Identifying factors impacting missingness within smartphone-based research: Implications for intensive longitudinal studies of adolescent suicidal thoughts and behaviors.

Intensive longitudinal research-including experience sampling and smartphone sensor monitoring-has potential for identifying proximal risk factors for psychopathology, including suicidal thoughts and behaviors (STB). Yet, missing data can complicate analysis and interpretation. This study aimed to address whether clinical and study design factors are associated with missing data and whether missingness predicts changes in symptom severity or STB. Adolescents ages 13- to 18 years old (N = 179) reporting depressive, anxiety, and/or substance use disorders were enrolled; 65% reported current suicidal ideation and 29% indicated a past-year attempt. Passively acquired smartphone sensor data (e.g., global positioning system, accelerometer, and keyboard inputs), daily mood surveys, and weekly suicidal ideation surveys were collected during the 6-month study period using the effortless assessment research system smartphone app. First, acquisition of passive smartphone sensor data (with data on ∼80% of days across the whole sample) was strongly associated with survey data acquisition on the same day (∼44% of days). Second, STB and psychiatric symptoms were largely not associated with missing data. Rather, temporal features (e.g., length of time in study, weekends, and summer) explained more missingness of survey and passive smartphone sensor data. Last, within-participant changes in missing data over time neither followed nor predicted subsequent change in suicidal ideation and psychiatric symptoms. Findings indicate that considering technical and study design factors impacting missingness is critical and highlight several factors that should be addressed to maximize the validity of clinical interpretations in intensive longitudinal research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Google Health Digital Well-Being Study: Protocol for a Digital Device Use and Well-Being Study.

BACKGROUND: The impact of digital device use on health and well-being is a pressing question. However, the scientific literature on this topic, to date, is marred by small and unrepresentative samples, poor measurement of core constructs, and a limited ability to address the psychological and behavioral mechanisms that may underlie the relationships between device use and well-being. Recent authoritative reviews have made urgent calls for future research projects to address these limitations. The critical role of research is to identify which patterns of use are associated with benefits versus risks and who is more vulnerable to harmful versus beneficial outcomes, so that we can pursue evidence-based product design, education, and regulation aimed at maximizing benefits and minimizing the risks of smartphones and other digital devices. OBJECTIVE: The objective of this study is to provide normative data on objective patterns of smartphone use. We aim to (1) identify how patterns of smartphone use impact well-being and identify groups of individuals who show similar patterns of covariation between smartphone use and well-being measures across time; (2) examine sociodemographic and personality or mental health predictors and which patterns of smartphone use and well-being are associated with pre-post changes in mental health and functioning; (3) discover which nondevice behavior patterns mediate the association between device use and well-being; (4) identify and explore recruitment strategies to increase and improve the representation of traditionally underrepresented populations; and (5) provide a real-world baseline of observed stress, mood, insomnia, physical activity, and sleep across a representative population. METHODS: This is a prospective, nonrandomized study to investigate the patterns and relationships among digital device use, sensor-based measures (including both behavioral and physiological signals), and self-reported measures of mental health and well-being. The study duration is 4 weeks per participant and includes passive sensing based on smartphone sensors, and optionally a wearable (Fitbit), for the complete study period. The smartphone device will provide activity, location, phone unlocks and app usage, and battery status information. RESULTS: At the time of submission, the study infrastructure and app have been designed and built, the institutional review board of the University of Oregon has approved the study protocol, and data collection is underway. Data from 4182 enrolled and consented participants have been collected as of March 27, 2023. We have made many efforts to sample a study population that matches the general population, and the demographic breakdown we have been able to achieve, to date, is not a perfect match. CONCLUSIONS: The impact of digital devices on mental health and well-being raises important questions. The Digital Well-Being Study is designed to help answer questions about the association between patterns of smartphone use and well-being. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49189.

Adolescent Social Communication Through Smartphones: Linguistic Features of Internalizing Symptoms and Daily Mood.

The increasing use of smartphone technology by adolescents has led to unprecedented opportunities to identify early indicators of shifting mental health. This intensive longitudinal study examined the extent to which differences in mental health and daily mood are associated with digital social communication in adolescence. In a sample of 30 adolescents (ages 11-15 years), we analyzed 22,152 messages from social media, email, and texting across one month. Lower daily mood was associated with linguistic features reflecting self-focus and reduced temporal distance. Adolescents with lower daily mood tended to send fewer positive emotion words on a daily basis, and more total words on low mood days. Adolescents with lower daily mood and higher depression symptoms tended to use more future focus words. Dynamic linguistic features of digital social communication that relate to changes in mental states may represent a novel target for passive detection of risk and early intervention in adolescence.

