1
|
Businelle MS, Perski O, Hébert ET, Kendzor DE. Mobile Health Interventions for Substance Use Disorders. Annu Rev Clin Psychol 2024; 20:49-76. [PMID: 38346293 DOI: 10.1146/annurev-clinpsy-080822-042337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
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.
Collapse
Affiliation(s)
- Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA;
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Olga Perski
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA;
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
2
|
Jones-Patten A, Shin SS, Bounds DT, Nyamathi A. Discrimination, Mental Health, and Readiness to Quit Smoking. Clin Nurs Res 2023; 32:1081-1091. [PMID: 37365813 PMCID: PMC10504822 DOI: 10.1177/10547738231183210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
We conducted a cross-sectional study, examining the mediation effects of depression and anxiety on the association between discrimination and readiness to quit cigarette smoking among African American adult cigarette smokers experiencing homelessness. Using a convenience sample, participants were recruited from a homeless shelter in Southern California. Scores of discrimination, depressive, and anxiety symptoms, and readiness to quit smoking were analyzed using linear regression modeling. We enrolled 100 participants; 58 participants were male. In the final model, discrimination had no association with readiness to quit (b = 0.02; 95% CI [-0.04, 0.08]; p = 0.47). The indirect effects of depression (b = 0.04, [0.01, 0.07]; p = 0.02) and anxiety (b = 0.03; [0.01, 0.05]; p = 0.04) reached statistical significance; the direct effects of depression (b = -0.01; [-0.09, 0.04]; p = 0.70) and anxiety (b = -0.00; [-0.09, 0.06]; p = 0.86) did not. Future studies should explore these associations to enhance smoking cessation programs for this population.
Collapse
|
3
|
Milojevich HM, Stickel D, Swingler MM, Zhang X, Terrell J, Sheridan MA, Tan X. Building an ecological momentary assessment smartphone app for 4- to 10-year-old children: A pilot study. PLoS One 2023; 18:e0290148. [PMID: 37647264 PMCID: PMC10468030 DOI: 10.1371/journal.pone.0290148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE Ecological momentary assessment (EMA) minimizes recall burden and maximizes ecological validity and has emerged as a valuable tool to characterize individual differences, assess contextual associations, and document temporal associations. However, EMA has yet to be reliably utilized in young children, in part due to concerns about responder reliability and limited compliance. The present study addressed these concerns by building a developmentally appropriate EMA smartphone app and testing the app for feasibility and usability with young children ages 4-10 (N = 20; m age = 7.7, SD = 2.0). METHODS To pilot test the app, children completed an 11-item survey about their mood and behavior twice a day for 14 days. Parents also completed brief surveys twice a day to allow for parent-child comparisons of responses. Finally, at the end of the two weeks, parents provided user feedback on the smartphone app. RESULTS Results indicated a high response rate (nearly 90%) across child surveys and high agreement between parents and children ranging from 0.89-0.97. CONCLUSIONS Overall, findings suggest that this developmentally appropriate EMA smartphone app is a reliable and valid tool for collecting in-the-moment data from young children outside of a laboratory setting.
Collapse
Affiliation(s)
- Helen M. Milojevich
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina, United States of America
| | - Daniel Stickel
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Margaret M. Swingler
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xinyi Zhang
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jeffery Terrell
- Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Margaret A. Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Xianming Tan
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
4
|
Liang M, Koslovsky MD, Hébert ET, Kendzor DE, Businelle MS, Vannucci M. Bayesian continuous-time hidden Markov models with covariate selection for intensive longitudinal data with measurement error. Psychol Methods 2023; 28:880-894. [PMID: 34928674 PMCID: PMC9207158 DOI: 10.1037/met0000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intensive longitudinal data collected with ecological momentary assessment methods capture information on participants' behaviors, feelings, and environment in near real-time. While these methods can reduce recall biases typically present in survey data, they may still suffer from other biases commonly found in self-reported data (e.g., measurement error and social desirability bias). To accommodate potential biases, we develop a Bayesian hidden Markov model to simultaneously identify risk factors for subjects transitioning between discrete latent states as well as risk factors potentially associated with them misreporting their true behaviors. We use simulated data to demonstrate how ignoring potential measurement error can negatively affect variable selection performance and estimation accuracy. We apply our proposed model to smartphone-based ecological momentary assessment data collected within a randomized controlled trial that evaluated the impact of incentivizing abstinence from cigarette smoking among socioeconomically disadvantaged adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Emily T. Hébert
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Austin (UTHealth) School of Public Health
| | - Darla E. Kendzor
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center
| | - Michael S. Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center
| | | |
Collapse
|
5
|
Potter LN, Schlechter CR, Nahum-Shani I, Lam CY, Cinciripini PM, Wetter DW. Socio-economic status moderates within-person associations of risk factors and smoking lapse in daily life. Addiction 2023; 118:925-934. [PMID: 36564898 PMCID: PMC10073289 DOI: 10.1111/add.16116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Individuals of lower socio-economic status (SES) display a higher prevalence of smoking and have more diffxiculty quitting than higher SES groups. The current study investigates whether the within-person associations of key risk (e.g. stress) and protective (self-efficacy) factors with smoking lapse varies by facets of SES. DESIGN AND SETTING Observational study using ecological momentary assessment to collect data for a 28-day period following a smoking quit attempt. Multi-level mixed models (i.e. generalized linear mixed models) examined cross-level interactions between lapse risk and protective factors and indicators of SES on smoking lapse. PARTICIPANTS A diverse sample of 330 adult US smokers who completed a larger study examining the effects of race/ethnicity and social/environmental influences on smoking cessation. MEASUREMENTS Risk factors included momentary urge, negative affect, stress; protective factors included positive affect, motivation, abstinence self-efficacy; SES measures: baseline measures of income and financial strain; the primary outcome was self-reported lapse. FINDINGS Participants provided 43 297 post-quit observations. Mixed models suggested that income and financial strain moderated the effect of some risk factors on smoking lapse. The within-person association of negative [odds ratio (OR) = 0.967, 95% CI= 0.945, 0.990, P < 0.01] and positive affect (OR = 1.023, 95% CI = 1.003, 1.044, P < 0.05) and abstinence self-efficacy (OR = 1.020, 95% CI = 1.003, 1.038, P < 0.05) on lapse varied with financial strain. The within-person association of negative affect (OR = 1.005, 95% CI = 1.002, 1.008, P < 0.01), motivation (OR = 0.995, 95% CI = 0.991, 0.999, P < 0.05) and abstinence self-efficacy (OR = 0.996, 95% CI = 0.993, 0.999, P < 0.01) on lapse varied by income. The positive association of negative affect with lapse was stronger among individuals with higher income and lower financial strain. The negative association between positive affect and abstinence self-efficacy with lapse was stronger among individuals with lower financial strain, and the negative association between motivation and abstinence self-efficacy with lapse was stronger among those with higher income. The data were insensitive to detect statistically significant moderating effects of income and financial strain on the association of urge or stress with lapse. CONCLUSION Some risk factors (e.g. momentary negative affect) exert a weaker influence on smoking lapse among lower compared to higher socio-economic status groups.
Collapse
Affiliation(s)
- Lindsey N Potter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI, USA
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Unit 1330, Houston, TX, 77230, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA
| |
Collapse
|
6
|
Hébert ET, Vandewater EA, Businelle MS, Harrell MB, Kelder SH, Perry CL. Tobacco advertising exposure and product use among young adults: An ecological momentary assessment approach. Addict Behav 2023; 139:107601. [PMID: 36592525 PMCID: PMC9872832 DOI: 10.1016/j.addbeh.2022.107601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Tobacco-related content is prevalent on social media, yet many methods of measuring exposure are inadequate due to the personalized nature of online marketing. The purpose of this paper is to examine the association between exposure to pro-tobacco messages (both industry-sponsored and user-generated) and the use of tobacco products, as reported via ecological momentary assessment (EMA). METHODS Young adults (n = 175) were instructed to record all sightings of marketing (both in-person and online) related to tobacco for 28 days. Tobacco product use and recall of message encounters were assessed daily using app-initiated EMA. RESULTS Participants who reported exposure to tobacco messages were significantly more likely to report using tobacco, adjusting for gender, age, race/ethnicity, baseline use of any tobacco product, and having friends who use tobacco and e-cigarettes (p <.001). For each industry-sponsored message viewed, the odds of using tobacco or e-cigarettes in a given day increased by a factor of 1.77 (95 % CI = 1.41, 2.23). For each user-generated message viewed, the odds of using tobacco or e-cigarettes in a given day increased by a factor of 1.52 (95 % CI = 1.27, 1.83). DISCUSSION To our knowledge, this is the first study to specifically examine the association between exposure to user-generated messages and daily tobacco use. The findings suggests that there is a unique element to user-generated messages that distinguishes them from both traditional marketing and from simple peer influence.
Collapse
Affiliation(s)
- Emily T Hébert
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States.
| | | | - Michael S Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Melissa B Harrell
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
| | - Steven H Kelder
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, Austin, TX, United States
| |
Collapse
|
7
|
Garey L, Zvolensky MJ, Gallagher MW, Vujanovic A, Kendzor DE, Stephens L, Cheney MK, Cole AB, Kezbers K, Matoska CT, Robison J, Montgomery A, Zappi CV, Businelle MS. A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40713. [PMID: 36409958 PMCID: PMC9728024 DOI: 10.2196/40713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. OBJECTIVE This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. METHODS The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. RESULTS Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19-specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. CONCLUSIONS Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40713.
Collapse
Affiliation(s)
- Lorra Garey
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael J Zvolensky
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Department of Behavioral Science, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
| | - Matthew W Gallagher
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, United States
| | - Anka Vujanovic
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Lancer Stephens
- College of Public Health, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
- Oklahoma Shared Clinical and Translational Research Resources, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| | - Marshall K Cheney
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, United States
| | - Ashley B Cole
- Department of Psychology, Oklahoma State University, Stillwater, OK, United States
| | - Krista Kezbers
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Cameron T Matoska
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Jillian Robison
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Audrey Montgomery
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Christopher V Zappi
- HEALTH Institute, University of Houston, Houston, TX, United States
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
- Department of Family and Preventive Medicine, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, United States
| |
Collapse
|
8
|
Potter LN, Schlechter CR, Shono Y, Lam CY, Cinciripini PM, Wetter DW. An ecological momentary assessment study of outcome expectancies and smoking lapse in daily life. Drug Alcohol Depend 2022; 238:109587. [PMID: 35932749 DOI: 10.1016/j.drugalcdep.2022.109587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/30/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Outcome expectancies have been identified as key components of behavior change. Expectancies related to affect control are hypothesized to play an important role in smoking cessation, such that smokers may be more likely to lapse if they believe they can control their affect by smoking and less likely if they believe they can control their affect by means other than smoking. However, little is known about whether real-time, real-world changes in affect control expectancies influence smoking lapse during a quit attempt. METHODS A diverse sample (N = 369) of adult smokers completed ecological momentary assessment of smoking expectancies and lapse for 28 days following a quit attempt. Multilevel logistic regression was used to examine whether the difference score of positive smoking outcome expectancies (the belief that smoking would improve mood) minus positive coping outcome expectancies (the belief that something other than smoking would improve mood) was related to smoking lapse in daily life. RESULTS There was a significant within-person association between the expectancies difference score and lapse likelihood. When the difference score was 1 unit above a person's typical level, odds of lapse increased by 18.65 % (β = 0.174, SE = 0.024, p < .0001, OR = 1.189, 95 % CI [1.135, 1.247]). CONCLUSION Smokers undergoing a quit attempt were more likely to lapse in moments when the difference in the belief that smoking would improve their mood minus the belief that something other than smoking would improve their mood was larger. This work has relevance for tailoring interventions to both cultivate positive coping outcome expectancies and reduce smoking outcome expectancies, and informs theoretical models about the dynamic nature of outcome expectancies.
