daily diaries and 63.3 % for past-hour surveys. In multivariable regression, participants holding a graduate degree completed a lower proportion of daily diaries (b = -0.109, SE = 0.052, p < .05) and past-hour surveys (b = -0.148, SE = 0.071, p < .05), compared to those with less than a 4-year degree. Participants completing a higher proportion of daily diaries reported greater ease of use at follow-up (b = 0.050, SE = 0.022, p < .05) and those completing a higher proportion of past-hour surveys desired higher rewards (b = 0.066, SE = 0.033, p < .05).

Conclusions

Study results confirm the feasibility of using EMA methods to assess patterns of prescription opioids and medical cannabis among individuals experiencing chronic pain.

Sexual Alcohol Expectancies, Alcohol Intoxication, and Sexual Behavior in MSM: An Experience Sampling Study

Despite advances in prevention and treatment, the transmission of human immunodeficiency virus remains a significant problem in the United States, especially among men who have sex with men (MSM). Alcohol use can promote risky sexual decisions, and alcohol expectancies may influence the role of alcohol in decision making. The present secondary analysis tests the moderating role of sexual alcohol expectancies (SAEs) in the relation between daily alcohol intoxication and sexual behavior in a sample of 248 moderate- to heavy-drinking MSM. SAEs were assessed with the Sexual Alcohol Expectancies Questionnaire at baseline, followed by two 23-day bursts of ecological momentary assessment including self-initiated morning assessments of sexual behavior and the prior night's perceived intoxication, as well as nine daily random alcohol assessments. Multilevel modeling showed that SAEs moderated a curvilinear association between intoxication and anal intercourse with a condom such that the relation between daily intoxication and anal intercourse with a condom is a more pronounced inverted u-shape among individuals with strong SAEs, and this moderation effect was not seen for condomless anal intercourse (CAI). While SAEs do appear to influence the association between intoxication and sexual behavior in MSM, they do not appear to moderate the association between alcohol intoxication and CAI.

Comparing the psychometric properties of reward and relief drinking measures

Previous work examining the extent to which individuals seek alcohol to enhance positive experiences (reward drinking) or relieve aversive states (relief drinking) has shown that reward/relief drinking predicts response to naltrexone and acamprosate treatment for alcohol use disorder. Yet, various measures of reward/relief drinking have been used in prior research, and the comparative psychometric properties of these measures are unknown. Evaluating and comparing the psychometric properties of these reward/relief drinking measures could identify measures with the most promise for translating precision medicine findings to clinical practice. In a community sample of 65 individuals with heavy/hazardous alcohol use on the Alcohol Use Disorder Identification Test, we showed good internal consistency reliability, test-retest reliability, and concurrent validity for theoretically aligned measures (e.g., reward drinking and reward responsiveness, relief drinking and depression/anxiety symptoms) of the reward and relief subscales across the six measures. We then used ecological momentary assessment to determine whether reward and relief drinking subscales predicted within-person associations between contextual factors of interest (e.g., negative affect, positive affect, distress intolerance, physical pain, hangover symptoms, social drinking situations, alcohol cues) and same-moment alcohol craving. All six measures demonstrated limited predictive validity for alcohol craving contexts in daily life as assessed via ecological momentary assessment. Despite these findings, reward and relief drinking measures show good reliability and concurrent validity and previously demonstrated clinical utility for predicting response to alcohol use disorder treatments, including naltrexone. Future research should aim to elucidate the mechanisms underlying the association between responses to reward/relief drinking measures and pharmacotherapy outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychometric Properties of Measuring Antiretroviral Therapy Adherence Among Young Latino Sexual Minority Men With HIV: Ecological Momentary Assessment and Electronic Pill Dispenser Study

Background

Increasing HIV rates among young Latino sexual minority men (YLSMM) warrant innovative and rigorous studies to assess prevention and treatment strategies. Ecological momentary assessments (EMAs) and electronic pill dispensers (EPDs) have been used to measure antiretroviral therapy (ART) adherence repeatedly in real time and in participants' natural environments, but their psychometric properties among YLSMM are unknown.

Objective

The study's objective was to assess the concurrent validity, acceptability, compliance, and behavioral reactivity of EMAs and EPDs among YLSMM with HIV.

Methods

A convenience sample of 56 YLSMM with HIV with suboptimal ART adherence, aged 18-34 years, was recruited into a 28-consecutive-day EMA study. Concurrent validity was analyzed by comparing median ART adherence rates and calculating Spearman correlations between ART adherence measured by EMA, EPD, and baseline retrospective validated 3-item and single-item measures. Acceptability was assessed in exit interviews asking participants to rate EMA and EPD burden. Compliance was assessed by computing the percent lost to follow-up, the percent of EMAs missed, and the percentage of days the EPD was not opened that had corresponding EMA data self-reporting adherence to ARTs. Behavioral reactivity was assessed by computing the median change in ART adherence during the study period, using generalized mixed models to assess whether the cumulative number of EMAs completed and days of EPD use predicted ART adherence over time, and by asking participants to rate perceived reactivity using a Likert scale.

Results

EMA ART adherence was significantly correlated with baseline validated 3-item (r=0.41, P=.003) and single-item (r=0.52, P<.001) measures, but correlations were only significant for participants that reported EMA was not burdensome. Correlations for EPD ART adherence were weaker but significant (r=0.36, P=.009; r=0.34, P=.01, respectively). Acceptability was high for EMAs (48/54, 89%) and EPDs (52/54, 96%) per self-report. Loss to follow-up was 4% (2/56), with the remaining participants completing 88.6% (1339/1512) of study-prompted EMAs. The percentage of missed EMA surveys increased from 5.8% (22/378) in week 1 of the study to 16.7% (63/378) in week 4. Of 260 days when EPDs were not opened, 68.8% (179) had a corresponding EMA survey self-reporting ART adherence. Reactivity inferred from the median change in ART adherence over time was 8.8% for EMAs and -0.8% for EPDs. Each completed EMA was associated with 1.03 odds (95% CI 1-1.07) of EMA ART adherence over time, and each day of EPD use with 0.97 odds (95% CI 0.96-0.99) of EPD ART adherence over time. Self-reported perceived behavioral reactivity was 39% for EMAs and 35% for EPDs.