Intensive Longitudinal Assessment of Adolescents to Predict Suicidal Thoughts and Behaviors.

OBJECTIVE: Suicide is a leading cause of death among adolescents. However, there are no clinical tools to detect proximal risk for suicide. METHOD: Participants included 13- to 18-year-old adolescents (N = 103) reporting a current depressive, anxiety, and/or substance use disorder who owned a smartphone; 62% reported current suicidal ideation, with 25% indicating a past-year attempt. At baseline, participants were administered clinical interviews to assess lifetime disorders and suicidal thoughts and behaviors (STBs). Self-reports assessing symptoms and suicide risk factors also were obtained. In addition, the Effortless Assessment of Risk States (EARS) app was installed on adolescent smartphones to acquire daily mood and weekly suicidal ideation severity during the 6-month follow-up period. Adolescents completed STB and psychiatric service use interviews at the 1-, 3-, and 6-month follow-up assessments. RESULTS: K-means clustering based on aggregates of weekly suicidal ideation scores resulted in a 3-group solution reflecting high-risk (n = 26), medium-risk (n = 47), and low-risk (n = 30) groups. Of the high-risk group, 58% reported suicidal events (ie, suicide attempts, psychiatric hospitalizations, emergency department visits, ideation severity requiring an intervention) during the 6-month follow-up period. For participants in the high-risk and medium-risk groups (n = 73), mood disturbances in the preceding 7 days predicted clinically significant ideation, with a 1-SD decrease in mood doubling participants' likelihood of reporting clinically significant ideation on a given week. CONCLUSION: Intensive longitudinal assessment through use of personal smartphones offers a feasible method to assess variability in adolescents' emotional experiences and suicide risk. Translating these tools into clinical practice may help to reduce the needless loss of life among adolescents.

Reintroducing the Effortless Assessment Research System (EARS).

This paper reintroduces the Effortless Assessment Research System (EARS), 4 years and 10,000 participants after its initial launch. EARS is a mobile sensing tool that affords researchers the opportunity to collect naturalistic, behavioral data via participants' naturalistic smartphone use. The first section of the paper highlights improvements made to EARS via a tour of EARS's capabilities-the most important of which is the expansion of EARS to the iOS operating system. Other improvements include better keyboard integration for the collection of typed text; full control of survey design and administration for research teams; and the addition of a researcher-facing EARS dashboard, which facilitates survey design, the enrollment of participants, and the tracking of participants. The second section of the paper goes behind the scenes to describe 3 challenges faced by the EARS developers-remote participant enrollment and tracking, keeping EARS running in the background, and continuous attention and effort toward data protection-and how those challenges shaped the design of the app.

A Longitudinal Study of E-Cigarette, Cigarette, and Marijuana Use Sequence in Youth.

Objective: There is evidence linking youth use of electronic (e-) cigarettes to subsequent cigarette and marijuana use, raising public health concerns. We examined the sequence of use of e-cigarettes, conventional cigarettes, and marijuana in a longitudinal sample of adolescents, to determine if use of e-cigarettes often preceded use of other substances. Methods: We collected self-reports from 1123 Oregon adolescents (52% female; 37% Hispanic) longitudinally from 8th to 11th grade (8 total surveys) regarding their lifetime (ever use) and current use (last 30 days) of e-cigarettes, cigarettes, and marijuana. If applicable, students also reported the delivery method of their current marijuana use. Results: Almost 10% of adolescents reported using e-cigarettes prior to use of cigarettes or marijuana, and the majority of these youth initiated use of marijuana, cigarettes, or both by 11th grade. More youth transitioned from e-cigarette use to marijuana use then from e-cigarettes to use of conventional cigarettes. Participants who were co-using e-cigarettes and marijuana in 11th grade had an increased likelihood of consuming marijuana via vaping, dabbing, and edibles, compared to those who were only using marijuana. Discussion: E-cigarettes were often the first substance used in this longitudinal sample, and more of these youth subsequently used marijuana compared to cigarettes. While research has focused on the progression from e-cigarettes to cigarettes in youth, these findings indicate that more attention should be focused on the subsequent initiation of marijuana.