Collapse
Affiliation(s)
- Lindsey N Potter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Yusuke Shono
- Department of Medical Social Sciences Northwestern University Feinberg School of Medicine, 625 N. Michigan Avenue, 27th Floor, Chicago, IL 60611, USA.
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Paul M Cinciripini
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Unit 1330, Houston, TX 77230, USA
| | - David W Wetter
- Center for Health Outcomes and Population Equity (HOPE), Huntsman Cancer Institute and Department of Population Health Sciences, The University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| |
Collapse
|
9
|
Guttentag A, Tseng TY, Shelley D, Kirchner T. Analyzing Trajectories of Acute Cigarette Reduction Post-Introduction of an E-Cigarette Using Ecological Momentary Assessment Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7452. [PMID: 35742698 PMCID: PMC9223631 DOI: 10.3390/ijerph19127452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023]
Abstract
Electronic cigarettes (ECs) may hold great potential for helping smokers transition off combustible cigarettes (CCs); however, little is known about the patterns that smokers follow when using an EC as a CC-substitute in order to ultimately reduce and quit smoking. Our primary aim in this study was to evaluate whether common patterns of CC use exist amongst individuals asked to substitute an EC for at least half of the CCs they would normally smoke. These patterns may elucidate the immediate switching and reduction behaviors of individuals using ECs as a reduction/cessation tool. This analysis uses data from a randomized controlled trial of 84 adult smokers assigned to receive either 4.5% nicotine or placebo (0% nicotine) EC. Participants were advised to use the EC to help them reach a 50% reduction in cigarettes-per-day (CPD) within 3 weeks. Longitudinal trajectory analysis was used to identify CPD reduction classes amongst the sample; participants clustered into four distinct, linear trajectories based on daily CC use during the 3-week intervention. Higher readiness to quit smoking, prior successful quit attempts, and lower baseline CC consumption were associated with assignment into "more successful" CC reduction classes. ECs may be a useful mechanism to promote CC reduction. This study demonstrates that a fine-grained trajectory approach can be applied to examine switching patterns in the critical first weeks of an attempt.
Collapse
Affiliation(s)
- Alexandra Guttentag
- Department of Epidemiology, New York University School of Global Public Health, New York, NY 10003, USA;
| | - Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY 10003, USA;
| | - Thomas Kirchner
- Department of Epidemiology, New York University School of Global Public Health, New York, NY 10003, USA;
- Departments of Epidemiology and Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003, USA
| |
Collapse
|
10
|
Cui Y, Robinson JD, Rymer RE, Minnix JA, Cinciripini PM. You Don't Need an App-Conducting Mobile Smoking Research Using a Qualtrics-Based Approach. Front Digit Health 2022; 3:799468. [PMID: 35072151 PMCID: PMC8770325 DOI: 10.3389/fdgth.2021.799468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/14/2021] [Indexed: 12/05/2022] Open
Abstract
With the increasing availability of smartphones, many tobacco researchers are exploring smartphone-delivered mobile smoking interventions as a disseminable means of treatment. Most effort has been focused on the development of smartphone applications (apps) to conduct mobile smoking research to implement and validate these interventions. However, developing project-specific smartphone apps that work across multiple mobile platforms (e.g., iOS and Android) can be costly and time-consuming. Here, using a hypothetical study, we present an alternate approach to demonstrate how mobile smoking cessation and outcome evaluation can be conducted without the need of a dedicated app. Our approach uses the Qualtrics platform, a popular online survey host that is used under license by many academic institutions. This platform allows researchers to conduct device-agnostic screening, consenting, and administration of questionnaires through Qualtrics's native survey engine. Researchers can also collect ecological momentary assessment data using text messaging prompts with the incorporation of Amazon Web Services' Pinpoint. Besides these assessment capabilities, Qualtrics has the potential for delivering personalized behavioral interventions through the use of JavaScript code. By customizing the question's web elements in Qualtrics (e.g., using texts, images, videos, and buttons), researchers can integrate interactive web-based interventions and complicated behavioral and cognitive tasks into the survey. In conclusion, this Qualtrics-based methodology represents a novel and cost-effective approach for conducting mobile smoking cessation and assessment research.
Collapse
Affiliation(s)
- Yong Cui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | | | | | | |
Collapse
|
11
|
Rubin SB, Vijayaraghavan M, Weiser SD, Tsoh JY, Cohee A, Delucchi K, Riley ED. Homeless women's perspectives on smoking and smoking cessation programs: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103377. [PMID: 34481110 PMCID: PMC9115776 DOI: 10.1016/j.drugpo.2021.103377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/27/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Individuals who are unsheltered or experiencing homelessness are more likely to smoke than those in the general population and have a higher prevalence of tobacco-related illnesses. Those who are unhoused make quit attempts at rates similar to the general population, however rates of successful quitting are much lower. Women bear a higher burden of smoking-related diseases and are less successful in their cessation efforts than men. Despite these increased risks and challenges, cessation programs specifically designed to meet the needs of women experiencing homelessness are extremely rare. METHODS To examine perceptions of smoking cessation programs among women who are unstably housed, we conducted in-depth, semi-structured interviews with twenty-nine women experiencing homelessness or unstable housing who had histories of tobacco and substance use. Interviews explored the social context of smoking, as well as interest in, barriers to, and facilitators of quitting. We used a grounded theory approach to analyze the transcripts. RESULTS Participants reported a number of structural barriers to cessation. They reported obstacles to participating in existing cessation programs, including chronic stress related to experiences of being unsheltered and fear of being exposed to neighborhood violence. These conditions were paired with a strong need to self-isolate in order to maintain personal safety, which runs counter to traditional group-based cessation programs. CONCLUSION A dissonance exists between current smoking cessation programs and the needs of women who are unsheltered or unstably housed. Alternative cessation treatment delivery models that address extremely high levels of chronic stress violence, and avoidance of group settings are needed, as are programs that provide options for safe participation.
Collapse
Affiliation(s)
- Sara Bissell Rubin
- University of California, Department of Psychiatry and Behavioral Sciences, San Francisco, United States
| | - Maya Vijayaraghavan
- University of California, Department of Medicine, San Francisco, United States
| | - Sheri D Weiser
- University of California, Department of Medicine, San Francisco, United States
| | - Janice Y Tsoh
- University of California, Department of Psychiatry and Behavioral Sciences, San Francisco, United States
| | - Alison Cohee
- University of California, Department of Psychiatry and Behavioral Sciences, San Francisco, United States; University of California, Department of Medicine, San Francisco, United States
| | - Kevin Delucchi
- University of California, Department of Psychiatry and Behavioral Sciences, San Francisco, United States
| | - Elise D Riley
- University of California, Department of Medicine, San Francisco, United States.
| |
Collapse
|
12
|
Santa Maria D, Padhye N, Businelle M, Yang Y, Jones J, Sims A, Lightfoot M. Efficacy of a Just-in-Time Adaptive Intervention to Promote HIV Risk Reduction Behaviors Among Young Adults Experiencing Homelessness: Pilot Randomized Controlled Trial. J Med Internet Res 2021; 23:e26704. [PMID: 34255679 PMCID: PMC8292946 DOI: 10.2196/26704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/26/2021] [Accepted: 05/05/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors. OBJECTIVE This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information. METHODS A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruited from shelters and drop-in centers in May 2019. Participants were randomized to either a control or an intervention group. The intervention (called MY-RID [Motivating Youth to Reduce Infection and Disconnection]) consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges. RESULTS Participants (N=97) were predominantly youth (mean age 21.2, SD 2.1 years) who identified as heterosexual (n=51, 52%), male (n=56, 57%), and African American (n=56, 57%). Reports of sexual activity, drug use, alcohol use, stress, and all urges (ie, sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group (Multimedia Appendix 4). Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant reduction in reports of feeling stressed the day before between the intervention and control conditions (P=.03). CONCLUSIONS Findings indicate promising intervention effects on drug use, stress, and urges for sex in a hard-to-reach, high-risk population. The MY-RID intervention should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024.
Collapse
Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Yijiong Yang
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Alexis Sims
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
13
|
Santa Maria D, Lightfoot M, Nyamathi A, Businelle M, Paul M, Quadri Y, Padhye N, Jones J, Calvo Armijo M. A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial. JMIR Res Protoc 2021; 10:e26716. [PMID: 34018967 PMCID: PMC8178739 DOI: 10.2196/26716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/26716
Collapse
Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Adey Nyamathi
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Mary Paul
- Baylor College of Medicine, Houston, TX, United States
| | - Yasmeen Quadri
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Margarita Calvo Armijo
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
14
|
Walters ST, Businelle MS, Suchting R, Li X, Hébert ET, Mun EY. Using machine learning to identify predictors of imminent drinking and create tailored messages for at-risk drinkers experiencing homelessness. J Subst Abuse Treat 2021; 127:108417. [PMID: 34134874 PMCID: PMC8217726 DOI: 10.1016/j.jsat.2021.108417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/04/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
Adults experiencing homelessness are more likely to have an alcohol use disorder compared to adults in the general population. Although shelter-based treatments are common, completion rates tend to be poor, suggesting a need for more effective approaches that are tailored to this understudied and underserved population. One barrier to developing more effective treatments is the limited knowledge of the triggers of alcohol use among homeless adults. This paper describes the use of ecological momentary assessment (EMA) to identify predictors of “imminent drinking” (i.e., drinking within the next 4 h), among a sample of adults experiencing homelessness and receiving health services at a homeless shelter. A total of 78 mostly male (84.6%) adults experiencing homelessness (mean age = 46.6) who reported hazardous drinking completed up to five EMAs per day over 4 weeks (a total of 4557 completed EMAs). The study used machine learning techniques to create a drinking risk algorithm that predicted 82% of imminent drinking episodes within 4 h of the first drink of the day, and correctly identified 76% of nondrinking episodes. The algorithm included the following 7 predictors of imminent drinking: urge to drink, having alcohol easily available, feeling confident that alcohol would improve mood, feeling depressed, lower commitment to being alcohol free, not interacting with someone drinking alcohol, and being indoors. The research team used the results to develop intervention content (e.g., brief tailored messages) that will be delivered when imminent drinking is detected in an upcoming intervention phase. Specifically, we created three theoretically grounded message tracks focused on urge/craving, social/availability, and negative affect/mood, which are further tailored to a participant’s current drinking goal (i.e., stay sober, drink less, no goal) to support positive change. To our knowledge, this is the first study to develop tailored intervention messages based on likelihood of imminent drinking, current drinking triggers, and drinking goals among adults experiencing homelessness.
Collapse
Affiliation(s)
- Scott T Walters
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Xiaoyin Li
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Emily T Hébert
- University of Texas Health Science Center (UTHealth), School of Public Health Austin, Austin, TX, USA
| | - Eun-Young Mun
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| |
Collapse
|
15
|
Acorda D, Businelle M, Santa Maria D. Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study. JMIR Form Res 2021; 5:e21638. [PMID: 33821805 PMCID: PMC8058691 DOI: 10.2196/21638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/06/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective. OBJECTIVE This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. METHODS YEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. RESULTS A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the "freezing" of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time. CONCLUSIONS YEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population.
