Ecological Momentary Assessment Surveys Research Articles

Quantifying cigarette and e-cigarette marketing exposure among Chinese adolescents using ecological momentary assessment.

Addressing cigarette and e-cigarette use in China is key to reducing the global tobacco epidemic. Marketing exposure is one causal factor for adolescent smoking and e-cigarette use. Currently, China restricts cigarette and e-cigarette ads in public places and online; however, there may not be full policy compliance. We collected real-time data in the natural environment to estimate how much and where Chinese adolescents - a group susceptible to smoking and e-cigarette use - are exposed to cigarette and e-cigarette marketing to inform policy responses. In June 2022, we conducted a seven-day ecological momentary assessment (EMA) study with 15-16-year-olds (n=96) across eight Chinese cities. Participants completed up to 42 EMA surveys (6 per day), sent at random intervals outside of school hours. In each survey, participants reported whether they saw (1) displays and (2) ads in the past hour (none, cigarette, e-cigarette, both) in the past hour. We also captured the source of cigarette/e-cigarette ad exposure. Most participants were exposed to cigarette and/or e-cigarette displays (89.6%) or ads (79.2%) over the seven days. On average, participants reported past-hour exposure to displays 12.7 times and past-hour exposure to ads 10.8 times over the week. The most common sources of cigarette ads were public places (e.g., kiosks, supermarkets); the most common sources of e-cigarette ad exposure were social media/internet or e-cigarette stores. Findings highlight the need to enhance enforcement of restrictions on cigarette and e-cigarette ads in public places and online in China and extend restrictions to ban displays. Marketing exposure is a causal factor in youth smoking and e-cigarette use. We used ecological momentary assessments to estimate cigarette and e-cigarette display and ad exposure among Chinese adolescents. On average, participants reported past-hour exposure to cigarette and/or e-cigarette displays 13 times and past-hour exposure to cigarette and/or e-cigarette ads 11 times over one week. Most saw ads in public places and online. Results suggest strengthening implementation of China's ban on cigarette and e-cigarette ads in public places and online and banning product displays. These are policy responses that can contribute to reducing adolescent cigarette and e-cigarette uptake in China.

A longitudinal network analysis of suicide risk factors among service members and veterans sampled for suicidal ideation or attempt.

Suicidal thoughts and behaviors are elevated among active-duty service members (ADSM) and veterans compared to the general population. Hence, it is a priority to examine maintenance factors underlying suicidal ideation among ADSM and veterans to develop effective, targeted interventions. In particular, interpersonal risk factors, hopelessness, and overarousal have been robustly connected to suicidal ideation and intent. To identify the suicidal ideation risk factors that are most relevant, we employed network analysis to examine between-subjects (cross-sectional), contemporaneous (within seconds), and temporal (across four hours) group-level networks of suicidal ideation and related risk factors in a sample of ADSM and veterans (participant n = 92, observations n = 10 650). Participants completed ecological momentary assessment (EMA) surveys four times a day for 30 days, where they answered questions related to suicidal ideation, interpersonal risk factors, hopelessness, and overarousal. The between-subjects and contemporaneous networks identified agitation, not feeling close to others, and ineffectiveness as the most central symptoms. The temporal network revealed that feeling ineffective was most likely to influence other symptoms in the network over time. Our findings suggest that ineffectiveness, low belongingness, and agitation are important drivers of moment-to-moment and longitudinal relations between risk factors for suicidal ideation in ADSM and veterans. Targeting these symptoms may disrupt suicidal ideation.

Picturing self-harm: Investigating flash-forward mental imagery as a proximal and modifiable driver of non-suicidal self-injury.

