Primary Language Research Articles

Cultural conceptualisations and spatial cognition in Ghanaian English

AbstractKantian philosophy describes space as a universal cognitive primitive because all humans contend with attributes of space as they navigate their environments and communicate the location of things or their location in relation to the location of things. These spatial conceptualisations are encoded in human language and their grammars as either prepositions or postpositions, where different cultures and languages conceptualise space differently because of their different environments. It also means that linguistic terms about spatial relations, such as prepositions, contain not only linguistic information but also conceptual information as well as cultural schemas. This paper explores the variations in the use of prepositions in Ghanaian English and argues that such variations, which may contribute to marking off the variety of English spoken in Ghana as a distinct variety, may be motivated by the cultural conceptualisations of relational terms in the primary language(s)/culture(s) of the speakers of Ghanaian English.

Understanding “Love” in the English Lyrics of the Original Songs by the Multilingual New Creation Church Singapore

Understanding “Love” in the English Lyrics of the Original Songs by the Multilingual New Creation Church Singapore

The Effect of an Obesity Prevention Intervention Among Specific Subpopulations: A Heterogeneity of Treatment Effect Analysis of the Greenlight Trial.

Background: Understanding how different populations respond to a childhood obesity intervention could help optimize personalized treatment strategies, especially with the goal to reduce disparities in obesity. Methods: We conducted a secondary analysis of the Greenlight Cluster Randomized Controlled Trial, a health communication focused pediatric obesity prevention trial, to evaluate for heterogeneity of treatment effect (HTE) by child biological sex, caregiver BMI, caregiver reported race and ethnicity, primary language, and health literacy. To examine HTE on BMI z-score from 2 to 24 months of age, we fit linear mixed effects models. Results: We analyzed 802 caregiver-child pairs, of which 52% of children were female, 58% of households reported annual family income of <$20,000, and 83% did not have a college degree. We observed evidence to suggest HTE by primary language (p = 0.047 for Spanish vs. English) and the combination of primary language and health literacy (p = 0.01). There was insufficient evidence to suggest that the Greenlight intervention effect differed by biological sex, caregiver BMI, or by race/ethnicity. Conclusions: This HTE analysis found that the Greenlight obesity prevention intervention had a more beneficial effect on child BMI z-score over 2 years for children of caregivers with limited health literacy and for caregivers for whom Spanish was the primary language.

Research on Teaching Strategies of Group Reading in Primary Chinese based on Learning Task Group

This paper aims to explore the teaching strategy of group reading in primary school Chinese language education based on learning task groups. Through the construction of theoretical framework or conceptual model, the design and implementation of this teaching strategy are systematically expounded. Firstly, an overview of primary school Chinese language education, group reading teaching, and learning task group theory is provided, laying a theoretical foundation for the subsequent research. Then, the design principles, implementation steps, and preparation of teaching resources for the teaching strategy based on learning task groups are elaborated in detail. In the results section, the impact of this teaching strategy on students' reading levels and learning outcomes is analyzed. Finally, in the discussion and analysis section, the effectiveness of the teaching strategy is analyzed and evaluated, and comparisons with previous studies are made, along with prospects for future research. The conclusion summarizes the main findings of the study and discusses its contributions and implications for primary school Chinese language education, providing suggestions and insights for improving teaching practices.

Training attitudes of primary school foreign language teachers

Abstract Schooling practices founded upon the principles of Instructed Second Language Acquisition (ISLA) do not appear to have attained widespread adoption among teachers, consequently hindering the implementation of didactic measures that foster foreign language acquisition. These measures are closely entwined with the classroom climate, wherein the fundamental element often hinges upon the attitude of the teacher. For the most part, foreign language teachers are better equipped to embrace this attitude after having personally experienced it as learners themselves. To explore this matter further, the present study adopts a mixed-methods research design to gather insights from participants (n = 74) who attended the Didactics of Foreign Language in Primary Education – German course within the Bachelor Degree in Primary Education at the University of Cádiz (Spain) during the last nine editions; that is, from 2014/15 to 2022/23. The research findings reveal a near-unanimous consensus among all participants, regardless of nationality, teaching experience, or age, on the influential role of a classroom climate in shaping their teaching attitude. Based on the results, pre-service foreign language teachers must be allowed to acquaint themselves with effective didactic measures, together with a well-defined classroom climate wherein the significance of teaching attitude is accordingly recognized as one of the most influential factors in motivating learners.