Collapse
Affiliation(s)
- Darlene Acorda
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Texas Children's Hospital, Houston, TX, United States
| | - Michael Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Diane Santa Maria
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
16
|
Savoy EJ, Businelle MS, Nguyen N, Chen TA, Neighbors C, Norton PJ, Taing M, Reitzel LR. Examining moment to moment affective determinants of smoking rate following a quit attempt among homeless daily smokers. Addict Behav 2021; 115:106788. [PMID: 33360279 DOI: 10.1016/j.addbeh.2020.106788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cigarette smoking disproportionately affects homeless individuals, who have a higher smoking prevalence, fewer resources, and increased stressors compared to domiciled smokers. Little is known about how to facilitate smoking cessation among this population although some findings support focusing efforts on affective variables as well as alternate outcomes in order to optimize interventions for this group. METHODS Participants were homeless adults recruited from a Dallas, TX, shelter (N = 57, 61.4% male, Mage = 48.8 ± 9.0) to participate in tobacco cessation classes using an American Cancer Society-based therapy and support group with nicotine replacement therapy. Moment-to-moment changes in affect [e.g., negative affect (NA), positive affect (PA), and stress] were recorded via Ecological Momentary Assessments to assess whether they were associated with concurrent changes in cigarettes smoked per day (CPD) following a specific quit attempt. Separate generalized linear models (GLM) were evaluated for each predictor to examine the associations between affective variables and CPD in covariate-adjusted analyses. RESULTS Significant interaction effects of time and affect were found for all variables (NA: p = 0.0011, PA: p = 0.0006, stress: p = 0.0259), whereby the association of affect and CPD were significant in the early part of the week but the effects faded as time progressed. With regard to main effects, only increases in PA during the post-quit week significantly predicted fewer CPD (adjusted incidence rate ratio = 0.924, SE = 0.027, p = 0.0032). CONCLUSIONS Homeless smokers may be more likely to decrease their cigarette consumption during periods of greater PA throughout the post-quit week. Relationship between positive affect and reduction in CPD suggest focus on affective variables with homeless smokers may be an effective avenue for change in smoking behaviors, particularly in the days immediately following a quit attempt. Time effects should be further investigated to determine when these interventions might best be implemented.
Collapse
Affiliation(s)
- Elaine J Savoy
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA; Inpatient Program, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
| | - Michael S Businelle
- mHealth Shared Resource at Oklahoma Tobacco Research Center at the Stephenson Cancer Center, Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Nga Nguyen
- Biostatistics Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tzu-An Chen
- HEALTH Research Institute, University of Houston, Houston, TX, USA
| | - Clayton Neighbors
- Social Influences and Health Behaviors Lab, University of Houston, Houston, TX, USA
| | - Peter J Norton
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Matthew Taing
- HEALTH Research Institute, University of Houston, Houston, TX, USA; Department of Psychological, Health, & Learning Sciences, University of Houston, Texas, USA
| | - Lorraine R Reitzel
- HEALTH Research Institute, University of Houston, Houston, TX, USA; Department of Psychological, Health, & Learning Sciences, University of Houston, Texas, USA
| |
Collapse
|
17
|
Williams MT, Lewthwaite H, Fraysse F, Gajewska A, Ignatavicius J, Ferrar K. Compliance With Mobile Ecological Momentary Assessment of Self-Reported Health-Related Behaviors and Psychological Constructs in Adults: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e17023. [PMID: 33656451 PMCID: PMC7970161 DOI: 10.2196/17023] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/01/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023] Open
Abstract
Background Mobile ecological momentary assessment (mEMA) permits real-time capture of self-reported participant behaviors and perceptual experiences. Reporting of mEMA protocols and compliance has been identified as problematic within systematic reviews of children, youth, and specific clinical populations of adults. Objective This study aimed to describe the use of mEMA for self-reported behaviors and psychological constructs, mEMA protocol and compliance reporting, and associations between key components of mEMA protocols and compliance in studies of nonclinical and clinical samples of adults. Methods In total, 9 electronic databases were searched (2006-2016) for observational studies reporting compliance to mEMA for health-related data from adults (>18 years) in nonclinical and clinical settings. Screening and data extraction were undertaken by independent reviewers, with discrepancies resolved by consensus. Narrative synthesis described participants, mEMA target, protocol, and compliance. Random effects meta-analysis explored factors associated with cohort compliance (monitoring duration, daily prompt frequency or schedule, device type, training, incentives, and burden score). Random effects analysis of variance (P≤.05) assessed differences between nonclinical and clinical data sets. Results Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105 [61%], clinical=41/105 [39%]). The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets; secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%); median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I2>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance. Conclusions In this 10-year sample of studies using the mEMA of self-reported health-related behaviors and psychological constructs in adult nonclinical and clinical populations, mEMA was applied across contexts and health conditions and to collect a range of health-related data. There was inconsistent reporting of compliance and key features within protocols, which limited the ability to confidently identify components of mEMA schedules likely to have a specific impact on compliance.
Collapse
Affiliation(s)
- Marie T Williams
- Innovation, Implementation And Clinical Translation in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Hayley Lewthwaite
- Innovation, Implementation And Clinical Translation in Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montreal, QC, Canada
| | - François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Alexandra Gajewska
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jordan Ignatavicius
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Katia Ferrar
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| |
Collapse
|
18
|
Hébert ET, Suchting R, Ra CK, Alexander AC, Kendzor DE, Vidrine DJ, Businelle MS. Predicting the first smoking lapse during a quit attempt: A machine learning approach. Drug Alcohol Depend 2021; 218:108340. [PMID: 33092911 PMCID: PMC8496911 DOI: 10.1016/j.drugalcdep.2020.108340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 09/11/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Just-in-time adaptive interventions (JITAI) aim to prevent smoking lapse using tailored support delivered via mobile technology in the moments when it is most needed. Effective smoking cessation JITAI rely on the development of accurate decision rules that determine when someone is most likely to lapse. The primary goal of the present study was to identify the strongest predictors of first lapse among smokers undergoing a quit attempt. METHODS Smokers attending a clinic-based smoking cessation program (n = 74) were asked to complete ecological momentary assessments five times daily on study-provided smartphones for 4 weeks post-quit. A three-stage modeling process utilized Cox proportional hazards regression to examine time to lapse a function of 31 predictors. First, univariate models evaluated the relationship between each predictor and time to lapse. Second, the elastic net machine learning algorithm was used to select the best predictors. Third, backwards elimination further reduced the set of predictors to optimize parsimony. RESULTS Univariate models identified seven predictors significantly related to time to lapse. The elastic net algorithm retained five: perceived odds of smoking today, confidence in ability to avoid smoking, motivation to avoid smoking, urge to smoke, and cigarette availability. The reduced model demonstrated inadequate approximation to the non-penalized baseline model. CONCLUSIONS Accurate estimation of moments of high risk for smoking lapse remains an important goal in the development of JITAI. These results demonstrate the utility of exploratory data-driven approaches to variable selection. The results of this study can inform future JITAI by highlighting targets for intervention.
Collapse
Affiliation(s)
- Emily T Hébert
- University of Texas Health Science Center (UTHealth) School of Public Health, Austin, TX, United States.
| | - Robert Suchting
- UTHealth McGovern Medical School, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Chaelin K Ra
- TSET Health Promotion Research Center, Oklahoma City, OK, United States
| | - Adam C Alexander
- TSET Health Promotion Research Center, Oklahoma City, OK, United States
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Oklahoma City, OK, United States; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | | | - Michael S Businelle
- TSET Health Promotion Research Center, Oklahoma City, OK, United States; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| |
Collapse
|
19
|
Potter LN, Haaland BA, Lam CY, Cambron C, Schlechter CR, Cinciripini PM, Wetter DW. A time-varying model of the dynamics of smoking lapse. Health Psychol 2020; 40:40-50. [PMID: 33370151 DOI: 10.1037/hea0001036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The majority of smokers who make a quit attempt experience their first lapse within the first week of quitting, yet limited research to date has examined how the strength and direction of the relationship between smoking risk factors and lapse may change over longer periods of time. Time-varying effect modeling (TVEM) was used to address this gap. METHOD A diverse sample (N = 325) of adult smokers completed ecological momentary assessments of risk factors for lapse for 28 days after quitting. TVEM was used to examine the relationship between risk factors (abstinence self-efficacy, positive affect, positive coping expectancies, smoking expectancies, motivation, negative affect, stress, and urge) and lapse for 28 days postquit. RESULTS Some associations were stable (e.g., negative affect, motivation), whereas others varied over time. Abstinence self-efficacy, positive affect, and positive coping expectancies were most strongly associated with lapse between Days 3 and 8 postquit. The association of urge with lapse was strongest between Days 4 and 10, as well as near the end of the quit attempt. Stress was also most strongly associated with lapse near the beginning and end of the postquit period and was the only predictor associated with lapse on quit date. The strength of the association between smoking expectancies and lapse increased over time. CONCLUSION There may be periods during a quit attempt when certain risk factors are more strongly related to lapse. This work has relevance for tailoring interventions designed to deliver intervention components in particular contexts or times of need. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Collapse
Affiliation(s)
- Lindsey N Potter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah
| | - Benjamin A Haaland
- Cancer Biostatistics Shared Resource at Huntsman Cancer Institute, University of Utah
| | - Cho Y Lam
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah
| | | | - Chelsey R Schlechter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah
| | - Paul M Cinciripini
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, MD Anderson Cancer Center, University of Texas
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah
| |
Collapse
|
20
|
Vijayaraghavan M, Elser H, Frazer K, Lindson N, Apollonio D. Interventions to reduce tobacco use in people experiencing homelessness. Cochrane Database Syst Rev 2020; 12:CD013413. [PMID: 33284989 PMCID: PMC8130995 DOI: 10.1002/14651858.cd013413.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Populations experiencing homelessness have high rates of tobacco use and experience substantial barriers to cessation. Tobacco-caused conditions are among the leading causes of morbidity and mortality among people experiencing homelessness, highlighting an urgent need for interventions to reduce the burden of tobacco use in this population. OBJECTIVES To assess whether interventions designed to improve access to tobacco cessation interventions for adults experiencing homelessness lead to increased numbers engaging in or receiving treatment, and whether interventions designed to help adults experiencing homelessness to quit tobacco lead to increased tobacco abstinence. To also assess whether tobacco cessation interventions for adults experiencing homelessness affect substance use and mental health. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register, MEDLINE, Embase and PsycINFO for studies using the terms: un-housed*, homeless*, housing instability, smoking cessation, tobacco use disorder, smokeless tobacco. We also searched trial registries to identify unpublished studies. Date of the most recent search: 06 January 2020. SELECTION CRITERIA We included randomized controlled trials that recruited people experiencing homelessness who used tobacco, and investigated interventions focused on the following: 1) improving access to relevant support services; 2) increasing motivation to quit tobacco use; 3) helping people to achieve abstinence, including but not limited to behavioral support, tobacco cessation pharmacotherapies, contingency management, and text- or app-based interventions; or 4) encouraging transitions to long-term nicotine use that did not involve tobacco. Eligible comparators included no intervention, usual care (as defined by the studies), or another form of active intervention. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Tobacco cessation was measured at the longest time point for each study, on an intention-to-treat basis, using the most rigorous definition available. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study where possible. We grouped eligible studies according to the type of comparison (contingent reinforcement in addition to usual smoking cessation care; more versus less intensive smoking cessation interventions; and multi-issue support versus smoking cessation support only), and carried out meta-analyses where appropriate, using a Mantel-Haenszel random-effects model. We also extracted data on quit attempts, effects on mental and substance-use severity, and meta-analyzed these outcomes where sufficient data were available. MAIN RESULTS We identified 10 studies involving 1634 participants who smoked combustible tobacco at enrolment. One of the studies was ongoing. Most of the trials included participants who were recruited from community-based sites such as shelters, and three included participants who were recruited from clinics. We judged three studies to be at high risk of bias in one or more domains. We identified low-certainty evidence, limited by imprecision, that contingent reinforcement (rewards for successful smoking cessation) plus usual smoking cessation care was not more effective than usual care alone in promoting abstinence (RR 0.67, 95% CI 0.16 to 2.77; 1 trial, 70 participants). We identified very low-certainty evidence, limited by risk of bias and imprecision, that more intensive behavioral smoking cessation support was more effective than brief intervention in promoting abstinence at six-month follow-up (RR 1.64, 95% CI 1.01 to 2.69; 3 trials, 657 participants; I2 = 0%). There was low-certainty evidence, limited by bias and imprecision, that multi-issue support (cessation support that also encompassed help to deal with other challenges or addictions) was not superior to targeted smoking cessation support in promoting abstinence (RR 0.95, 95% CI 0.35 to 2.61; 2 trials, 146 participants; I2 = 25%). More data on these types of interventions are likely to change our interpretation of these data. Single studies that examined the effects of text-messaging support, e-cigarettes, or cognitive behavioral therapy for smoking cessation provided inconclusive results. Data on secondary outcomes, including mental health and substance use severity, were too sparse to draw any meaningful conclusions on whether there were clinically-relevant differences. We did not identify any studies that explicitly assessed interventions to increase access to tobacco cessation care; we were therefore unable to assess our secondary outcome 'number of participants receiving treatment'. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the effects of any tobacco cessation interventions specifically in people experiencing homelessness. Although there was some evidence to suggest a modest benefit of more intensive behavioral smoking cessation interventions when compared to less intensive interventions, our certainty in this evidence was very low, meaning that further research could either strengthen or weaken this effect. There is insufficient evidence to assess whether the provision of tobacco cessation support and its effects on quit attempts has any effect on the mental health or other substance-use outcomes of people experiencing homelessness. Although there is no reason to believe that standard tobacco cessation treatments work any differently in people experiencing homelessness than in the general population, these findings highlight a need for high-quality studies that address additional ways to engage and support people experiencing homelessness, in the context of the daily challenges they face. These studies should have adequate power and put effort into retaining participants for long-term follow-up of at least six months. Studies should also explore interventions that increase access to cessation services, and address the social and environmental influences of tobacco use among people experiencing homelessness. Finally, studies should explore the impact of tobacco cessation on mental health and substance-use outcomes.
