Development of a Web-App for the Ecological Momentary Assessment of Dietary Habits among College Students: The HEALTHY-UNICT Project.

The transition from adolescence to adulthood is a critical period for the development of healthy behaviors. Yet, it is often characterized by unhealthy food choices. Considering the current pandemic scenario, it is also essential to assess the effects of coronavirus disease-19 (COVID-19) on lifestyles and diet, especially among young people. However, the assessment of dietary habits and their determinants is a complex issue that requires innovative approaches and tools, such as those based on the ecological momentary assessment (EMA). Here, we describe the first phases of the "HEALTHY-UNICT" project, which aimed to develop and validate a web-app for the EMA of dietary data among students from the University of Catania, Italy. The pilot study included 138 students (mean age 24 years, SD = 4.2; 75.4% women), who used the web-app for a week before filling out a food frequency questionnaire with validation purposes. Dietary data obtained through the two tools showed moderate correlations, with the lowest value for butter and margarine and the highest for pizza (Spearman's correlation coefficients of 0.202 and 0.699, respectively). According to the cross-classification analysis, the percentage of students classified into the same quartile ranged from 36.9% for vegetable oil to 58.1% for pizza. In line with these findings, the weighted-kappa values ranged from 0.15 for vegetable oil to 0.67 for pizza, and most food categories showed values above 0.4. This web-app showed good usability among students, assessed through a 19-item usability scale. Moreover, the web-app also had the potential to evaluate the effect of the COVID-19 pandemic on students' behaviors and emotions, showing a moderate impact on sedentary activities, level of stress, and depression. These findings, although interesting, might be confirmed by the next phases of the HEALTHY-UNICT project, which aims to characterize lifestyles, dietary habits, and their relationship with anthropometric measures and emotions in a larger sample of students.

Study protocol: One plus one can be greater than two-Ecological momentary assessment for Black prostate cancer survivors and partners.

Given that romantic partners play a pivotal role in patients' survivorship period, integrating partners into survivorship care and broadening the focus of behavioral interventions from the individual (survivor) to the survivor-partner dyad may make healthy lifestyle behaviors more easily adopted and potentially maintained. Understanding the role of dyadic processes in Black survivors is particularly important because their lifestyle behaviors are poor and they have higher cancer-specific and all-cause mortality. To develop an effective dyadic lifestyle behavior intervention for Black survivors, micro-level investigations of interactions between Black survivors and their partners are necessary to pinpoint how survivors and partners facilitate or hinder each other's lifestyle behaviors in their natural, everyday lives. Accordingly, the objective of the present study is to fill these gaps using ecological momentary assessment to eventually develop more effective lifestyle interventions for Black prostate cancer (PCa) survivors and partners. A total of 120 dyads (i.e., 240 individuals) who are Black adult survivors diagnosed with non-metastatic PCa and their romantic partners will be asked to complete four assessments per day for 14 consecutive days on a smartphone after an initial retrospective survey. Over the 14 days, participants will be asked to complete a brief survey regarding their lifestyle behaviors (physical activity, sedentariness and eating behaviors), contexts of lifestyle behaviors, stress, and coping. Physical activity and sedentary behavior will be assessed via accelerometer; eating behaviors will be assessed with the Automated Self-Administered 24-hour Dietary Assessment Tool. After completing the 14-day assessment, participants will be asked to complete a final retrospective survey. Results of the proposed study will inform the rigorous development of a theory-based dyadic lifestyle intervention in this vulnerable survivorship population with the ultimate goal to improve overall survival and reduce morbidities (for survivors) and reduce cancer incidence (for partners).

Ecological momentary assessment for health behaviors and contextual factors in persons with diabetes: A systematic review.

AIM: The objective of this systematic review was to summarize the ecological momentary assessment (EMA) methodology and associations between EMA-measured psychosocial, contextual factors and diabetes self-management. METHODS: The inclusion criteria were: research of EMA and diabetes self-management behaviors such as glucose checks, administration of insulin and eating-and dietary intake behaviors among persons with diabetes. A comprehensive search of several databases was conducted across all dates until July 2020. RESULTS: A modified Checklist for Reporting EMA Studies was used to assess the quality of studies. Among the ten included studies, participants were predominantly White adolescents with type 1 diabetes (T1D) and type 2 diabetes was studied in two studies. Time-varying, psychosocial contexts such as negative affect or negative social interaction were associated with missed insulin injection and poor adherence to glucose check. More preceding psychological stress was associated with more calorie intake from snacks or binge eating behaviors. Mornings were the most challenging time of day for adherence to diabetes self-management among adolescents with T1D. Intentional insulin withholding was more common in the afternoon in adults with T1D. CONCLUSIONS: EMA has potential clinical utility in the assessment of diabetes self-management and in the development of timely and individualized diabetes interventions.