Outcomes and Device Usage for Fully Automated Internet Interventions Designed for a Smartphone or Personal Computer: The MobileQuit Smoking Cessation Randomized Controlled Trial.

BACKGROUND: Many best practice smoking cessation programs use fully automated internet interventions designed for nonmobile personal computers (desktop computers, laptops, and tablets). A relatively small number of smoking cessation interventions have been designed specifically for mobile devices such as smartphones. OBJECTIVE: This study examined the efficacy and usage patterns of two internet-based best practices smoking cessation interventions. METHODS: Overall, 1271 smokers who wanted to quit were randomly assigned to (1) MobileQuit (designed for-and constrained its use to-mobile devices, included text messaging, and embodied tunnel information architecture) or (2) QuitOnline (designed for nonmobile desktop or tablet computers, did not include text messages, and used a flexible hybrid matrix-hierarchical information architecture). Primary outcomes included self-reported 7-day point-prevalence smoking abstinence at 3- and 6-month follow-up assessments. Program visits were unobtrusively assessed (frequency, duration, and device used for access). RESULTS: Significantly more MobileQuit participants than QuitOnline participants reported quitting smoking. Abstinence rates using intention-to-treat analysis were 20.7% (131/633) vs 11.4% (73/638) at 3 months, 24.6% (156/633) vs 19.3% (123/638) at 6 months, and 15.8% (100/633) vs 8.8% (56/638) for both 3 and 6 months. Using Complete Cases, MobileQuit's advantage was significant at 3 months (45.6% [131/287] vs 28.4% [73/257]) and the combined 3 and 6 months (40.5% [100/247] vs 25.9% [56/216]) but not at 6 months (43.5% [156/359] vs 34.4% [123/329]). Participants in both conditions reported their program was usable and helpful. MobileQuit participants visited their program 5 times more frequently than did QuitOnline participants. Consistent with the MobileQuit's built-in constraint, 89.46% (8820/9859) of its visits were made on an intended mobile device, whereas 47.72% (691/1448) of visits to QuitOnline used an intended nonmobile device. Among MobileQuit participants, 76.0% (459/604) used only an intended mobile device, 23.0% (139/604) used both mobile and nonmobile devices, and 0.1% (6/604) used only a nonmobile device. Among QuitOnline participants, 31.3% (137/438) used only the intended nonmobile devices, 16.7% (73/438) used both mobile and nonmobile devices, and 52.1% (228/438) used only mobile devices (primarily smartphones). CONCLUSIONS: This study provides evidence for optimizing intervention design for smartphones over a usual care internet approach in which interventions are designed primarily for use on nonmobile devices such as desktop computers, laptops. or tablets. We propose that future internet interventions should be designed for use on all of the devices (multiple screens) that users prefer. We forecast that the approach of designing internet interventions for mobile vs nonmobile devices will be replaced by internet interventions that use a single Web app designed to be responsive (adapt to different screen sizes and operating systems), share user data across devices, embody a pervasive information architecture, and complemented by text message notifications. TRIAL REGISTRATION: ClinicalTrials.gov NCT01952236; https://clinicaltrials.gov/ct2/show/NCT01952236 (Archived by WebCite at http://www.webcitation.org/6zdSxqbf8).

Associations between marijuana use and anxious mood lability during adolescence.

OBJECTIVE: To date, research investigating the association between adolescent marijuana use and anxiety is mixed, given differences in how anxiety is measured and the age ranges studied. The research is further limited as many relevant studies have small sample sizes. This investigation examines the association between marijuana use (use in the past 30 days) and anxious mood lability (rapid fluctuation in emotional states) during early adolescence (average age 14.4, spring of 8th grade) through midadolescence (10th grade). METHODS: Participating adolescents (N = 466; 52.8% female) were from rural and suburban communities and 38% were Hispanic/Latino. Ecological Momentary Assessment (EMA) was used to measure adolescents' anxious mood in real time; the EMAs were collected within 30 days of the adolescent report of their marijuana use. RESULTS: Multilevel models with measurement waves (7 time points) nested in individuals showed that anxious mood lability was significantly higher for adolescents reporting recent marijuana use compared to those reporting no recent marijuana use. Although females were higher than males in anxious mood lability, the association between anxious mood lability and recent marijuana use did not differ by gender. Post hoc analysis showed that the associations between anxious mood lability and recent marijuana use did not differ between assessments conducted pre and post legalization of adult recreational marijuana use. CONCLUSIONS: The association between recent marijuana use and anxious mood lability for youth is important for understanding the developmental processes of cannabis use and anxious mood disorders in adolescence and young adulthood.