Collapse
Affiliation(s)
- Maya Vijayaraghavan
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Holly Elser
- Epidemiology, University of California, Berkeley, Berkeley, California, USA
| | - Kate Frazer
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dorie Apollonio
- Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
21
|
Koslovsky MD, Hébert ET, Businelle MS, Vannucci M. A Bayesian time-varying effect model for behavioral mHealth data. Ann Appl Stat 2020; 14:1878-1902. [DOI: 10.1214/20-aoas1402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
22
|
Resilience is associated with importance of quitting in homeless adult smokers. Addict Behav 2020; 110:106515. [PMID: 32652387 DOI: 10.1016/j.addbeh.2020.106515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/30/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The prevalence of cigarette smoking in homeless populations is disproportionately high with rates between 57 and 80%. Resilience may affect a smoker's ability to successfully quit smoking. This cross-sectional study examined the association between resilience levels and smoking behaviors in homeless adults. METHOD Fifty-nine homeless adults were recruited from a large multi-service homelessness agency in the northeast United States. Surveys were administered to measure smoking behaviors and resilience. RESULTS Most participants were current smokers (83.1%), with more than half (67.1%) identifying as "moderate smokers" (smoking 10-20 cigarettes per day). Of the current smokers, 93.9% reported smoking daily and 71.4% had tried to quit at least once in their lifetime. The number of quit attempts was significantly (p < 0.05) associated with one's contemplation of quitting (r = 0.29) and how one viewed importance of quitting (r = 0.33). Resilience levels were significantly associated with how participants ranked importance of quitting (r = 0.37). Smokers reported a high desire to quit smoking, but level of confidence in their ability to quit was low. Difficulty in finding stable housing and social support were reported as barriers to quitting. CONCLUSIONS This study demonstrates an association between importance of quitting and resilience levels in homeless adult smokers. Future work is needed to examine whether resilience is related to successful smoking cessation in homeless adults, and whether resilience levels can be increased with targeted interventions.
Collapse
|
23
|
Predicting Daily Sheltering Arrangements among Youth Experiencing Homelessness Using Diary Measurements Collected by Ecological Momentary Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186873. [PMID: 32962272 PMCID: PMC7558709 DOI: 10.3390/ijerph17186873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
Youths experiencing homelessness (YEH) often cycle between various sheltering locations including spending nights on the streets, in shelters and with others. Few studies have explored the patterns of daily sheltering over time. A total of 66 participants completed 724 ecological momentary assessments that assessed daily sleeping arrangements. Analyses applied a hypothesis-generating machine learning algorithm (component-wise gradient boosting) to build interpretable models that would select only the best predictors of daily sheltering from a large set of 92 variables while accounting for the correlated nature of the data. Sheltering was examined as a three-category outcome comparing nights spent literally homeless, unstably housed or at a shelter. The final model retained 15 predictors. These predictors included (among others) specific stressors (e.g., not having a place to stay, parenting and hunger), discrimination (by a friend or nonspecified other; due to race or homelessness), being arrested and synthetic cannabinoids use (a.k.a., “kush”). The final model demonstrated success in classifying the categorical outcome. These results have implications for developing just-in-time adaptive interventions for improving the lives of YEH.
Collapse
|
24
|
Businelle MS, Walters ST, Mun EY, Kirchner TR, Hébert ET, Li X. Reducing Drinking Among People Experiencing Homelessness: Protocol for the Development and Testing of a Just-in-Time Adaptive Intervention. JMIR Res Protoc 2020; 9:e15610. [PMID: 32297874 PMCID: PMC7193437 DOI: 10.2196/15610] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/13/2020] [Accepted: 01/27/2020] [Indexed: 11/20/2022] Open
Abstract
Background Adults who are homeless are more likely to have alcohol use disorders (AUDs) compared with domiciled adults. Although AUD treatments are commonly available, many factors (eg, transportation limitations and inability to schedule appointments) contribute to low treatment completion rates and low success rates of these interventions among adults experiencing homelessness. Most adults who are homeless own mobile phones; however, no interventions have been developed that use mobile devices to deliver and support AUD interventions for this population. Mobile phone–based AUD interventions may reduce barriers that have limited the use and utility of traditional interventions. Objective The aim of this study is to (1) identify variables (eg, affect, stress, geolocation, and cravings) that predict drinking among homeless adults (phase I), (2) develop a mobile intervention that utilizes an algorithm to identify moments of risk for drinking and deliver treatment messages that are tailored to the individual’s current needs in real time (phase II), and (3) pilot test the intervention app (phase III). Methods In phase I, adults experiencing homelessness with an AUD (N=80) will complete baseline, equipment, 2-week, and 4-week follow-up visits in person. Participants will be prompted to complete five daily ecological momentary assessments on a study-provided smartphone for 28 days. The smartphone app will collect GPS coordinates every 5 min for the entire 28-day study period. Participants will wear a transdermal alcohol sensor that will objectively measure alcohol use. In phase II, we will use phase I data to develop an algorithm that identifies moments of heightened risk for drinking and develop treatment messages that address risk factors for drinking. Phase III will pilot test the intervention in 40 adults experiencing homelessness with AUD. Results This project was funded in June 2018. IRB approval was obtained in October 2018, and data collection for phase I began in February 2019. Phase III data collection is expected to conclude in 2020. To date, 80 participants have consented to the study, and data analysis for phase I will begin in early 2020. Conclusions This research will highlight intervention targets and develop a novel intervention for understudied and underserved adults experiencing homelessness with AUD. International Registered Report Identifier (IRRID) DERR1-10.2196/15610
Collapse
Affiliation(s)
- Michael S Businelle
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Scott T Walters
- School of Public Health, University of North Texas Health Sciences Center, Fort Worth, TX, United States
| | - Eun-Young Mun
- School of Public Health, University of North Texas Health Sciences Center, Fort Worth, TX, United States
| | - Thomas R Kirchner
- School of Global Public Health, New York University, New York City, NY, United States
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Xiaoyin Li
- School of Public Health, University of North Texas Health Sciences Center, Fort Worth, TX, United States
| |
Collapse
|
25
|
Smoking amongst adults experiencing homelessness: a systematic review of prevalence rates, interventions and the barriers and facilitators to quitting and staying quit. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.11] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractBackgroundTo date, there has been no review of the research evidence examining smoking cessation among homeless adults. The current review aimed to: (i) estimate smoking prevalence in homeless populations; (ii) explore the efficacy of smoking cessation and smoking reduction interventions for homeless individuals; and (iii) describe the barriers and facilitators to smoking cessation and smoking reduction.MethodSystematic review of peer-reviewed research. Data sources included electronic academic databases. Search terms: ‘smoking’ AND ‘homeless’ AND ‘tobacco’, including adult (18+ years) smokers accessing homeless support services.ResultsFifty-three studies met the inclusion criteria (n = 46 USA). Data could not be meta-analysed due to large methodological inconsistencies and the lack of randomised controlled trials. Smoking prevalence ranged from 57% to 82%. Although there was no clear evidence on which cessation methods work best, layered approaches with additions to usual care seemed to offer modest enhancements in quit rates. Key barriers to cessation exist around the priority of smoking, beliefs around negative impact on mental health and substance use, and environmental influences.ConclusionsHomeless smokers will benefit from layered interventions which support many of their competing needs. To best understand what works, future recommendations include the need for consensus on the reporting of cessation outcomes.
Collapse
|
26
|
Hébert ET, Ra CK, Alexander AC, Helt A, Moisiuc R, Kendzor DE, Vidrine DJ, Funk-Lawler RK, Businelle MS. A Mobile Just-in-Time Adaptive Intervention for Smoking Cessation: Pilot Randomized Controlled Trial. J Med Internet Res 2020; 22:e16907. [PMID: 32149716 PMCID: PMC7091024 DOI: 10.2196/16907] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/17/2020] [Accepted: 02/03/2020] [Indexed: 01/23/2023] Open
Abstract
Background Smartphone apps for smoking cessation could offer easily accessible, highly tailored, intensive interventions at a fraction of the cost of traditional counseling. Although there are hundreds of publicly available smoking cessation apps, few have been empirically evaluated using a randomized controlled trial (RCT) design. The Smart-Treatment (Smart-T2) app is a just-in-time adaptive intervention that uses ecological momentary assessments (EMAs) to assess the risk for imminent smoking lapse and tailors treatment messages based on the risk of lapse and reported symptoms. Objective This 3-armed pilot RCT aimed to determine the feasibility and preliminary efficacy of an automated smartphone-based smoking cessation intervention (Smart-T2) relative to standard in-person smoking cessation clinic care and the National Cancer Institute’s free smoking cessation app, QuitGuide. Methods Adult smokers who attended a clinic-based tobacco cessation program were randomized into groups and followed for 13 weeks (1 week prequitting through 12 weeks postquitting). All study participants received nicotine patches and gum and were asked to complete EMAs five times a day on study-provided smartphones for 5 weeks. Participants in the Smart-T2 group received tailored treatment messages after the completion of each EMA. Both Smart-T2 and QuitGuide apps offer on-demand smoking cessation treatment. Results Of 81 participants, 41 (50%) were women and 55 (68%) were white. On average, participants were aged 49.6 years and smoked 22.4 cigarettes per day at baseline. A total of 17% (14/81) of participants were biochemically confirmed 7-day point prevalence abstinent at 12 weeks postquitting (Smart-T2: 6/27, 22%, QuitGuide: 4/27, 15%, and usual care: 4/27, 15%), with no significant differences across groups (P>.05). Participants in the Smart-T2 group rated the app positively, with most participants agreeing that they can rely on the app to help them quit smoking, and endorsed the belief that the app would help them stay quit, and these responses were not significantly different from the ratings given by participants in the usual care group. Conclusions Dynamic smartphone apps that tailor intervention content in real time may increase user engagement and exposure to treatment-related materials. The results of this pilot RCT suggest that smartphone-based smoking cessation treatments may be capable of providing similar outcomes to traditional, in-person counseling. Trial Registration ClinicalTrials.gov NCT02930200; https://clinicaltrials.gov/show/NCT02930200
Collapse
Affiliation(s)
- Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Chaelin K Ra
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Adam C Alexander
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Angela Helt
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Rachel Moisiuc
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Darla E Kendzor
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | | | - Rachel K Funk-Lawler
- Department of Psychiatry and Behavioral Sciences, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S Businelle
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| |
Collapse
|
27
|
Suchting R, Hébert ET, Ma P, Kendzor DE, Businelle MS. Using Elastic Net Penalized Cox Proportional Hazards Regression to Identify Predictors of Imminent Smoking Lapse. Nicotine Tob Res 2020; 21:173-179. [PMID: 29059349 DOI: 10.1093/ntr/ntx201] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/05/2017] [Indexed: 11/14/2022]
Abstract
Introduction Machine learning algorithms such as elastic net regression and backward selection provide a unique and powerful approach to model building given a set of psychosocial predictors of smoking lapse measured repeatedly via ecological momentary assessment (EMA). Understanding these predictors may aid in developing interventions for smoking lapse prevention. Methods In a randomized-controlled smoking cessation trial, smartphone-based EMAs were collected from 92 participants following a scheduled quit date. This secondary analysis utilized elastic net-penalized cox proportional hazards regression and model approximation via backward elimination to (1) optimize a predictive model of time to first lapse and (2) simplify that model to its core constituent predictors to maximize parsimony and generalizability. Results Elastic net proportional hazards regression selected 17 of 26 possible predictors from 2065 EMAs to model time to first lapse. The predictors with the highest magnitude regression coefficients were having consumed alcohol in the past hour, being around and interacting with a smoker, and having cigarettes easily available. This model was reduced using backward elimination, retaining five predictors and approximating to 93.9% of model fit. The retained predictors included those mentioned above as well as feeling irritable and being in areas where smoking is either discouraged or allowed (as opposed to not permitted). Conclusions The strongest predictors of smoking lapse were environmental in nature (e.g., being in smoking-permitted areas) as opposed to internal factors such as psychological affect. Interventions may be improved by a renewed focus of interventions on these predictors. Implications The present study demonstrated the utility of machine learning algorithms to optimize the prediction of time to smoking lapse using EMA data. The two models generated by the present analysis found that environmental factors were most strongly related to smoking lapse. The results support the use of machine learning algorithms to investigate intensive longitudinal data, and provide a foundation for the development of highly tailored, just-in-time interventions that can target on multiple antecedents of smoking lapse.
