Ecological Momentary Assessment Research Articles

Novel methods for the remote investigation of emerging substances: Application to kratom.

The botanical product commonly called "kratom" is still relatively novel to the United States. Like other natural products marketed as supplements, kratom is highly variable, both in terms of the alkaloids naturally occurring in kratom leaves and in terms of processing and formulation. Kratom products sold in the United States are not well-characterized, nor are daily use patterns among regular users. Surveys and case reports have comprised most of the literature on kratom use among humans. To advance our understanding of real-world kratom use, we developed a protocol for the remote study of regular kratom-using adults in the United States. Our study had three aspects implemented in one pool of participants nationwide: an in-depth online survey, 15 days of ecological momentary assessment (EMA) via smartphone app, and the collection and assay of the kratom products used by participants during EMA. Here, we describe these methods, which can be used to investigate myriad drugs or supplements. Recruiting, screening, and data collection occurred between July 20, 2022 and October 18, 2022. During this time, we demonstrated that these methods, while challenging from a logistical and staffing standpoint, are feasible and can produce high-quality data. The study achieved high rates of enrollment, compliance, and completion. Substances that are emerging or novel, but still largely legal, can be productively studied via nationwide EMA combined with assays of shipped product samples from participants. We discuss challenges and lessons learned so other investigators can adapt these methods. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of daily discrimination on naturalistic sleep health features in young adults.

Racial inequities in sleep health are well documented and may be partially attributable to discrimination experiences. However, the effects of acute discrimination experiences on same-night sleep health are understudied. We quantified naturalistic discrimination experiences captured using ecological momentary assessment (EMA) and examined whether reporting discrimination on a given day predicted sleep health that night. Participants completed baseline assessments and a 17-day EMA protocol, with text prompts delivered four times daily to collect discrimination experiences. Seven different daily sleep characteristics were ascertained each morning. Discrimination reasons (e.g., because of my racial identity) were reported by participants and categorized into any, racial, or nonracial discrimination. Outcomes included the seven sleep diary characteristics. We fit generalized linear mixed effects models for each sleep outcome and discrimination category, controlling for key covariates. The analytic sample included 116 self-identified Black and White individuals (48% Black, 71% assigned female at birth, average age = 24.5 years). Among Black participants, race-based discrimination was associated with a 0.5-hr reduction in total sleep time (TST). Among White individuals, nonracial discrimination was associated with a 0.6-hr reduction in TST, an earlier sleep offset, and reduced sleep efficiency (partly attributable to more nighttime awakenings). Young adults may sleep worse on nights after experiencing discrimination, and different types of discrimination affect different sleep outcomes for Black and White individuals. Future studies may consider developing treatments that account for different sleep vulnerabilities for people experiencing discrimination on a given day. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

244 Couples' Daily Health in Breast Cancer Survivorship: Dyadic Associations in Psychological, Physical, and Relational Health

OBJECTIVES/GOALS: Breast cancer survivors who experience psychological and physical symptoms after treatment ends have an increased risk for comorbid disease development, reduced quality of life, and premature mortality. However, survivors in satisfying marriages report lower stress and better health than those in dissatisfying marriages. METHODS/STUDY POPULATION: Research is needed to identify how survivors’ marriages provide these health benefits across the cancer continuum. Including both survivors and their partners’ perspectives can identify key pathways connecting relationships to better health. This study examined survivors’ and their partners’ psychological, physical, and relational health. Breast cancer survivors (stage 0-III) and their partners (n=34 individuals, 17 couples) completed a baseline online survey followed by a 7-day diary study with three ecological momentary assessments across the day. Questionnaires assessed their cancer-related communication, relationship distress, and psychological and physical symptoms. RESULTS/ANTICIPATED RESULTS: Survivors reported poorer sleep quality and greater fatigue than their partners. Survivors also reported disclosing more thoughts, feelings, and information about cancer compared to their partners. For both survivors and partners, feeling more satisfied with each other’s cancer-related discussions and reporting lower relational distress correlated with fewer physical symptoms, sleep problems, fatigue, and psychological distress. DISCUSSION/SIGNIFICANCE: For both survivors and their partners, feeling more satisfied with how often they talked about survivorship and the cancer experience was associated with better psychological and physical health. This research demonstrates the health benefits and importance of open communication for both survivors and their partners across the cancer continuum.

