Use Of Ecological Momentary Assessment Research Articles

Process-based therapy vs. routine-CBT for difficult-to-treat mood and anxiety disorders: study protocol for a randomized controlled trial

BackgroundProcess-based therapy (PBT) is a new framework to intervention planning, based on the use of ecological momentary assessment (EMA) data and dynamic and idiographic network analyses. Support for its applicability has been reported from a single-case studies. Here, we examine the feasibility and effectiveness of PBT in a larger clinical sample. We have translated a training manual of PBT and modified for delivery of CBT in mental health service. The aim of this study is to test the relative efficacy of PBT compared to traditional CBT delivered in routine practice (r-CBT) for difficult-to-treat mood and anxiety disorders.MethodsThe study is a randomized controlled trial (RCT) of PBT vs r-CBT for difficult-to-treat unipolar depression and anxiety disorders. In total, 80 patients are recruited at an outpatient clinic and included in two intervention arms.Primary outcome is emotional distress; secondary outcomes include psychological well-being and quality of life, adaptive behavior, psychological flexibility, and reflective functioning. Assessments of outcome variables are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes are collected for every session to investigate process of change. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and adherence with manual will be monitored using self-report.DiscussionThe current study will be the first RCT of PBT in a health care setting. The planned moderator and mediator analyses will clarify the mechanisms of change in psychotherapy and the association between personalized assessment based on dynamic network analysis and treatment effect.Trial registrationClinicalTrials.gov NCT06517589. Registered 24 July 2024.

Ecological Momentary Assessment of Mental Health Problems Among University Students: Data Quality Evaluation Study.

The use of ecological momentary assessment (EMA) designs has been on the rise in mental health epidemiology. However, there is a lack of knowledge of the determinants of participation in and compliance with EMA studies, reliability of measures, and underreporting of methodological details and data quality indicators. This study aims to evaluate the quality of EMA data in a large sample of university students by estimating participation rate and mean compliance, identifying predictors of individual-level participation and compliance, evaluating between- and within-person reliability of measures of negative and positive affect, and identifying potential careless responding. A total of 1259 university students were invited to participate in a 15-day EMA study on mental health problems. Logistic and Poisson regressions were used to investigate the associations between sociodemographic factors, lifetime adverse experiences, stressful events in the previous 12 months, and mental disorder screens and EMA participation and compliance. Multilevel reliability and intraclass correlation coefficients were obtained for positive and negative affect measures. Careless responders were identified based on low compliance or individual reliability coefficients. Of those invited, 62.1% (782/1259) participated in the EMA study, with a mean compliance of 76.9% (SD 27.7%). Participation was higher among female individuals (odds ratio [OR] 1.41, 95% CI 1.06-1.87) and lower among those aged ≥30 years (OR 0.20, 95% CI 0.08-0.43 vs those aged 18-21 years) and those who had experienced the death of a friend or family member in the previous 12 months (OR 0.73, 95% CI 0.57-0.94) or had a suicide attempt in the previous 12 months (OR 0.26, 95% CI 0.10-0.64). Compliance was particularly low among those exposed to sexual abuse before the age of 18 years (exponential of β=0.87) or to sexual assault or rape in the previous year (exponential of β=0.80) and among those with 12-month positive alcohol use disorder screens (exponential of β=0.89). Between-person reliability of negative and positive affect was strong (RkRn>0.97), whereas within-person reliability was fair to moderate (Rcn>0.43). Of all answered assessments, 0.86% (291/33,626) were flagged as careless responses because the response time per item was <1 second or the participants gave the same response to all items. Of the participants, 17.5% (137/782) could be considered careless responders due to low compliance (<25/56, 45%) or very low to null individual reliability (raw Cronbach α<0.11) for either negative or positive affect. Data quality assessments should be carried out in EMA studies in a standardized manner to provide robust conclusions to advance the field. Future EMA research should implement strategies to mitigate nonresponse bias as well as conduct sensitivity analyses to assess possible exclusion of careless responders.

Choosing Health: acceptability and feasibility of a theory-based, online-delivered, tailored weight loss, and weight loss maintenance intervention.