Conclusions

This study provides evidence of concurrent validity with retrospective validated measures for EMA- and EPD-measured ART adherence among YLSMM, when participant burden is carefully considered, without significant behavioral reactivity. While acceptability and compliance of EMAs and EPDs were high overall, noncompliance increased over time, suggesting respondent fatigue.

A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial

BACKGROUND

Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day.

OBJECTIVE

The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD.

METHODS

This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day.

RESULTS

Approval was granted by the university's institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research.

CONCLUSIONS

Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant's progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults' compliance and engagement in intensive longitudinal studies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/57664.

Differential impact of emotional and social loneliness on daily alcohol consumption in individuals with alcohol use disorder

BACKGROUND

Loneliness is a predisposing and maintaining factor of alcohol use behavior. Several studies have linked loneliness to daily drinking and elevated alcohol use disorder (AUD) risk; however, operationalizations of both loneliness and drinking have varied greatly.

METHODS

The current study adopted a multidimensional framework of loneliness (i.e., emotional and social subtypes) to examine daily prospective relations between loneliness and drinking among non-treatment seeking individuals with AUD. Participants (N= 60) reported on current loneliness and drinking twice daily for 14-days. Scores on emotional and social loneliness were disaggregated into within- and between-person predictors, and a multilevel hurdle model proxy was fitted with drinking likelihood (logistic) and quantity (zero truncated negative binomial) specified as separate outcomes.

RESULTS

Emotional loneliness (within-person) was associated with increased drinking likelihood (OR=1.05, 95 % BCI [1.01, 1.10]) and quantity (IRR=1.05, 95 % BCI [1.02, 1.09]), while social loneliness (within-person) was associated with decreases in both drinking likelihood (OR=.94, 95 % BCI [.89,.99]) and quantity (IRR=.96, 95 % BCI [.93,.99]). Between-person loneliness scores were unrelated to both outcomes.

CONCLUSIONS

These discrepant findings by loneliness subtype may be ascribed to differences in subjective manifestations, in that emotional loneliness is a more severe form of loneliness that overlaps significantly with other negative affective states and promotes a coping response, while social loneliness may be readily alleviated by adaptive behavioral strategies for some, and social withdrawal for others. These findings offer insight into the nuances of loneliness-drinking relations and their clinical implications.

Feasibility of ecological momentary assessment in measuring physical activity and sedentary behaviour in shift and non-shift workers

BACKGROUND

Previous studies assessing shift workers' behaviours have mainly used self-report recall questionnaires, however these measures don't always account for variations in work schedules. Alternative methods that allow for real-time assessments tailored to capture variations in work patterns might provide more accurate measures of physical activity (PA) and sedentary behaviour (SB). Therefore, the aim of this study was to evaluate the feasibility of Ecological Momentary Assessment (EMA), which provides real-time evaluations of PA and SB in shift workers. A secondary aim was to compare shift workers and non-shift worker responses.

METHODS

Participants (n = 120; 58% female, mean Mage=36.0), included 69 shift workers and 51 non-shift workers. After downloading the EMA app, shift workers received either interval-contingent tailored (SW-T) or standardized EMA prompts (SW-S) over 7-10 days, while non-shift workers received standardized prompts (NSW-S) for seven days. Prompts were scheduled five times daily, every three hours. The EMA survey asked participants to report their current activity, including type, duration, and location of physical activity and sitting. Feasibility was assessed by analysing recruitment, retention, and compliance rates (EMA surveys completed) across SW-T, SW-S, and NSW-S groups.

RESULTS

Approximately 78% of invited workers enrolled, and all enrolled workers completed at least one prompt on 4 out 7 days in the NSW-S and 7 out of 10 days in the SW group. Workers who chose not to participate reported unwillingness to travel for meetings (n = 14), while others did not respond (n = 20). Participants completed an average of 24 surveys per day, each one taking less than 30 s to complete. Overall, 64% of EMA surveys were started and completed. SW-S completed the least prompts (57%), while SW-T and NSW-S completed 64% and 68%, respectively (p = 0.90). On average, workers missed 36% EMA surveys which was similar for SW and NSW (p = 0.05).

CONCLUSION

Our study represents one of the few studies that has used EMA in the shift work population with adaptation to shift schedules. The findings showed a modest compliance to EMA. Strategies are needed to enhance compliance rates. However, EMA shows promise for capturing real-time behaviours in shift workers' natural work environments.

Compliance and response consistency in a lengthy intensive longitudinal data protocol

Research on real-world patterns of substance use increasingly involves intensive longitudinal data (ILD) collection, requiring long assessment windows. The present study extends limited prior research examining event- and person-level influences on compliance and response consistency by investigating how these behaviors are sustained over time in an ILD study of alcohol and cannabis co-use in college students. Participants (n = 316) completed two 28-day bursts of ILD comprising five daily surveys, which included a morning survey of prior-day drinking. We used linear mixed effects models in a multilevel interrupted time series framework to evaluate the associations of time and measurement burst with (a) noncompliance (count of missed surveys) and (b) response consistency (difference between same-day report of drinking and morning report of prior-day drinking). We observed that time was positively associated with noncompliance, with no discontinuity associated with measurement burst. The slope of time was more positive in the second burst. Neither time nor measurement burst were significantly associated with consistent reporting. However, survey nonresponse and consistency of responding appeared to be impacted by the same-day use of substances. Overall, compliance decreased while consistency was stable across the duration of a lengthy ILD protocol. Shorter assessment windows or adaptive prompting strategies may improve overall study compliance. Further work examining daily burden and context is needed to inform future ILD design. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A smartphone app-based mindfulness intervention to enhance recovery from substance use disorders: Protocol for a pilot feasibility randomized controlled trial

Background

Poor long-term recovery outcomes after treatment (e.g., readmission to inpatient treatment) are common among individuals with substance use disorders (SUDs). In-person mindfulness-based treatments (MBTs) are efficacious for SUDs and may improve recovery outcomes. However, existing MBTs for SUD have limited public health reach, and thus scalable delivery methods are needed. A digitally-delivered MBT for SUDs may hold promise.