Collapse
Affiliation(s)
- Robert Suchting
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
| | - Ping Ma
- Division of Population Health, Children's Medical Center, Dallas, TX
| | - Darla E Kendzor
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Michael S Businelle
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| |
Collapse
|
28
|
Businelle MS, Hébert ET, Kendzor DE. Introduction to the special issue on use of mobile technology for real-time assessment and treatment of substance-use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 44:499-501. [PMID: 30044667 DOI: 10.1080/00952990.2018.1484923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Michael S Businelle
- a Department of Family and Preventive Medicine , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA.,b Oklahoma Tobacco Research Center, Stephenson Cancer Center , Oklahoma City , OK , USA
| | - Emily T Hébert
- b Oklahoma Tobacco Research Center, Stephenson Cancer Center , Oklahoma City , OK , USA
| | - Darla E Kendzor
- a Department of Family and Preventive Medicine , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA.,b Oklahoma Tobacco Research Center, Stephenson Cancer Center , Oklahoma City , OK , USA
| |
Collapse
|
29
|
Kendzor DE, Hébert ET, Businelle MS. Epilogue to the special issue on the use of mobile technology for real-time assessment and treatment of substance use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 44:571-574. [PMID: 30044669 DOI: 10.1080/00952990.2018.1495220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Darla E Kendzor
- a The University of Oklahoma Health Sciences Center, Stephenson Cancer Center , Oklahoma City , OK , USA
| | - Emily T Hébert
- a The University of Oklahoma Health Sciences Center, Stephenson Cancer Center , Oklahoma City , OK , USA
| | - Michael S Businelle
- a The University of Oklahoma Health Sciences Center, Stephenson Cancer Center , Oklahoma City , OK , USA
| |
Collapse
|
30
|
Cambron C, Haslam AK, Baucom BRW, Lam C, Vinci C, Cinciripini P, Li L, Wetter DW. Momentary precipitants connecting stress and smoking lapse during a quit attempt. Health Psychol 2019; 38:1049-1058. [PMID: 31556660 DOI: 10.1037/hea0000797] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Most attempts at smoking cessation are unsuccessful, and stress is frequently characterized both as a momentary precipitant of smoking lapse and a predictor of subsequent changes in other key precipitants of lapse. The current study examined longitudinal associations among stress, multiple precipitants of lapse, and lapse among smokers attempting to quit. METHOD Ecological momentary assessments (EMAs) were gathered from a multiethnic, gender-balanced sample of 370 adults enrolled in a smoking cessation program. EMAs (N = 32,563) assessed smoking lapse and precipitants of lapse, including stress, negative affect, smoking urge, abstinence self-efficacy, motivation to quit, difficulty concentrating, coping outcome expectancies, and smoking outcome expectancies. A multilevel structural equation model simultaneously estimated within-subject paths from stress to multiple precipitants and subsequent smoking lapse. Indirect effects of stress to smoking lapse through precipitants were computed. RESULTS Results indicated that increased stress was significantly associated with all precipitants of lapse, consistent with a greater risk for lapse (i.e., increased negative affect, smoking urge, difficulty concentrating, and smoking outcome expectancies and reduced abstinence self-efficacy, motivation to quit, and coping outcome expectancies). All precipitants were significantly associated with subsequent lapse. Indirect effects indicated that stress was uniquely connected to lapse through negative affect, smoking urge, abstinence self-efficacy, coping outcome expectancies, and smoking outcome expectancies. CONCLUSIONS Results of this study highlight the broad importance of stress for smoking lapse during a quit attempt. Smoking cessation programs should pay close attention to the role of stress in exacerbating key precipitants of lapse to improve cessation success rates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | - Cho Lam
- Huntsman Cancer Institute, University of Utah
| | | | - Paul Cinciripini
- Department of Behavioral Science, M. D. Anderson Cancer Center, The University of Texas
| | - Liang Li
- Department of Biostatistics, M. D. Anderson Cancer Center, The University of Texas
| | | |
Collapse
|
31
|
Koslovsky MD, Hébert ET, Swartz MD, Chan W, Leon-Novelo L, Wilkinson AV, Kendzor DE, Businelle MS. The Time-Varying Relations Between Risk Factors and Smoking Before and After a Quit Attempt. Nicotine Tob Res 2019; 20:1231-1236. [PMID: 29059413 DOI: 10.1093/ntr/ntx225] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 09/28/2017] [Indexed: 11/13/2022]
Abstract
Introduction Intensive longitudinal data (ILD) collected with ecological momentary assessments (EMAs) can provide a rich resource for understanding the relations between risk factors and smoking in the time surrounding a cessation attempt. Methods Participants (N = 142) were smokers seeking treatment at a safety-net hospital smoking cessation clinic who were randomly assigned to receive standard clinic care (ie, counseling and cessation medications) or standard care plus small financial incentives for biochemically confirmed smoking abstinence. Participants completed EMAs via study provided smartphones several times per day for 14 days (1 week prequit through 1 week postquit). EMAs assessed current contextual factors including environmental (eg, easy access to cigarettes, being around others smoking), cognitive (eg, urge to smoke, stress, coping expectancies, cessation motivation, cessation self-efficacy, restlessness), behavioral (ie, recent smoking and alcohol consumption), and affective variables. Temporal relations between risk factors and smoking were assessed using a logistic time-varying effect model. Results Participants were primarily female (57.8%) and Black (71.8%), with an annual household income of <$20000 per year (71.8%), who smoked 17.6 cigarettes per day (SD = 8.8). Individuals assigned to the financial incentives group had decreased odds of smoking compared with those assigned to usual care beginning 3 days before the quit attempt and continuing throughout the first week postquit. Environmental, cognitive, affective, and behavioral variables had complex time-varying impacts on smoking before and after the scheduled quit attempt. Conclusions Knowledge of time-varying effects may facilitate the development of interventions that target specific psychosocial and behavioral variables at critical moments in the weeks surrounding a quit attempt. Implications Previous research has examined time-varying relations between smoking and negative affect, urge to smoke, smoking dependence, and certain smoking cessation therapies. We extend this work using ILD of unexplored variables in a socioeconomically disadvantaged sample of smokers seeking cessation treatment. These findings could be used to inform ecological momentary interventions that deliver treatment resources (eg, video- or text-based content) to individuals based upon critical variables surrounding their attempt.
Collapse
Affiliation(s)
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK
| | - Michael D Swartz
- Department of Biostatistics & Data Science, UTHealth, Houston, TX
| | - Wenyaw Chan
- Department of Biostatistics & Data Science, UTHealth, Houston, TX
| | - Luis Leon-Novelo
- Department of Biostatistics & Data Science, UTHealth, Houston, TX
| | | | - Darla E Kendzor
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK.,Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Michael S Businelle
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, Oklahoma City, OK.,Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| |
Collapse
|
32
|
Vijayaraghavan M, Elser H, Apollonio D. Interventions to reduce tobacco use in people experiencing homelessness. Hippokratia 2019. [DOI: 10.1002/14651858.cd013413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maya Vijayaraghavan
- University of California, San Francisco; Division of General Internal Medicine; San Francisco California USA
| | - Holly Elser
- University of California, Berkeley; Epidemiology; Berkeley California USA
| | - Dorie Apollonio
- University of California San Francisco; Clinical Pharmacy; 3333 California Street Suite 420 San Francisco CA USA 94143-0613
| |
Collapse
|
33
|
Husain SA, Diaz K, Schwartz JE, Parsons FE, Burg MM, Davidson KW, Kronish IM. Behavioral economics implementation: Regret lottery improves mHealth patient study adherence. Contemp Clin Trials Commun 2019; 15:100387. [PMID: 31198881 PMCID: PMC6555893 DOI: 10.1016/j.conctc.2019.100387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/22/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022] Open
Abstract
Background Nonadherence to study protocols reduces the generalizability, validity, and statistical power of longitudinal studies. Purpose To determine whether an automated electronically-delivered regret lottery would improve adherence to an intensive mHealth self-monitoring protocol as part of a longitudinal observational study. Methods We enrolled 77 adults into a 52-week study requiring five daily ecologic momentary assessments (EMA) of stress and daily accelerometer use. We performed a pre/post single-arm study to evaluate the efficacy of a lottery intervention in improving adherence to this protocol. Midway through the study, participants were invited to enter a weekly regret lottery ($50 prize, expected value <$1) in which prize collection was contingent upon meeting adherence thresholds for the prior week. Study protocol adherence before and after lottery initiation were compared using mixed models repeated measures analysis of variance. Results 62 participants consented to lottery participation. In the 12 weeks prior to lottery initiation, weekly adherence was declining (slope −1.4%/week). The weekly per-participant probability of adherence was higher after lottery initiation when comparing the 4-week (32% pre-lottery vs 50% post-lottery, p < 0.001), 8-week (37% vs 49%, p < 0.001), and 12-week periods (39% vs 45%, p = 0.001) before and after lottery initiation. However, the rate of decline in adherence over time was unchanged. Conclusion The implementation of an automated, electronically-delivered weekly regret lottery improved adherence with an intensive self-monitoring study protocol. Regret lotteries may represent a cost-effective tool to improve adherence and reduce bias caused by dropout or nonadherence.
Collapse
Affiliation(s)
- S Ali Husain
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.,Division of Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Keith Diaz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.,Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, NY, USA
| | - Faith E Parsons
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Matthew M Burg
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
34
|
Baggett TP, McGlave C, Kruse GR, Yaqubi A, Chang Y, Rigotti NA. SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e13162. [PMID: 31165717 PMCID: PMC6746087 DOI: 10.2196/13162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/27/2019] [Accepted: 04/23/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. OBJECTIVE This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. METHODS From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. RESULTS Of the SmokefreeTXT arm participants (n=25), 88% (22) enrolled in the program, but only 56% (14) had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. CONCLUSIONS SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. TRIAL REGISTRATION ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ).