Few weight loss and weight loss maintenance interventions are tailored to include factors demonstrated to predict the user's behavior. Establishing the feasibility and acceptability of such interventions is crucial. The aim of this study was to assess the acceptability and feasibility of a theory-based, tailored, online-delivered weight loss and weight loss maintenance intervention (Choosing Health). We conducted a mixed methods process evaluation of the Choosing Health tailored intervention, nested in a randomized controlled trial (N = 288) with an embedded N-of-1 study, investigating participants' and implementers' experiences related to intervention context, implementation, and mechanisms of impact. Measures included: (i) surveys, (ii) data-prompted interviews (DPIs) with study participants, (iii) semi-structured interviews with implementers, and (iv) intervention access and engagement data. Five themes described the acceptability of the intervention to participants: (i) monitoring behavior change and personal progress to better understand the weight management process, (ii) working collaboratively with the intervention implementers to achieve participants' goals, (iii) perceived benefits of non-judgmental and problem-solving tone of the intervention, (iv) changes in personal perception of the weight management process due to intervention tailoring, and (v) insufficient intervention content tailoring. The intervention delivery was feasible, however, emails and text messages differed in terms of accessibility and resources required to deliver the content. The use of Ecological Momentary Assessment as a technique to gather personal data for further tailoring was acceptable, and facilitated behavior change monitoring. Personalization of the intervention content above and beyond domain-specific issues, for example, by addressing participants' social roles may better match their needs. Support from the implementers and feedback on body composition changes may increase participants' engagement.

Use of Ecological Momentary Assessment to Measure Dyspnea in COPD.

Dyspnea is an unpredictable and distressing symptom of chronic obstructive pulmonary disease (COPD). Dyspnea is challenging to measure due to the heterogeneity of COPD and recall bias associated with retrospective reports. Ecological Momentary Assessment (EMA) is a technique used to collect symptoms in real-time within a natural environment, useful for monitoring symptom trends and risks of exacerbation in COPD. EMA can be integrated into mobile health (mHealth) platforms for repeated data collection and used alongside physiological measures and behavioral activity monitors. The purpose of this paper is to discuss the use of mHealth and EMA for dyspnea measurement, consider clinical implications of EMA in COPD management, and identify needs for future research in this area.

The use of ecological momentary assessment for family caregivers of adults with chronic conditions: A systematic review.

Ecological momentary assessment (EMA) as a real-time data collection method can provide insight into the daily experiences of family caregivers. This systematic review aimed to synthesize studies involving EMA completed by family caregivers of adults with chronic conditions. A systematic search was conducted within six databases for articles published from the inception of the database through September 2023. We extracted the characteristics of the included studies and data on EMA-specific methods to determine the quality of the included studies. A total of 12 studies involving EMA completed by family caregivers of adults with chronic conditions were identified, with almost all studies focused on caregivers of persons with Alzheimer's or dementia-related conditions. The average compliance rate across the included studies was 75%, below the recommended rate. In addition, most of the included studies did not collect the family caregivers' daily activities and care contexts in their responses (i.e., affect, stress, well-being, care demand, and fatigue) to the EMA prompts. This review showed that using EMA to collect information on family caregivers of adults with chronic health conditions appeared feasible and acceptable. However, the methodology or design of using EMA to collect caregiver information in this population is still preliminary. The limited number of existing studies that have used EMA to capture the daily experiences of family caregivers does not provide key information that could improve understanding of caregivers' emotional experiences and well-being in real-life situations. We identified gaps in the literature that warrant additional EMA studies for this population.

Exploring the Use of Ecological Momentary Assessment within a Telehealth Intervention for Families of Children with Autism

Exploring the Use of Ecological Momentary Assessment within a Telehealth Intervention for Families of Children with Autism

A-36 Tracking Compliance To A Home Exercise Program For Concussion Using Ecological Momentary Assessment: A Pilot Study

Abstract Purpose: The management of pediatric concussions creates a clinical challenge due to unknown patient compliance with prescribed therapies and interventions. The purpose of this pilot study was to describe the logistical use of ecological momentary assessment (EMA) to track compliance to a physical therapy facilitated vestibular/ocular motor home exercise program (HEP) in patients diagnosed with concussion. Methods: A convenience sample of 20 concussed patients (aged 13–18 years [mdn = 14.5, IQR = 14.0–16.8]) was included in this initial pilot study. All participants were evaluated within seven days of injury. Participants were instructed to complete one daily HEP compliance log until medical clearance on their parent or guardians’ mobile device using an EMA application. Results: Participants were evaluated a median 3.5 (IQR = 1.3–6.5) days post injury, recovered in a median 15.5 (IQR = 11.0–25.0) days, and completed a mean 5.85 (SD = 3.9) total EMA logs representing a 47% completion rate. Participants reported completing a mean 1.21 (SD = 0.77) HEPs per day with a range of 0.0 to 3.0. Self-reported HEP compliance did not significantly correlate with recovery time in days (P = 0.26). Conclusions: The overall response rate for EMA logs was 47% and participants reported completing 1.2 HEPs per day. Analysis of this preliminary data did not reveal a correlation between HEP compliance and recovery time in days. Participants reported the primary barrier to completing daily questionnaires was access to their parent or guardians’ mobile device at the time of the prompt. Overall, the data derived from EMA appears useful for tracking the progression of this heterogenous injury.

