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Brobbin E, Deluca P, Coulton S, Parkin S, Drummond C. Comparison of transdermal alcohol concentration and self-reported alcohol consumption in people with alcohol dependence attending community alcohol treatment services. Drug Alcohol Depend 2024; 256:111122. [PMID: 38367536 DOI: 10.1016/j.drugalcdep.2024.111122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
AIM We aimed to assess the accuracy and wearability of a transdermal alcohol sensor (TAS) (BACtrack Skyn) with people currently receiving treatment at alcohol services. METHOD A mixed methods observational study involving three NHS alcohol services in south London was conducted. All participants (7=male, 9=female) wore a TAS for 1 week and met with the researcher every other weekday to complete the TAS data download and a TimeLine Follow Back (TLFB). At the end of the week, a post-wear survey was completed. Transdermal Alcohol Concentration (TAC) from the TAS was compared to the TLFB. Post-wear survey responses, attendance voucher incentives and descriptive TAS data (removals, missing and skin temperature data) were analysed. We investigated different drinking event thresholds changing the criteria of TAC level and length of time TAC was increased and analysed each drinking threshold sensitivity, specificity, positive and negative predicative values, and percentage accuracy classification. RESULTS The TAS recorded the number of alcohol-drinking days with a high degree of accuracy compared to the TLFB as gold-standard. However, of the participation time of the 16 participants, 14.5% of the TAS data was missing in output and 16.4% of the recorded data suggests the TAS was not currently being worn. Of the data recorded, in line with the drinking event threshold of >15 ug/l TAC, >15minutes, we found that sensitivity = 93%, specificity = 84% and a Pearson correlation of r(16) =.926, p = <.001, BCa 95% CI [.855 -.981]. The threshold with the highest accuracy was TAC>15 ug/l, >60minutes which classified alcohol events with 90% accuracy, AUC =.910, sensitivity = 90%, specificity = 96%. The post-wear survey reported that most participants found it comfortable and that wearing it did not interfere with daily activities. Six participants reported side effects, including itching and a rash, but these would not deter them from wearing it again with all six reporting they would wear the TAS again and for longer than one week. CONCLUSIONS The TAS did not capture every drinking event that was self-reported but maintained a high correlation. There were instances of missing TAS data and TAS removals. Overall, our findings would support the acceptability and feasibility of TAS as a tool that could be used in clinical settings for objective alcohol monitoring with patients being responsible for the TAS.
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Affiliation(s)
- Eileen Brobbin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Brobbin E, Deluca P, Coulton S, Drummond C. Accuracy of transdermal alcohol monitoring devices in a laboratory setting. Alcohol Alcohol 2024; 59:agad068. [PMID: 37873967 DOI: 10.1093/alcalc/agad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
The development of transdermal alcohol sensors (TASs) presents a new method to monitor alcohol consumption with the ability to objectively measure data 24/7. We aimed to evaluate the accuracy of two TASs (BACtrack Skyn and Smart Start BARE) in a laboratory setting. Thirty-two adults received a dose of ethanol 0.56 g/kg body weight as a 20% solution while wearing the two TASs and provided Breath Alcohol Concentration (BrAC) measurements for 3.5 h postalcohol consumption. Pearson's correlations and repeated measures analysis of variance tests were conducted on the peak, time-to-peak, and area under the curve data. Bland-Altman plots were derived. A time series analysis and cross-correlations were conducted to adjust for time lag. Both TASs were able to detect alcohol and increase within 20 min. BrAC peaked significantly quicker than Skyn and BARE. BrAC and Skyn peaks were negatively significantly correlated (r = -0.381, P = .035, n = 31), while Skyn and BARE peaks were positively significantly correlated (r = 0.380, P = .038, n = 30). Repeated measures analysis of variance found a significant difference between BrAC, Skyn, and BARE (F(1.946, 852.301) = 459.873, P < .001)). A time series analysis found when BrAC-Skyn and BrAC-BARE were adjusted for the delay to peak, and there was still a significant difference. Failure rates: 1.7% (Skyn) and 4.8% (BARE). Some evidence was obtained for TAS validity as both consistently detected alcohol. Failure rates and time lag show improvements in older device generations. However, neither TAS presented strong equivalence to the breathalyser even when the lag time was adjusted. With further testing and technology advancements, TAS could be a potential alcohol monitoring tool. Two of the newest TAS devices were worn in laboratory conditions for one afternoon to compare their accuracy of alcohol monitoring to a breathalyser. Findings suggest that the two TASs (BACtrack Skyn and SmartStart BARE) recorded significantly similar data postalcohol consumption, but not with the breathalyser.
