Ecological Momentary Assessment Methods Research Articles

Combining mobile-health (mHealth) and artificial intelligence (AI) methods to avoid suicide attempts: the Smartcrises study protocol

BackgroundThe screening of digital footprint for clinical purposes relies on the capacity of wearable technologies to collect data and extract relevant information’s for patient management. Artificial intelligence (AI) techniques allow processing of real-time observational information and continuously learning from data to build understanding. We designed a system able to get clinical sense from digital footprints based on the smartphone’s native sensors and advanced machine learning and signal processing techniques in order to identify suicide risk.Method/designThe Smartcrisis study is a cross-national comparative study. The study goal is to determine the relationship between suicide risk and changes in sleep quality and disturbed appetite. Outpatients from the Hospital Fundación Jiménez Díaz Psychiatry Department (Madrid, Spain) and the University Hospital of Nimes (France) will be proposed to participate to the study. Two smartphone applications and a wearable armband will be used to capture the data. In the intervention group, a smartphone application (MEmind) will allow for the ecological momentary assessment (EMA) data capture related with sleep, appetite and suicide ideations.DiscussionSome concerns regarding data security might be raised. Our system complies with the highest level of security regarding patients’ data. Several important ethical considerations related to EMA method must also be considered. EMA methods entails a non-negligible time commitment on behalf of the participants. EMA rely on daily, or sometimes more frequent, Smartphone notifications. Furthermore, recording participants’ daily experiences in a continuous manner is an integral part of EMA. This approach may be significantly more than asking a participant to complete a retrospective questionnaire but also more accurate in terms of symptoms monitoring. Overall, we believe that Smartcrises could participate to a paradigm shift from the traditional identification of risks factors to personalized prevention strategies tailored to characteristics for each patient.Trial registration numberNCT03720730. Retrospectively registered.

Feasibility and acceptability of intensive longitudinal data collection of activity and patient-reported outcomes during chemotherapy for breast cancer.

Ecological momentary assessment (EMA) may help us better understand biopsychosocial determinants and outcomes of physical activity during chemotherapy, but may be burdensome for patients. The purpose of this study was to determine the feasibility and acceptability of using EMA to assess activity, symptoms, and motivation among early-stage breast cancer patients undergoing chemotherapy. Women were instructed to wear an accelerometer 24/7 (hip during day and wrist overnight). Text message prompts were sent 4 times/day concerning patient-reported symptoms and motivational factors for 10 consecutive days (3days pre-, day of, and 6days post-chemotherapy dose). These measures occurred at the beginning, middle, and end of a full course of chemotherapy. At study conclusion, participants reported on perceived study acceptability, burden, and reactivity. Of the 75 women who consented to participate, 63 (84%) completed all 3 assessment time points. Participants responded to 86% of total text prompts and had valid accelerometer data on 82% of study days. Compliance was similar across all time points. The majority (78%) rated their study experience as positive; 100% were confident in their ability to use study technology. Reactivity varied with 27% indicating answering symptom questions did not affect how they felt and 44% and 68% indicated answering questions and wearing the accelerometer, respectively, made them want to increase activity. Findings indicate EMA methods are feasible for breast cancer patients undergoing chemotherapy. EMA may help us better understand the biopsychosocial processes underlying breast cancer patients' activity in the context of daily life.

Context and dynamics: The new frontier for developmental research on emotion regulation.

Despite much research and progress in understanding the development of emotion regulation over the past 3 decades, there is still much to be understood about how developing individuals modulate their affect as they go about their daily life. The papers in this special issue highlight context and dynamics as 2 important intersecting foci for future developmental research on emotion regulation. Ecological momentary assessment, passive sensing, and other ambulatory methods offer exciting new tools for capturing contextual features of the environment that may influence the selection of emotion regulation strategies and the effectiveness of specific strategies in different contexts. New interdisciplinary, methodological, and quantitative approaches also offer new tools for better characterizing the temporal dynamics of emotion regulation, including a focus on the coregulation of affect between parents and children. The next generation of emotion regulation researchers will require advanced interdisciplinary, quantitative, and technological skills to be able to leverage new tools that can better characterize the fine-grained dynamics of emotion regulation processes and the precise ways in which social contextual features modulate these processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