Methods

We recently developed Mindful Journey, a smartphone app-based adjunctive MBT for improving long-term recovery outcomes. In this paper, we present details on the app and describe the protocol for a single-site pilot feasibility randomized controlled trial of Mindful Journey. In this trial, individuals (n = 34) in an early phase of outpatient treatment for SUDs will be randomized to either treatment-as-usual (TAU) plus Mindful Journey, or TAU only. The trial will focus on testing the feasibility (e.g., engagement) and acceptability of the app (e.g., perceived usability and helpfulness for recovery), as well as feasibility of study procedures (e.g., assessment completion). The trial will incorporate ecological momentary assessment before and after treatment to assess mechanisms in real-time, including mindfulness, craving, difficulties with negative emotion regulation, and savoring. To examine the sensitivity to change of outcomes (substance use, substance-related problems, and psychological distress) and mechanism variables (noted above), we will test within-treatment-condition changes over time.

Discussion

The proposed pilot trial will provide important preliminary data on whether Mindful Journey is feasible and acceptable among individuals with SUDs.

Trial registration

ClinicalTrials.gov NCT05109507.

Examining missingness at the momentary level in clinical research using ecological momentary assessment: Implications for suicide research

The use of intensive time sampling methods, such as ecological momentary assessment (EMA), has increased in clinical, and specifically suicide, research during the past decade. While EMA can capture dynamic intraindividual processes, repeated assessments increase participant burden, potentially resulting in low compliance. This study aimed to shed light on study-level and psychological variables, including suicidal ideation (SI), that may predict momentary prompt (i.e., prompt-to-prompt) completion. We combined data from three EMA studies examining mental health difficulties (N = 103; 10,656 prompts; 7144 completed), using multilevel models and machine learning to determine how well we can predict prompt-to-prompt completion and which variables are most important. The two most important variables in prompt-to-prompt completion were hours since the last prompt and time in study. Psychological variables added little predictive validity; similarly, trait-level SI demonstrated a small effect on prompt-to-prompt completion. Our study showed how study-level characteristics can be used to explain prompt-to-prompt compliance rates in EMA research, highlighting the potential for developing adaptive assessment schedules to improve compliance.

Predicting Completion of Ecological Momentary Assessments Among Substance-Using Women Experiencing Intimate Partner Violence

Noncompletion of ecological momentary assessment (EMA) surveys is a common issue and may yield bias in results if not properly handled. Using data observed at scheduled times as well as data retrieved later to fill missing responses, this study aims to investigate predictors of EMA completion, including demographic characteristics, time-related factors, and momentary experiences/behaviors. Data were from a 30-day EMA study including 145 women currently experiencing intimate partner violence (IPV) and using substances. The average rate of EMA completion was initially 51.4% at the scheduled times and increased to 72.6% after incorporating data from later-retrieved surveys. Participants who were younger, had more children, or had lower mean levels of negative affect dysregulation showed lower completion rates. At the momentary survey level, more days into the study and afternoon/evening reports (vs. morning reports) were associated with lower completion; lower levels of negative affect dysregulation, less smoking or alcohol use, and experiencing IPV were linked to lower momentary completion. Implications of the results for handling missing data in EMA are discussed and have important ramifications for future research, practice, and theory.

Momentary Minority Stress, Nicotine Use, and Craving: Moderation by Nicotine-Use Motives Among Sexual Minority Youth

OBJECTIVE

This pre-registered analysis aimed to examine the moderating role of nicotine-use motives on the association between minority stress and nicotine use and craving among sexual minority youth.

METHOD

Data stem from a 30-day ecological momentary assessment study conducted among 83 sexual minority youth ages 15-19 years old (M age = 17.96, SD = 1.10; 56.63% cisgender women; 73.5% non-Hispanic White). Participants were instructed to complete at least four assessments per day on wireless devices. Two types of multilevel models were estimated: models predicting day-level nicotine use and models predicting momentary nicotine use craving.

RESULTS

Experiencing minority stressors was not associated with day-level nicotine use, but it was associated with greater momentary nicotine craving. Nicotine use-motives did not moderate the association between minority stress and nicotine use. In contrast, stress-reduction motives, assessed as a person-level trait, moderated the association between minority stress and nicotine craving, such that nicotine craving after experiencing a minority stressor was consistently higher relative to when minority stress had not been reported. Sensitivity analyses that examined associations between minority stress and nicotine use on a given day, regardless of temporal order, showed that minority stress was associated with higher odds of nicotine use on that day.

CONCLUSIONS

Experiencing minority stressors did not predict day-level nicotine use but does contribute to greater momentary nicotine craving, informing minority stress theory. Consistency of the minority stress and nicotine craving relation, largely regardless of trait-level motives, highlights the potential context dependence of nicotine craving among sexual minority youth.Preregistration: This study was preregistered at osf.io/w5sz9.

Anything that would help is a positive development": feasibility, tolerability, and user experience of smartphone-based digital phenotyping for people with and without type 2 diabetes

Background

Digital phenotyping, the in-situ collection of passive (phone sensor) and active (daily surveys) data using a digital device, may provide new insights into the complex relationship between daily behaviour and mood for people with type 2 diabetes. However, there are critical knowledge gaps regarding its use in people with type 2 diabetes. This study assessed feasibility, tolerability, and user experience of digital phenotyping in people with and without type 2 diabetes after participation in a 2-month digital phenotyping study in Ireland. At study completion, participants rated methodology elements from "not a problem" to a "serious problem" on a 5-point scale and reported their comfort with the potential future use of digital phenotyping in healthcare, with space for qualitative expansion.

Results

Eighty-two participants completed baseline. Attrition was 18.8%. Missing data ranged from 9-44% depending on data stream. Sixty-eight participants (82.9%) completed the user experience questionnaire (51.5% with type 2 diabetes; 61.8% female; median age-group 50-59). Tolerability of digital phenotyping was high, with "not a problem" being selected 76.5%-89.7% of the time across questions. People with type 2 diabetes (93.9%) were significantly more likely to be comfortable with their future healthcare provider having access to their digital phenotyping data than those without (53.1%), χ2 (1) = 14.01, p =  < .001. Free text responses reflected a range of positive and negative experiences with the study methodology.

Conclusions

An uncompensated, 2-month digital phenotyping study was feasible among people with and without diabetes, with low attrition and reasonable missing data rates. Participants found digital phenotyping to be acceptable, and even enjoyable. The potential benefits of digital phenotyping for healthcare may be more apparent to people with type 2 diabetes than the general population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44247-024-00116-6.