An Expanded Approach to the Ascertainment of Children and Youth With Special Health Care Needs.

To describe the prevalence, characteristics, and health-related outcomes of children with diagnosed health conditions and functional difficulties who do not meet criteria for having a special health care need based on the traditional scoring of the Children with Special Health Care Needs (CSHCN) Screener. Data come from the 2016 to 2021 National Survey of Children's Health (n = 225 443). Child characteristics and health-related outcomes were compared among 4 mutually exclusive groups defined by CSHCN Screener criteria and the presence of both conditions and difficulties. Among children who do not qualify as children and youth with special health care needs (CYSHCN) on the CSHCN Screener, 6.8% had ≥1 condition and ≥1 difficulty. These children were more likely than CYSHCN to be younger, female, Hispanic, uninsured, privately insured, living in a household with low educational attainment, have families with more children and a primary household language other than English. After adjustment, non-CYSHCN with ≥1 conditions and ≥1 difficulty were less likely than CYSHCN, but significantly more likely than other non-CYSHCN, to have ≥2 emergency department visits, have unmet health care needs, not meet flourishing criteria, live in families that experienced child health-related employment impacts and frustration accessing services. Including these children in the calculation of CYSHCN prevalence increases the national estimate from 19.1% to 24.6%. Approximately 4 million children have both a diagnosed health condition and functional difficulties but are not identified as CYSHCN. An expanded approach to identify CYSHCN may better align program and policy with population needs.

Disparities in telemedicine use among Native Hawaiian and Pacific Islander individuals insured through Medicaid.

States have implemented policy changes to increase access to telemedicine services for individuals receiving Medicaid benefits. Native Hawaiian and Pacific Islander (NHPI) individuals experienced disproportionate harms from COVID-19 and have long experienced disparities in health care access compared with other racial and ethnic groups, making the issue of telemedicine access particularly salient for NHPI individuals on Medicaid. Utilizing 100% 2020-2021 Medicaid claims, we compared trends in telemedicine use between NHPI and non-Hispanic White individuals on Medicaid in Washington State and conducted a decomposition analysis to identify drivers of underlying disparities. In both years, NHPI individuals were 38%-39% less likely to use any telemedicine than White individuals after adjusting for patient- and area-level characteristics. Decomposition analysis revealed that most of this difference was due to differential effects of characteristics, rather than group differences in characteristics. Namely, several characteristics that were associated with increased telemedicine use had more muted associations for NHPI vs White individuals, such as English as the primary spoken language and female sex. These findings suggest the presence of limited acceptability of or group-specific barriers to telemedicine for NHPI individuals, including potential discrimination in being offered telemedicine visits. These issues should be understood and mitigated through close collaboration between health care leaders and NHPI communities.

The 5 love languages of children (Chapman; Campbell, 2017): are its two main principles academically valid for qualitative research and teacher training?

This paper presents a qualitative analysis of seven quantitative academic studies on two main concepts from Gary Chapman's five love languages theory, the foundation of “The 5 love languages of children”. These studies were selected from a literature review conducted in 2021 through the State of Knowledge methodology. The texts were analyzed using the Discursive Textual Analysis technique. This article aims to show what has been studied on Chapman’s theory outside Brazil. Three of the studies confirmed the empirical validity of each of the five love languages as proposed in Chapman’s thesis. Additionally, two academic works empirically validated the primary love language hypothesis. Findings indicate both of Chapman’s claims as empirically valid concepts through quantitative research. Results suggest that these principles in the realm of childhood could be meaningful to qualitative research – on education and teacher training – to improve both teaching and learning processes.

Patient-related Factors Associated with Potentially Unnecessary Transfers for Pediatric Patients with Asthma: A Retrospective Cohort Study.

Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma. We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers. A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4). Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.