What Do People With Schizophrenia Do All Day? Ecological Momentary Assessment of Real-World Functioning in Schizophrenia

Schizophrenia is a major cause of disability worldwide. As new treatments for functioning are tested, the need grows to demonstrate real-world functioning gains. Ecological momentary assessment (EMA) may provide a more ecologically valid measure of functioning. In this study, smartphone-based EMA was used to signal participants with schizophrenia (N = 100) and controls (N = 71) 7 times a day for 7 days to respond to brief questionnaires about social interactions and functioning behaviors. Excellent adherence was found, with both groups completing an average of 85% of surveys and only 3% of participants with schizophrenia excluded for poor adherence. Four-week test-retest reliability was high (r = .83 for total productive behaviors). Relative to controls, participants with schizophrenia reported significantly less total productive activity (d = 1.2), fewer social interactions (d = 0.3), more nonproductive behaviors (d = 1.0; watching TV, resting), and more time at home (d = 0.8). Within the schizophrenia group, participants living independently showed better functioning on EMA relative to participants in supported housing (d = 0.8) and participants engaged in vocational activities showed better functioning than individuals not engaged in vocational activities (d = 0.55). Modest correlations were found between EMA and an in-lab self-report measure of functioning activities performed in the community, but not between EMA and measures of functional capacity or potential. This study demonstrated the feasibility, sensitivity reliability, and validity of EMA methods to assess functioning in schizophrenia. EMA provides a much-needed measure of what individuals with schizophrenia are actually doing in real-world contexts. These results also suggest that there may be important disjunctions between indices of abilities and actual real-world functioning.

A study on treatment sensitivity of ecological momentary assessment in obsessive-compulsive disorder.

As part of a larger clinical trial, this ecological momentary assessment (EMA) study pursued the main goal of demonstrating that the EMA method is sensitive to treatment effects of detached mindfulness and cognitive restructuring for obsessive-compulsive disorder (OCD). A second goal was to provide a descriptive analysis of OCD symptoms and influencing factors in participants' everyday lives. Thirty-nine participants were included in the final analyses. EMA sampling involved a smartphone and comprised 4 days with 10 random prompts per day both before (Pre-Treatment EMA) and after the completion of a 2-week clinical intervention of either detached mindfulness or cognitive restructuring (Post-Treatment EMA) that participants had been randomly allocated to. The EMA questionnaire included items on the frequency of obsessions, subjective burden due to obsessions, perceived current stress, emotions, and on the frequency of compulsions and other dysfunctional behaviors. Descriptive Pre-Treatment EMA results highlight the importance of compulsions and emotional states of tension/discomfort in OCD. Pre-Post comparisons showed a significant reduction of avoidance behavior, obsessions, and burden due to obsessions, with a nonsignificant trend also indicating a reduction of compulsions. There was no pre to post effect concerning emotions. This study adds to the existing research on OCD symptoms and offers further evidence in confirmation of established theoretical models of OCD. Also, our results can be taken as evidence for treatment sensitivity of the EMA method in OCD. Further research is needed to replicate, broaden, and generalize our results.

Risk-Taking Propensity, Affect, and Alcohol Craving in Adolescents’ Daily Lives

Background: Alcohol craving is common among adolescents, stronger among those with more alcohol-related problems, and predicts drinking levels in their daily lives. Yet, the conditions that predict momentary changes in craving in real time among adolescents remain unclear. Objectives: This study examined the interactive effects of momentary risk-taking propensity and affect on adolescents’ alcohol craving by leveraging ecological momentary assessment (EMA) methods. Methods: Participants were 29 adolescents ages 15–19 years (55% female; 69% White; 10% Black; 17% Hispanic); 45% met criteria for alcohol dependence. Following a laboratory session that captured self-report and behavioral assessments, including the well-established Balloon Analog Risk Task (BART), participants completed multiple daily assessments of alcohol craving, positive and negative affect, and risk propensity for approximately one week. Momentary risk propensity was captured in real-world settings via an EMA behavioral task (“Balloon Game”). Results: Mixed-effects models with EMA reports (Level 1) nested within participants (Level 2) revealed the majority (74%) of variability in “Balloon Game” performance was due to within-person, momentary, fluctuations. Greater momentary positive affect predicted increased alcohol craving, but only when participants exhibited heightened risk-taking propensity. Negative affect did not influence the relation between momentary risk-taking and craving. Conclusions/Importance: Momentary fluctuations in positive affect predicted acute increases in craving but only in moments when adolescents demonstrated higher levels of risk-taking propensity, as captured with an EMA-delivered behavioral task. Momentary risk-taking assessments offer new avenues to substantiate dominant theories on the driving mechanisms of craving and alcohol use among adolescents.