Ecological Momentary Assessment of Alcohol Marketing Exposure, Alcohol Use, and Purchases Among University Students: Prospective Cohort Study

BACKGROUND

The relationships between alcohol marketing exposure, alcohol use, and purchase have been widely studied. However, prospective studies examining the causal relationships in real-world settings using mobile health tools are limited.

OBJECTIVE

We used ecological momentary assessment (EMA) to examine both the within-person- and between-person-level effects of alcohol marketing exposure on any alcohol use, amount of alcohol use, any alcohol purchase, and frequency of alcohol purchase among university students.

METHODS

From January to June 2020, we conducted a prospective cohort study via EMA among university students in Hong Kong who reported current drinking. Over 14 consecutive days, each participant completed 5 fixed-interval, signal-contingent EMAs daily via a smartphone app. Each EMA asked about the number and types of alcohol marketing exposures, the amount and types of alcohol used, and whether any alcohol was purchased, all within the past 3 hours. We used 2-part models, including multilevel logistic regressions and multilevel gamma regressions, to examine if the number of alcohol marketing exposure was associated with subsequent alcohol use and alcohol purchase.

RESULTS

A total of 49 students participated, with 33% (16/49) being male. The mean age was 22.6 (SD 2.6) years. They completed 2360 EMAs (completion rate: 2360/3430, 68.8%). Participants reported exposure to alcohol marketing in 5.9% (140/2360), alcohol use in 6.1% (145/2360), and alcohol purchase in 2.4% (56/2360) of all the EMAs. At the between-person level, exposure to more alcohol marketing predicted a higher likelihood of alcohol use (adjusted odd ratio [AOR]=3.51, 95% CI 1.29-9.54) and a higher likelihood of alcohol purchase (AOR=4.59, 95% CI 1.46-14.49) the following day. Exposure to more alcohol marketing did not increase the amount of alcohol use or frequency of alcohol purchases the following day in participants who used or purchased alcohol. At the within-person level, exposure to more alcohol marketing was not associated with a higher likelihood of alcohol use, amount of alcohol use, higher likelihood of alcohol purchase, or frequency of alcohol purchases the following day (all Ps>.05). Each additional exposure to alcohol marketing within 1 week predicted an increase of 0.85 alcoholic drinks consumed in the following week (adjusted B=0.85, 95% CI 0.09-1.61). On days of reporting alcohol use, the 3 measures for alcohol marketing receptivity were not associated with more alcohol use or purchase (all Ps>.05).

CONCLUSIONS

By using EMA, we provided the first evidence for the effect of alcohol marketing exposure on initiating alcohol use and purchase in current-drinking university students. Our findings provide evidence of the regulation of alcohol marketing for the reduction of alcohol use and purchase among young adults.

Using mHealth Technology to Evaluate Daily Symptom Burden among Adult Survivors of Childhood Cancer: A Feasibility Study

BACKGROUND

Cancer therapies predispose survivors to a high symptom burden. This study utilized mobile health (mHealth) technology to assess the feasibility of collecting daily symptoms from adult survivors of childhood cancer to evaluate symptom fluctuation and associations with future health-related quality-of-life (HRQOL).

METHODS

This prospective study used an mHealth platform to distribute a 20-item cancer-related symptom survey (5 consecutive days each month) and an HRQOL survey (the day after the symptom survey) over 3 consecutive months to participants from the Childhood Cancer Survivor Study. These surveys comprised a PROMIS-29 Profile and Neuro-QOL assessed HRQOL. Daily symptom burden was calculated by summing the severity (mild, moderate, or severe) of 20 symptoms. Univariate linear mixed-effects models were used to analyze total, person-to-person, day-to-day, and month-to-month variability for the burden of 20 individual symptoms. Multivariable linear regression was used to analyze the association between daily symptom burden in the first month and HRQOL in the third month, adjusted for covariates.

RESULTS

Out of the 60 survivors invited, 41 participated in this study (68% enrollment rate); 83% reported their symptoms ≥3 times and 95% reported HRQOL in each study week across 3 months. Variability of daily symptom burden differed from person-to-person (74%), day-to-day (18%), and month-to-month (8%). Higher first-month symptom burden was associated with poorer HRQOL related to anxiety (regression coefficient: 6.56; 95% CI: 4.10-9.02), depression (6.32; 95% CI: 3.18-9.47), fatigue (7.93; 95% CI: 5.11-10.80), sleep (6.07; 95% CI: 3.43-8.70), pain (5.16; 95% CI: 2.11-8.22), and cognitive function (-6.89; 95% CI: -10.00 to -3.79) in the third month.

CONCLUSIONS

Daily assessment revealed fluctuations in symptomology, and higher symptom burden was associated with poorer HRQOL in the future. Utilizing mHealth technology for daily symptom assessment improves our understanding of symptom dynamics and sources of variability.

Older adults' compliance with mobile ecological momentary assessments in behavioral nutrition and physical activity research: pooled results of four intensive longitudinal studies and recommendations for future research

BACKGROUND

Mobile Ecological Momentary Assessment (EMA) is increasingly used to gather intensive, longitudinal data on behavioral nutrition, physical activity and sedentary behavior and their underlying determinants. However, a relevant concern is the risk of non-random non-compliance with mobile EMA protocols, especially in older adults. This study aimed to examine older adults' compliance with mobile EMA in health behavior studies according to participant characteristics, and prompt timing, and to provide recommendations for future EMA research.

METHODS

Data of four intensive longitudinal observational studies employing mobile EMA to understand health behavior, involving 271 community-dwelling older adults (M = 71.8 years, SD = 6.8; 52% female) in Flanders, were pooled. EMA questionnaires were prompted by a smartphone application during specific time slots or events. Data on compliance (i.e. information whether a participant answered at least one item following the prompt), time slot (morning, afternoon or evening) and day (week or weekend day) of each prompt were extracted from the EMA applications. Participant characteristics, including demographics, body mass index, and smartphone ownership, were collected via self-report. Descriptive statistics of compliance were computed, and logistic mixed models were run to examine inter- and intrapersonal variability in compliance.

RESULTS

EMA compliance averaged 77.5%, varying from 70.0 to 86.1% across studies. Compliance differed among subgroups and throughout the day. Age was associated with lower compliance (OR = 0.96, 95%CI = 0.93-0.99), while marital/cohabiting status and smartphone ownership were associated with higher compliance (OR = 1.83, 95%CI = 1.21-2.77, and OR = 4.43, 95%CI = 2.22-8.83, respectively). Compliance was lower in the evening than in the morning (OR = 0.82, 95%CI = 0.69-0.97), indicating non-random patterns that could impact study validity.

