Measurement Properties of Smartphone Approaches to Assess Diet, Alcohol Use, and Tobacco Use: Systematic Review

Addressing key risk factors for suicide at a societal level

A public health approach to suicide prevention recognises the powerful influence of social determinants. In this paper-the fifth in a Series on a public health approach to suicide prevention-we consider four major risk factors for suicide (alcohol use, gambling, domestic violence and abuse, and suicide bereavement) and examine how their influence on suicide is socially determined. Cultural factors and societal responses have an important role in all four risk factors. In the case of alcohol use and gambling, commercial entities are culpable. This Series paper describes a range of universal, selective, and indicated interventions that might address these risk factors, and focuses particularly on key universal interventions that are likely to yield substantial population-level benefits.

Social mobile sensing and problematic alcohol consumption: Insights from smartphone metadata

BACKGROUND

Alcohol is often consumed in a social context. We aim to investigate whether social mobile sensing is associated with real-world social interactions and alcohol consumption. In addition, we investigate how social restriction policies implemented during the COVID-19 pandemic have influenced these associations.

METHODS

We conducted a smartphone-based ecological momentary assessment (EMA) study for 7 days over a 213-day period from 8 August 2020 to 9 March 2021 in Germany, including both no-lockdown and lockdown stages. Participants used a smartphone application which passively collects data on social behavior (e.g., app usage, phone calls, SMS). Moreover, we assessed real-world social interactions and alcohol consumption via daily questionnaires.

RESULTS

We found that each one-hour increase in social media usage was associated with a 40.2% decrease in the average number of drinks consumed. Mediation analysis suggested that social media usage decreases alcohol intake through decreased real-world social interactions. Notably, we did not find that any significant influence of the lockdown stage on the association between social mobile sensing and alcohol intake.

CONCLUSIONS

Our study suggests that people who use more social media drink less, likely due to reduced face-to-face social interactions. This highlights the potential of social mobile sensing as an objective measure of social activity and its implications for understanding alcohol consumption behavior.

Acceptability and validity of using the BACtrack skyn wrist-worn transdermal alcohol concentration sensor to capture alcohol use across 28 days under naturalistic conditions - A pilot study

Wrist-worn transdermal alcohol concentration (TAC) sensors have the potential to provide detailed information about day-level features of alcohol use but have rarely been used in field-based research or in early adulthood (i.e., 26-40 years) alcohol users. This pilot study assessed the acceptability, user burden, and validity of using the BACtrack Skyn across 28 days in individuals' natural settings. Adults aged 26-37 (N = 11, Mage = 31.2, 55% female, 73% non-Hispanic white) participated in a study including retrospective surveys, a 28-day field protocol wearing Skyn and SCRAM sensors and completing ecological momentary assessments (EMA) of alcohol use and duration (daily morning reports and participant-initiated start/stop drinking EMAs), and follow-up interviews. Day-level features of alcohol use extracted from self-reports and/or sensors included drinks consumed, estimated Blood Alcohol Concentration (eBAC), drinking duration, peak TAC, area under the curve (AUC), rise rate, and fall rate. Repeated-measures correlations (rrm) tested within-person associations between day-level features of alcohol use from the Skyn versus self-report or the SCRAM. Participants preferred wearing the Skyn over the SCRAM [t (10) = -6.79, p < .001, d = 2.74]. Skyn data were available for 5614 (74.2%) out of 7566 h, with 20.7% of data lost due to syncing/charging issues and 5.1% lost due to device removal. Skyn agreement for detecting drinking days was 55.5% and 70.3% when compared to self-report and the SCRAM, respectively. Correlations for drinking intensity between self-report and the Skyn were 0.35 for peak TAC, 0.52 for AUC, and 0.30 for eBAC, which were smaller than correlations between self-report and SCRAM, at 0.78 for peak TAC, 0.79 for AUC, and 0.61 for eBAC. Correlations for drinking duration were larger when comparing self-report to the Skyn (rrm = 0.36) versus comparing self-report to the SCRAM (rrm = 0.31). The Skyn showed moderate-to-large, significant correlations with the SCRAM for peak TAC (rrm = 0.54), AUC (rrm = 0.80), and drinking duration (rrm = 0.63). Our findings support the acceptability and validity of using the Skyn for assessing alcohol use across an extended time frame (i.e., 28 days) in individuals' natural settings, and for providing useful information about day-level features of alcohol use.

Measurement properties of smartphone approaches to assess physical activity in healthy young people: A systematic review (Preprint)

Background

Physical inactivity is a preventable risk factor for several chronic diseases and one of the driving forces behind the growing global burden of disease. Recent evidence has shown that interventions using mobile smartphone apps can promote a significant increase in physical activity (PA) levels. However, the accuracy and reliability of using apps is unknown.

Objective

The aim of our review was to determine the accuracy and reliability of using mobile apps to measure PA levels in young people. We conducted a systematic review guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Methods

Studies published from 2007 to 2020 were sourced from 8 databases—Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsychINFO (EBSCOhost), CINAHL (EBSCOhost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library database. Studies were conducted in young people aged 10-24 years and without chronic illnesses, who evaluated a mobile app’s ability to measure PA. Primary outcomes included validity, reliability, and responsiveness of the measurement approach. Duplicate screening was conducted for eligibility, data extraction, and assessing the risk of bias. Results were reported as a systematic review. The main physical activity measures evaluated for each study were the following: total PA time (min/day or min/week), total moderate to vigorous PA per week, daily step count, intensity measure (heart rate), and frequency measure (days per week).

Results

Of the 149 identified studies, 5 met the inclusion criteria (322 participants, 176 female; mean age 14, SD 3 years). A total of 3 studies measured criterion validity and compared PA measured via apps against PA measured via an Actigraph accelerometer. The 2 studies that reported on construct validity identified a significant difference between self-reported PA and the objective measure. Only 1 of the 5 apps examined was available to the public, and although this app was highly accepted by young people, the app recorded PA to be significantly different to participants’ self-reported PA.

Conclusions

Overall, few studies assess the reliability, validity, and responsiveness of mobile apps to measure PA in healthy young people, with studies typically only reporting on one measurement property. Of the 3 studies that measured validity, all concluded that mobile phones were acceptable and valid tools. More research is needed into the validity and reliability of smartphone apps to measure PA levels in this population as well as in populations with other characteristics, including other age groups and those with chronic diseases.

Trial Registration

PROSPERO CRD42019122242; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=122242

eHealth interventions targeting poor diet, alcohol use, tobacco smoking and vaping among disadvantaged youth: A systematic review protocol (Preprint)

Background

Chronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas.

Objective

This is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping.

Methods

A systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool.

Results

As of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022.

Conclusions

This systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations.

Trial Registration

PROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=294119

International Registered Report Identifier (IRRID)

PRR1-10.2196/35408