Methodological Strategies for Ecological Momentary Assessment to Evaluate Mood and Stress in Adult Patients Using Mobile Phones: Systematic Review.

BackgroundEcological momentary assessment (EMA) has utility for measuring psychological properties in daily life. EMA has also allowed researchers to collect data on diverse experiences and symptoms from various subjects.ObjectiveThe aim of this study was to review methodological strategies and useful related information for EMA using mobile phones to capture changes of mood and stress in adult patients seeking health care.MethodsWe searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Library, PsycINFO, and Web of Science. This review included studies published in peer-reviewed journals in English between January 2008 and November 2017 that used basic- or advanced-feature mobile phones to measure momentary mood or stress in adult patients seeking health care in outpatient departments. We excluded studies of smoking and substance addictions and studies of mental disorder patients who had been diagnosed by physicians.ResultsWe reviewed 12 selected articles that used EMA via mobile phones to measure momentary mood and stress and other related variables from various patients with chronic fatigue syndrome, breast cancer, migraine, HIV, tinnitus, temporomandibular disorder, end-stage kidney disease, and traumatic brain injury. Most of the selected studies (11/12, 92%) used signal contingency and in 8 of the 12 studies (67%) alarms were sent at random or semirandom intervals to prompt the momentary measurement. Out of 12 studies, 7 (58%) used specific apps directly installed on mobile phones, 3 (25%) used mobile phones to link to Web-based survey programs, and 2 (17%) used an interactive voice-response system.ConclusionsThis study provides researchers with useful information regarding methodological details for utilizing EMA to measure mood and stress in adult patients. This review shows that EMA methods could be effective and reasonable for measuring momentary mood and stress, given that basic- and advanced-feature mobile phones are ubiquitous, familiar, and easy to approach. Therefore, researchers could adopt and utilize EMA methods using mobile phones to measure psychological health outcomes, such as mood and stress, in adult patients.

Real-time predictors and consequences of binge eating among adults with type 1 diabetes

BackgroundObjective binge eating (OBE) is common among individuals with type 1 diabetes (T1D) and may have negative consequences for glycemic control. Recent studies have suggested that diabetes distress (i.e., emotional distress specific to diabetes and living with the burden of management) is a distinct emotional experience among individuals with diabetes. Preliminary studies have found diabetes distress is associated with eating disorder symptoms and poor glycemic control. The aim of the current study was to examine real-time emotional precursors and consequences of OBE in adults with T1D (i.e., general negative affect, specific emotional states and diabetes distress) using ecological momentary assessment methods. We also explore the impact of OBE on 2-h postprandial glycemic control relative to non-OBE eating episodes.MethodsAdults with T1D (N = 83) completed 3-days of ecological momentary assessment assessing mood and eating behavior using a telephone-based survey system. Participants were prompted to rate momentary affect, including level diabetes distress, at random intervals and reported on eating episodes. Participants also wore continuous glucose monitors allowing for ongoing assessment of glycemic control. Multi-level modeling was used to examine between- and within-person effects of momentary increases in emotions prior to eating on the likelihood of OBE and the impact of OBE on postprandial blood glucose. Generalized linear mixed models examined whether change in post-meal affect differed between OBE and non-OBE episodes.ResultsParticipants were predominately middle-aged (Mean = 42; SD = 12.43) Caucasian (87%) females (88%) reporting clinically significant eating disorder symptoms (76%). Nearly half of the sample (43%) reported OBE during the 3-day study period. The between-person effect for negative affect was significant (OR = 1.93, p < .05), indicating a 93% increased risk of OBE among individuals with higher negative affect compared to individuals with average negative affect. Between-person effects were also significant for guilt, frustration and diabetes distress (OR = 1.48–1.77, ps < .05). Analyses indicated that mean change in post-meal negative affect was significantly greater for OBE relative to non-OBE episodes (B = 0.44, p < .001). Blood glucose at 120 min postprandial was also higher for OBE than for non-OBE episodes (p = .03).ConclusionsFindings indicate that individuals who tend to experience negative affect and diabetes distress before eating are at increased risk of OBE at the upcoming meal. Results also suggest that engaging in binge eating may result in greater subsequent negative affect, including diabetes distress, and lead to elevated postprandial blood glucose levels. These findings add to a growing literature suggesting diabetes distress is related to eating disordered behaviors among individuals with T1D.