Non-suicidal self-injury (NSSI) is theorized to be reinforced by its emotional consequences. Mental images of NSSI are commonly reported as occurring prior to NSSI. Based on the known functional properties of anticipatory mental imagery as an emotional and motivational amplifier, this study investigated whether NSSI mental imagery constitutes a proximal and dynamic mechanism underpinning NSSI risk. An intensive ecological momentary assessment (EMA) study was conducted to track the occurrence and characteristics of NSSI mental imagery alongside NSSI urge and behavior in naturalistic settings. A sample of N = 43 individuals aged 17 to 24 with a history of repetitive NSSI completed EMA surveys seven times a day for 14 days. Mental preoccupation in the form of NSSI mental imagery-based flash-forwards to the actions, bodily sensations, and emotional benefits of NSSI was found to occur when NSSI urge was high but not when urge was low. Critically, objective cross-panel analyses showed that higher frequencies of NSSI imagery occurrence predicted greater future NSSI urge and increased likelihood of acting on urge, over and above current urge. Mental imagery of NSSI is not simply an epiphenomenal by-product of NSSI urge and may constitute a dynamic and proximal novel intervention target.

A Bluetooth-Based Smartphone App for Detecting Peer Proximity: Protocol for Evaluating Functionality and Validity.

While ecological momentary assessment (EMA) is commonly used to study social contexts and social influence in the real world, EMA almost exclusively relies on participant self-report of present circumstances, including the proximity to influential peers. There is the potential for developing a proximity sensing approach that uses small Bluetooth beacons and smartphone-based detection and data collection to collect information about interactions between individuals passively in real time. This paper aims to describe the methods for evaluating the functionality and validity of a Bluetooth-based beacon and a smartphone app to identify when ≥2 individuals are physically proximal. We will recruit 20 participants aged 18 to 29 years with Android smartphones to complete a 3-week study during which beacon detection and self-report data will be collected using a smartphone app (MEI Research). Using an interviewer-administered social network interview, participants will identify up to 3 peers of the same age who are influential on health behavior (alcohol use in this study). These peers will be asked to carry a Bluetooth beacon (Kontakt asset tag) for the duration of the study; each beacon has a unique ID that, when detected, will be recorded by the app on the participant's phone. Participants will be prompted to respond to EMA surveys (signal-contingent reports) when a peer beacon encounter meets our criteria and randomly 3 times daily (random reports) and every morning (morning reports) to collect information about the presence of peers. In all reports, the individualized list of peers will be presented to participants, followed by questions about peer and participant behavior, including alcohol use. Data from multiple app data sets, including beacon encounter specifications, notification, and app logs, participant EMA self-reports and postparticipation interviews, and peer surveys, will be used to evaluate project goals. We will examine the functionality of the technology, including the stability of the app (eg, app crashes and issues opening the app), beacon-to-app detection (ie, does the app detect proximal beacons?), and beacon encounter notification when encounter criteria are met. The validity of the technology will be defined as the concordance between passive detection of peers via beacon-to-app communication and the participant's EMA report of peer presence. Disagreement between the beacon and self-report data (ie, false negatives and false positives) will be investigated in multiple ways (ie, to determine if the reason was technology-related or participant compliance-related) using encounter data and information collected from participants and peers. Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. This Bluetooth-based technology has important applications and clinical implications for various health behaviors, including the potential for just-in-time adaptive interventions that target high-risk behavior in real time. DERR1-10.2196/50241.

Perceived responses, capitalization, and daily gratitude: Do age and closeness matter?

Successful capitalization and feelings of gratitude are both dependent upon perceived responsiveness of a social partner, but they are understudied in combination and have yet to be studied jointly in a daily context. Taking a new approach to studying capitalization, the current study examines the effect of daily capitalization on momentary gratitude and investigates the role of the capitalizer's typical perceived responses to capitalization attempts (PRCA) on daily gratitude and future capitalization attempts. Age and social closeness are studied as amplifiers, as older adults prioritize positive emotional experiences and it is more common to capitalize with closer others for whom the capitalizer's good news is salient and who are thus motivated to provide support to the capitalizer. Participants (N = 290) aged 25-85 years completed a trait-level survey followed by ecological momentary assessment surveys (six per day) for 10 days. Results demonstrate that people experienced higher daily gratitude when capitalizing, especially when interacting with a social partner rated as high in closeness. Those who had higher trait active-constructive PRCA also experienced higher daily gratitude, with this effect strengthened among older adults. Perceived responses were also associated with more attempts to capitalize in daily life. This work suggests engaging in capitalization and perceiving regular enthusiastic and supportive responses to one's capitalization attempts have daily emotional and behavioral benefits. Notably, regular enthusiastic responses to capitalization attempts may be a motivator for future attempts across adulthood, but it may be particularly likely to foster feelings of gratitude in old age. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Daily vitality fluctuations in older adults with depressive symptoms: A multilevel location-scale model