Confinement effects on older adults using ecological momentary assessment in the U.S.

• The use of ecological momentary assessment is novel in the analysis of confinement effects on older adults during the COVID-19 pandemic. • onfinement effects on mood is not significant among older adults with higher income during the COVID-19 pandemic. • Social interactions and positive affect are highly related.

Temporal relationships of ecological momentary mood and actigraphy-based sleep measures in bipolar disorder

Sleep disturbances are a key feature of bipolar disorder (BD), and poor sleep has been linked to mood symptoms. Recent use of ecological momentary assessment (EMA) has allowed for nuanced exploration of the sleep-mood link; though, the scale and directionality of this relationship is still unclear. Using EMA, actigraphy, and self-reported sleep measures, this study examines the concurrent and predictive relationships between sleep and mood. Participants with BD (n = 56) wore actigraphy devices for up to 14 days and completed validated scales and daily EMA surveys about mood and sleep quality. Linear mixed models were used to examine overall and time-lagged relationships between sleep and mood variables. EMA mood ratings were correlated with validated rating scales for depression, mania, anxiety, and impulsivity. Poor self-reported sleep quality was associated with worse overall ratings of sadness and anger. Worse self-reported sleep quality was associated with greater sadness the following day. Higher daytime impulsivity was associated with worse sleep quality the following night. Exploratory analyses found relationships between worse and more variable mood (sadness, anger, and impulsivity) with worse and more variable sleep that evening (efficiency, WASO, and sleep onset time). The sample size was modest, fairly homogenous, and included mainly euthymic persons with BD. EMA-based assessments of mood and sleep are correlated with validated scale scores and provide novel insight into intra-individual variability. Further work on the complex two-way interactions between sleep and mood is needed to better understand how to improve outcomes in BD.

Ecological momentary assessment of outcomes in allergic rhinitis and chronic rhinosinusitis: A review

Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) rely on patient-reported symptoms and quality-of-life measures, which are subject to bias. Ecological momentary assessment (EMA) captures data in real time through repeated short surveys, thus reducing errors/biases. EMA's use in sinonasal conditions has not been well described, and the goal of this study was to examine the literature on EMA and AR/CRS. METHODS: A literature review was performed using the following search terms: AR, CRS, and EMA. Inclusion criteria were the use of EMA reporting of sinonasal symptoms at more than one time point. Systematic reviews and non-full text articles were excluded. Population demographics, sinonasal disease, type of EMA platform used, type and severity of symptoms reported, medication use and symptom correlation with location/pollen/pollution were collected. Eight studies met the inclusion criteria, and all focused on AR. All studies were conducted outside the United States in both children and adults. Seven studies used a smartphone application for reporting symptoms, and one used WeChat surveys. EMA data collection varied, with repetitive survey intervals determined either by patients (n=6) or research team (n=2). All studies reported sinonasal severity scores, while six reported additional symptoms (e.g., ocular, pulmonary, sleep, general health). Five collected self-reported allergy medication use. Seven studies correlated symptoms with location, pollen, or pollution. Few studies in AR and no studies in CRS assessed the use of EMA. EMA may provide a better understanding of the real-time relationship of environmental triggers with symptoms, in turn guiding treatment decisions.

Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study.

BackgroundEcological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients’ behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability.ObjectiveThe aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance.MethodsThe participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on “being user versus nonuser” (acceptability), which was the main outcome measure.ResultsOut of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability.ConclusionsAcceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment.Trial RegistrationClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347

Use of Ecological Momentary Assessment to Study Suicidal Thoughts and Behavior: a Systematic Review.