Influence of parent-youth relationship, parental monitoring, and parent substance use on adolescent substance use onset.

The quality of parent-child relationships likely influences many decisions and behaviors made by early adolescents, including their alcohol and marijuana use. We examined how parent-youth relationship quality, parental monitoring, and parent substance use were associated with initiation of alcohol use, binge drinking, and marijuana use by 400 adolescents by the spring of 8th grade (ages 13-14), and changes in initiation through 9th grade (assessed 3 times; fall, winter, and spring). We measured both parent and adolescent report of parent-youth relationship quality and parental monitoring, expecting that both perspectives would uniquely contribute. Discrete Time Survival models showed that youth report of both a poorer parent-youth relationship and lower parental monitoring were associated with alcohol use, binge drinking, and marijuana use onset. Parent binge drinking also predicted youth alcohol onset and parent report of poor quality relationship predicted marijuana onset. Youth report of a poor relationship with parents was a stronger predictor for girls than boys on their alcohol use onset, and youth report of parental monitoring was more protective for girls than boys for both alcohol and marijuana use onset. Implications for preventing use of these substances during early and mid-adolescence are discussed. (PsycINFO Database Record

Legalization of recreational marijuana and community sales policy in Oregon: Impact on adolescent willingness and intent to use, parent use, and adolescent use.

Studies investigating the impact of medical marijuana legalization have found no significant changes in adolescent use. In one of the few studies focused on recreational marijuana, we investigated how recreational marijuana legalization and community sales policy influenced factors that likely impact youth use (youth willingness and intent to use, parent use) as well as youth use. Legalization of recreational marijuana in Oregon coincided with our study on adolescent substance use. Cohort 1 transitioned from 8th to 9th grade prior to legalization and Cohort 2 made this transition during legalization (N = 444; 53% female). Communities were allowed to opt out of sales. Multivariate linear regression models estimated the impact of legalization and community sales policy on changes in attitudes and parent use (2 time points 1 year apart). Zero-inflated Poisson growth curve models estimated the effects on initial levels and rate of change from 8th through 9th grade (4 time points). In communities opting out of sales, the prior-to-legalization cohort was less likely to increase their willingness and intent to use marijuana, and the legalization cohort was more likely to increase intent to use. For youth who used marijuana, legalization was associated with increased use, and those in communities opting out of sales had greater growth in marijuana use. Community policy appears to impact youth attitudes toward, and use of, marijuana. Results suggest that legalization of recreational marijuana did not increase marijuana use for youth who did not use marijuana but did increase use in youth who were already using. (PsycINFO Database Record

Electronic Cigarette Use by Youth: Prevalence, Correlates, and Use Trajectories From Middle to High School.

PURPOSE: The aim of this study was to examine the use of electronic cigarettes (e-cigarettes) among adolescents over time, including correlates of lifetime use by eighth grade and trajectories of current use across ninth grade. METHODS: Participants (N = 1,091) from seven school districts in Oregon, United States, completed four self-report surveys on substance use, from the spring of eighth grade (M age = 14.4 years old; standard deviation = .50) through the spring of ninth grade. RESULTS: Overall, 27.7% of eighth graders had used e-cigarettes, and 16.8% were current e-cigarette users (used in the past 30 days); use did not significantly differ by gender or ethnicity. Correlates of e-cigarette lifetime use by eighth grade included lifetime and current use of marijuana, alcohol, cigarettes, and chewing tobacco. Five percent of students were "accelerators," on average using e-cigarettes 14 of the last 30 days in eighth grade, increasing to daily use (30/30 days) by the end of ninth grade. Across all substances, those in the accelerator group were more likely to have reported lifetime substance use by eighth grade and current substance use in ninth grade, compared to the "infrequent/no use" group. CONCLUSIONS: A sizeable proportion of young adolescents are using e-cigarettes, and e-cigarette use is highly correlated with use of other substances, including marijuana. Adolescents who progress to daily e-cigarette use in high school are more likely to use other substances compared to low or nonusers. E-cigarettes may be a relatively new addition to a constellation of substances being actively used by a segment of the youth population.