Acceptability of smartphone applications for global positioning system (GPS) and ecological momentary assessment (EMA) research among sexual minority men.

BackgroundEmerging research is using global positioning system (GPS) and ecological momentary assessment (EMA) methods among sexual minority men (SMM), a population that experiences multiple health disparities. However, we are not aware of any research that has combined these approaches among SMM, highlighting the need for acceptability and feasibility research. The purpose of this study was to examine the acceptability of implementing GPS and EMA research protocols using smartphone applications among SMM as well as related socio-demographic correlates.MethodsData come from a sample of SMM on a popular geosocial-networking app in Paris, France (n = 580). We assessed the acceptability of implementing GPS and EMA research protocols on smartphone apps as well as socio-demographic characteristics (i.e., age, sexual orientation, country of origin, employment status, and relationship status). We examined the anticipated acceptability of GPS and EMA data collection methods as well as socio-demographic correlates of acceptability of GPS and EMA methods.ResultsWe found that over half (54.1%) of the sample was willing to download a smartphone app for GPS-based research and we found that almost 60% of the participants were willing to download a smartphone app for EMA-based research. In total, 44.0% reported that they were willing to download both GPS and EMA apps. In addition, we found that older participants were less willing to download a smartphone app for EMA research than younger participants aged 18–24 (40–49 years: aPR = 0.40; 95% CI = 0.20, 0.78) and students were more willing to download smartphone apps for both GPS and EMA research (aPR = 1.41; 95% CI = 1.02, 1.95).ConclusionResults from this study suggest that using smartphone apps to implement GPS and EMA methods among some SMM are acceptable. However, care should be taken as segments of SMM are less likely to be willing to engage in this type of research.

Factors Associated with Daily Completion Rates in a Smartphone-Based Ecological Momentary Assessment Study.

ObjectivesEcological momentary assessment (EMA) methods are known to have validity for capturing momentary changes in variables over time. However, data quality relies on the completion rates, which are influenced by both participants' characteristics and study designs. This study applied an EMA method using a mobile application to assess momentary moods and stress levels in patients with Moyamoya disease to examine variables associated with EMA completion rates.MethodsAdults with Moyamoya disease were recruited from a tertiary hospital in Seoul. Patients with cognitive impairment were excluded. The EMA survey was loaded as a mobile application onto the participants' personal smartphones. Notifications were sent at semi-random intervals four times a day for seven consecutive days. Daily completion rates were calculated as the percentage of completed responses per day; overall completion rates were calculated as the proportion of completed responses per total of the 28 scheduled measures in the study and assessed through a descriptive analysis, t-test, ANOVA, and regression analysis, with mixed modeling to identify the point at which the daily completion rate significantly decreased.ResultsA total of 98 participants responded (mean age, 41.00 ± 10.30 years; 69.4% female; 75.5% married). The overall completion rate was 70.66%, with no gender or age differences found. The daily completion rate decreased significantly after day 5 (p = 0.029).ConclusionsObtaining a good completion rate is essential for quality data in EMA methods. Strategic approaches to a study design should be established to encourage participants throughout a study to improve completion rates.