Ecological momentary assessment (EMA) is a recently introduced approach to patient evaluation that consists of asking patients questions in real time and in their usual habitat. This method seeks to contribute to suicide prevention by providing psychiatrists with detailed information about suicidal thoughts and behavior, how these fluctuate over short periods of time, and the short-term risk factors presented by patients. We conducted a systematic review of published research using EMA to study suicidal thoughts and behavior. Several systematic reviews of EMA in mental health have been conducted to date, and the literature contains numerous theoretical papers and compilations on EMA and suicide phenomena. To date, however, no systematic reviews have explored the use of this tool to study suicidal thoughts and behavior. We performed a systematic review of five databases (i.e., PubMed, Embase, Scopus, Web of Science, and PsycINFO) to identify studies on EMA and suicidal thoughts and behavior. An initial search revealed 544 articles. Following the study selection process, 35 studies were included in the review. Almost three-quarters of the studies were published in the last 4 years. The studies reviewed concluded that EMA was generally feasible and well accepted. EMA findings correlated well with the results of a retrospective assessment, though tended to over-represent symptom severity. Our review points to important aspects of suicidal thoughts and behavior, such as its wide fluctuation over short periods of time. Negative affect and disturbed sleep, among others, emerged as short-term predictors of suicidal thoughts and behavior. Therefore, EMA is a potentially useful tool in clinical practice, although not without drawbacks, such as participant fatigue with questionnaires and ethical concerns.

Using machine learning to identify predictors of imminent drinking and create tailored messages for at-risk drinkers experiencing homelessness

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.

Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study.

BackgroundThe 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.ObjectiveThis study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective.MethodsYEH 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.ResultsA 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.ConclusionsYEH 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.

A perspective on the use of ecological momentary assessment and intervention to promote stroke recovery and rehabilitation

ABSTRACT Motivated by recent advances in technologies, ecological momentary assessment (EMA), and ecological momentary intervention (EMI) have seen a rise in behavioral medicine research that in real-time, informs the context for the behavior and prompts interventions to change that behavior in the natural setting when necessary. However, EMA and EMI have yet to be fully embraced in the field of stroke rehabilitation. Our objective is to provide a theoretically based perspective for the combined and synergistic use of EMA and EMI to promote person-centered, recovery-based durable changes in functional movement behaviors of stroke survivors. Research abounds for non-stroke populations with emerging evidence for the benefits of using real-time data capture techniques (i.e. EMA) coupled with EMI to better customize the content and timing of interventions to the inherent fluctuations in state and context that encompass the target behavior. We review existing EMA and EMI literature broadly in behavioral medicine and psychological science to identify how real-time repeated sampling technology has been used in the context of stroke rehabilitation and to delineate the pros and cons of this approach in general with non-stroke populations. We propose a coupled EMA and EMI strategy be used in conjunction with existing stroke recovery and rehabilitation practices. There is tremendous potential to effectively personalize recovery-promoting interventions to achieve durable behavior change, and importantly, shift the focus of rehabilitation practice from the health-care provider and clinical environment to the individual and their lived experience in the home and community.

Implications for Using Mobile Ecological Momentary Assessment to Collect Climate Data from Vulnerable Urban Populations

This work documents the use of Ecological Momentary Assessment (EMA) to gather data on household behaviors related to outdoor temperatures. In order for urban decision-makers to take effective action to address heat events, they must understand vulnerable residents’ current practices in relation to outdoor temperature. However, vulnerable residents are often excluded from research and can be difficult to reach. EMA allows researchers to gather data in real time and in a subject’s natural environment, which reduces recall bias and improves ecological validity. In this study, EMA was used via a mobile phone app to gather information on home cooling behaviors from residents in vulnerable neighborhoods. Few participants reported making changes to their indoor environments apart from adjusting the thermostat. Despite low participation, the experience of conducting this research has resulted in valuable “lessons learned”. These lessons are used to inform implications and considerations for future use of EMA with vulnerable populations.

The use of ecological momentary assessment to evaluate real-world aided outcomes with children

Background Ecological momentary assessment (EMA) methods allow for real-time, real-world survey data collection. Studies with adults have reported EMA as a feasible and valid tool in the measurement of real-world listening experience. Research is needed to investigate the use of EMA with children who wear hearing aids. Objectives This study explored the implementation of EMA with children using a single-blinded repeated measures design to evaluate real-world aided outcome. Methods Twenty-nine children, aged 7–17, used manual program switching to access hearing aid programs, fitted according to Desired Sensation Level (DSL) version 5.0 child quiet and noise prescriptive targets. Aided outcome was measured using participant-triggered twice-daily EMA entries, across listening situations and hearing dimensions. Results Adherence to the EMA protocol by the children was high (82.4% compliance rate). Speech loudness, understanding and preference results were found to relate to both the hearing aid program and the listening situation. Aided outcomes related to prescription-based noise management were found to be highest in noisy situations. Conclusions Mobile device-based EMA methods can be used to inform daily life listening experience with children. Prescription-based noise management was found to decrease perceived loudness in noisy, non-school environments; this should be evaluated in combination with hearing aid noise reductions features.