BackgroundExamining the daily experiences of older adults with depression facilitates the development and application of personalized effective treatments for them. In previous clinical research on depression, traditional mean-based approaches have mainly been employed. However, the within-person residual variance as a random effect provides greater insight into the heterogeneity of daily experiences among geriatric samples. ObjectiveThis study aimed to examine the relationship between depression and daily vitality in older adults. Specifically, it focused on the mean and residual variance of daily vitality measured by the Ecological Momentary Assessment (EMA). MethodsData from 64 older adults aged 65 years or more, who participated in community welfare centers or retirees’ associations, were used. Daily vitality was examined using EMA surveys for seven consecutive days (four random surveys per day). The data were analyzed using a location-scale model. ResultsThe intraclass correlation computed from the empty model for the EMA data was 0.488, indicating significant variances in daily vitality across time between individuals. Older adults with higher levels of depressive symptoms showed low mean levels of daily vitality and a large log-residual variance of daily vitality. ConclusionsThe findings from the current study suggest that individuals experiencing depression not only exhibit low vitality in their daily lives but also struggle to maintain stable levels of vitality in their lives. These insights could contribute to the facilitation and advancement of personalized interventions tailored for older adults.

Psychological and behavioral responses to daily weight gain during behavioral weight loss treatment

Self-weighing is consistently associated with more effective weight control. However, patterns show that participants disengage from their weight control behaviors following weight gain. Women with BMIs in the overweight/obese range (N = 50) enrolled in a long-term behavioral weight loss program completed ecological momentary assessment (EMA) surveys immediately after their daily weigh-ins. Nightly EMA surveys and self-monitoring data through Fitbit measured their weight control behavior that day. On days when participants gained weight (vs. lost or maintained), they reported more negative mood, more guilt/shame, and lower confidence in weight control. Motivation following daily weight gain depended on participants’ overall satisfaction with their weight loss so far: more satisfied participants had marginally higher, but less satisfied participants had marginally lower motivation in response to daily weight gain. Greater guilt/shame and lower motivation after the weigh-in predicted less effective weight control behavior that day (e.g., lower likelihood of calorie tracking, fewer minutes of physical activity). Results demonstrate that even small weight gain is distressing and demoralizing for women in BWL programs, which can lead to goal disengagement. These findings have implications for future BWL interventions, including the potential utility of just-in-time adaptive interventions to promote more adaptive responses in the moments after weigh-ins.

Intraindividual variability in post-stroke cognition and its relationship with activities of daily living and social functioning: an ecological momentary assessment approach

ABSTRACT Introduction Ecological momentary assessment (EMA) is a methodological approach to studying intraindividual variation over time. This study aimed to use EMA to determine the variability of cognition in individuals with chronic stroke, identify the latent classes of cognitive variability, and examine any differences in daily activities, social functioning, and neuropsychological performance between these latent classes. Methods Participants (N = 202) with mild-to-moderate stroke and over 3-month post-stroke completed a study protocol, including smartphone-based EMA and two lab visits. Participants responded to five EMA surveys daily for 14 days to assess cognition. They completed patient-reported measures and neuropsychological assessments during lab visits. Using latent class analysis, we derived four indicators to quantify cognitive variability and identified latent classes among participants. We used ANOVA and Chi-square to test differences between these latent classes in daily activities, social functioning, and neuropsychological performance. Results The latent class analysis converged on a three-class model. The moderate and high variability classes demonstrated significantly greater problems in daily activities and social functioning than the low class. They had significantly higher proportions of participants with problems in daily activities and social functioning than the low class. Neuropsychological performance was not statistically different between the three classes, although a trend approaching statistically significant difference was observed in working memory and executive function domains. Discussion EMA could capture intraindividual cognitive variability in stroke survivors. It offers a new approach to understanding the impact and mechanism of post-stroke cognitive problems in daily life and identifying individuals benefiting from self-regulation interventions.