Analyzing cyclic patterns in psychological data: A tutorial

A growing number of studies on psychological phenomena employ the Ecological Momentary Assessment (EMA) method for obtaining intensive longitudinal data in daily life. Whereas cyclic processes may underlie different psychological and physiological outcomes, the cyclic model that describes such processes is rarely used for fitting EMA data. The aim of this paper is to introduce the cyclic model to researchers, and to demonstrate its use in an empirical data set. It is shown how the cyclic terms can be incorporated in multilevel models. Based on secondary analyses on an existing EMA data set, it can be concluded that adding cyclic terms in EMA analyses may improve model fit and may help understanding the dynamic processes.

An Ecological Momentary Assessment of Affect, Mental Health Symptoms, and Decisions to Drink Among First-Year College Women: A Pilot Study.

College women experience more consequences (e.g., blacking out, unprotected/unwanted sex) on days when they engage in their heaviest drinking. To inform prevention efforts, research is needed to understand decision-making processes that influence women's drinking behaviors at the event level. The present study used ecological momentary assessment (EMA) methods to examine: (1) associations between positive affect (PA) and negative affect (NA) and decision-making processes on days leading up to, during, and following heavy drinking events; and (2) mental health symptoms as moderators of these associations. Female undergraduate drinkers (N = 57) completed a 14-day EMA protocol on their smartphones, which included three daily assessments of PA, NA, and willingness and intentions to drink. Trait anxiety and depressive symptoms were measured before the EMA protocol and assessed as moderators. Time-varying effect models were used to examine covariation among PA, NA, and willingness and intentions to drink on the days leading up to participants' heaviest drinking events, the day of the event itself, and the days following the event. Results revealed PA was positively associated with willingness to drink the 2days before, the day of, and the day after the heaviest drinking event. Similar effects were observed for PA and intentions to drink. Trait anxiety moderated the association between PA and intentions to drink. Findings underscore that positive affect may influence drinking-related decision-making processes surrounding heavy drinking events, particularly in those college women low in anxiety. Results identify potential entry points for real-time intervention efforts targeting college women during times of elevated PA.

Extending the Passive-Sensing Toolbox: Using Smart-Home Technology in Psychological Science

New smart-home devices provide the opportunity to advance psychological science and theory through novel research opportunities in home environments. These technologies extend the in vivo research and intervention capabilities afforded by other assessment techniques such as Ecological Momentary Assessment methods as well as mobile and wearable devices. Smart-home devices contain a multitude of sensors capable of continuously and unobtrusively collecting multimodal data within home contexts. These devices have some complementary strengths and limitations compared with other assessment methods. This article (a) briefly reviews data collection methods in home environments, (b) discusses the unique advantages of smart-home devices, (c) describes the extant smart-home literature, (d) explores how these devices may advance evaluation and refinement of psychological theories, (e) describes examples of psychological processes that are potential targets for smart-home assessment and intervention, (f) considers methodological challenges and barriers, (g) discusses ethical considerations, and (h) concludes with a discussion of future directions for research and the merging of passive-sensing technologies with active self-report methods. This article aims to highlight the potential utility of smart-home devices within psychological research to evaluate psychological theories related to behavior within the home context.

Measuring Sexual Minority Stressors in Lesbian Women's Daily Lives: Initial Scale Development.

Lesbian women face unique sexual minority stressors (SMS) due to their stigmatized and marginalized status in society. Existing studies of SMS are primarily cross-sectional and use global measures of SMS. The goal of the present study was to develop a brief daily measure of SMS for use in daily diary or ecological momentary assessment (EMA) studies. Existing retrospective measures of SMS were reviewed, resulting in an initial pool of 29 items. Thirty-eight lesbian women (Mage=24.3 years, range: 19-30 years) completed a daily web-based survey including the SMS items for 12 days. Two response scales were tested; participants were randomized to receive a 3-point (for brevity) or 7-point (for precision) scale for the first 6 days and the other response scale for the remaining 6 days to counterbalance order. Findings suggest the 7-point scale was optimal because it provided greater variability. To reduce scale length, item correlations were examined to identify clusters and one item was retained from each cluster, reducing the scale to 18 items. Then, using HLM, null models with each item as the outcome were conducted to examine level-1 and level-2 variances; 8-, 10-, 12-, and 18-item scales were compared to identify the ideal number of items. The 8-item scale had the highest Cronbach's alpha (.85) and the smallest intraclass correlation (ICC; .13), suggesting these 8 items are optimal for capturing within-person variability in young lesbian women's daily SMS experiences. As researchers are increasingly interested in using EMA methods, this 8-item measure can assess SMS in lesbian women's everyday lives.