An Efficacy Trial of Carescapes: Home-Based Child-Care Practices and Children's Social Outcomes.

This study reported findings from a longitudinal randomized controlled trial of Carescapes, a professional development program for home-based child-care providers in promoting children's social competence. Participants included 134 child-care providers and 310 children, ages 3-5 years, in Oregon. The Carescapes intervention group made significant improvements in observed caregiver responsiveness and monitoring, and showed decreased caregiver-reported child problem behavior and improved parent-reported peer relationships compared to the control group. Increased caregiver-reported cooperation skills were found for the intervention group at follow-up. No differences in condition were found for kindergarten teacher-reported social-behavioral, classroom, and academic skills. Moderation effects on children's behavior and peer relations were found for child age and exposure to the intervention child care.

Randomized Controlled Trial of the Combined Effects of Web and Quitline Interventions for Smokeless Tobacco Cessation.

BACKGROUND: Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. OBJECTIVES: To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined. METHODS: Smokeless tobacco users (N= 1,683) wanting to quit were recruited online and randomly offered one of four treatment conditions in a 2×2 design: Web Only, Quitline Only, Web + Quitline, and Control (printed self-help guide). Point-prevalence all tobacco abstinence was assessed at 3- and 6-months post enrollment. RESULTS: 69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR = 1.41, 95% CI = 1.03, 1.94, p = .033) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, p = .007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, p = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p <.05) and satisfaction (p <.05) were higher for those offered both interventions versus offered only quitline. CONCLUSION: Combining Web and Quitline interventions did not result in additive or synergistic effects, as have been found for smoking. Both interventions were more effective than a self-help control condition in helping motivated smokeless tobacco users quit tobacco. Intervention usage and satisfaction were related to the amount intervention content offered. Usage of the Quitline intervention decreased when offered in combination, though rates of helpfulness and recommendations were higher when offered in combination. TRIAL REGISTRATION: Clinicaltrials.gov NCT00820495; http://clinicaltrials.gov/ct2/show/NCT00820495.

Emulating real-life situations with a play task to observe parenting skills and child behaviors.

Play tasks that use standardized procedures and materials are a practical way to assess parenting skills, child behaviors, and the ways in which parents and children interact. We describe a systematic process for developing the parent-child play task (PCPT) to assess mother-child interactions for a randomized controlled trial of a video-based parenting program. Participants were 307 mothers and their 3- to 6-year-old children who presented oppositional and disruptive behavior challenges. The validity of the PCPT was investigated by testing (a) the extent to which the tasks elicited the specific parent and child behaviors of interest, (b) the consistency of individuals' behavior across the play tasks, and (c) the concurrent associations of the PCPT-observed child behaviors and mother reports of child behavior. The different tasks elicited the mother and child behaviors that they were designed to elicit. Behavior consistency across tasks for individual mothers and children was fair to good, with the exception of 2 task-specific behaviors. Mother's guidance (provision of instructions to foster a skill) during the teaching task and children's interruptions while mother was busy during the questionnaire task were highly task specific. Modest associations were found between observed children's noncompliance and inappropriate behaviors and mother-reported conduct problems and oppositional behaviors. Implications for clinical and research assessments are discussed.

Randomized trial of nicotine lozenges and phone counseling for smokeless tobacco cessation.

INTRODUCTION: Relatively few treatment programs have been developed specifically for smokeless tobacco (ST) users who want to quit. Their results suggest that self-help materials, telephone counseling, and nicotine lozenges are efficacious. This study provides the first direct examination of the separate and combined effects of telephone counseling and lozenges. METHODS: We recruited ST users online (N = 1067) and randomly assigned them to 1 of 3 conditions: (a) a lozenge group (n = 356), who were mailed 4-mg nicotine lozenges; (b) a coach calls group (n = 354), who were offered 3 coaching phone calls; or (c) a lozenge + coach calls group (N = 357), who received both lozenges and coaching calls. Additionally, all participants were mailed self-help materials. Self-reported tobacco abstinence was assessed at 3 and 6 months after randomization. RESULTS: Complete-case and intention-to-treat (ITT) analyses for all tobacco abstinence were performed at 3 months, 6 months, and both 3 and 6 months (repeated point prevalence). ITT analyses revealed a highly similar result: the lozenge + coach calls condition was significantly more successful in encouraging tobacco abstinence than either the lozenge group or the coach calls group, which did not differ. CONCLUSIONS: Combining nicotine lozenges and phone counseling significantly increased tobacco abstinence rates compared with either intervention alone, whereas coach calls and lozenges were equivalent. The study confirms the high tobacco abstinence rates for self-help ST cessation interventions and offers guidance to providing tobacco treatment to ST users.