Acceptability and Feasibility of a Smartphone-Based Real-Time Assessment of Suicide Among Black Men: Mixed Methods Pilot Study.

Suicide rates in the United States have increased recently among Black men. To address this public health crisis, smartphone-based ecological momentary assessment (EMA) platforms are a promising way to collect dynamic, real-time data that can help improve suicide prevention efforts. Despite the promise of this methodology, little is known about its suitability in detecting experiences related to suicidal thoughts and behavior (STB) among Black men. This study aims to clarify the acceptability and feasibility of using smartphone-based EMA through a pilot study that assesses the user experience among Black men. We recruited Black men aged 18 years and older using the MyChart patient portal messaging (the patient-facing side of the Epic electronic medical record system) or outpatient provider referrals. Eligible participants self-identified as Black men with a previous history of STB and ownership of an Android or iOS smartphone. Eligible participants completed a 7-day smartphone-based EMA study. They received a prompt 4 times per day to complete a brief survey detailing their STB, as well as proximal risk factors, such as depression, social isolation, and feeling like a burden to others. At the conclusion of each day, participants also received a daily diary survey detailing their sleep quality and their daily experiences of everyday discrimination. Participants completed a semistructured exit interview of 60-90 minutes at the study's conclusion. In total, 10 participants completed 166 EMA surveys and 39 daily diary entries. A total of 4 of the 10 participants completed 75% (21/28) or more of the EMA surveys, while 9 (90%) out of 10 completed 25% (7/28) or more. The average completion rate of all surveys was 58% (20.3/35), with a minimum of 17% (6/35) and maximum of 100% (35/35). A total of 4 (40%) out of 10 participants completed daily diary entries for the full pilot study. No safety-related incidents were reported. On average, participants took 2.08 minutes to complete EMA prompts and 2.72 minutes for daily diary surveys. Our qualitative results generally affirm the acceptability and feasibility of the study procedures, but the participants noted difficulties with the technology and the redundancy of the survey questions. Emerging themes also addressed issues such as reduced EMA survey compliance and diminished mood related to deficit-framed questions related to suicide. Findings from this study will be used to clarify the suitability of EMA for Black men. Overall, our EMA pilot study demonstrated mixed feasibility and acceptability when delivered through smartphone-based apps to Black men. Specific recommendations are provided for managing safety within these study designs and for refinements in future intervention and implementation science research. RR2-10.2196/31241.

Increased Duration and Intensity of Physical Activity Are Associated With Increased Pain in Individuals With Femoroacetabular Impingement Syndrome: An Ecological Momentary Assessment Study