Frequency of Intrusions and Appraisal of Related Distress After Analogue Trauma: A Comparative Ecological Momentary Assessment Methods Study

Intrusive thoughts, images, and their appraisal remain difficult to study despite their clinical relevance. Clinical studies typically used time-based (frequency and distress per observation period), while analogue studies mainly used event-based (report upon occurrence) assessment. A comparison of intrusion frequency, distress appraisal, compliance, and reactivity across different assessments is mostly lacking, particularly with regard to analogue research. Here, intrusions were induced via aversive films and assessed by a smart phone application for 4 days. Three sampling modes were compared by randomizing participants to one of three conditions: either one, or five time-based daily prompts, or event-based assessment. At the end of the study, all participants reported intrusions once again in a retrospective summary assessment. Results indicate that intrusions and their distress decayed over a few days. The three assessments did not differ in intrusion frequency, distress appraisal, compliance (generally high), reactivity (generally low), or retrospective summary assessment. Across groups, the more aversive and arousing participants rated the film clips and the more reactivity to the electronic-diary assessment they reported, the more intrusive memories they had; assessment modes did not differ on this. Thus, no general differences were found between electronic-diary assessment modes for analogue intrusions, giving researchers flexibility for tailoring ecological momentary assessment to specific study aims.

Sex differences in daily life stress and craving in opioid-dependent patients

ABSTRACTBackground: Responses to stress and drug craving differ between men and women. Differences in the momentary experience of stress in relation to craving are less well-understood. Objectives: Using ecological momentary assessment (EMA), we examined sex differences in real-time in two areas: (1) causes and contexts associated with stress, and (2) the extent to which stress and drug cues are associated with craving. Methods: Outpatients on opioid-agonist treatment (135 males, 47 females) reported stress, craving, and behavior on smartphones for 16 weeks. They initiated an entry each time they felt more stressed than usual (stress event) and made randomly prompted entries 3 times/day. In stress-event entries, they identified the causes and context (location, activity, companions), and rated stress and craving severity. Results: The causes reported for stress events did not differ significantly by sex. Women reported arguing and being in a store more often during stress events, and men reported working more often during stress events, compared to base rates (assessed via random prompts). Women showed a greater increase in opioid craving as a function of stress (p < 0.0001) and had higher stress ratings in the presence of both stress and drug cues relative to men (p < 0.01). Similar effects were found for cocaine craving in men (p < 0.0001). Conclusion: EMA methods provide evidence based on real-time activities and moods that opioid-dependent men and women experience similar contexts and causes for stress but differ in stress- and cue-induced craving. These findings support sex-based tailoring of treatment, but because not all participants conformed to the overall pattern of sex differences, any such tailoring should also consider person-level differences.

Students' Experiences with Ecological Momentary Assessment Tools to Report on Emotional Well-being

Ecological Momentary Assessment (EMA) methods have emerged as an approach that enhances the ecological validity of data collected for the study of human behavior and experience. In particular, EMA methods are used to capture individuals' experiences (e.g., symptoms, affect, and behaviors) in real-world contexts and in near-real time. However, work investigating participants' experiences in EMA studies and in particular, how these experiences may influence the collected data, is limited. We conducted in-depth focus groups with 32 participants following an EMA study on mental well-being in college students. In doing so, we probed how the elicitation of high-quality, reflective responses is related to the design of EMA interactions. Through our study, we distilled three primary considerations for designing EMA interactions, based on observations of 1) response strategies to repeated questions, 2) the perceived burden of EMA prompts, and 3) challenges to the validity and robustness of EMA data. We present these considerations in the context of two microinteraction-based EMA approaches that we tested: lock-screen EMA and image-based question prompts. We conclude by characterizing design tensions in the presentation and delivery of EMA prompts, and outline directions for future work to address these tensions.