CONCLUSIONS

The findings of this study shed light on the complexities surrounding compliance with mobile EMA protocols among older adults in health behavior studies. Our analysis revealed that non-compliance within our pooled dataset was not completely random. This non-randomness could introduce bias into study findings, potentially compromising the validity of research findings. To address these challenges, we recommend adopting tailored approaches that take into account individual characteristics and temporal dynamics. Additionally, the utilization of Directed Acyclic Graphs, and advanced statistical techniques can help mitigate the impact of non-compliance on study validity.

Investigating Best Practices for Ecological Momentary Assessment: Nationwide Factorial Experiment

BACKGROUND

Ecological momentary assessment (EMA) is a measurement methodology that involves the repeated collection of real-time data on participants' behavior and experience in their natural environment. While EMA allows researchers to gain valuable insights into dynamic behavioral processes, the need for frequent self-reporting can be burdensome and disruptive. Compliance with EMA protocols is important for accurate, unbiased sampling; yet, there is no "gold standard" for EMA study design to promote compliance.

OBJECTIVE

The purpose of this study was to use a factorial design to identify optimal study design factors, or combinations of factors, for achieving the highest completion rates for smartphone-based EMAs.

METHODS

Participants recruited from across the United States were randomized to 1 of 2 levels on each of 5 design factors in a 2×2×2×2×2 design (32 conditions): factor 1-number of questions per EMA survey (15 vs 25); factor 2-number of EMAs per day (2 vs 4); factor 3-EMA prompting schedule (random vs fixed times); factor 4-payment type (US $1 paid per EMA vs payment based on the percentage of EMAs completed); and factor 5-EMA response scale type (ie, slider-type response scale vs Likert-type response scale; this is the only within-person factor; each participant was randomized to complete slider- or Likert-type questions for the first 14 days or second 14 days of the study period). All participants were asked to complete prompted EMAs for 28 days. The effect of each factor on EMA completion was examined, as well as the effects of factor interactions on EMA completion. Finally, relations between demographic and socioenvironmental factors and EMA completion were examined.

RESULTS

Participants (N=411) were aged 48.4 (SD 12.1) years; 75.7% (311/411) were female, 72.5% (298/411) were White, 18.0% (74/411) were Black or African American, 2.7% (11/411) were Asian, 1.5% (6/411) were American Indian or Alaska Native, 5.4% (22/411) belonged to more than one race, and 9.6% (38/396) were Hispanic/Latino. On average, participants completed 83.8% (28,948/34,552) of scheduled EMAs, and 96.6% (397/411) of participants completed the follow-up survey. Results indicated that there were no significant main effects of the design factors on compliance and no significant interactions. Analyses also indicated that older adults, those without a history of substance use problems, and those without current depression tended to complete more EMAs than their counterparts. No other demographic or socioenvironmental factors were related to EMA completion rates. Finally, the app was well liked (ie, system usability scale score=82.7), and there was a statistically significant positive association between liking the app and EMA compliance.

CONCLUSIONS

Study results have broad implications for developing best practices guidelines for future studies that use EMA methodologies.

TRIAL REGISTRATION

ClinicalTrials.gov number NCT05194228; https://clinicaltrials.gov/study/NCT05194228.

Hair cortisol and substance use among women currently experiencing intimate partner violence: The role of PTSD symptom severity

INTRODUCTION

Substance use is highly prevalent among women experiencing intimate partner violence (IPV) and has been associated with dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis and resulting cortisol response. Posttraumatic stress disorder (PTSD) symptoms may play an important role in exacerbating the association between cortisol levels and substance use behaviors.

PURPOSE

This study examined the role of PTSD symptoms in the relation between cortisol and past month substance use behaviors. The current study used hair cortisol as an index of past 30-day HPA-axis functioning and ecological momentary assessment (EMA) to characterize substance use behaviors more accurately over a 30-day period.

METHOD

Participants were 90 community women who had experienced physical or sexual IPV in the past 30 days by their current male partner and used any amount of alcohol or drugs (M age = 40.71; 54.4 % white). Participants completed (a) a baseline interview, (b) EMA for 30-days, and (c) a follow up interview where they were asked to provide a hair sample for cortisol analyses. Data collection took place from 2018 to 2020.

RESULTS

PTSD severity moderated the relations between cortisol and days of drinking and binge drinking. In the context of high PTSD symptomology, women with high cortisol levels spent, on average, an additional 7.4 days drinking and 8.1 days binge drinking in the past 30 days compared to women with low cortisol levels, in a model adjusted for age.

CONCLUSIONS

Results highlight the prominent role of PTSD symptoms in the association between cortisol and alcohol use among women experiencing IPV.

Examining early adherence measures as predictors of subsequent adherence in an intensive longitudinal study of individuals in mutual help groups: One day at a time

BACKGROUND

Individuals with a substance use disorder complete ecological momentary assessments (EMA) at lower rates than community samples. Previous research in tobacco users indicates that early log-in counts to smoking cessation websites predicted subsequent smoking cessation website usage. We extended this line of research to examine individuals who are seeking to change their drinking behaviors through mutual support groups. We examined whether adherence in the first 7 days (1487 observations) of an intensive longitudinal study design could predict subsequent EMA protocol adherence (50% and 80% adherence separately) at 30 (5700 observations) and 60 days (10,750 observations).

METHODS

Participants (n = 132) attending mutual-help groups for alcohol use completed two assessments per day for 6 months. We trained four classification models (logistic regression, recursive partitioning, support vector machines, and neural networks) using a training dataset (80% of the data) with each of the first 7 days' cumulative EMA assessment completion. We then tested these models to predict the remaining 20% of the data and evaluated model classification accuracy. We also used univariate receiver operating characteristic curves to examine the minimal combination of days and completion percentage to best predict subsequent adherence.

RESULTS

Different modeling techniques can be used with early assessment completion as predictors to accurately classify individuals that will meet minimal and optimal adherence rates later in the study. Models ranged in their performance from poor to outstanding classification, with no single model clearly outperforming other models.