ObjectiveTo investigate the relation between accelerometer-measured physical activity and real-time pain in individuals with femoroacetabular impingement syndrome (FAIS). We tested the hypothesis that increased duration of high intensity activity would contribute to momentary increases in pain. DesignObservational study. SettingParticipants’ natural, day-to-day environment. ParticipantsPopulation-based sample of 33 individuals with unilateral FAIS. Important eligibility criteria included no concomitant hip disorders or previous hip surgery. Key sociodemographic features include that all participants were required to have a smartphone. InterventionsNot applicable. Main Outcome MeasuresDuration and intensity of physical activity as measured by a waist-worn accelerometer, and instantaneous pain reported in real-time smartphone-based ecological momentary assessment surveys. Physical activity variables included each person's average sedentary time, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) in the 90 minutes proceeding all pain surveys as well as fluctuation in sedentary, LPA, and MVPA above or below average prior to each individual survey. ResultsLinear mixed models revealed that the significant predictors of pain included fluctuation in sedentary time (B=-0.031, P<.001), average LPA (B=0.26, P=.035), and the interaction between fluctuation in LPA and fluctuation in MVPA (B=0.001, P<.001). Fluctuation in sedentary time above a person's average was associated with lower pain, while average LPA and fluctuations above average in both LPA and MVPA were associated with higher pain. ConclusionsThese results suggest that individuals with FAIS can engage in health-enhancing MVPA but should focus on avoiding concurrent increase above average in both high intensity and LPA in the same 90-minute period. Future work is warranted testing the efficacy of such an approach on pain. Additionally, given that high levels of LPA may arise from a host of socioeconomic factors, additional research is needed to disentangle the effect of LPA on pain in FAIS.

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

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

Bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors: An ecological momentary assessment study.

Sleep plays a critical role in daily functioning and stroke recovery but receives little attention in stroke rehabilitation. Sleep disturbances are linked to affective and cognitive impairments, but temporal associations between sleep and affect and cognitive symptomsare less clear. Understanding these temporal associations may inform new directions in intervention and prevention to support continued stroke recovery. To examine the bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors. A secondary analysis of a longitudinal observational study involving 7 days of ecological momentary assessment (EMA), during which participants completed eight EMA surveys and a sleep diary per day. Multilevel modeling was used to analyze data. Community. Community-dwelling stroke survivors (N = 40). Not applicable. EMA measures of depressed affect, cheerful affect, and cognitive symptoms. Sleep quality and duration as measured using a sleep diary. Between-person sleep quality was negatively associated with next-day depressed affect (B = -.16; p = .028) and positively associated with next-day cheerful affect (B = .63; p < .001). Inversely, between-person depressed affect was negatively associated with next night sleep quality (B = -.77; p = .015), and vice versa for cheerful affect (between-person: B = .45; p < .001; within-person: B = .09; p = .008). Long sleep (>9 hours) was positively associated with next-day cognitive symptoms (B = .13; p = .002), whereas cognitive symptoms were associated with a higher odds of long sleep the following night (odds ratio [OR] = 0.25; p = .047). This study identified the bidirectional associations of sleep with affect and cognitive symptoms in the context of the everyday life of stroke survivors. The findings suggest that interventions addressing sleep quality and duration may impact affect and cognitive symptoms, and vice versa.

Gauging the stress of long-term care nursing assistants using ecological momentary assessment, wearable sensors and end of day reconstruction.

Nursing assistants working in long-term care (LTC) often report that their job is stressful. To reduce their work stress, a better understanding of their stress profile is needed. We aimed to pilot test methods to identify and understand stressors that LTC nursing assistants experience. We asked each participant to provide wearable sensor/watch data, ecological momentary assessment (EMA) surveys and end of day review data over two eight-hour working shifts. Eight nursing assistants participated. All participants worked in a common continuing care retirement community in Maryland, United States of America. Our stress assessment method revealed 83 stressful events that were classified under 10 categories. Most of the reported events were rated as having a mild to low-moderate intensity. The three most common causes of stress were work demands and pressure (28.35%), heavy workload and staffing (19.69%), and safety issues and COVID-19 concerns (17.32%). We also explored the difference between stress events and intensity among different shifts. Disrespect from residents (22.73%) was the most commonly reported stressor during day shifts. Feeling rushed was the most commonly reported stressor during the evening (22.47%) and the night (38.46%) shifts. We found stress was commonly reported. Stress intensity conflicted with prior literature, and we explored possible explanations. We discuss potential implications for these findings, modification of our methods to increase feasibility, the utility of these data collection methods for future work and suggest next steps.