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Affiliation(s)
- Eileen Brobbin
- Addiction Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, United Kingdom
| | - Paolo Deluca
- Addiction Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, United Kingdom
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury CT2 7NF, United Kingdom
| | - Colin Drummond
- Addiction Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, United Kingdom
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Rosenberg M, Kianersi S, Luetke M, Jozkowski K, Guerra-Reyes L, Shih PC, Finn P, Ludema C. Wearable alcohol monitors for alcohol use data collection among college students: Feasibility and acceptability. Alcohol 2023; 111:75-83. [PMID: 37295566 PMCID: PMC10527594 DOI: 10.1016/j.alcohol.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We assessed the feasibility and acceptability of using BACtrack Skyn wearable alcohol monitors for alcohol research in a college student population. METHODS We enrolled n = 5 (Sample 1) and n = 84 (Sample 2) Indiana University undergraduate students to wear BACtrack Skyn devices continuously over a 5-day to 7-day study period. We assessed feasibility in both samples by calculating compliance with study procedures, and by analyzing amount and distributions of device output [e.g., transdermal alcohol content (TAC), temperature, motion]. In Sample 1, we assessed feasibility and acceptability with the Feasibility of Intervention Measure (FIM) scale and the Acceptability of Intervention Measure (AIM) scale. RESULTS All participants were able to successfully use the alcohol monitors, producing a total of 11,504 h of TAC data. TAC data were produced on 567 days of the 602 total possible days of data collection. The distribution of the TAC data showed between-person variation, as would be expected with between-person differences in drinking patterns. Temperature and motion data were also produced as expected. Sample 1 participants (n = 5) reported high feasibility and acceptability of the wearable alcohol monitors in survey responses with a mean FIM score of 4.3 (of 5.0 possible score) and mean AIM score of 4.3 (of 5.0 possible score). CONCLUSIONS The high feasibility and acceptability we observed underscore the promise of using BACtrack Skyn wearable alcohol monitors to improve our understanding of alcohol consumption among college students, a population at particularly high risk for alcohol-related harms.
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Affiliation(s)
- Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States.
| | - Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Maya Luetke
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States; University of Minnesota Institute for Social Research and Data Innovation, Minneapolis, MN, United States
| | - Kristen Jozkowski
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Patrick C Shih
- Department of Informatics, Luddy School of Informatics, Computing, and Engineering, Indiana University-Bloomington, Bloomington, IN, United States
| | - Peter Finn
- Department of Psychological and Brain Sciences, Indiana University-Bloomington, Bloomington, IN, United States
| | - Christina Ludema
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
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Kushniruk A, Deluca P, Hemrage S, Drummond C. Acceptability and Feasibility of Wearable Transdermal Alcohol Sensors: Systematic Review. JMIR Hum Factors 2022; 9:e40210. [PMID: 36563030 PMCID: PMC9823584 DOI: 10.2196/40210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Transdermal alcohol sensors (TASs) have the potential to be used to monitor alcohol consumption objectively and continuously. These devices can provide real-time feedback to the user, researcher, or health professional and measure alcohol consumption and peaks of use, thereby addressing some of the limitations of the current methods, including breathalyzers and self-reports. OBJECTIVE This systematic review aims to evaluate the acceptability and feasibility of the currently available TAS devices. METHODS A systematic search was conducted in CINAHL, EMBASE, Google Scholar, MEDLINE, PsycINFO, PubMed, and Scopus bibliographic databases in February 2021. Two members of our study team independently screened studies for inclusion, extracted data, and assessed the risk of bias. The study's methodological quality was appraised using the Mixed Methods Appraisal Tool. The primary outcome was TAS acceptability. The secondary outcome was feasibility. The data are presented as a narrative synthesis. RESULTS We identified and analyzed 22 studies. Study designs included laboratory- and ambulatory-based studies, mixed designs, randomized controlled trials, and focus groups, and the length the device was worn ranged from days to weeks. Although views on TASs were generally positive with high compliance, some factors were indicated as potential barriers and there are suggestions to overcome these. CONCLUSIONS There is a lack of research investigating the acceptability and feasibility of TAS devices as a tool to monitor alcohol consumption in clinical and nonclinical populations. Although preliminary evidence suggests their potential in short-term laboratory-based studies with volunteers, more research is needed to establish long-term daily use with other populations, specifically, in the clinical and the criminal justice system. TRIAL REGISTRATION PROSPERO CRD42021231027; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231027.