Moment-to-Moment Association Between Cognitive Regulation and Performance of Daily Activities in Mild Stroke and Transient Ischemic Attack using Ecological Momentary Assessment

Moment-to-Moment Association Between Cognitive Regulation and Performance of Daily Activities in Mild Stroke and Transient Ischemic Attack using Ecological Momentary Assessment

362 Examining Temporal Links Between Distinct Negative Emotions and Tobacco Lapse During A Cessation Attempt

OBJECTIVES/GOALS: Negative emotions (NE) play a pivotal role in addiction-related processes, including tobacco lapse during a quit attempt. Some NEs (e.g., shame, guilt) are posited to lead to a spiraling effect, whereby lapse predicts increased NEs leading to further lapse. This study goal is to examine associations between NEs and lapse. METHODS/STUDY POPULATION: This study examined associations between tobacco lapse and 13 distinct NEs among people who use tobacco and are trying to quit in two tobacco cessation studies. In Study 1, 220 adult (ages 18-74) cigarette users who identified as Black (50% female) participated in a 14-day study where ecological momentary assessment (with assessments approximately every 4 hours) was used to assess emotions and lapse in real-time and real-world settings. In Study 2, 288 adult (ages 18-71) cigarette users who were low socioeconomic status (51% White, 14% Black, 10% Hispanic, 49% female) participated in a 14-day study with the same study protocol as Study 1. Between and lagged within-person associations testing links between distinct NEs and lapse were examined with multilevel modeling with logistic links for binary outcomes. RESULTS/ANTICIPATED RESULTS: Results from Study 1 suggested that at the between-person level, disgust (OR =1.22, CI: 1.05, 1.42), nervousness (OR=1.23, CI:1.05,1.43), guilt (OR=1.40, CI: 1.16,1.69), and sadness (OR=1.18, CI:1.02,1.36) were predictive of higher odds of lapse, and at the within-person level, shame (OR=1.23, CI:1.04,1.45) was associated with higher odds of lapse. Results from Study 2 were similar and suggested that at the between-person level, disgust (OR=1.35, CI: 1.16, 1.56) and guilt (OR=1.88, CI:1.07,3.30), and at the within-person level, shame (OR =1.31, CI:1.10,1.55), were associated with higher odds of lapse. DISCUSSION/SIGNIFICANCE: The present study uses real-time, real-world data to demonstrate the role of distinct NEs on momentary tobacco lapse and helps elucidate specific NE that hinder the ability to abstain from tobacco use during a quit attempt. Results suggest that disgust, guilt, and shame play consistent roles in predicting lapse among diverse samples of tobacco users.

Variability of the Behavioral Assessment Screening Tool for Mobile Health (BASTmHealth) for ecological momentary assessment in chronic traumatic brain injury

Variability of the Behavioral Assessment Screening Tool for Mobile Health (BASTmHealth) for ecological momentary assessment in chronic traumatic brain injury

Experiential Avoidance During Mealtimes Among Individuals with Eating Disorders

The relationship between negative emotions and avoidance is widely theorized as a bidirectional cycle implicated in a range of psychopathology. Historically, research on this cycle has examined one type of negative emotion: anxiety. Yet, a broader range of internal experiences may be implicated in the maintenance of unhealthy avoidance cycles in psychopathology. This study examines prospective relationships among anxiety, guilt, physical discomfort, and experiential avoidance during mealtimes for individuals with eating disorders (EDs). Participants (N = 108) completed ecological momentary assessments four times a day for 25 days. We computed multilevel models to examine between- and within-person effects of negative emotions and physical discomfort on experiential avoidance. When including guilt and anxiety in one model, guilt, but not anxiety, explained significant variance in experiential avoidance at the next meal. Mealtime physical discomfort and experiential avoidance evidenced reciprocal prospective relationships. Future research should test whether interventions targeting experiential avoidance and physical discomfort at mealtimes disrupt guilt.

Ecological momentary assessment of anxiety and depression symptoms in individuals with phenylketonuria

Ecological momentary assessment of anxiety and depression symptoms in individuals with phenylketonuria

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).

Preoperative Mobile Health Data Improve Predictions of Recovery From Lumbar Spine Surgery.