Associations between real-time, self-reported adolescent mental health and urban and architectural design concepts

ABSTRACTUrban environments influence mental health and development of younger populations. Around 50% of lifetime mental illnesses begin at or prior to the age of 14 years old, and global urbanization trends are forecasted to continue into the coming decades, making links between urban spaces and youth mental health especially important. Little extant research explores links between urban environments, and especially distinct urban design exposures, and adolescent (ages 9–17) mental health. This study uses on-site, ecological momentary assessment (i.e. real-time) surveys and adjusted linear mixed models to explore associations between adolescent (n = 70) mental health indicators and multiple pedestrian design and architecture concepts. Results indicated several significant associations. Notably, spaces high in complexity (visual richness), imageability (distinctiveness), and enclosure (room-like quality) tended to support positive affect. Additionally, mixed built-natural spaces scoring high in scale (pedestrian amenities) and complexity appeared to increase calmness and mitigate anxiousness, while biophilic architecture (nature in built design) seemed to support perceived restorativeness. Practice implications include recommendations for planners to consider implementing natural forms of enclosure (e.g. tall trees), imageability (e.g. natural landmarks), and/or complexity (e.g. variety of gardens/shrubs) in or around spaces frequented by adolescents (e.g. schoolyards) to promote psychological well-being, and design socially supportive environments.

Dispositional and contextual correlates of in-play sports betting and related harms: A 2-week ecological momentary assessment study.

In-play betting is a novel form of sports betting that allows players to make continuous bets during a game. The present study examined the dispositional and contextual correlates of in-play sports betting and related harms. Participants were 84 individuals (73.81% men, Mage = 41.02) who engaged in in-play betting. Participants first completed an online questionnaire including measures of problem gambling severity, childhood trauma, impulsivity, and emotion dysregulation. Participants then completed a 14-day ecological momentary assessment (EMA) study involving completing brief surveys twice per day. EMA surveys assessed in-play betting behaviors, motives, contexts, and harms. A total of 1,365 EMA surveys were completed, of which 32.89% involved placing at least one in-play bet. A total of 77 (91.67%) participants placed at least one in-play bet during the study period. Participants reported greater in-play betting involvement (the number of bets placed, money spent) and an increased likelihood of experiencing in-play betting-related financial and relationship harms when using substances while betting and when motivated to place in-play bets by an interest in sports or to "be in the game." Participants, who used substances during a greater proportion of in-play betting occasions, who more frequently endorsed coping motives for in-play betting, and who exhibited elevated problem gambling severity, reported greater in-play betting involvement and the likelihood of experiencing in-play betting-related harms overall. Responsible gambling initiatives targeting contextual risk factors, such as using alcohol and cannabis while in-play betting, may help to reduce the intensity of in-play betting and its associated harms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Feasibility of recruiting adolescents into a prospective cohort study of the effects of social isolation during COVID-19

BackgroundSocial connection and loneliness in adolescence are increasingly understood as critical influences on adult mental and physical health. The unique impact of the social isolation imposed by the COVID-19 lockdown on emerging adults is therefore expected to be especially profound. We sought to investigate the feasibility of using ecological momentary assessment (EMA) and wearable accelerometers to characterize the effects of social isolation and/or loneliness experienced by adolescents during the COVID-19 pandemic.MethodsWe recruited 19 participants aged 13–18 from an Adolescent Medicine practice in Atlanta, GA. Participants completed surveys at baseline and throughout a 2-week study period using EMA regarding their degree of social isolation, loneliness, family functioning, school climate, social media use, and COVID-19 experiences surrounding their physical, mental, and social domains. Six participants agreed to wear an activity tracker and heart rate measurement device for 14 days to monitor their emotional state and physical health. Participant feedback was collected via open-ended exit interviews. Feasibility of recruitment/retention, adherence, and outcome measures were investigated. Implementation was also assessed by evaluating the barriers and facilitators to study delivery. Associations between the social isolation and loneliness variables and all other variables were performed with univariate linear regression analysis with significance set at p < 0.05. The progression criteria were a recruitment rate of > 30% and a retention rate of > 80%.ResultsProgression criteria were met for recruitment (76%) of participants, but not retention (38%). Adherence to EMA survey completion was highly variable with only 54% completing ≥ 1 survey a day, and accelerometry use was not feasible. Social isolation was significantly correlated with lower school climate, higher COVID-19 experiences, higher depression scores, and lower sleep quality. Loneliness also showed a significant correlation with all these factors except COVID-19 experiences.ConclusionsEMA and wearable accelerometer use was not feasible in this longitudinal study of adolescents during the COVID-19 pandemic. Future research should further investigate barriers to conducting long-term research with adolescents and the potential effects of the pandemic on subject recruitment and retention.