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Affiliation(s)
- Andre Kushniruk
- Department of AddictionsInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUnited Kingdom
| | - Paolo Deluca
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sofia Hemrage
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Colin Drummond
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Yu J, Fairbairn CE, Gurrieri L, Caumiant EP. Validating transdermal alcohol biosensors: a meta-analysis of associations between blood/breath-based measures and transdermal alcohol sensor output. Addiction 2022; 117:2805-2815. [PMID: 35603913 PMCID: PMC9529851 DOI: 10.1111/add.15953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/22/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Transdermal alcohol sensors carry immense promise for the continuous assessment of drinking but are inconsistent in detecting more fine-grained indicators of alcohol consumption. Prior studies examining associations between transdermal alcohol concentration (TAC) and blood/breath alcohol concentration (BAC) have yielded highly variable correlations and lag times. The current review aimed to synthesize transdermal validation studies, aggregating results from more than three decades of research to characterize the validity of transdermal sensors for assessing alcohol consumption. METHODS Databases were searched for studies listed prior to 1 March 2022 that examined associations between transdermal alcohol sensor output and blood and breath-based alcohol measures, resulting in 31 primarily laboratory-derived participant samples (27 precise effect sizes) including both healthy and clinical populations. Correlation coefficients and lag times were pooled using three-level random-effects meta-regression. Independent raters coded study characteristics, including the body position of transdermal sensors (ankle- versus arm/hand/wrist-worn device) and methodological bias (e.g. missing data). RESULTS Analyses revealed that, in this primarily laboratory-derived sample of studies, the average correlation between TAC and BAC was large in magnitude [r = 0.87, 95% confidence interval (CI) = 0.80, 0.93], and TAC lagged behind BAC by an average of 95.90 minutes (95% CI = 55.50, 136.29). Device body position significantly moderated both TAC-BAC correlation (b = 0.11, P = 0.009) and lag time (b = -69.41, P < 0.001). Lag times for ankle-worn devices were approximately double those for arm/hand/wrist-worn devices, and TAC-BAC correlations also tended to be stronger for arm/hand/wrist-worn sensors. CONCLUSIONS This meta-analysis indicates that transdermal alcohol sensors perform strongly in assessing blood/breath alcohol concentration under controlled conditions, with particular promise for the newer generation of wrist-worn devices.
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Affiliation(s)
- Jiachen Yu
- University of Illinois, Urbana‐ChampaignILUSA,Division of the Social SciencesUniversity of ChicagoChicagoILUSA
| | | | - Laura Gurrieri
- University of Illinois, Urbana‐ChampaignILUSA,Department of PsychologyGeorgia State UniversityAtlantaGAUSA
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Hollenberg E, Bani-Fatemi A, Durbin A, Castle D, Kozloff N, Ziegler C, Stergiopoulos V. Using financial incentives to improve health service engagement and outcomes of adults experiencing homelessness: A scoping review of the literature. Health Soc Care Community 2022; 30:e3406-e3434. [PMID: 35912903 DOI: 10.1111/hsc.13944] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/26/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
People experiencing homelessness (PEH) have high rates of acute and chronic health conditions, complex support needs and often face multiple barriers to accessing health services. Financial incentive (FI) interventions have been found effective in improving service engagement and health outcomes for a range of health conditions, populations and settings, but little is known about their impact on PEH. We conducted a scoping review to explore the impact of FI interventions on treatment retention, adherence and other health outcomes of PEH. We searched seven electronic databases from inception to September 2021 to identify peer-reviewed published English language studies that used FI interventions with adult PEH. A scoping review methodology was used to chart relevant data uniformly. Descriptive statistics and narrative syntheses were used to describe outcomes. Thirty-three quantitative articles related to 29 primary studies were published between 1990 and 2021 and met inclusion criteria. Studies targeted three areas of health behaviour change: decreasing substance use or increasing abstinence rates, preventing or treating infectious diseases or promoting lifestyle/general health goal attainment. A variety of FIs were used (cash/non-cash, escalating/fixed schedule, larger/smaller amounts, some/all behaviours rewarded, certain/uncertain reward) across studies. Twenty-six of the primary studies reported significantly better outcomes for the participants receiving FI compared to controls. There were mixed findings about the efficacy of cash versus non-cash FIs, non-cash FIs versus other interventions and higher versus lower value of incentives. Furthermore, there was limited research about long-term outcomes and impacts. FIs have promise in increasing abstinence from substances, engagement in infectious disease treatment, retention in health services and general lifestyle modifications for PEH. Future research should examine long-term impacts and the contribution of co-interventions and intermediary lifestyle behaviour changes.