Neurosurgeons and hospitals devote tremendous resources to improving recovery from lumbar spine surgery. Current efforts to predict surgical recovery rely on one-time patient report and health record information. However, longitudinal mobile health (mHealth) assessments integrating symptom dynamics from ecological momentary assessment (EMA) and wearable biometric data may capture important influences on recovery. Our objective was to evaluate whether a preoperative mHealth assessment integrating EMA with Fitbit monitoring improved predictions of spine surgery recovery. Patients age 21-85 years undergoing lumbar surgery for degenerative disease between 2021 and 2023 were recruited. For up to 3 weeks preoperatively, participants completed EMAs up to 5 times daily asking about momentary pain, disability, depression, and catastrophizing. At the same time, they were passively monitored using Fitbit trackers. Study outcomes were good/excellent recovery on the Quality of Recovery-15 (QOR-15) and a clinically important change in Patient-Reported Outcomes Measurement Information System Pain Interference 1 month postoperatively. After feature engineering, several machine learning prediction models were tested. Prediction performance was measured using the c-statistic. A total of 133 participants were included, with a median (IQR) age of 62 (53, 68) years, and 56% were female. The median (IQR) number of preoperative EMAs completed was 78 (61, 95), and the median (IQR) number of days with usable Fitbit data was 17 (12, 21). 63 patients (48%) achieved a clinically meaningful improvement in Patient-Reported Outcomes Measurement Information System pain interference. Compared with traditional evaluations alone, mHealth evaluations led to a 34% improvement in predictions for pain interference (c = 0.82 vs c = 0.61). 49 patients (40%) had a good or excellent recovery based on the QOR-15. Including preoperative mHealth data led to a 30% improvement in predictions of QOR-15 (c = 0.70 vs c = 0.54). Multimodal mHealth evaluations improve predictions of lumbar surgery outcomes. These methods may be useful for informing patient selection and perioperative recovery strategies.

Daily Ecological Momentary Assessments of Pain and Ability to Work after Ureteroscopy and Stenting.

Introduction Ureteral stents can cause significant patient discomfort, yet the temporal dynamics and impact on activities remain poorly characterized. We employed an automated tool to collect daily ecological momentary assessments (EMA) regarding pain and ability to work following ureteroscopy with stenting. Our aim was to assess feasability, and better characterize the postoperative patient experience. Methods As an exploratory endpoint within an ongoing clinical trial, patients undergoing ureteroscopy with stenting were asked to complete daily EMAs for 10 days postoperatively, or until the stent was removed. Questionnaires were distributed via text message and included a pain scale (0-10) and a single item from the validated PROMIS Ability to Participate in Social Roles and Activities instrument, as well as days missed from work or school. Results Among the first 65 trial participants, 59 completed at least 1 EMA (overall response rate 91%). Response rates were >85% for each timepoint through POD10. Median respondent age was 58 years (IQR 50-67), 56% were female. Stones were 54% renal and 46% ureteric, with median diameter 9 mm (IQR 7-10). Median stent dwell time was 7 days (IQR 6-8). Pain scores were highest on POD1 (median score 4) and declined with each subsequent day, reaching median score 2 on POD5. 63% of patients on POD1 reported they had trouble performing their usual work at least sometimes, but by POD5 this was <50% of patients. Patients who work or attend school reported a median of 1 day missed (IQR 0-2). Conclusions An automated daily EMA system for capturing patient-reported outcomes was demonstrated to be feasible with sustained excellent engagement. Patients with stents reported the worst pain and interference with work on POD1 with steady improvements thereafter, and by POD5 the majority of patients had minimal pain or trouble performing their usual work.

Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens

According to the cognitive model of suicide, interactions between hopelessness and attentional biases toward suicidal information create a narrowed attentional focus on suicide as a viable solution, particularly in the presence of life stress, leading to increased suicide risk. This study used a dynamic systems approach to examine the short-term temporal patterns between stress, hopelessness, suicide-specific rumination, and suicidal intent. Adults (N = 237; M = 27.12 years; 62% cisgender women; 87% White/European American) with elevated suicidal ideation completed ecological momentary assessments six times a day for 14 days. A multilevel model approach informed by dynamic systems theory was used to simultaneously assess stable and dynamic temporal processes underlying perceived stress, hopelessness, suicide-specific rumination, and suicidal intent. Each variable demonstrated temporal stability. In support of the cognitive model of suicide, we observed (1) a reciprocal relationship between stress and hopelessness such that stress and hopelessness amplified each other (early-stage processes), and (2) reinforcing loops such that hopelessness, suicide-specific rumination, and suicidal intent amplified each other (later-stage processes). A dynamic systems modeling approach underscored the negative impact of a perpetuating cycle of suicide-specific rumination, deepening hopelessness, and escalating suicidal intent on increasing suicide risk, which may be targets for intervention.