Daily Functioning of Veterans With Type 2 Diabetes: Protocol for an Ambulatory Assessment Study.

Diabetes impacts nearly 25% of veterans. Many veterans do not engage in recommended physical activity and other diabetes self-management behaviors. Type 2 diabetes is generally asymptomatic; as such, the long-term consequences of inadequate self-management and benefits of consistent self-management are not salient in the short term. Furthermore, self-management behaviors typically take place outside of medical visits; however, self-management-related factors are only assessed during medical visits, likely missing large amounts of variability. Thus, ambulatory assessment methods such as ecological momentary assessment (EMA), accelerometry, and continuous glucose monitoring are needed to understand the dynamics of daily self-management and identify potential intervention targets. The overarching goal of this study is to understand daily, time-varying factors (comorbid affective symptoms and social context) that influence physical activity, diabetes self-management, glycemic management, daily functioning, and quality of life in participants' natural environments. We are recruiting veterans with type 2 diabetes (target N=100). Participants are required to complete a battery of baseline assessments related to mental health, psychosocial factors, and self-management behaviors. Participants then receive 5 momentary EMA surveys and 1 daily EMA survey per day, in which veterans report comorbid affective symptoms (mood, stress, and pain), social support, social interactions, physical activity, and other self-management behaviors. Momentary surveys are delivered randomly during daily preprogrammed intervals over a 14-day sampling period. Accelerometry and continuous glucose monitoring are also used to assess physical activity and blood glucose, respectively. The first 6 participants also completed interviews assessing their experience in the study and barriers to participation. These test participants informed modifications to the protocol for the remaining participants. The project received funding in April of 2023. Enrollment began in March of 2023 and is planned to be completed in April 2025. Among the 6 test participants, the overall EMA response rate was 87% (range 74%-95%). The response rate for the EMA survey including daily items (67%, range 21%-93%) was lower than the earlier shorter EMA surveys (89%, range 81%-96%). The mean rate of valid accelerometer wear of at least 20 hours per day was 93% (SD 11%), and continuous glucose monitoring data were available for 91% (SD 17%) of days on average. Participants reported few barriers to completing EMA surveys but noted the random timing of questions made it difficult to plan around, and the end-of-day survey was long. Two participants reported survey items reminded or motivated them to engage in diabetes self-management behaviors. Assessment tools developed from this study can inform clinical decision-making by considering barriers to self-management that occur in daily life. Clinical applications include tailored, adaptive technology-supported interventions to improve self-management that provide the right type and amount of support at the right time by adapting to an individual's changing internal and contextual state. DERR1-10.2196/53874.