CONCLUSIONS

Traditional and machine learning approaches can be used concurrently to examine several methods of predicting EMA adherence based on early assessment completion. Future studies could investigate the use of several algorithms in real time to help improve participant adherence rates by monitoring early adherence and using early assessment completion as features in predictive modeling.

The integration of geographic methods and ecological momentary assessment in public health research: A systematic review of methods and applications

With the widespread prevalence of mobile devices, ecological momentary assessment (EMA) can be combined with geospatial data acquired through geographic techniques like global positioning system (GPS) and geographic information system. This technique enables the consideration of individuals' health and behavior outcomes of momentary exposures in spatial contexts, mostly referred to as "geographic ecological momentary assessment" or "geographically explicit EMA" (GEMA). However, the definition, scope, methods, and applications of GEMA remain unclear and unconsolidated. To fill this research gap, we conducted a systematic review to synthesize the methodological insights, identify common research interests and applications, and furnish recommendations for future GEMA studies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to systematically search peer-reviewed studies from six electronic databases in 2022. Screening and eligibility were conducted following inclusion criteria. The risk of bias assessment was performed, and narrative synthesis was presented for all studies. From the initial search of 957 publications, we identified 47 articles included in the review. In public health, GEMA was utilized to measure various outcomes, such as psychological health, physical and physiological health, substance use, social behavior, and physical activity. GEMA serves multiple research purposes: 1) enabling location-based EMA sampling, 2) quantifying participants' mobility patterns, 3) deriving exposure variables, 4) describing spatial patterns of outcome variables, and 5) performing data linkage or triangulation. GEMA has advanced traditional EMA sampling strategies and enabled location-based sampling by detecting location changes and specified geofences. Furthermore, advances in mobile technology have prompted considerations of additional sensor-based data in GEMA. Our results highlight the efficacy and feasibility of GEMA in public health research. Finally, we discuss sampling strategy, data privacy and confidentiality, measurement validity, mobile applications and technologies, and GPS accuracy and missing data in the context of current and future public health research that uses GEMA.

Exploration of weekly variation in naloxone possession and carriage among people who use opioids in New York City before, during, and after the COVID-19 pandemic

BACKGROUND

Naloxone is critical for reversing opioid-related overdoses. However, there is a dearth of research examining how naloxone possession and carriage are impacted by time-varying individual and social determinants, and if this differed during the height of the COVID-related mitigation measures (e.g., shutdowns).

METHODS

We utilized weekly ecological momentary assessments (EMA) to measure factors associated with naloxone possession and carriage among 40 people who use illicit opioids in New York City, for 24 months. Descriptive statistics were used to explore the frequency of weeks with consistent naloxone possession and carriage. Mixed effects binary and multivariable logistic regression was used to test for the impact of time-varying EMA- and baseline-level factors on each outcome.

RESULTS

Approximately 70% of weekly EMAs were associated with consistent naloxone possession or carriage. In multivariable models, compared to during the height of the COVID-related shutdowns (March 12, 2020-May 19, 2021), the time before was associated with lower odds of consistent possession (Odds Ratio (OR) = 0.05, 95% Confidence Interval (CI) = 0.01-0.15) and consistent carriage (OR = 0.06, CI = 0.01-0.25). Additionally, being female (OR = 11.15, CI = 2.85-43.42), being White versus being Black or Hispanic/Latinx (OR = 8.05, CI = 1.96-33.06), and lifetime overdose (OR = 1.96, CI = 1.16-19.80) were associated with higher odds of consistent possession. Recent opioid injection (OR = 3.66, CI = 1.34-9.94), being female (OR = 7.91, CI = 3.91-8.23), and being White (OR = 5.77, CI = 1.35-24.55) were associated with higher odds of consistent carriage. Not wanting to be perceived as a drug user was reported in nearly one third (29.0%; 190/656) of EMAs where inconsistent possession was reported.

CONCLUSIONS

Our findings paint a relatively positive picture of possession and carriage during COVID-related shutdowns, particularly among white and female participants, and highlight the importance of capturing time-varying factors to understand naloxone-related behavior. To curb growing disparities, outreach to equip Black and Hispanic/Latinx people with naloxone is needed as well as interventions to reduce stigma as a barrier to naloxone engagement.

Person-specific and pooled prediction models for binge eating, alcohol use and binge drinking in bulimia nervosa and alcohol use disorder

BACKGROUND

Machine learning could predict binge behavior and help develop treatments for bulimia nervosa (BN) and alcohol use disorder (AUD). Therefore, this study evaluates person-specific and pooled prediction models for binge eating (BE), alcohol use, and binge drinking (BD) in daily life, and identifies the most important predictors.

METHODS

A total of 120 patients (BN: 50; AUD: 51; BN/AUD: 19) participated in an experience sampling study, where over a period of 12 months they reported on their eating and drinking behaviors as well as on several other emotional, behavioral, and contextual factors in daily life. The study had a burst-measurement design, where assessments occurred eight times a day on Thursdays, Fridays, and Saturdays in seven bursts of three weeks. Afterwards, person-specific and pooled models were fit with elastic net regularized regression and evaluated with cross-validation. From these models, the variables with the 10% highest estimates were identified.

RESULTS

The person-specific models had a median AUC of 0.61, 0.80, and 0.85 for BE, alcohol use, and BD respectively, while the pooled models had a median AUC of 0.70, 0.90, and 0.93. The most important predictors across the behaviors were craving and time of day. However, predictors concerning social context and affect differed among BE, alcohol use, and BD.

CONCLUSIONS

Pooled models outperformed person-specific models and the models for alcohol use and BD outperformed those for BE. Future studies should explore how the performance of these models can be improved and how they can be used to deliver interventions in daily life.

Mobile Health Interventions for Substance Use Disorders

Substance use disorders (SUDs) have an enormous negative impact on individuals, families, and society as a whole. Most individuals with SUDs do not receive treatment because of the limited availability of treatment providers, costs, inflexible work schedules, required treatment-related time commitments, and other hurdles. A paradigm shift in the provision of SUD treatments is currently underway. Indeed, with rapid technological advances, novel mobile health (mHealth) interventions can now be downloaded and accessed by those that need them anytime and anywhere. Nevertheless, the development and evaluation process for mHealth interventions for SUDs is still in its infancy. This review provides a critical appraisal of the significant literature in the field of mHealth interventions for SUDs with a particular emphasis on interventions for understudied and underserved populations. We also discuss the mHealth intervention development process, intervention optimization, and important remaining questions.

Feasibility of and reactivity to ecological momentary assessment (EMA) during electronic cigarette use initiation in adults who smoke daily

Background and objectives

This pilot study tested the feasibility of tracking e-cigarette initiation over three months using a burst-of-measurement approach and examined reactivity to the ecological momentary assessment (EMA) data capture technique in this context.

Methods

Adults who smoked daily and were interested in trying e-cigarette use received an e-cigarette starter kit and were randomized to complete EMA reports (n=30) vs. not (n=29). Participants (M age =44.1 years [SD=12.6], 61.0% male, 54.3% White, 38.9% Black/African American) smoked 13.0 cigarettes per day on average (SD=8.4) and reported mild-tomoderate nicotine dependence (M FTND =4.0 [SD=2.3]). Biochemical assessment and surveys were conducted at enrollment, e-cigarette initiation (1 week later), and 1-week, 1-month, and 3-month post e-cigarette initiation.

Results

A subset (17%) of participants did not achieve the minimum 75% EMA adherence at Week 1. The remaining participants showed excellent adherence with the EMA protocol, with a consistently high response rate to audibly prompted mini-surveys during screening (93%) and follow-up weeks (93%, 93%, and 92%, respectively). No consistent trend emerged in comparing the two randomized groups, either on variables relevant to the public health impact of e-cigarette initiation (i.e., cigarettes/day, exposure to smoke, exposure to nicotine, motivation to quit smoking), or in e-cigarette use (i.e., bouts/day, puffs/bout), with average Cohen's d values across timepoints ranging from d=0.02 for exposure to smoke to d=0.06 for cigarettes per day.

Conclusions

Conducting EMA with adults who smoke daily and are initiating e-cigarette use appears feasible, with some caveats. Reactivity to EMA during e-cigarette initiation appears to be small or non-significant.

Using a Smartwatch App to Understand Young Adult Substance Use: Mixed Methods Feasibility Study

BACKGROUND

Young adults in the United States exhibit some of the highest rates of substance use compared to other age groups. Heavy and frequent substance use can be associated with a host of acute and chronic health and mental health concerns. Recent advances in ubiquitous technologies have prompted interest and innovation in using technology-based data collection instruments to understand substance use and associated harms. Existing methods for collecting granular, real-world data primarily rely on the use of smartphones to study and understand substance use in young adults. Wearable devices, such as smartwatches, show significant potential as platforms for data collection in this domain but remain underused.

OBJECTIVE

This study aims to describe the design and user evaluation of a smartwatch-based data collection app, which uses ecological momentary assessments to examine young adult substance use in daily life.

METHODS

This study used a 2-phase iterative design and acceptability evaluation process with young adults (aged 18-25 y) reporting recent alcohol or cannabis use. In phase 1, participants (8/15, 53%) used the data collection app for 14 days on their Apple Watches to report their substance use patterns, social contexts of substance use, and psychosocial risk factors (eg, affect). After this 14-day deployment, the participants completed a user experience survey and a semistructured interview to record their perspectives and experiences of using the app. Formative feedback from this phase informed feature modification and refinement of the app. In phase 2, an additional cohort (7/15, 47%) used the modified app for 14 days and provided feedback through surveys and interviews conducted after the app use period.

RESULTS

Analyses of overall app use patterns indicated high, consistent use of the app, with participants using the app for an average of 11.73 (SD 2.60) days out of 14 days of data collection. Participants reported 67 instances of substance use throughout the study, and our analysis indicates that participants were able to respond to ecological momentary assessment prompts in diverse temporal and situational contexts. Our findings from the user experience survey indicate that participants found the app usable and functional. Comparisons of app use metrics and user evaluation scores indicate that the iterative app design had a measurable and positive impact on users' experience. Qualitative data from the participant interviews highlighted the value of recording substance use patterns, low disruption to daily life, minimal overall burden, preference of platforms (smartphones vs smartwatches), and perspectives relating to privacy and app use in social contexts.

CONCLUSIONS

This study demonstrated the acceptability of using a smartwatch-based app to collect intensive, longitudinal substance use data among young adults. The findings document the utility of smartwatches as a novel platform to understand sensitive and often-stigmatized behaviors such as substance use with minimal burden.

Smartphone-Based Survey and Message Compliance in Adults Initially Unready to Quit Smoking: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Efficacy of smartphone-based interventions depends on intervention content quality and level of exposure to that content. Smartphone-based survey completion rates tend to decline over time; however, few studies have identified variables that predict this decline over longer-term interventions (eg, 26 weeks).

OBJECTIVE

This study aims to identify predictors of survey completion and message viewing over time within a 26-week smoking cessation trial.

METHODS

This study examined data from a 3-group pilot randomized controlled trial of adults who smoke (N=152) and were not ready to quit smoking within the next 30 days. For 182 days, two intervention groups received smartphone-based morning and evening messages based on current readiness to quit smoking. The control group received 2 daily messages unrelated to smoking. All participants were prompted to complete 26 weekly smartphone-based surveys that assessed smoking behavior, quit attempts, and readiness to quit. Compliance was operationalized as percentages of weekly surveys completed and daily messages viewed. Linear regression and mixed-effects models were used to identify predictors (eg, intervention group, age, and sex) of weekly survey completion and daily message viewing and decline in compliance over time.

RESULTS

The sample (mean age 50, SD 12.5, range 19-75 years; mean years of education 13.3, SD 1.6, range 10-20 years) was 67.8% (n=103) female, 74.3% (n=113) White, 77% (n=117) urban, and 52.6% (n=80) unemployed, and 61.2% (n=93) had mental health diagnoses. On average, participants completed 18.3 (71.8%) out of 25.5 prompted weekly surveys and viewed 207.3 (60.6%) out of 345.1 presented messages (31,503/52,460 total). Age was positively associated with overall weekly survey completion (P=.003) and daily message viewing (P=.02). Mixed-effects models indicated a decline in survey completion from 77% (114/148) in the first week of the intervention to 56% (84/150) in the last week of the intervention (P<.001), which was significantly moderated by age, sex, ethnicity, municipality (ie, rural/urban), and employment status. Similarly, message viewing declined from 72.3% (1533/2120) in the first week of the intervention to 44.6% (868/1946) in the last week of the intervention (P<.001). This decline in message viewing was significantly moderated by age, sex, municipality, employment status, and education.