Risk Factors Associated With Being Lost to Follow-up Among Patients With Pregnancy of Unknown Location [ID 2683399

INTRODUCTION: Managing pregnancy of unknown location (PUL) is a logistical challenge for obstetrician–gynecologists. Close follow-up is a key component of management to reduce the risk of a ruptured ectopic pregnancy. We examined factors that may put patients at increased risk of being lost to follow-up. METHODS: We performed a case–control study of patients presenting to our emergency room with a positive pregnancy test and without previously confirmed intrauterine pregnancy in the first trimester between January 2020 and December 2022. Patients with newly diagnosed PUL were added to a secure list for follow-up (“beta book”). We compared patients who were lost to follow-up, which was defined as after three failed attempts at contact made multiple days apart, with those who were not. Chi-square and Fisher exact assessed demographic exposures putting patients at risk of being lost to follow-up. RESULTS: One hundred nineteen patients had PUL and were added to the beta book. Overall, 15 (12.6%) of patients were lost to follow-up (cases) compared to 104 (87.4%) of patients who were not (controls). No associations were found between sociodemographic variables and risk of being lost to follow-up, including age (P=.15), parity (P=.59), insurance type (P=.81), primary language (P=.77), race (P=.26), and ethnicity (P=.80). Finally, lost to follow-up rates were similar among women enrolled and not enrolled in the institution’s app-based medical communication system (P=.75). CONCLUSION: In a state in which pregnancy-related care is available regardless of immigration status, we found no demographic associations with risk of being lost to follow-up. As 12% of people in this study were still lost to follow-up, qualitative interviews may be useful to better understand factors not captured in a retrospective chart review to improve safe and equitable care.

Expectations for Paternity Leave Among Male Partners in the Postpartum Setting: A Cross-Sectional Survey at a Public Hospital in Los Angeles, California (2023) [ID 2683493

INTRODUCTION: Early paternal involvement in childcare benefits both birthing mothers and their children. Unfortunately, paid paternity leave is neither mandated nor protected at the state and federal levels, leading to wide variations in early paternal involvement. METHODS: As a part of this IRB-approved study, we conducted interviewer-facilitated surveys with English- and Spanish-speaking male partners encountered in the postpartum ward at Los Angeles General Medical Center. The survey queried general sociodemographic factors, employment status, and access to, as well as, planned utilization of paternity leave (both paid and unpaid). We conducted bivariate analyses and multivariable logistic regressions to identify factors linked to fathers not taking paternity leave. RESULTS: Most respondents (N=100) identified as Hispanic or Latinx (76.0%), reported English as their primary language (58.0%), and had an average age of 30.6 years. Ninety-three respondents reported being employed; more than half either reported that their workplace did not have a paternity leave policy (39.1%) or being unsure of their workplace’s policy (17.4%). Only 15.2% reported anticipating paternity leave with full pay. Respondents who knew their workplace policies planned to take no more than 3 weeks of leave on average. Respondents had greater odds of not taking paternity leave if non-English speaking (adjusted odds ratio [aOR] 2.39; 95% CI, 0.93–6.16), uninsured (aOR 5.01; 95% CI, 1.26–20.35), or publicly insured (aOR 2.86; 95% CI, 0.95–8.65). CONCLUSION: Male partners in our primarily Hispanic, publicly insured patient population anticipated taking minimal paternity leave, raising questions regarding the role of employee protections or the lack thereof in the face of socioeconomic pressures and cultural differences.

Bridging Content and Language in English-medium Engineering Programs

English-medium Instruction (EMI) is increasingly being implemented in diverse educational settings where English is not the primary language. However, a persistent challenge of EMI implementation lies in the scarcity of high-quality EMI teaching materials that effectively enhance both content knowledge and language acquisition. This study aimed to investigate how language is integrated with content in EMI lessons and to assess their efficacy. The study involved three Civil Engineering teachers, three language teachers, and 102 students. Data collection instruments comprised journals kept by content and language teachers during the EMI materials development process, pre-tests and post-tests, satisfaction surveys, and semi-structured interviews. The quantitative results were analyzed using descriptive statistics and t-tests, while content analysis was used to analyze qualitative data. Results revealed that students expressed high satisfaction with the materials, noting increased participation in EMI classes, enhanced content comprehension, and heightened awareness of language use in lessons. Nonetheless, the design process of EMI materials is intricate, non-linear, time-consuming, and demanding of pedagogical expertise. While collaborative efforts between content and language teachers have appeared promising in theory, practical implementation in real contexts has proven to be challenging. It is recommended that the EMI materials developers possess pedagogical knowledge on content and language teaching, recognize the iterative and complex nature of the material design process, and the need for ongoing communication with the respective to enhance the success of the collaboration.