Need to belong, daily social engagement, and transient loneliness in late life

Social experiences are of great importance in late life, and the need to belong may play a key role in shaping those experiences. A higher need to belong may motivate older adults to maintain a wide variety of social connections (e.g., family ties, friends, acquaintances, group engagement), yet may also lead to higher risks of feeling unsatisfied and lonely. However, little research examines how the need to belong may shape older adults’ social life in the daily context. This study examines the associations between older adults’ need to belong, daily social engagement, and transient loneliness in their everyday life. Older adults ( N = 299) aged 65–89 completed the Need to Belong Scale, measures of their social networks, and ecological momentary assessment (EMA) surveys for five to six days. At each three-hour assessment, they reported in-person and phone contact with a variety of social partners (e.g., family, friends, acquaintances, etc.), whether they engaged in a social group, and rated their feelings of loneliness. In multilevel models, the need to belong did not predict the variety of partners encountered in-person or by phone, but predicted a greater likelihood of engagement with social groups. Older adults with a higher need to belong reported that they felt lonelier at three-hour intervals throughout the day, but this association was attenuated when they had in-person encounters with a greater variety of social partners. Group engagement was associated with feeling less lonely, whereas phone communication was associated with feeling more lonely, regardless of the need to belong. The findings suggest that social engagement with a variety of types of social partners may help satisfy older adults’ need to belong, and highlight the unique benefits that in-person contact (vs. phone contact) and group engagement may confer to mitigate older adults’ loneliness.

Computerized Cognitive and Skills Training in Older People With Mild Cognitive Impairment: Using Ecological Momentary Assessment to Index Treatment-Related Changes in Real-World Performance of Technology-Dependent Functional Tasks

ObjectivesCognitive and functional skills training improves skills and cognitive test performance, but the true test of efficacy is real-world transfer. We trained participants with mild cognitive impairment (MCI) or normal cognition (NC) for up to 12 weeks on six technology-related skills using remote computerized functional skills assessment and training (FUNSAT) software. Using ecological momentary assessment (EMA), we measured real-world performance of the technology-related skills over 6 months and related EMA-identified changes in performance to training gains. DesignRandomized clinical trial with post-training follow-up. SettingA total of 14 Community centers in New York City and Miami. ParticipantsOlder adults with normal cognition (n = 72) or well-defined MCI (n = 92), ranging in age from 60 to 90, primarily female, and racially and ethnically diverse. InterventionComputerized cognitive and skills training. MeasurementsEMA surveys measuring trained and untrained functional skills 3 or more days per week for 6 months and training gains from baseline to end of training. ResultsTraining gains in completion times across all 6 tasks were significant (p <0.001) for both samples, with effect sizes more than 1.0 SD for all tasks. EMA surveys detected increases in performance for both trained (p <0.03) and untrained (p <0.001) technology-related skills for both samples. Training gains in completion times predicted increases in performance of both trained and untrained technology-related skills (all p <0.001). ConclusionsComputerized training produces increases in real-world performance of important technology-related skills. These gains continued after the end of training, with greater gains in MCI participants.

Associations of self-regulation strategy use with in-play betting intensity and associated harms: An ecological momentary assessment study

Self-regulation strategies, such as limit setting, can be effective in reducing harms associated with gambling. However, limited research has examined their applicability to in-play sports betting. The current study therefore examined the utility of self-regulation strategies in reducing in-play betting intensity and associated harms. Adults engaging in-play betting (N = 77; Mage = 41.23 years, 71.43 % men) completed 14 days of ecological momentary assessment surveys in which they reported their in-play betting behaviours (number of bets placed, money spent), use of self-regulation strategies for in-play betting (setting monetary limits, setting time limits, stopping betting when no longer fun, taking frequent breaks), and in-play-betting-related harms. Multilevel models revealed that participants with a greater propensity to set monetary limits were overall less likely to experience financial, interpersonal, and health harms. In addition, participants were less likely to experience emotional/psychological harms following in-play betting occasions during which they set monetary limits (versus when they did not). In contrast, participants with a greater propensity to set time limits tended to spend more money on in-play bets, experienced more harms on average, and were overall more likely to experience financial and work/study harms. Results provide preliminary support for the utility of monetary limit setting, but not time limit setting, in reducing in-play-betting-related harms. Findings support the applicability of select self-regulation strategies originally proposed for more traditional forms of gambling to in-play sports betting, and highlight a need for further research investigating whether other responsible gambling strategies may be effective in reducing in-play-betting-related harms.