Use of Ecological Momentary Assessment to Measure Self-Monitoring of Blood Glucose Adherence in Youth With Type 1 Diabetes.

Daily self-monitoring of blood glucose (SMBG) is essential for type 1 diabetes management yet is challenging during adolescence. Ecological momentary assessment (EMA) is the repeated sampling of behaviors and experiences in real time in the natural environment. The purpose of this study was to evaluate 1) the validity of self-reported SMBG values via text message-delivered EMA surveys compared with objective SMBG values via glucose meters and 2) in-the-moment motivators and barriers to performing SMBG in a pediatric type 1 diabetes population. Youth (n = 62, aged 11-21 years) with type 1 diabetes received three text messages daily for 10 days containing surveys inquiring about SMBG engagement. Objective SMBG values were downloaded from glucose meters. On average, participants reported performing SMBG 4 times/day. Of the self-reported SMBG values, 39.6% were accurate. Inaccurate values included additions (i.e., self-reported value with no objective value), omissions (i.e., objective value with no self-reported value), and alterations (difference between self-report and objective SMBG values ≥10 mg/dL). Of the matched pairs of self-reported and objective SMBG values, 41.3% were altered. Bland-Altman plots determined that the mean difference between self-reported and objective glucose data were -5.43 mg/dL. Participants reported being motivated to check their blood glucose because it was important for their health, and reported barriers included wanting to ignore the task, forgetting, and not having devices. Youth's self-reported SMBG values may not align with objective readings. The results of this study can facilitate future research to determine individual factors related to SMBG and accuracy of self-reporting.

Guidelines and Recommendations for Training Ethical Alcohol Researchers.

Research on alcohol use presents several ethical challenges, and therefore, training of ethical alcohol researchers is particularly important. While the Helsinki Declaration (World Medical Association, 2001), Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978), and American Psychological Association's (APA) Ethics Code (2002) provide ethical guidelines and aspirational principles for researchers, there are a number of areas in which these principles allow for judgment. For trainees in particular, this ambiguity may be disconcerting. Along with these broader principles, there are also specific considerations for training alcohol researchers in the responsible conduct of research, which may further complicate matters for trainees. Although alcohol research is an important avenue for understanding a large public health concern and investigating risk and protective factors associated with use, it also presents a number of ethical and legal challenges for researchers. Working with high-risk drinking populations presents unique ethical and legal challenges in the areas of informed consent, confidentiality, compensation, and risk-benefit ratios. Additionally, alcohol administration studies present challenges for those supervising, as well as conducting, such experiments. New technology, such as the use of ecological momentary assessment (EMA) or other ambulatory assessment methods to examine risky and illegal behaviors, also presents new ethical challenges that are likely to continue to evolve in the coming years for trainees. Specific recommendations for handling a variety of concerns that may arise when conducting alcohol research are provided. Additionally, suggestions for improving the training of ethical alcohol researchers are discussed.

Ecological momentary assessment of the snacking environments of children from racially/ethnically diverse households

Children consume nearly one-third of their daily energy intake as snacks (i.e., eating occasions that occur between meals); thus there is a growing interest in understanding what snacking occasions look like in the homes of young children. This study makes use of ecological momentary assessment (EMA) to 1) examine differences in the contextual factors, including location, food preparation style, people present, presence of media devices, and overall atmosphere, between meal and snack occasions; and 2) explore differences in the context of snacking occasions across children's gender and weight status. Data for the current study came from the Family Matters Study, which included 150 families with children aged 5–7 years old (n = 25 from each of the following groups: Black/African American, Hispanic, Hmong, Native American, Somali, White). Parents completed an 8-day EMA observation period, during which they were surveyed after each eating occasion with the study child; questions explored contextual factors including location, food preparation style, people present, presence of media devices, and the overall atmosphere of each eating occasion. Differences between meals and snacks were observed; a smaller percentage of snacks (compared to meals) were prepared by the parent, consisted of only homemade food, and were planned ahead of time, as opposed to being served in response to a child's request. Snacks were more likely than other meals to be eaten on the couch and in the presence of a screen. Furthermore, important differences in snacking context were observed by child gender and weight status. Findings illuminate opportunities to improve children's overall dietary intake via interventions focused on improving the quality of foods served during snacks, as well as the contextual environment in which snacks are eaten.