Collapse
Affiliation(s)
- Travis P Baggett
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Claire McGlave
- Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Gina R Kruse
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Awesta Yaqubi
- Boston University School of Medicine, Boston, MA, United States
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| |
Collapse
|
35
|
Berg CJ, Haardörfer R, Payne JB, Getachew B, Vu M, Guttentag A, Kirchner TR. Ecological momentary assessment of various tobacco product use among young adults. Addict Behav 2019; 92:38-46. [PMID: 30579116 DOI: 10.1016/j.addbeh.2018.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Young adults are at high risk for using traditional and novel tobacco products. However, little is known about daily/weekly use patterns or psychosocial triggers for using various tobacco products. METHODS This ecological momentary assessment (EMA) study examined timing, tobacco cravings, affect, social context, and other substance use (alcohol, marijuana) in relation to use of cigarettes, electronic nicotine delivery systems (ENDS), and any tobacco product (i.e., cigarettes, ENDS, cigars, hookah), respectively. We also examined interactions between these predictors, sex, and race/ethnicity. From a longitudinal study of 3418 18-25 year-olds from seven Georgia colleges/universities, we recruited 72 reporting current tobacco use to participate in the 21-day EMA study; 43 participated, of which 31 completed ≥66% assessments and were analyzed. Cravings, affect, social context, and substance use were assessed daily across four four-hour windows. RESULTS Of the 31 participants, average age was 21.10 years (SD = 1.95), 45.2% were female, and 71.0% non-Hispanic White; 71.0% used cigarettes, 58.1% ENDS, 38.7% cigars, and 25.8% hookah (25.6% used one product, 46.5% two, 27.9% ≥ three). Predictors of cigarette use included higher anxiety, greater odds of marijuana and alcohol use, and higher boredom levels among women. Predictors of ENDS use included being non-White and greater odds of marijuana use, as well as higher tobacco cravings among women and higher boredom among men. Predictors of any tobacco product use included being non-White, higher boredom levels, and greater odds of marijuana and alcohol use. CONCLUSIONS Distinct interventions may be needed to address use of differing tobacco products among young adults.
Collapse
Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States; Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322, United States.
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Jackelyn B Payne
- Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Betelihem Getachew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, United States
| | - Alexandra Guttentag
- College of Global Public Health, New York University, 715 Broadway, 12th Floor New York, NY 10003, United States
| | - Thomas R Kirchner
- College of Global Public Health, New York University, 715 Broadway, 12th Floor New York, NY 10003, United States
| |
Collapse
|
36
|
Cooper MR, Case KR, Hébert ET, Vandewater EA, Raese KA, Perry CL, Businelle MS. Characterizing ENDS use in young adults with ecological momentary assessment: Results from a pilot study. Addict Behav 2019; 91:30-36. [PMID: 30471788 PMCID: PMC6364672 DOI: 10.1016/j.addbeh.2018.11.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ecological Momentary Assessment (EMA) allows for assessment of electronic nicotine delivery systems (ENDS) use in real-time. This EMA study aimed to 1) describe study participation rates; 2) evaluate the concordance of EMA and survey items measuring frequency and quantity of ENDS use; and 3) assess the relationships between EMA items measuring frequency and quantity of ENDS use with ENDS dependence, measured at baseline and with saliva cotinine collected at follow-up. METHODS Fifty young adult ENDS users completed baseline surveys, EMAs (i.e., random, event-based, daily diaries), and follow-up questionnaires over a 14-day period. Spearman correlations were conducted to determine concordance of survey items. Linear regression models assessed the relationships between EMA ENDS use characteristics (e.g., puffs, number of days used, quantity of e-liquid) with dependence items at baseline and saliva cotinine at follow-up. RESULTS Overall completion for the prompted EMAs (random and daily diaries) was 68%. Correlations between EMA measures assessing ENDS use ranged from weak (ρ = -0.02; NS) to strong (ρ = 0.69, p < .001); EMA to follow-up items ranged from weak (ρ = 0.16; p < .05) to moderate (ρ = 0.54; p < .001). Significant associations were found between ENDS use measured via random and daily diary EMAs and saliva cotinine at follow-up after controlling for cigarette smoking (B = 0.70-1.76; p < .01), but not for event-based EMAs. Items measuring frequency/quantity of use from random EMAs were consistently associated with ENDS dependence at baseline (B = 0.74-1.58; p < .01). CONCLUSION EMA represents a promising methodology to capture real-time ENDS use behaviors, primarily through daily diary and random EMAs.
Collapse
Affiliation(s)
- Maria R Cooper
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA.
| | - Kathleen R Case
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Emily T Hébert
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA
| | - Elizabeth A Vandewater
- University of Texas at Austin, Population Research Center, 305 E. 23rd Street, Stop G1800, Austin, TX 78712, USA
| | - Kristen A Raese
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Cheryl L Perry
- University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Austin Campus, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Michael S Businelle
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA
| |
Collapse
|
37
|
Nandy RR, Nandy K, Hébert ET, Businelle MS, Walters ST. Identifying Behaviors Predicting Early Morning Emotions by Observing Permanent Supportive Housing Residents: An Ecological Momentary Assessment. JMIR Ment Health 2019; 6:e10186. [PMID: 30730296 PMCID: PMC6385519 DOI: 10.2196/10186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 10/07/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Behavior and emotions are closely intertwined. The relationship between behavior and emotions might be particularly important in populations of underserved people, such as people with physical or mental health issues. We used ecological momentary assessment (EMA) to examine the relationship between emotional state and other characteristics among people with a history of chronic homelessness who were participating in a health coaching program. OBJECTIVE The goal of this study was to identify relationships between daily emotional states (valence and arousal) shortly after waking and behavioral variables such as physical activity, diet, social interaction, medication compliance, and tobacco usage the prior day, controlling for demographic characteristics. METHODS Participants in m.chat, a technology-assisted health coaching program, were recruited from housing agencies in Fort Worth, Texas, United States. All participants had a history of chronic homelessness and reported at least one mental health condition. We asked a subset of participants to complete daily EMAs of emotions and other behaviors. From the circumplex model of affect, the EMA included 9 questions related to the current emotional state of the participant (happy, frustrated, sad, worried, restless, excited, calm, bored, and sluggish). The responses were used to calculate two composite scores for valence and arousal. RESULTS Nonwhites reported higher scores for both valence and arousal, but not at a statistically significant level after correcting for multiple testing. Among momentary predictors, greater time spent in one-on-one interactions, greater time spent in physical activities, a greater number of servings of fruits and vegetables, greater time spent interacting in a one-on-one setting as well as adherence to prescribed medication the previous day were generally associated with higher scores for both valence and arousal, and statistical significance was achieved in most cases. Number of cigarettes smoked the previous day was generally associated with lower scores on both valence and arousal, although statistical significance was achieved for valence only when correcting for multiple testing. CONCLUSIONS This study provides an important glimpse into factors that predict morning emotions among people with mental health issues and a history of chronic homelessness. Behaviors considered to be positive (eg, physical activity and consumption of fruits and vegetables) generally enhanced positive affect and restrained negative affect the following morning. The opposite was true for behaviors such as smoking, which are considered to be negative.
Collapse
Affiliation(s)
- Rajesh R Nandy
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Karabi Nandy
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S Businelle
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Scott T Walters
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, United States
| |
Collapse
|
38
|
Neisler J, Reitzel LR, Garey L, Kenzdor DE, Hébert ET, Vijayaraghavan M, Businelle MS. The moderating effect of perceived social support on the relation between heaviness of smoking and quit attempts among adult homeless smokers. Drug Alcohol Depend 2018; 190:128-132. [PMID: 30016736 PMCID: PMC6084469 DOI: 10.1016/j.drugalcdep.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Over 70% of homeless adults smoke cigarettes. Despite the desire to quit, this group rarely receives the external support to make or maintain a successful quit attempt (SQA; intentional quit attempt lasting >24 h). The Heaviness of Smoking Index (HSI) is a cigarette dependence measure that independently predicts SQAs among domiciled adults. For homeless adults, social support may be a way to buffer the impact of cigarette dependence on SQAs. METHODS The association of the HSI and past-year SQAs, and the potential moderating role of social support, was examined among 445 homeless smokers (Mage = 43.2 + 11.8, 65% male, 57.5% white). Support was measured by the International Support Evaluation List (ISEL-12) and its 3 subscales: tangible, belonging, & appraisal support. RESULTS The HSI was negatively correlated with SQAs (r=-.283, p < .01) and in a regression model controlling for age, sex, and race/ethnicity, appraisal support significantly moderated this relationship (p < .05). The HSI was significantly related to SQAs across low, moderate, and high levels of appraisal support [mean, +1 SD; low (β=-.657, p < .001), medium (β=-.457, p < .001), and high (β=-.258, p < .05)]. Neither the ISEL-12 total nor the other subscales were moderators. CONCLUSION The perceived availability of someone to talk to about one's problems appeared to attenuate the strength of the inverse relationship between the heaviness of smoking and SQAs. Fostering appraisal support for homeless smokers through group treatment may reduce the impact of cigarette dependence on making quit attempts. Social support coupled with the increased availability of empirically-supported cessation aids may improve dismal quit rates among homeless adults.
Collapse
Affiliation(s)
- Julie Neisler
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX, 77204, USA; HEALTH Research Institute, The University of Houston, 4849 Calhoun Road, Houston, TX, 77204, USA
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, College of Education, The University of Houston, 491 Farish Hall, Houston, TX, 77204, USA; HEALTH Research Institute, The University of Houston, 4849 Calhoun Road, Houston, TX, 77204, USA.
| | - Lorra Garey
- Department of Psychology, The University of Houston, 126 Heyne Building, Houston, TX, 77204, USA
| | - Darla E Kenzdor
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Emily T Hébert
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| | - Maya Vijayaraghavan
- Division of General Internal Medicine/Zuckerberg San Francisco General Hospital, University of California San Francisco, 1001 Potrero Ave., Rm. 1311E, San Francisco, CA, 94110, USA
| | - Michael S Businelle
- The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA
| |
Collapse
|
39
|
Mead EL, Chen JC, Kirchner TR, Butler J, Feldman RH. An Ecological Momentary Assessment of Cigarette and Cigar Dual Use Among African American Young Adults. Nicotine Tob Res 2018; 20:S12-S21. [PMID: 30125017 PMCID: PMC6093372 DOI: 10.1093/ntr/nty061] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 03/28/2018] [Indexed: 11/25/2022]
Abstract
Introduction The dual use of cigarettes and cigars among African American young adults is a significant public health issue. Patterns of and reasons for dual use are difficult to capture using traditional self-report methods. This study used ecological momentary assessment (EMA) to characterize patterns of dual smoking and examine the personal and environmental predictors of cigarette and cigar smoking among African American young adult dual users (ages 18-29) in real-time. Methods For 14 days, 64 participants smoked ad libitum and were prompted four times daily to record their smoking, craving, emotions, social smoking, and environment via text message on their mobile phones. The odds of single product and dual use were examined using adjusted generalized estimating equations. Results Participants smoked an average of 7.9 cigarettes and 4.2 cigars per day. Cigarettes and cigars were smoked as frequently during periods of dual use as they were during periods of single product use. Cigarette craving was positively associated with cigarette-only smoking (OR: 1.07), whereas cigar craving was positively associated with cigar-only smoking (OR: 1.43) and dual use (OR: 1.08). Cigars had the greatest odds of dual use when with others (OR: 4.69) and in others' homes (OR: 4.33). Cigarettes had the greatest odds of being smoked while alone (OR: 1.57). Conclusions EMA was useful for capturing variable smoking patterns and predictors. In this study population, cigarettes and cigars appeared to be smoked additively, and cigars smoked socially. These findings can inform future interventions addressing dual use in this high priority population. Implications This is the first study to use EMA to examine naturalistic patterns and predictors of multiple tobacco use in real-time. African American young adults smoked cigarettes and cigars during periods of dual use as frequently as during periods of single product use. This suggests that most use was additive (one product smoked in addition to another) and less often as substitution (one product smoked instead of another). Social smoking and craving were strongly associated with cigar smoking in single and dual use periods. This study suggests the need for cessation messaging specifically targeted to reduce dual use in this population.