Implementation of an Ecological Momentary Assessment (EMA) in Naturalistic Psychotherapy Settings: Qualitative Insights from Patients, Therapists, and Supervisors Perspectives.

Ecological momentary assessment (EMA) allows measuring intra-individual processes moment by moment, identifying and modeling, in a naturalistic way, individual levels and changes in different psychological processes. However, active EMA requires a high degree of adherence, as it implies a significant burden for patients. Moreover, there is still no consensus on standardized procedures for implementation. There have been few results in detecting desirable characteristics for the design and implementation of an EMA device. Studies that address these issues from the perspectives of participants in psychotherapeutic processes are needed. To analyze the perspectives of patients, therapists and supervisors on the implementation of an EMA device in a psychotherapeutic treatment for depression. The sample will include eight patients, eleven therapists and five supervisors, taken from a research project that implemented an EMA system for monitoring the dynamics of affectivity at the beginning of psychotherapies for depression. Semi-structured interviews specific to each group are being conducted and analyzed from a qualitative approach based on consensual qualitative research (CQR). Participants reported having a positive evaluation of the study's informational resources and implementation. Difficulties were expressed in responding in the morning hours and the importance of having a customized EMA that is tailored to the needs of the patients was expressed. Furthermore, patients and therapists agreed that the impact of the use of the monitoring system on treatment was neutral or positive. In contrast, patients considered the EMA to be positive for their daily life.

Study protocol: randomized controlled trial of an individualized music intervention for people with dementia in the home care setting

BackgroundStudies suggest that individualized music listening is an effective, non-pharmacological intervention for improving the quality of life of people with dementia in the institutional care setting. Noting that most people with dementia live at home, we conduct a randomized controlled trial to assess the feasibility and effectiveness of an app-based individualized music listening intervention for people with dementia in the home care setting. The intervention is delivered by family caregivers.MethodsWe will recruit N = 130 dyads consisting of one person with dementia living at home and their family caregiver. After a baseline assessment, dyads are randomly assigned by gender to either the intervention or control group. People with dementia in the intervention group listen to individualized music playlists for 20 min every other day for six weeks via the self-developed Individualized Music and Dementia app. The control group receives standard care. All dyads complete paper-and-pencil questionnaires six weeks before the start of the intervention (T0), directly before the intervention (T1), directly after the intervention (T2), and six weeks later (T3). During the intervention period, all caregivers also complete daily ecological momentary assessments via the app. During three home visits, a trained project member will observe the dyads and collect hair samples. After the intervention, semi-structured interviews will be conducted to collect information about participants’ experiences with the app and intervention. The primary outcome is the attainment of individual goals established during the baseline assessment. Secondary outcomes are the well-being, physiological stress and quality of life of people with dementia and their caregivers; people with dementia’s behavioural and psychological symptoms of dementia, resistance during care, and reactions to the music; caregivers’ burden of care, positive aspects of care, and caregiving self-efficacy; and the quality of the caregiver-care recipient interaction.DiscussionOur study will assess the extent to which an app-based individualized music listening intervention is feasible and effective for enhancing the well-being and quality of life of people with dementia living at home and their family caregivers.Trial registrationGerman Clinical Trials Register DRKS00025502 and ISRCTN registry ISRCTN68084105, https://doi.org/10.1186/ISRCTN68084105

The IMPOWR Network Divided or Single Exposure Study (DOSE) Protocol: A Randomized Controlled Comparison of Once Versus Split Dosing of Methadone for the Treatment of Comorbid Chronic Pain and Opioid Use Disorder.