Effective Teaching Strategies for Multilevel Classes: A Focus on Alternating Instructional Modes

This paper explores a teaching strategy in multilevel classes (MLCs) to tackle learning time loss and teacher strain. Focused on Moroccan primary education, the strategy involves alternating traditional and virtual teaching methods. Expanding previous research, this work 3rd year primary Arabic language and 4th year primary Islamic Education double-level classing. Using NetSupport School software, lessons were conducted with real and virtual teachers’ presences, analyzing impacts on lesson duration, teacher effort, and learners’ time on task. Results demonstrate the strategy significantly increased effective lesson duration in experimental groups, reducing teacher intervention time and increasing learner task duration compared to controls. Virtual teacher presence showed promise in managing time-out and enhancing student engagement, particularly with the learners' permanent teacher. Challenges emerged when learners interacted with alternative virtual teachers, highlighting the significance of the teacher's perceived status on student engagement and non-adaptation of the learners to a new virtual teacher. For a deep interpretation of this non-adaptation, the importance of the perceived "status" of the teacher has been developed. This study underscores strategic teaching's importance in MLCs to optimize learning outcomes and mitigate time constraints. It emphasizes the pivotal role of the teacher's perceived status in student engagement dynamics.

Forming correct speaking skills in primary class english language lessons with the help of poems and rhymes

This article considers to the introduction of a foreign language in elementary school. It also points out one of the most important problems in the teaching methodology using rhyme and poems in class. Rhymed material influences on a better development of pronunciation skills. The main objective of foreign language teaching in primary schools is to develop pupils' ability to communicate in the target language. Experience shows that the motivation of learning foreign language of elementary school pupils at the beginning of the school course is quite high, and pupils, in spite of the rapidfatigue, ready to pronounce a lot of time every sound. Comfortable n-aj' of remembering articulation and auditory sound contributes to review the use of game material (rhymes, patters and others).

Barriers to Completing Low Dose Computed Tomography Scan for Lung Cancer Screening

IntroductionAnnual low-dose computed tomography (LDCT) screening has been shown to reduce lung cancer mortality in high-risk individuals by detecting the disease at an earlier stage. This study aims to assess the barriers to completing LDCT in a cohort of patients who were determined eligible for lung cancer screening (LCS). MethodsWe performed a single institution, mixed methods, cross-sectional study of patients who had a LDCT ordered from July to December 2022. We then completed phone surveys with patients who did not complete LDCT to assess knowledge, attitude, and perceptions toward LCS. ResultsWe identified 380 patients who met inclusion criteria, including 331 (87%) who completed LDCT and 49 (13%) who did not. Patients who completed a LDCT and those who did not were similar regarding age, sex, race, primary language, household income, body mass index, median pack years, and quit time. Positive predictors of LDCT completion were: meeting USPSTF guidelines (97.9% vs 81.6%), being married (58.3% vs 44.9%), former versus current smokers (55% vs 41.7%), personal history of emphysema (60.4% vs 42.9%), and family history of lung cancer (13.9% vs 4.1%) (all P < .05). Of the patients who participated in the phone survey, only 7% of respondents thought they were high risk for developing lung cancer despite attending a shared decision-making visit and only 10% wanted to re-schedule their LDCT. ConclusionThere exist barriers to completing LDCT even after patients are identified as eligible and complete a shared decision-making visit secondary to knowledge barriers, misperceptions, and patient disinterest.

Factors Predicting Readmission and Mortality in Patients Admitted for Malignant Bowel Obstruction.

Malignant bowel obstruction (MBO) is a common complication of patients with advanced malignancies and has poor prognosis. Currently, there are limited guidelines for MBO management or predicting outcomes for these patients. To identify patient factors associated with readmission and mortality after hospital admission for MBO. A 5-year retrospective review was performed from 2017 to 2022 at a single tertiary institution to evaluate patients admitted for MBO. All patients had advanced cancer of gastrointestinal or gynecologic primary. Patient demographics, socioeconomic factors, tumor characteristics, and inpatient outcomes were collected. Multivariable analyses were performed to determine variables predicting hospital readmission for recurrent MBO and 90-day mortality. 210 patients were included. Mean age was 61 years, 28% were male, and 19% did not primarily speak English. 35% of patients lived over 50 miles from the hospital. On multivariable analysis, non-English speaking patients exhibited increased risk of readmission for MBO (OR = 2.82, P = .039). Older age was associated with decreased risk for MBO readmission (OR = .96, P = .007). Ascites was associated with increased mortality (OR = 2.17, P = .043). Earlier palliative care (PC) consultation predicted decreased readmission (OR = .24, P < .001) yet increased mortality at 90 days (OR = 3.20, P = .003). Patient age, primary language, and PC consult were predictors for MBO readmission, which may impact 90-day mortality. Given the palliative nature of MBO, modifiable factors such as PC consultation and multidisciplinary goals of care discussions should be prioritized in order to reduce readmissions and focus on quality of life (QOL) for this patient population.