Collapse
Affiliation(s)
- Erin L Mead
- University of Connecticut Health, School of Medicine, Farmington, CT
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, Tobacco Center of Regulatory Science, College Park, MD
| | - Julia Cen Chen
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD
| | | | - James Butler
- University of Maryland Center for Health Equity, School of Public Health, Department of Behavioral and Community Health, College Park, MD
| | - Robert H Feldman
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, Tobacco Center of Regulatory Science, College Park, MD
| |
Collapse
|
40
|
Reingle Gonzalez JM, Businelle MS, Kendzor D, Staton M, North CS, Swartz M. Using mHealth to Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2Care): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e151. [PMID: 29871852 PMCID: PMC6008513 DOI: 10.2196/resprot.9868] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/23/2018] [Accepted: 04/10/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). Many barriers (eg, limited transportation, inability to schedule appointments, and limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services. Objective The aim of the Link2Care study is to assess the effectiveness of a smartphone app for increasing case management and treatment service utilization, and in turn reduce homelessness and rearrest. The goals of this research are to (1) assess the impact of an innovative smartphone app that will prompt and directly link recently incarcerated homeless adults to community-based case management services and resources and (2) utilize in-person and smartphone-based assessments to identify key variables (eg, alcohol or drug use, social support, psychological distress, and quality of life) that predict continued homelessness and rearrest. Methods Homeless adults (N=432) who enroll in a shelter-based Homeless Recovery Program after release from the Dallas County Jail will be randomly assigned to one of the three treatment groups: (1) usual case management, (2) usual case management plus smartphone, and (3) usual case management with a study-provided smartphone that is preloaded with an innovative case management app (smartphone-based case management). Those assigned to smartphone-based case management will receive smartphones that prompt (twice weekly) connections to shelter-based case managers. The app will also offer direct links to case managers (available during normal business hours) and crisis interventionists (available 24 hours a day, 7 days a week) with the touch of a button. Results Recruitment began in the spring of 2018, and data collection will conclude in 2021. Conclusions This research represents an important step toward integrated service connection and health care service provision for one of the most underserved, high need, and understudied populations in the United States. Trial Registration ClinicalTrials.gov NCT03399500; https://clinicaltrials.gov/ct2/show/NCT03399500 (Archived by WebCite at http://www.webcitation.org/6zSJwdgUS) Registered Report Identifier RR1-10.2196/9868
Collapse
Affiliation(s)
- Jennifer M Reingle Gonzalez
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Dallas, TX, United States
| | - Michael S Businelle
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Darla Kendzor
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center and Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Carol S North
- Metrocare Services and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michael Swartz
- Department of Biostatistics, School of Public Health, University of Texas, Houston, TX, United States
| |
Collapse
|
41
|
Santa Maria D, Padhye N, Yang Y, Gallardo K, Businelle M. Predicting Sexual Behaviors Among Homeless Young Adults: Ecological Momentary Assessment Study. JMIR Public Health Surveill 2018; 4:e39. [PMID: 29636318 PMCID: PMC5915668 DOI: 10.2196/publichealth.9020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/02/2018] [Accepted: 02/02/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Homeless youth continue to be disproportionately affected by HIV compared with their housed peers, with prevalence rates as high as 13%. Yet, HIV prevention in this high-risk population has been only marginally effective. OBJECTIVE The aim of this study was to use ecological momentary assessments to examine real-time factors to determine the predictors of sexual activity among homeless youth. METHODS Youth experiencing homelessness aged between 18 and 24 years were recruited from a drop-in center in Houston, Texas, between August 2015 and May 2016. All the participants received a study-issued mobile phone that prompted brief ecological momentary assessments (EMAs) 5 times a day for 21 days. EMA items assessed near real-time sexual behaviors, cognitions, stress, affect, environmental factors, and environmental circumstances. RESULTS Participants (N=66) were predominantly male (41/66, 64%) and black (43/66, 66%) with a median age of 20 years. The mean number of EMAs completed by each participant was 45 out of 105 possible observations. During the study, 70% (46/66) of participants were sexually active and reported condomless sex in 102 of the 137 cases of sexual intercourse (74.5%). In total, 82% (38/46) of the youth who reported having sex during the 3 weeks of data collection also reported engaging in high-risk sexual activities, including having condomless sex (24/46, 53%), having multiple sexual partners on the same day (12/46, 26%), trading sex (7/46, 16%), and sharing needles while injecting drugs (1/46, 3%). Of those, 71% (27/38) were engaged in multiple sexual risk behaviors. The predictive model was based on observations from 66 subjects who reported 137 cases of sexual intercourse over 811 days; sexual orientation, race, mental health, drug use, and sexual urge were included as predictors in the parsimonious generalized linear mixed model selected on the basis of the Akaike information criterion. The estimated odds ratios (ORs) were notable for same-day drug use (OR 2.17, 95% CI 4.48-17.31; P<.001) and sexual urge (OR 1.44, 95% CI 1.60-11.28; P=.004). The performance of the risk estimator was satisfactory, as indicated by the value of 0.834 for the area under the receiver operating characteristic curve. CONCLUSIONS Real-time EMA data can be used to predict sexual intercourse among a sample of high-risk, predominately unsheltered homeless youth. Sexual urge and drug use accounts for increased odds of engaging in sexual activity on any given day. Interventions targeting sexual urge and drug use may help predict sexual activity among a population at high risk of HIV.
Collapse
Affiliation(s)
- Diane Santa Maria
- School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Nikhil Padhye
- School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yijiong Yang
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kathryn Gallardo
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Michael Businelle
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| |
Collapse
|
42
|
Tomko RL, Gray KM, Oppenheimer SR, Wahlquist AE, McClure EA. Using REDCap for ambulatory assessment: Implementation in a clinical trial for smoking cessation to augment in-person data collection. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018. [PMID: 29513609 DOI: 10.1080/00952990.2018.1437445] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The use of ambulatory assessment to study behavior and physiology in daily life is becoming more common, yet barriers to implementation remain. Limitations in budget, time, and expertise may inhibit development or purchase of dedicated ambulatory assessment software. Research Electronic Data Capture (REDCap) is widely used worldwide, offering a cost-effective and accessible option for implementing research studies. OBJECTIVES To present a step-by-step guideline on how to implement ambulatory assessment using REDCap and provide preliminary evidence of feasibility. METHODS Feasibility and acceptability data are presented for randomized participants (N ranged from 19 to 36, depending on analysis) from an ongoing 8-week smoking cessation pharmacological clinical trial (ClinicalTrials.gov Identifier: NCT02737358). Participants (N = 36; 50% female) completed up to three ambulatory assessment surveys per day, depending on the phase of the study. These included self-report and video confirmation of smoking biomarkers and medication adherence. RESULTS Participants completed 74.8% of morning reports (86.6% for study completers), 73.8% of videos confirming smoking biomarkers, and 70.4% of videos confirming medication adherence. Study completers reported that the REDCap assessments were easy to use, and 78.9% of participants preferred the REDCap assessments to traditional, paper measures. CONCLUSIONS These data from a pharmacological trial suggest feasibility of remote data collection using REDCap. As REDCap functionality is continually evolving, it is likely that options for collecting ambulatory assessment data via this platform will progressively improve allowing for greater individualization of assessment scheduling for enhancing data collection in clinical trials.
Collapse
Affiliation(s)
- Rachel L Tomko
- a Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Kevin M Gray
- a Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Stephanie R Oppenheimer
- b South Carolina Clinical and Translational Research (SCTR) Institute , Medical University of South Carolina , Charleston , SC , USA
| | - Amy E Wahlquist
- c Department of Public Health Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Erin A McClure
- a Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| |
Collapse
|
43
|
Hébert ET, Stevens EM, Frank SG, Kendzor DE, Wetter DW, Zvolensky MJ, Buckner JD, Businelle MS. An ecological momentary intervention for smoking cessation: The associations of just-in-time, tailored messages with lapse risk factors. Addict Behav 2018; 78:30-35. [PMID: 29121530 DOI: 10.1016/j.addbeh.2017.10.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/16/2017] [Accepted: 10/27/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Smartphone apps can provide real-time, tailored interventions for smoking cessation. The current study examines the effectiveness of a smartphone-based smoking cessation application that assessed risk for imminent smoking lapse multiple times per day and provided messages tailored to current smoking lapse risk and specific lapse triggers. METHODS Participants (N=59) recruited from a safety-net hospital smoking cessation clinic completed phone-based ecological momentary assessments (EMAs) 5 times/day for 3 consecutive weeks (1week pre-quit, 2weeks post-quit). Risk for smoking lapse was estimated in real-time using a novel weighted lapse risk estimator. With each EMA, participants received messages tailored to current level of risk for imminent smoking lapse and self-reported presence of smoking urge, stress, cigarette availability, and motivation to quit. Generalized linear mixed model analyses determined whether messages tailored to specific lapse risk factors were associated with greater reductions in these triggers than messages not tailored to specific triggers. RESULTS Overall, messages tailored to smoking urge, cigarette availability, or stress corresponded with greater reductions in those triggers than messages that were not tailored to specific triggers (p's=0.02 to <0.001). Although messages tailored to stress were associated with greater reductions in stress than messages not tailored to stress, the association was non-significant (p=0.892) when only moments of high stress were included in the analysis. CONCLUSIONS Mobile technology can be used to conduct real-time smoking lapse risk assessment and provide tailored treatment content. Findings provide initial evidence that tailored content may impact users' urge to smoke, stress, and cigarette availability.
Collapse
Affiliation(s)
- Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
| | - Elise M Stevens
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Summer G Frank
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Darla E Kendzor
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - David W Wetter
- Department of Population Health Sciences and the Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Michael J Zvolensky
- The University of Houston, College of Liberal Arts and Social Sciences, Department of Psychology, Houston, TX, United States
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Michael S Businelle
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| |
Collapse
|
44
|
Abstract
Objectives We used ecological momentary assessment (EMA) to examine young adults' attitudes towards pro-tobacco messages encountered in real time and their association with intentions to use tobacco. Methods Young adults (N = 92, ages 18-29) recorded sightings of marketing or social media related to tobacco in real time via mobile app for 28 days. Participants reported message characteristics, their attitudes towards the message, and intentions to use the depicted product for each submission. We used generalized linear mixed models to examine factors related to attitude towards message and intentions to use tobacco. Results Messages depicting e-cigarettes (p < .001) or hookah (p < .05) were associated with significantly more favorable attitudes compared with traditional cigarettes. Positive attitude towards the message was significantly associated with intention to use the depicted product (p < .001). Messages depicting e-cigarettes and hookah were significantly associated with higher intention to use. Message source was not significantly related to attitudes towards the message or product use intentions. Conclusions Marketing featuring e-cigarettes and hookah is an important target for future regulation. Given that pro-tobacco and e-cigarette messages are prevalent online, future research should consider the Internet and social media as important venues for counter-marketing and intervention efforts.