The Divided or Single Exposure (DOSE) trial is a double-blind, placebo-controlled examination of once versus split dosing of methadone for comorbid pain and opioid use disorder (OUD) among persons receiving methadone for OUD treatment. This multisite trial consists of a 12-week active intervention phase and 6-month follow-up period. Persons receiving methadone who endorse clinically-significant chronic pain are randomized into once-daily dosing or split dosing that is managed remotely via an electronic pillbox. Clinical pain is assessed weekly and using ecological momentary assessments. Experimentally-evoked pain is assessed using a quantitative sensory testing battery. Additional outcomes related to OUD, including withdrawal and craving, are also collected. The study hypothesizes that persons assigned to the split dosing condition will report lower pain and opioid withdrawal relative to persons assigned to the traditional once-daily dosing strategy. Split dosing is a relatively common technique in OUD treatments; therefore, if data support this hypothesis, there is high potential for implementation.

Personalized AI-Driven Real-Time Models to Predict Stress-Induced Blood Pressure Spikes Using Wearable Devices: Proposal for a Prospective Cohort Study

Background Referred to as the “silent killer,” elevated blood pressure (BP) often goes unnoticed due to the absence of apparent symptoms, resulting in cumulative harm over time. Chronic stress has been consistently linked to increased BP. Prior studies have found that elevated BP often arises due to a stressful lifestyle, although the effect of exact stressors varies drastically between individuals. The heterogeneous nature of both the stress and BP response to a multitude of lifestyle decisions can make it difficult if not impossible to pinpoint the most deleterious behaviors using the traditional mechanism of clinical interviews. Objective The aim of this study is to leverage machine learning (ML) algorithms for real-time predictions of stress-induced BP spikes using consumer wearable devices such as Fitbit, providing actionable insights to both patients and clinicians to improve diagnostics and enable proactive health monitoring. This study also seeks to address the significant challenges in identifying specific deleterious behaviors associated with stress-induced hypertension through the development of personalized artificial intelligence models for individual patients, departing from the conventional approach of using generalized models. Methods The study proposes the development of ML algorithms to analyze biosignals obtained from these wearable devices, aiming to make real-time predictions about BP spikes. Given the longitudinal nature of the data set comprising time-series data from wearables (eg, Fitbit) and corresponding time-stamped labels representing stress levels from Ecological Momentary Assessment reports, the adoption of self-supervised learning for pretraining the network and using transformer models for fine-tuning the model on a personalized prediction task is proposed. Transformer models, with their self-attention mechanisms, dynamically weigh the importance of different time steps, enabling the model to focus on relevant temporal features and dependencies, facilitating accurate prediction. Results Supported as a pilot project from the Robert C Perry Fund of the Hawaii Community Foundation, the study team has developed the core study app, CardioMate. CardioMate not only reminds participants to initiate BP readings using an Omron HeartGuide wearable monitor but also prompts them multiple times a day to report stress levels. Additionally, it collects other useful information including medications, environmental conditions, and daily interactions. Through the app’s messaging system, efficient contact and interaction between users and study admins ensure smooth progress. Conclusions Personalized ML when applied to biosignals offers the potential for real-time digital health interventions for chronic stress and its symptoms. The project’s clinical use for Hawaiians with stress-induced high BP combined with its methodological innovation of personalized artificial intelligence models highlights its significance in advancing health care interventions. Through iterative refinement and optimization, the aim is to develop a personalized deep-learning framework capable of accurately predicting stress-induced BP spikes, thereby promoting individual well-being and health outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/55615

I can’t believe I missed that! How the fear of missing out impacts on alcohol behaviours

BackgroundThe Fear of Missing Out (FoMO), which is often experienced over missing opportunities for social gains associated with drinking, has been linked to heavy episodic drinking and experiencing negative consequences. The UK Coronavirus (COVID-19)-related lockdown provided a unique context to study FoMO’s ability to predict of alcohol consumption. The aim of the current study was to test if FoMO predicted alcohol consumption during a time of social restrictions. MethodsOne hundred and five UK adults (aged 18–30, 61% female) participated in a study using an ecological momentary assessment design. Surveys were completed on smartphones and assessed FoMO and drinking intentions, three time a day (morning, afternoon, evening) over three consecutive weekends (Friday, Saturday, Sunday). Alcohol consumption was recorded once per day, based on previous day consumption. ResultsRepeated mixed model analyses found FoMO significantly predicted quantity of alcohol consumption (b =.05, p =.01) and drinking intentions (b =.47, p <.001), but did not predict frequency of consumption. Being male (b = 2.93, p =.02) and higher intentions (b = 0.5, p <.001) predicted higher quantity of consumption. Drinking intentions was the only variable to predict frequency of consumption (b =.004, p <.001). ConclusionsThe study showed FoMO can predict quantity of alcohol consumption and drinking intentions, which are linked to increased negative consequences. Future studies should assess FoMO against other predictive factors. Results provide an insight into how a social predictor influenced alcohol consumption during a time of restrictions.