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Affiliation(s)
- Elisa Hollenberg
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Ali Bani-Fatemi
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Anna Durbin
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - David Castle
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Brobbin E, Deluca P, Hemrage S, Drummond C. Accuracy of Wearable Transdermal Alcohol Sensors: Systematic Review. J Med Internet Res 2022; 24:e35178. [PMID: 35436239 PMCID: PMC9052024 DOI: 10.2196/35178] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There are a range of wearable transdermal alcohol sensors that are available and are being developed. These devices have the potential to monitor alcohol consumption continuously over extended periods in an objective manner, overcoming some of the limitations of other alcohol measurement methods (blood, breath, and urine). OBJECTIVE The objective of our systematic review was to assess wearable transdermal alcohol sensor accuracy. METHODS A systematic search of the CINAHL, Embase, Google Scholar, MEDLINE, PsycINFO, PubMed, and Scopus bibliographic databases was conducted in February 2021. In total, 2 team members (EB and SH) independently screened studies for inclusion, extracted data, and assessed the risk of bias. The methodological quality of each study was appraised using the Mixed Methods Appraisal Tool. The primary outcome was transdermal alcohol sensor accuracy. The data were presented as a narrative synthesis. RESULTS We identified and analyzed 32 studies. Study designs included laboratory, ambulatory, and mixed designs, as well as randomized controlled trials; the length of time for which the device was worn ranged from days to weeks; and the analyzed sample sizes ranged from 1 to 250. The results for transdermal alcohol concentration data from various transdermal alcohol sensors were generally found to positively correlate with breath alcohol concentration, blood alcohol concentration, and self-report (moderate to large correlations). However, there were some discrepancies between study reports; for example, WrisTAS sensitivity ranged from 24% to 85.6%, and specificity ranged from 67.5% to 92.94%. Higher malfunctions were reported with the BACtrack prototype (16%-38%) and WrisTAS (8%) than with SCRAM (2%); however, the former devices also reported a reduced time lag for peak transdermal alcohol concentration values when compared with SCRAM. It was also found that many companies were developing new models of wearable transdermal alcohol sensors. CONCLUSIONS As shown, there is a lack of consistency in the studies on wearable transdermal alcohol sensor accuracy regarding study procedures and analyses of findings, thus making it difficult to draw direct comparisons between them. This needs to be considered in future research, and there needs to be an increase in studies directly comparing different transdermal alcohol sensors. There is also a lack of research investigating the accuracy of transdermal alcohol sensors as a tool for monitoring alcohol consumption in clinical populations and use over extended periods. Although there is some preliminary evidence suggesting the accuracy of these devices, this needs to be further investigated in clinical populations. TRIAL REGISTRATION PROSPERO CRD42021231027; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231027.
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Affiliation(s)
- Eileen Brobbin
- Department of Addictions, King's College London, London, United Kingdom
| | - Paolo Deluca
- Department of Addictions, King's College London, London, United Kingdom
| | - Sofia Hemrage
- Department of Addictions, King's College London, London, United Kingdom
| | - Colin Drummond
- Department of Addictions, King's College London, London, United Kingdom
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van Egmond K, Wright CJC, Livingston M, Kuntsche E. A parallel test of the SCRAM-CAM transdermal monitors ensuring reliability. Drug Alcohol Rev 2021; 40:1122-1130. [PMID: 34235793 DOI: 10.1111/dar.13353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/06/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Previous studies validating the transdermal alcohol concentration (TAC) as measured by the Secure Continuous Remote Alcohol Monitors Continuous Alcohol Monitoring (SCRAM-CAM) have tested the monitor against self-reports or breath alcohol concentration (BrAC). This study aims to provide further evidence of the reliability of the SCRAM-CAM testing two monitors in parallel. METHODS Participants (N = 21) received four standard drinks in a laboratory session while wearing SCRAM-CAMs simultaneously on their left and right ankles. The SCRAM-CAMs sampled TAC every 30 min and participants were monitored for at least 2-3 h after their BrAC levels reached zero. Weight and height measures were taken to calculate body mass index (BMI). RESULTS There was a positive correlation between the TAC measurements from the left and right SCRAM-CAM (r = 0.718), a cross-correlation model revealed that this correlation was not significantly different for sex or BMI. Area under the TAC curve (AUC) and peak TAC values as measured by the left and right SCRAM-CAM also show positive correlations (r = 0.554 and r = 0.579, respectively). Cross-correlation models show a significant effect of BMI on the relationship between left and right peak TAC values, which may be due to outlier effects. No further effects were significant for on both peak and AUC values. DISCUSSION AND CONCLUSIONS Results show that TAC measured by SCRAM-CAMs worn on the left and right showed a good correlation, with correlations between AUC and peak TAC values considered to be fair. TAC monitors show promise for use in research settings; however, work is needed testing the reliability of TAC as measured by two TAC monitors.