Collapse
|
45
|
Santa Maria D, Padhye N, Yang Y, Gallardo K, Santos GM, Jung J, Businelle M. Drug use patterns and predictors among homeless youth: Results of an ecological momentary assessment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:551-560. [PMID: 29286835 DOI: 10.1080/00952990.2017.1407328] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Alcohol and drug use is associated with significant morbidity and mortality and is highly prevalent among homeless youth. Ecological Momentary Assessments (EMA) have been used to examine the effect of urges on drug use, though not among homeless youth. OBJECTIVES We assessed the patterns of drug use and the correlation between real-time contextual factors and drug use using EMA collected daily. We identified predictors of drug use among a sample of homeless youth 18-25 years old in Houston, Texas. METHODS Homeless youth (n = 66, 62% male) were recruited from a drop-in center between September 2015 and May 2016. We used generalized linear mixed models and cross-validation methods to determine the best predictive model of drug use. RESULTS The overall drug use was high: 61% and 32% of participants reported using drugs or alcohol at least one day, respectively. Marijuana and synthetic marijuana use (i.e., Kush, K2, incense packs) were reported most frequently; 86% and 13% of the total drug use EMAs, respectfully. Drug use urge was reported on 26% of days and was the highest on drug use days. Drug use was predicted by discrimination, pornography use, alcohol use, and urges for drugs, alcohol, and to steal. CONCLUSIONS EMA can be used to predict drug use among homeless youth. Drug use treatment among homeless youth should address the role of experiencing discrimination, pornography and alcohol use, and urge management strategies on drug use. Research is needed to determine if EMA informed just-in-time interventions targeting these predictors can reduce use.
Collapse
Affiliation(s)
- Diane Santa Maria
- a University of Texas Health Science Center , School of Nursing, Center for Nursing Research , Houston , TX , USA
| | - Nikhil Padhye
- a University of Texas Health Science Center , School of Nursing, Center for Nursing Research , Houston , TX , USA
| | - Yijiong Yang
- b University of Texas Health Science , Center School of Public Health , Houston , TX , USA
| | - Kathryn Gallardo
- b University of Texas Health Science , Center School of Public Health , Houston , TX , USA
| | - Glenn-Milo Santos
- c Department of Community Health Systems, University of California , San Francisco School of Nursing , San Francisco , CA , USA
| | | | - Michael Businelle
- e The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center , Oklahoma City , OK , USA
| |
Collapse
|
46
|
Holt NJ. Using the experience-sampling method to examine the psychological mechanisms by which participatory art improves wellbeing. Perspect Public Health 2017; 138:55-65. [PMID: 29130867 DOI: 10.1177/1757913917739041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To measure the immediate impact of art-making in everyday life on diverse indices of wellbeing ('in the moment' and longer term) in order to improve understanding of the psychological mechanisms by which art may improve mental health. METHODS Using the experience-sampling method, 41 artists were prompted (with a 'beep' on a handheld computer) at random intervals (10 times a day, for one week) to answer a short questionnaire. The questionnaire tracked art-making and enquired about mood, cognition and state of consciousness. This resulted in 2,495 sampled experiences, with a high response rate in which 89% of questionnaires were completed. RESULTS Multi-level modelling was used to evaluate the impact of art-making on experience, with 2,495 'experiences' (experiential-level) nested within 41 participants (person-level). Recent art-making was significantly associated with experiential shifts: improvement in hedonic tone, vivid internal imagery and the flow state. Furthermore, the frequency of art-making across the week was associated with person-level measures of wellbeing: eudemonic happiness and self-regulation. Cross-level interactions, between experiential and person-level variables, suggested that hedonic tone improved more for those scoring low on eudemonic happiness, and further that, those high in eudemonic happiness were more likely to experience phenomenological features of the flow state and to experience inner dialogue while art-making. CONCLUSION Art-making has both immediate and long-term associations with wellbeing. At the experiential level, art-making affects multiple dimensions of conscious experience: affective, cognitive and state factors. This suggests that there are multiple routes to wellbeing (improving hedonic tone, making meaning through inner dialogue and experiencing the flow state). Recommendations are made to consider these factors when both developing and evaluating public health interventions that involve participatory art.
Collapse
Affiliation(s)
- Nicola J Holt
- Senior Lecturer, Department of Health and Social Sciences, University of the West of England, Bristol, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| |
Collapse
|
47
|
Koslovsky MD, Swartz MD, Chan W, Leon-Novelo L, Wilkinson AV, Kendzor DE, Businelle MS. Bayesian variable selection for multistate Markov models with interval-censored data in an ecological momentary assessment study of smoking cessation. Biometrics 2017; 74:636-644. [PMID: 29023626 DOI: 10.1111/biom.12792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022]
Abstract
The application of sophisticated analytical methods to intensive longitudinal data, collected with ecological momentary assessments (EMA), has helped researchers better understand smoking behaviors after a quit attempt. Unfortunately, the wealth of information captured with EMAs is typically underutilized in practice. Thus, novel methods are needed to extract this information in exploratory research studies. One of the main objectives of intensive longitudinal data analysis is identifying relations between risk factors and outcomes of interest. Our goal is to develop and apply expectation maximization variable selection for Bayesian multistate Markov models with interval-censored data to generate new insights into the relation between potential risk factors and transitions between smoking states. Through simulation, we demonstrate the effectiveness of our method in identifying associated risk factors and its ability to outperform the LASSO in a special case. Additionally, we use the expectation conditional-maximization algorithm to simplify estimation, a deterministic annealing variant to reduce the algorithm's dependence on starting values, and Louis's method to estimate unknown parameter uncertainty. We then apply our method to intensive longitudinal data collected with EMA to identify risk factors associated with transitions between smoking states after a quit attempt in a cohort of socioeconomically disadvantaged smokers who were interested in quitting.
Collapse
Affiliation(s)
| | - Michael D Swartz
- Department of Biostatistics & Data Science, UTHealth, Houston, Texas, U.S.A
| | - Wenyaw Chan
- Department of Biostatistics & Data Science, UTHealth, Houston, Texas, U.S.A
| | - Luis Leon-Novelo
- Department of Biostatistics & Data Science, UTHealth, Houston, Texas, U.S.A
| | | | - Darla E Kendzor
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, U.S.A
| | - Michael S Businelle
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, U.S.A
| |
Collapse
|
48
|
Vijayaraghavan M, Olsen P, Weeks J, McKelvey K, Ponath C, Kushel M. Older African American Homeless-Experienced Smokers' Attitudes Toward Tobacco Control Policies-Results from the HOPE HOME Study. Am J Health Promot 2017; 32:381-391. [PMID: 28893086 DOI: 10.1177/0890117117729928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine attitudes toward tobacco control policies among older African American homeless-experienced smokers. APPROACH A qualitative study. SETTING Oakland, California. PARTICIPANTS Twenty-two African American older homeless-experienced smokers who were part of a longitudinal study on health and health-related outcomes (Health Outcomes of People Experiencing Homelessness in Older Middle Age Study). METHOD We conducted in-depth, semistructured interviews with each participant to explore beliefs and attitudes toward tobacco use and cessation, barriers to smoking cessation, and attitudes toward current tobacco control strategies including raising cigarette prices, smoke-free policies, and graphic warning labels. We used a grounded theory approach to analyze the transcripts. RESULTS Community social norms supportive of cigarette smoking and co-use of tobacco with other illicit substances were strong motivators of initiation and maintenance of tobacco use. Self-reported barriers to cessation included nicotine dependence, the experience of being homeless, fatalistic attitudes toward smoking cessation, substance use, and exposure to tobacco industry marketing. While participants were cognizant of current tobacco control policies and interventions for cessation, they felt that they were not specific enough for African Americans experiencing homelessness. Participants expressed strong support for strategies that de-normalized tobacco use and advertised the harmful effects of tobacco. CONCLUSION Older African American homeless-experienced smokers face significant barriers to smoking cessation. Interventions that advertise the harmful effects of tobacco may be effective in stimulating smoking cessation among this population.
Collapse
Affiliation(s)
- Maya Vijayaraghavan
- 1 Division of General Internal Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,2 Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Pamela Olsen
- 1 Division of General Internal Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - John Weeks
- 1 Division of General Internal Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Karma McKelvey
- 2 Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Claudia Ponath
- 1 Division of General Internal Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Margot Kushel
- 1 Division of General Internal Medicine, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| |
Collapse
|
49
|
Kim JE, Flentje A, Tsoh JY, Riley ED. Cigarette Smoking among Women Who Are Homeless or Unstably Housed: Examining the Role of Food Insecurity. J Urban Health 2017; 94:514-524. [PMID: 28589340 PMCID: PMC5533665 DOI: 10.1007/s11524-017-0166-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Smoking prevalence remains high among individuals who are homeless, partly due to stressors related to homelessness. Beyond housing insecurity, homelessness involves financial stresses and unmet subsistence needs. In particular, food insecurity contributes to negative health outcomes and other health risks. This study examined associations between food insecurity severity and smoking among homeless and marginally housed women in San Francisco, California. We used data from 247 women from a longitudinal cohort study. Generalized estimating equations were used to estimate longitudinal associations between study factors and smoking based on data from five biannual assessment points between 2009 and 2012. The longitudinal adjusted odds of smoking were higher among severely food insecure individuals compared to those who were not food insecure (AOR = 1.68, 95% CI [1.02, 2.78]), while associations with other study factors, including demographics, time, HIV status, mental health, and substance use (except marijuana use), did not reach levels of significance. Similar adjusted longitudinal results were observed when food insecurity was the dependent variable and smoking an independent variable, suggesting the possibility of a bidirectional association. Considering unmet needs, such as food and hunger, may improve comprehensive smoking cessation strategies targeting individuals for whom mainstream tobacco control efforts have not been effective. Similarly, offering improved access to smoking cessation resources should be considered in efforts to address food insecurity among individuals experiencing homelessness.
Collapse
Affiliation(s)
- Jin E Kim
- University of California San Francisco, San Francisco, CA, USA.
| | - Annesa Flentje
- University of California San Francisco, San Francisco, CA, USA
| | - Janice Y Tsoh
- University of California San Francisco, San Francisco, CA, USA
| | - Elise D Riley
- University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
50
|
Vinci C, Li L, Wu C, Lam CY, Guo L, Correa-Fernández V, Spears CA, Hoover DS, Etcheverry PE, Wetter DW. The association of positive emotion and first smoking lapse: An ecological momentary assessment study. Health Psychol 2017; 36:1038-1046. [PMID: 28726478 DOI: 10.1037/hea0000535] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Individuals attempting to quit smoking typically have poor success rates, and the majority fail to maintain long-term abstinence. Although a large body of evidence documents the impact of negative affect on reducing abstinence, there is a much smaller body of research on positive emotions, which could be an important mechanism that is associated with successful cessation. As such, this study examined positive emotions in real-time via ecological momentary assessment (EMA) to determine whether discrete positive emotions were uniquely related to 2 cessation milestones: quit day lapse and first lapse. METHOD Participants were 391 smokers who received tobacco cessation treatment. EMAs were completed pre- and postquit, and positive emotion was assessed with 3 items (enthusiastic, happy, and relaxed) rated on 5-point Likert scales. Analyses examined the associations of the means and slopes of each emotion on the current day with the likelihood of lapse on the following day. RESULTS When controlling for relevant covariates, prequit positive emotions were not related to quit day lapse. However, postquit positive emotions were associated with first lapse. Specifically, high levels of happiness and relaxation, as well as increasing levels of enthusiasm, happiness, and relaxation were related to a lower likelihood of next day lapse. CONCLUSIONS These are some of the first real-time, real-world data to demonstrate that distinct positive emotions are associated with a lower risk of lapse during the postquit period among smokers attempting to quit. (PsycINFO Database Record
Collapse
Affiliation(s)
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center
| | - Cai Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center
| | - Cho Y Lam
- Department of Population Health Sciences, University of Utah
| | | | | | - Claire A Spears
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University
| | - Diana S Hoover
- Department of Health Disparities, The University of Texas MD Anderson Cancer Center
| | | | - David W Wetter
- Department of Population Health Sciences, University of Utah
| |
Collapse
|