Using Empirical Information to Prioritize Early Literacy Assessment and Instruction in Preschool and Kindergarten

Early literacy skill development predicts later reading success, and development of skills in specific domains during the preschool years has been established as both a prerequisite and precursory for reading. Early literacy assessments typically include measures of separate skills across domains, and results can assist with determining where instructions may be most needed. When multiple areas of need are identified, understanding which skills to prioritize can be a challenge. Therefore, empirically identifying the relative contribution of each skill measured in preschool to subsequent reading success can promote more efficient systems of assessment. This study, conducted in the United States, examined the predictive validity of early literacy skills measured in preschool compared to skills measured in kindergarten, with a specific practical focus on identifying the most efficient predictive model for understanding reading readiness. Participants were 119 preschoolers (mean age = 66 months) who mostly spoke English as their primary language (79%). Results indicated early literacy and language skills in preschool are highly predictive of early reading in kindergarten, accounting for 59% of the variance in a reading composite score. The most parsimonious model indicated that first sounds, letter sounds, early comprehension, and expressive vocabulary measures adequately explained 52% of the variance in children’s kindergarten reading performance.

Race, Ethnicity, and Other Barriers to Access Dental Care During Pregnancy.

Historically, women of color showed poorer oral health and lower dental service utilization in the USA. These barriers to dental care during pregnancy included dental coverage, primary language, dental provider availability, safety concerns, affordability of dental care, and perceived oral health benefits during pregnancy. The purpose of this study is to examine whether race/ethnicity modified the associations between barriers to accessing dental care and dental service utilization during pregnancy. This cross-sectional study sample included 62,189 women aged 20 and older with a recent birth history in 21 states from the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016 to 2019. We introduced a race/ethnicity by barrier interaction term to our multiple logistic regression models. After adjusting for other confounders, dental insurance during pregnancy and perceived oral health benefits were associated with 4.0- and 5.6-fold higher odds, respectively, of dental service utilization during pregnancy. Statistically significant effect modification by race/ethnicity was observed in crude and adjusted analyses of the relationship between dental service utilization for all barriers included in the interaction analyses with all adjusted p-values < 0.001. The interaction analysis found that racial/ethnic disparity in visiting dentists during pregnancy was significant among women who reported these dental barriers. In contrast, such racial/ethnic disparity was substantially attenuated among women who did not report such barriers. The observed racial/ethnic disparities could be mitigated by such supporting mechanisms: dental coverage, provider availability and willingness to treat pregnant women, oral health education on the safety of dental care during pregnancy, and affordable dental care costs.

The influence of primary language on postoperative stroke outcomes

BackgroundLanguage barriers have the potential to influence acute stroke outcomes. Thus, we examined postoperative stroke outcomes among non-English primary language speakers. MethodsUtilizing the Healthcare Cost and Utilization Project State Inpatient Database (2016–2019), we conducted a retrospective cohort study of adults diagnosed with a postoperative stroke in Michigan, Maryland, and New Jersey. Patients were classified by primary language spoken: English (EPL) or non-English (n-EPL). The primary outcome was hospital length-of-stay. Secondary outcomes included stroke intervention, feeding tube, tracheostomy, mortality, cost, disposition, and readmission. Propensity-score matching and post-match regression were used to quantify outcomes. ResultsAmong 3078 postoperative stroke patients, 6.2 ​% were n-EPL. There were no differences in length-of-stay or secondary outcomes, except for higher odds of feeding tube placement (OR 1.95, 95 ​% CI 1.10–3.47, p ​= ​0.0227) in n-EPL. ConclusionsPostoperative stroke outcomes were comparable by primary language spoken. However, higher odds of feeding tube placement in n-EPL may suggest differences in patient-provider communication.

Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment.

Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question "Overall, how difficult was it for you to fill out the surveys today?" on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. The burden was low at 1.2 (SD 1.14) indicating "a little" burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English-speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (β=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives.