Subjective intoxication predicts alcohol-related consequences at equivalent alcohol concentrations in young adults using ecological momentary assessment and alcohol sensors.

OBJECTIVE: Subjective intoxication (SI) when drinking may serve as an internal barometer of whether to continue drinking or engage in potentially unsafe behavior. Mobile assessments offer the potential to use SI as a prospective risk indicator during drinking episodes; little evidence exists for the validity of real-time SI measures. We test the correspondence of SI with estimated blood alcohol concentration and transdermal alcohol concentration (TAC) in young adults' natural settings. We provide a novel test of whether SI features (peak and mean SI) uniquely predict consequences adjusting for alcohol concentration. METHOD: Two hundred twenty-two heavy-drinking young adults (Mage = 22.3, 64% female, 79% non-Hispanic White, 84% undergraduates) participated in a 6-day study that used ecological momentary assessment of drinking and TAC sensors. SI was assessed every 30 min during drinking episodes. Multilevel modeling was used to test hypotheses. RESULTS: Momentary SI and estimated blood alcohol concentration had moderate associations at the moment and day levels (standardized ßs = 0.5-0.6); SI was moderately associated with TAC at the day level (ßs = 0.5). Associations between SI and alcohol concentration varied widely between persons and across days. Day-level SI features predicted consequences when adjusting for alcohol concentration (incidence rate ratios, IRRs = 1.29-1.70). CONCLUSIONS: Our two-item SI measure shows evidence of validity in real-world settings with heavy-drinking young adults. SI was significantly correlated with alcohol concentration and was a unique predictor of consequences. The strength of these associations varied greatly across persons and days. Real-time SI measurement may be useful in preventive interventions, but continued research is needed into when and for whom momentary SI is most predictive of risk. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Transdermal sensor features correlate with ecological momentary assessment drinking reports and predict alcohol-related consequences in young adults' natural settings.

BACKGROUND: Wearable transdermal alcohol concentration (TAC) sensors allow passive monitoring of alcohol concentration in natural settings and measurement of multiple features from drinking episodes, including peak intoxication level, speed of intoxication (absorption rate) and elimination, and duration. These passively collected features extend commonly used self-reported drink counts and may facilitate the prediction of alcohol-related consequences in natural settings, aiding risk stratification and prevention efforts. METHOD: A total of 222 young adults aged 21-29 (M age = 22.3, 64% female, 79% non-Hispanic white, 84% undergraduates) who regularly drink heavily participated in a 5-day study that included the ecological momentary assessment (EMA) of alcohol consumption (daily morning reports and participant-initiated episodic EMA sequences) and the wearing of TAC sensors (SCRAM-CAM anklets). The analytic sample contained 218 participants and 1274 days (including 554 self-reported drinking days). Five features-area under the curve (AUC), peak TAC, rise rate (rate of absorption), fall rate (rate of elimination), and duration-were extracted from TAC-positive trajectories for each drinking day. Day- and person-level associations of TAC features with drink counts (morning and episodic EMA) and alcohol-related consequences were tested using multilevel modeling. RESULTS: TAC features were strongly associated with morning drink reports (r = 0.6-0.7) but only moderately associated with episodic EMA drink counts (r = 0.3-0.5) at both day and person levels. Higher peaks, larger AUCs, faster rise rates, and faster fall rates were significantly predictive of day-level alcohol-related consequences after adjusting for both morning and episodic EMA drink counts in separate models. Person means of TAC features added little above daily scores to the prediction of alcohol-related consequences. CONCLUSIONS: These results support the utility of TAC sensors in studies of alcohol misuse among young adults in natural settings and outline the specific TAC features that contribute to the day-level prediction of alcohol-related consequences. TAC sensors provide a passive option for obtaining valid and unique information predictive of drinking risk in natural settings.

Testing affect regulation models of drinking prior to and after drinking initiation using ecological momentary assessment.

OBJECTIVE: Affect regulation models of drinking state that affect motivates and reinforces drinking. Few studies have been able to elucidate the timing of these associations in natural settings. We tested positive affect (PA) and negative affect (NA) as predictors of drinking behavior, both prior to and during drinking episodes, and whether drinking predicted changes in affect during episodes. METHOD: Two hundred twenty-two regularly drinking young adults (21-29 years, 84% undergraduates), completed an ecological momentary assessment (EMA) protocol for five consecutive 24-hr periods stretching across 6 days (Wednesday-Monday). Participants provided PA and NA reports three times daily and every half hour during drinking episodes. Alcohol consumption reports were provided each morning and every half hour during drinking episodes. RESULTS: Multi-level models showed that greater pre-drinking PA predicted higher odds of drinking, but not number of drinks consumed. Pre-drinking NA did not predict same day odds of drinking or drinks consumed. Episode-level results revealed different associations for PA and NA with drinking. Current PA did not predict drinks consumed over the next half hour; however, increased drinking was associated with greater increases in PA over the next half hour. Higher NA predicted fewer drinks consumed in the next half hour and higher odds of the end of a drinking episode; however, increased drinking was not associated with changes in NA. CONCLUSIONS: PA increased following drinking during episodes. Our results suggest that a focus on PA prior to episodes and a focus on NA during episodes may interrupt processes leading to heavy drinking, and may therefore aid prevention efforts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effectiveness and Utility of Mobile Device Assessment of Subjective Craving during Residential Opioid Dependence Treatment.

Background: Craving is a dynamic state that is both theoretically and empirically linked to relapse in addiction. Static measures cannot adequately capture the dynamic nature of craving, and research has shown that these measures are limited in their capacity to link craving to treatment outcomes. Methods: The current study reports on assessments of craving collected 4x-day across 12 days from 73 patients in residential treatment for opioid dependence. Analyses investigated whether the within-person assessments yielded expected across- and within-day variability, whether levels of craving changed across and within days, and, finally, whether individual differences in craving variability predicted post-residential treatment relapse. Results: Preliminary analyses found acceptable levels of data entry compliance and reliability. Consistent with expectations, craving varied both between (46%) and within persons, with most within-person variance (over 40%) existing within days. Other patterns that emerged indicated that, on average, craving declined across the 12-days of assessment, and was generally strongest at mid-day. Analyses also found that patients' person-level craving variability predicted post-treatment relapse, above and beyond their mean levels of craving. Conclusion: Analyses support the reliability, sensitivity, and potential utility of the 4x-day, 12-day assessment protocol for measuring craving during residential treatment.

Affect relative to day-level drinking initiation: Analyzing ecological momentary assessment data with multilevel spline modeling.

Affect regulation models state that affect both motivates and reinforces alcohol use. We aimed to examine whether affect levels and rates of change differed across drinking versus nondrinking days in a manner consistent with affect regulation models. Four hundred four regularly drinking adults, aged 18-70 years, completed ecological momentary assessments over 3 weeks. Participants provided positive affect (PA; enthusiastic, excited, happy) and negative affect (NA; distressed, sad) reports during all prompts; alcohol consumption reports were also provided. Multilevel spline models revealed that on drinking days, PA was higher and NA was lower both before and after drinking compared to matched times on nondrinking days. PA and NA were also higher and lower, respectively, both before and after drinking, when heavy drinking days were compared to moderate drinking days. Examination of affect rates of change revealed that (a) accelerating increases in PA and accelerating decreases in NA preceded drinking initiation, (b) PA increases and NA decreases were seen up to 2 hr after drinking initiation, and (c) pre- and postdrinking PA increases were larger on heavy versus moderate drinking days, whereas only postdrinking NA decreases were larger on heavy drinking days. Results supported affect regulation models while adding nuance, showing accelerating changes in predrinking affect on drinking days and pre- and postdrinking differences in affect levels and rates of change across days of varying drinking intensity. Beyond theory, our results suggest that accelerating changes in affect may provide a clue to future commencement of heavy drinking, which may aid momentary intervention development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry.

BACKGROUND: Enhancements in mobile phone technology allow the study of children and adolescents' everyday lives like never before. Ecological momentary assessment (EMA) uses these advancements to allow in-depth measurements of links between context, behavior, and physiology in youths' everyday lives. FINDINGS: A large and diverse literature now exists on using EMA to study mental and behavioral health among youth. Modern EMA methods are built on a rich tradition of idiographic inquiry focused on the intensive study of individuals. Studies of child and adolescent mental and behavioral health have used EMA to characterize lived experience, document naturalistic within-person processes and individual differences in these processes, measure familiar constructs in novel ways, and examine temporal order and dynamics in youths' everyday lives. CONCLUSIONS: Ecological momentary assessment is feasible and reliable for studying the daily lives of youth. EMA can inform the development and augmentation of traditional and momentary intervention. Continued research and technological development in mobile intervention design and implementation, EMA-sensor integration, and complex real-time data analysis are needed to realize the potential of just-in-time adaptive intervention, which may allow researchers to reach high-risk youth with intervention content when and where it is needed most.

Adolescents' Subjective Social Status Predicts Day-to-Day Mental Health and Future Substance Use.

Adolescents' subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross-sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low-SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18-month follow-up. Results showed that with each perceived step "up" the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.

Evaluating the Use of Commercially Available Wearable Wristbands to Capture Adolescents' Daily Sleep Duration.

Commercially available wearable devices are marketed as a means of objectively capturing daily sleep easily and inexpensively outside of the laboratory. Two ecological momentary assessment studies-with 120 older adolescents (aged 18-19) and 395 younger adolescents (aged 10-16)-captured nightly self-reported and wearable (Jawbone) recorded sleep duration. Self-reported and wearable recorded daily sleep duration were moderately correlated (r ~ .50), associations which were stronger on weekdays and among young adolescent boys. Older adolescents self-reported sleep duration closely corresponded with estimates from the wearable device, but younger adolescents reported having an hour more of sleep, on average, compared to device estimates. Self-reported, but not wearable-recorded, sleep duration and quality were consistently associated with daily well-being measures. Suggestions for the integration of commercially available wearable devices into future daily research with adolescents are provided.

Perceived social status and mental health among young adolescents: Evidence from census data to cellphones.

Adolescents in the United States live amid high levels of concentrated poverty and increasing income inequality. Poverty is robustly linked to adolescents' mental health problems; however, less is known about how perceptions of their social status and exposure to local area income inequality relate to mental health. Participants consisted of a population-representative sample of over 2,100 adolescents (ages 10-16), 395 of whom completed a 14-day ecological momentary assessment (EMA) study. Participants' subjective social status (SSS) was assessed at the start of the EMA, and mental health symptoms were measured both at baseline for the entire sample and daily in the EMA sample. Adolescents' SSS tracked family, school, and neighborhood economic indicators (|r| ranging from .12 to .30), and associations did not differ by age, race, or gender. SSS was independently associated with mental health, with stronger associations among older (ages 14-16) versus younger (ages 10-13) adolescents. Adolescents with lower SSS reported higher psychological distress and inattention problems, as well as more conduct problems, in daily life. Those living in areas with higher income inequality reported significantly lower subjective social status, but this association was explained by family and neighborhood income. Findings illustrate that adolescents' SSS is correlated with both internalizing and externalizing mental health problems, and that by age 14 it becomes a unique predictor of mental health problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Emergence of electronic cigarette use in US adolescents and the link to traditional cigarette use.

BACKGROUND: Electronic cigarettes (e-cigarettes) are increasingly used by US adolescents and may be a gateway to traditional cigarette use. We examine rates of both products by age and examine differences in age-varying rates by sex and race/ethnicity. METHODS: Data are from the 2014 National Youth Tobacco Survey, a national sample of US middle and high school students (n=22.007); students ages 11-19 were included. Past 30-day e-cigarette and traditional cigarette use were examined as a function of age; sex and race/ethnicity were included as moderators. The age-varying association between e-cigarette and traditional cigarette use was also examined. RESULTS: Rates of e-cigarette use increase faster than traditional cigarette use from ages 13-16. Compared to females, males had higher rates of e-cigarette use from ages 14-17.5 and traditional cigarette use from ages 15-18. Between ages 12-14, more Hispanic adolescents used e-cigarettes compared to White or Black adolescents; after age 14 Hispanics and Whites reported similar rates, peaking at twice the rate for Blacks. Hispanic adolescents report greater traditional cigarette use versus Whites between ages 12-13, but lower rates between ages 15-18. E-cigarette use was strongly associated with traditional cigarette use, particularly during early adolescence [OR>40 before age 12]. CONCLUSIONS: Young Hispanic adolescents are at elevated risk for use of e-cigarettes and traditional cigarettes during early adolescence. During early adolescence, youth using e-cigarettes are more likely to smoke traditional cigarettes compared to youth not using e-cigarettes. The study of age-varying effects holds promise for advancing understanding of disparities in health risk behaviors.

Age-Varying Links Between Violence Exposure and Behavioral, Mental, and Physical Health.

PURPOSE: To examine age-varying prevalence rates and health implications of weapon-related violence exposure (WRVE) from adolescence to young adulthood (ages 14-30) using time-varying effect modeling. METHODS: Data were from the Add Health study, a longitudinal study of adolescents in the United States (N = 5,103) followed into young adulthood across four assessment waves from age 14-30. RESULTS: WRVE rates varied with age, peaking during mid-to-late adolescence (ages 16-18). Rates were higher for males (vs. females) and African-American youth (vs. white) across nearly all ages. Rates were higher for Hispanic youth (vs. white) during adolescence. WRVE was positively associated with frequent heavy episodic drinking and negatively associated with self-reported general health; these associations were significant during adolescence and early adulthood (ages 15-24). WRVE was positively associated with depressive symptoms. This association remained stable over age and was stronger for females from ages 16-21. The association between violence exposure and decreased general physical health was stronger for white versus African-American youth from ages 15-17, with no significant association observed for African-American youth at any age. CONCLUSIONS: Despite its severity, WRVE is prevalent among U.S. youth during adolescence and young adulthood, particularly among males and African-Americans during mid-to-late adolescence. The associations between WRVE and health were stronger during adolescence and differed by sex and race/ethnicity. This information may assist in the timing and targeting of intervention efforts aimed at interrupting the effects of violence exposure on youth behavioral, mental, and physical health.

Witnessing substance use increases same-day antisocial behavior among at-risk adolescents: Gene-environment interaction in a 30-day ecological momentary assessment study.

Many young adolescents are embedded in neighborhoods, schools, and homes where alcohol and drugs are frequently used. However, little is known about (a) how witnessing others' substance use affects adolescents in their daily lives and (b) which adolescents will be most affected. The current study used ecological momentary assessment with 151 young adolescents (ages 11-15) to examine the daily association between witnessing substance use and antisocial behavior across 38 consecutive days. Results from multilevel logistic regression models indicated that adolescents were more likely to engage in antisocial behavior on days when they witnessed others using substances, an association that held when substance use was witnessed inside the home as well as outside the home (e.g., at school or in their neighborhoods). A significant Gene × Environment interaction suggested that the same-day association between witnessing substance use and antisocial behavior was significantly stronger among adolescents with, versus without, the dopamine receptor D4 seven repeat (DRD4-7R) allele. The implications of the findings for theory and research related to adolescent antisocial behavior are discussed.

Morbidity and mortality risk among the "forgotten few": why are girls in the justice system in such poor health?

The present study assessed the physical health of a population of girls sentenced to custody in a large US State via medical examinations and clinical assessments in adolescence and young adulthood. Findings indicated that injuries, obesity, and sexually transmitted diseases were the norm, with over 50% of the population meeting criteria for each of these health problems. A dose-response relationship was documented between childhood victimization and injuries and injury risk in adolescence and self-harm, HIV risk, physical health symptoms, and hospitalizations in young adulthood. The relationship between childhood victimization and poor adult physical health was fully mediated by health-risk behaviors in adolescence. Clinical and policy implications of the high mortality and morbidity risk among female juvenile offenders are discussed.