Psychosocial correlates of physical and sedentary activities of early adolescent youth.

This study examines physical and sedentary activities of early adolescent boys and girls using Ecological Momentary Assessment (EMA), a method that can link mood and behaviors in specific social situations. Twenty-seven assessments were collected across 7 days from 82 participating adolescents, three times in seventh grade and one time in eighth grade. Assessments were completed during nonschool hours when youth had "free time." Gender differences, longitudinal trends, and associations of physical activities (PA) and small screen recreation (SSR) with moods and peer presence are examined. Boys were engaged in PA more than girls. Patterns of PA differed by gender; boys significantly decreased PA from seventh to eighth grade, whereas girls had increased PA only during the spring. PA was associated with happier mood and was more likely to occur in the presence of peers. SSR significantly increased from seventh grade to eighth grade for both boys and girls. SSR occurred more when youth were alone and was not associated with mood. Neither PA nor SSR was more likely to occur during weekdays or weekends. Implications for intervention efforts to increase PA in youth are discussed.

Concurrent and predictive associations between early adolescent perceptions of peer affiliates and mood states collected in real time via ecological momentary assessment methodology.

This study uses ecological momentary assessment (EMA) to simultaneously capture youths' perceptions of peer affiliates and social contexts to determine their association with youths' current and future mood states. A sample of 82 seventh grade students (36 at risk for developing or escalating rule breaking and substance use and 46 randomly selected) from 4 schools participated. Using EMA methodology, we had students report their peer affiliations, perceptions of peer affiliates, moods, activities, location, and behaviors during their free time. Data from 3 assessment waves were collected; each wave consisted of 27 randomly prompted assessments during a week. Youths spent a large portion of their free time watching television, on the computer, or playing video games. Being "out and about" increased over the school year, whereas adult supervision decreased, showing an increase in potentially risky situations. Happiness was associated with affiliating with peers who were perceived to be popular. Negative moods were associated with affiliating with peers by whom they were teased or treated meanly. Multilevel models found that both levels and lability of negative moods (i.e., sadness, anxiety) were predicted by risk status and affiliation with peers who tease them. Compared with boys, girls who affiliated more with peers who teased them and were classified as at risk had more extreme negative moods and negative mood lability. EMA methodology has demonstrated the ways in which salient intrapersonal and peer processes are associated over time, which can inform efforts to prevent the development and escalation of behavior problems, substance use, and mood disorders in adolescence.

Using consumer preference information to increase the reach and impact of media-based parenting interventions in a public health approach to parenting support.

Within a public health approach to improving parenting, the mass media offer a potentially more efficient and affordable format for directly reaching a large number of parents with evidence-based parenting information than do traditional approaches to parenting interventions that require delivery by a practitioner. Little is known, however, about factors associated with parents' interest in and willingness to watch video messages about parenting. Knowledge of consumer preferences could inform the effective design of media interventions to maximize parental engagement in the parenting messages. This study examined parents' preferred formats for receiving parenting information, as well as family sociodemographic and child behavior factors that predict parents' ratings of acceptability of a media-based parenting intervention. An ethnically diverse sample of 162 parents of children ages 3-6 years reported their preferences for various delivery formats for parenting information and provided feedback on a prototype episode of a video-format parenting program based on the Triple P Positive Parenting Program. Parents reported the strongest preference for self-administered delivery formats such as television, online programs, and written materials; the least preferred formats were home visits, therapists, and multiweek parenting groups. Parents' ratings of engagement, watchability, and realism of the prototype parenting episode were quite strong. Parents whose children exhibited clinical levels of problem behaviors rated the episode as more watchable, engaging, and realistic. Mothers also rated the episodes as more engaging and realistic than did fathers. Lower income marginally predicted higher watchability ratings. Minority status and expectations of future problems did not predict acceptability ratings. The results suggest that the episode had broad appeal across groups.