An Electronic Ecological Momentary Assessment Study to Examine the Consumption of High-Fat/High-Sugar Foods, Fruits/Vegetables, and Affective States Among Women

ObjectiveTo examine the associations between high-fat/high-sugar foods (HFHS) and fruit and vegetable (FV) consumption and affective states in women. MethodsThe researchers used electronic ecological momentary assessment to capture HFHS and FV consumption in the past 2 hours (predictor) and current affective states (outcome) across 1 week among 202 women. Multilevel linear regression was conducted. Weight status was tested as a moderator. ResultsConsumption of FV in the past 2 hours was positively associated with feeling happy (P < .05). Women who consumed more HFHS or fewer FV than others in the study reported higher average sadness (both P < .05). Overweight or obese women who reported more frequent HFHS consumption than others had higher average stress than normal weight women (P < .05). Conclusions and ImplicationsThe association between HFHS consumption and stress might be stronger in overweight or obese than normal weight women. Future studies could further enhance the electronic ecological momentary assessment method to explore other time-varying moderators and mediators of food consumption and affect.

Do daily fluctuations in inhibitory control predict alcohol consumption? An ecological momentary assessment study

RationaleDeficient inhibitory control is predictive of increased alcohol consumption in the laboratory; however, little is known about this relationship in naturalistic, real-world settings.ObjectivesIn the present study, we implemented ecological momentary assessment methods to investigate the relationship between inhibitory control and alcohol consumption in the real world.MethodsHeavy drinkers who were motivated to reduce their alcohol consumption (N = 100) were loaned a smartphone which administered a stop signal task twice per day at random intervals between 10 a.m. and 6 p.m. for 2 weeks. Each day, participants also recorded their planned and actual alcohol consumption and their subjective craving and mood. We hypothesised that day-to-day fluctuations in inhibitory control (stop signal reaction time) would predict alcohol consumption, over and above planned consumption and craving.ResultsMultilevel modelling demonstrated that daily alcohol consumption was predicted by planned consumption (β = .816; 95% CI .762–.870) and craving (β = .022; 95% CI .013–.031), but inhibitory control did not predict any additional variance in alcohol consumption. However, secondary analyses demonstrated that the magnitude of deterioration in inhibitory control across the day was a significant predictor of increased alcohol consumption on that day (β = .007; 95% CI .004–.011), after controlling for planned consumption and craving.ConclusionsThese findings demonstrate that short-term fluctuations in inhibitory control predict alcohol consumption, which suggests that transient fluctuations in inhibition may be a risk factor for heavy drinking episodes.

Momentary smoking context as a mediator of the relationship between SES and smoking

There is a well-established socioeconomic gradient in smoking behavior: those with lower socioeconomic status smoke more. However, much less is known about the mechanisms explaining how SES is linked to smoking. This study takes a social-ecological perspective by examining whether socioeconomic status affects smoking behavior by differential exposure to places where smoking is allowed. Exposure to smoking restrictions was assessed in real-time using Ecological Momentary Assessment methods. A sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether a smoker's momentary context mediated the relationship between socioeconomic status (educational attainment) and cigarettes smoked per day (CPD). Momentary context was operationalized as the proportion of random assessments answered in locations where smoking was allowed versus where smoking was not allowed. Data were analysed using multilevel regression (measurements nested within participants) with a lower level mediation model (2-1-1 mediation). Although no significant direct effect of SES on CPD were observed, there was a significant indirect effect of SES on CPD via the momentary context. Compared to participants with higher education, lower educated participants were more likely to encounter places where smoking was allowed, and this in turn, was associated with a higher number of CPD. These findings suggest that SES is associated with smoking at least partially via differential exposure to smoking-friendly environments, with smokers from lower SES backgrounds accessing more places where smoking is allowed. Implications for current smoke-free legislation are discussed.