CONCLUSIONS

This study demonstrated the feasibility of a 26-week smartphone-based smoking cessation intervention. Study results identified subgroups that displayed accelerated rates in the decline of survey completion and message viewing. Future research should identify ways to maintain high levels of interaction with mobile health interventions that span long intervention periods, especially among subgroups that have demonstrated declining rates of intervention engagement over time.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03405129; https://clinicaltrials.gov/ct2/show/NCT03405129.

Detecting and Understanding Social Influence During Drinking Situations: Protocol for a Bluetooth-Based Sensor Feasibility and Acceptability Study

BACKGROUND

High-risk alcohol consumption among young adults frequently occurs in the presence of peers who are also drinking. A high-risk drinking situation may consist of particular social network members who have a primary association with drinking. Fine-grained approaches such as ecological momentary assessment (EMA) are growing in popularity for studying real-time social influence, but studies using these approaches exclusively rely on participant self-report. Passive indicators of peer presence using Bluetooth-based technology to detect real-time interactions have the potential to assist in the development of just-in-time interventions.

OBJECTIVE

This study seeks to examine the feasibility and acceptability of using a Bluetooth-based sensor and smartphone app to measure social contact in real-world drinking situations.

METHODS

Young adults (N=20) who drink heavily and report social drinking will be recruited from the community to participate in a 3-week EMA study. Using a social network interview, index participants will identify and recruit 3 of their friends to carry a Bluetooth beacon. Participants will complete a series of EMA reports on their own personal Android devices including random reports; morning reports; first-drink reports; and signal-contingent reports, which are triggered following the detection of a beacon carried by a peer participant. EMA will assess alcohol use and characteristics of the social environment, including who is nearby and who is drinking. For items about peer proximity and peer drinking, a customized peer list will be presented to participants. Feedback about the study protocol will be ascertained through weekly contact with both index and peer participants, followed by a qualitative interview at the end of the study. We will examine the feasibility and acceptability of recruitment, enrollment of participants and peers, and retention. Feasibility will be determined using indexes of eligibility, enrollment, and recruitment. Acceptability will be determined through participant enrollment and retention, protocol compliance, and participant-reported measures of acceptability. Feasibility and acceptability for peer participants will be informed by enrollment rates, latency to enrollment, compliance with carrying the beacon, and self-reported reasons for compliance or noncompliance with beacon procedures. Finally, EMA data about peer proximity and peer drinking will support the validity of the peer selection process.

RESULTS

Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025.

CONCLUSIONS

The protocol allows us to examine the feasibility and acceptability of a Bluetooth-based sensor for the detection of social contact between index participants and their friends, including social interactions during real-world drinking situations. Data from this study will inform just-in-time adaptive interventions seeking to address drinking in the natural environment by providing personalized feedback about a high-risk social context and alerting an individual that they are in a potentially unsafe situation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50650.

Recruitment and retention of adolescents for an ecological momentary assessment measurement burst mental health study: The MHIM engagement strategy

INTRODUCTION

Recruitment and long-term retention of adolescent participants in longitudinal research are challenging and may be especially so in studies involving remote measurement and biosampling components. The ability to effectively recruit and retain participants can be supported by the use of specific evidence-based engagement strategies that are built in from the earliest stages.

METHODS

Informed by a review of the evidence on effective engagement strategies and consultations with adolescents (via two Young Person Advisory Groups [YPAGs]; ages 11-13 and 14-17), the current protocol describes the planned participant engagement strategy for the Mental Health in the Moment Study: a multimodal measurement burst study of adolescent mental health across ages 11-19.

RESULTS

The protocol incorporates engagement strategies in four key domains: consultations/co-design with the target population, incentives, relationship-building and burden/barrier reduction. In addition to describing general engagement strategies in longitudinal studies, we also discuss specific concerns regarding engagement in data collection methods such as biosampling and ecological momentary assessment where a paucity of evidence exists.

CONCLUSION

Engagement strategies for adolescent mental health studies should be based on existing evidence and consultations with adolescents. We present our approach in developing the planned engagement strategies and also discuss limitations and future directions in engaging adolescents in longitudinal research.

PATIENT OR PUBLIC CONTRIBUTION

The study design for this project places a strong emphasis on the active engagement of adolescents throughout its development. Specifically, the feedback and suggestions provided by the YPAGs have been instrumental in refining our strategies for maximising the recruitment and retention of participants.

How is alcohol consumption and heavy episodic drinking spread across different types of drinking occasion in Great Britain: An event-level latent class analysis

BACKGROUND

This paper aimed to (i) update a previous typology of British alcohol drinking occasions using a more recent and expanded dataset and revised modelling procedure, and (ii) estimate the average consumption level, prevalence of heavy drinking, and distribution of all alcohol consumption and heavy drinking within and across occasion types.

METHODS

The paper uses a cross-sectional latent class analysis of event-level diary data that includes characteristics of 43,089 drinking occasions in 2019 reported by 17,821 adult drinkers in Great Britain. The latent class indicators are characteristics of off-trade only (e.g. home), on-trade only (e.g. bar) and mixed trade (e.g. home and bar) drinking occasions. These describe companions, locations, purpose, motivation, accompanying activities, timings, consumption volume in units (1 UK unit = 8g ethanol) and beverages consumed.

RESULTS

The analysis identified four off-trade only, eight on-trade only and three mixed-trade occasion types (i.e. latent classes). Mean consumption per occasion varied between 4.4 units in Family meals to 17.7 units in Big nights out with pre-loading. It exceeded ten units in all mixed-trade occasion types and in Off-trade get togethers, Big nights out and Male friends at the pub. Three off-trade types accounted for 50.8% of all alcohol consumed and 51.8% of heavy drinking occasions: Quiet drink at home alone, Evening at home with partner and Off-trade get togethers. For thirteen out of fifteen occasion types, more than 25% of occasions involved heavy drinking. Conversely, 41.7% of Big nights out and 16.4% of Big nights out with preloading were not heavy drinking occasions.

CONCLUSIONS

Alcohol consumption varies substantially across and within fifteen types of drinking occasion in Great Britain. Heavy drinking is common in most occasion types. However, moderate drinking is also common in occasion types often characterised as heavy drinking practices. Mixed-trade drinking occasions are particularly likely to involve heavy drinking.