How Individuals Shape Their Acoustic Environment: Implications for Hearing Aid Comparison in Ecological Momentary Assessment.

When using ecological momentary assessment (EMA) to compare different hearing aid programs, it is usually assumed that for sufficiently long study durations similar situations will be experienced in both programs. However, conscious or subconscious adaptation of situations to one's hearing ability (e.g., asking a conversation partner to speak up, increasing TV volume)-which might be different across the time spent in different hearing aid programs-may challenge this assumption. In the present study, we investigated how test participants modify their acoustic environment and if these modifications depend on the hearing program. Twenty-nine experienced hearing aid users were provided with hearing aids containing two hearing programs differing in directionality and noise reduction (NR). The hearing programs called NR-on and NR-off changed each day automatically. Over the course of 3 weeks, participants were asked to answer a questionnaire every time they encountered an acoustic situation they modified or would have liked to modify to improve the listening situation. Objective data on sound pressure level and classification of the acoustic situation were collected from the hearing aids. At the beginning of the study participants recollected modifications of the acoustic environments they typically do when using their own hearing aids and reported on the frequency of this behavior. During the field trial, participants reported on average 2.3 situations per day that they modified or would have liked to modify. Modifications were usually performed quickly after the onset of the situation and significantly improved the pleasantness of the listening situation. While the number of the reported situations did not differ between the programs, modifications increasing the volume of the target signal and increasing the hearing aid volume were more frequent for the NR-on hearing program. Changes in the objective data at the time of the modification were consistent with the reported modifications. Further, the usage time as well as the distribution of the acoustic situations over the entire study period differed between the two hearing programs. The large improvement in pleasantness due to the modification might explain the generally positive ratings observed in EMA studies. Furthermore, the results found here suggest that caution is needed when comparing ratings of audiological attributes in EMA, because the different modification behavior across hearing programs may lead to an underestimation of hearing problems and reduced sensitivity when comparing two technologies.

Digital Neuropsychology beyond Computerized Cognitive Assessment: Applications of Novel Digital Technologies.

Compared with other health disciplines, there is a stagnation in technological innovation in the field of clinical neuropsychology. Traditional paper-and-pencil tests have a number of shortcomings, such as low-frequency data collection and limitations in ecological validity. While computerized cognitive assessment may help overcome some of these issues, current computerized paradigms do not address the majority of these limitations. In this paper, we review recent literature on the applications of novel digital health approaches, including ecological momentary assessment, smartphone-based assessment and sensors, wearable devices, passive driving sensors, smart homes, voice biomarkers, and electronic health record mining, in neurological populations. We describe how each digital tool may be applied to neurologic care and overcome limitations of traditional neuropsychological assessment. Ethical considerations, limitations of current research, as well as our proposed future of neuropsychological practice are also discussed.

Development and Initial Validation of a Momentary Cannabis Craving Scale Within a Homogeneous Sample of U.S. Emerging Adults.

Given the popularity and ease of single-item craving assessments, we developed a multi-item measure and compared it to common single-item assessments in an ecological momentary assessment (EMA) context. Two weeks of EMA data were collected from 48 emerging adults (56.25% female, 85.42% White) who frequently used cannabis. Eight craving items were administered, and multilevel factor analyses were used to identify the best fitting model. The resulting scale's factors represented purposefulness/general desire and emotionality/negative affect craving. Convergent validity was examined using measures of craving, cannabis use disorder symptoms, frequency of use, cannabis cue reactivity, cannabis use, negative affect, and impulsivity. The scale factors were associated with cue-reactivity craving, negative affect, impulsivity, and subfactors of existing craving measures. For researchers interested in using a single item to capture craving, one item performed particularly well. However, the new scale may provide a more nuanced assessment of mechanisms underlying craving.