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Affiliation(s)
- Kelly van Egmond
- Centre for Alcohol Policy and Research, Department of Public Health and Psychology, La Trobe University, Melbourne, Australia
| | - Cassandra J C Wright
- Centre for Alcohol Policy and Research, Department of Public Health and Psychology, La Trobe University, Melbourne, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Burnet Institute, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Livingston
- Centre for Alcohol Policy and Research, Department of Public Health and Psychology, La Trobe University, Melbourne, Australia.,National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy and Research, Department of Public Health and Psychology, La Trobe University, Melbourne, Australia.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
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9
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Mun EY, Li X, Businelle MS, Hébert ET, Tan Z, Barnett NP, Walters ST. Ecological Momentary Assessment of Alcohol Consumption and Its Concordance with Transdermal Alcohol Detection and Timeline Follow-Back Self-report Among Adults Experiencing Homelessness. Alcohol Clin Exp Res 2021; 45:864-876. [PMID: 33583057 PMCID: PMC8252787 DOI: 10.1111/acer.14571] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/07/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Background Studies of alcohol use presume valid assessment measures. To evaluate this presumption, we examined the concordance of alcohol use as measured by ecological momentary assessment (EMA) self‐reports, transdermal alcohol concentration readings via the Secure Continuous Remote Alcohol Monitor (SCRAM), and retrospective self‐reports via the Timeline Follow‐Back (TLFB) among adults experiencing homelessness. Methods Forty‐nine adults who reported alcohol misuse (mean age = 47, SD = 9; 57% Black; 82% men) were recruited from a homeless shelter. For 4 weeks, alcohol use was assessed: (i) 5 times or more per day by EMA, (ii) every 30 minutes by a SCRAM device worn on the ankle, and (iii) by TLFB for the past month at the end of the study period. There were 1,389 days of observations of alcohol use and alcohol use intensity for 49 participants. Results EMA and SCRAM alcohol use data agreed on 73% of days, with an interrater agreement Kappa = 0.46. A multilevel analysis of concordance of 3 measures for alcohol use yielded statistically significant correlations of 0.40 (day level) and 0.63 (person level) between EMA and SCRAM. Alcohol use was detected on 49, 38, and 33% of days by EMA, SCRAM, and TLFB, respectively. For alcohol use intensity, EMA and SCRAM resulted in statistically significant correlations of 0.46 (day level) and 0.78 (person level). The concordance of TLFB with either EMA or SCRAM was weak, especially at the day level. Conclusions This is the first study to examine concordance of alcohol use estimates using EMA, SCRAM, and TLFB methods in adults experiencing homelessness. EMA is a valid approach to quantifying alcohol use, especially given its relatively low cost, low participant burden, and ease of use. Furthermore, any stigma associated with wearing the SCRAM or reporting alcohol use in person may be attenuated by using EMA, which may be appealing for use in studies of stigmatized and underserved populations.
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Affiliation(s)
- Eun-Young Mun
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Xiaoyin Li
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Michael S Businelle
- Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA.,Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Emily T Hébert
- UTHealth School of Public Health in Austin, Austin, OK, USA
| | - Zhengqi Tan
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Nancy P Barnett
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, RI, USA
| | - Scott T Walters
- Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA
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10
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Abstract
Very little is known about how reward programs are implemented in real-world substance use treatment settings and whether training in contingency management (CM), an empirically supported rewards-based intervention, impacts their design quality. Providers (N = 214) completed surveys assessing CM beliefs, training, and practices related to use of tangible rewards in treatment. For providers reporting they had not used rewards in treatment previously (54%, n = 116), we assessed beliefs about and interest in adopting a reward-based program. For those endorsing prior reward experience (46%, n = 98), we assessed the features and delivery of rewards and the relation of reward-based intervention training to 4 parameters related to CM efficacy: reinforcement magnitude, immediacy, frequency, and escalation. Among providers without reward experience, endorsement of supportive statements about CM predicted interest in adopting a rewards-based program. Providers with reward experience most often targeted treatment attendance and engaged in behaviors likely to decrease the effectiveness of the intervention, including use of low magnitudes (≤ $25/client), delayed reinforcement, failure to escalate reward values, and offering reward opportunities less than weekly. Providers with longer durations of training were more likely to engage in behaviors consistent with effective CM, including larger magnitude rewards and immediate delivery of rewards. Results indicate that real-world treatment clinics are using reward-based programs but not in ways consistent with research protocols. Longer training exposure is associated with greater adherence to some aspects of CM protocol design. Other evidence-based design features are not being implemented as recommended, even with training. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carla J Rash
- University of Connecticut Health School of Medicine
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