Ecological Momentary Assessment of Alcohol Consumption and Its Concordance with Transdermal Alcohol Detection and Timeline Follow-Back Self-report Among Adults Experiencing Homelessness.

BACKGROUND: Studies of alcohol use presume valid assessment measures. To evaluate this presumption, we examined the concordance of alcohol use as measured by ecological momentary assessment (EMA) self-reports, transdermal alcohol concentration readings via the Secure Continuous Remote Alcohol Monitor (SCRAM), and retrospective self-reports via the Timeline Follow-Back (TLFB) among adults experiencing homelessness. METHODS: Forty-nine adults who reported alcohol misuse (mean age = 47, SD = 9; 57% Black; 82% men) were recruited from a homeless shelter. For 4 weeks, alcohol use was assessed: (i) 5 times or more per day by EMA, (ii) every 30 minutes by a SCRAM device worn on the ankle, and (iii) by TLFB for the past month at the end of the study period. There were 1,389 days of observations of alcohol use and alcohol use intensity for 49 participants. RESULTS: EMA and SCRAM alcohol use data agreed on 73% of days, with an interrater agreement Kappa = 0.46. A multilevel analysis of concordance of 3 measures for alcohol use yielded statistically significant correlations of 0.40 (day level) and 0.63 (person level) between EMA and SCRAM. Alcohol use was detected on 49, 38, and 33% of days by EMA, SCRAM, and TLFB, respectively. For alcohol use intensity, EMA and SCRAM resulted in statistically significant correlations of 0.46 (day level) and 0.78 (person level). The concordance of TLFB with either EMA or SCRAM was weak, especially at the day level. CONCLUSIONS: This is the first study to examine concordance of alcohol use estimates using EMA, SCRAM, and TLFB methods in adults experiencing homelessness. EMA is a valid approach to quantifying alcohol use, especially given its relatively low cost, low participant burden, and ease of use. Furthermore, any stigma associated with wearing the SCRAM or reporting alcohol use in person may be attenuated by using EMA, which may be appealing for use in studies of stigmatized and underserved populations.

Feasibility and acceptability of intensive, real-time biobehavioral data collection using ecological momentary assessment, salivary biomarkers, and accelerometers among middle-aged African Americans.

Perceived racial discrimination is linked to unhealthy behaviors and stress-related morbidities. A compelling body of research indicates that perceived racial discrimination may contribute to health disparities among African Americans (AAs). The purposes of this study were to describe the study protocol including data collection procedures and study measures and to evaluate the feasibility and acceptability of intensive biobehavioral data collection using ecological momentary assessment (EMA), salivary biomarkers, and accelerometers over 7 days among middle-aged AAs with a goal of understanding the relationships between perceived racial discrimination and biobehavioral responses to stress. Twelve AA men and women participated in the feasibility/acceptability study. They completed surveys, anthropometrics, and received in-person training in EMA and saliva sample collection at baseline. Participants were asked to respond to the random prompt text message-based EMA five times a day, wear an accelerometer daily for 7 days, and to self-collect saliva samples four times a day for 4 consecutive days. The EMA surveys included perceived racial discrimination, affective states, lifestyle behaviors, and social and physical contexts. The mean EMA response rate was 82.8%. All participants collected saliva samples four times a day for 4 consecutive days. About 83% of participants wore the accelerometer on the hip 6 out of 7 days. Despite the perception that the intensive nature of assessments would result in high participant burden, the acceptability of the study procedures was uniformly favorable.

Comparing effects of detached mindfulness and cognitive restructuring in obsessive-compulsive disorder using ecological momentary assessment.

Ecological momentary assessment (EMA) has been shown to be a valid and sensitive measure of treatment effects in obsessive-compulsive disorder (OCD). As part of a clinical trial, this EMA study deals with a comparison of two treatment conditions, that is, cognitive restructuring (CR) and detached mindfulness (DM). EMA data from n = 39 OCD patients were available from a randomized clinical trial on the effectiveness of CR and DM. Smartphone-based EMA sampling spread over 4 days each before and after treatment, with 10 random prompts per day and a 2-week intervention of either CR or DM. We tracked CR strategies (e.g., questioning an appraisal by re-evaluating risk), DM strategies (e.g., allowing one's thoughts to come and go), and application of newly learned strategies during Post-Treatment EMA. Although there was a trend towards DM strategies being applied more often during Pre-Treatment EMA than CR strategies, we did not find differences during Post-Treatment EMA between CR and DM regarding frequency or difficulty of application and experienced relief. As expected, we found a clear pre-post increase for all CR and DM behaviours except for one DM item. However, we did not find a treatment-specific increase of CR and DM behaviours; that is, both interventions equally well promoted a seemingly general treatment effect. Despite the ecological validity of EMA, however, social desirability effects cannot be ruled out, so that this conclusion must be handled cautiously. Further research is needed to replicate and generalize our results.

Body-related cognitive distortions (thought-shape fusion body) associated with thin-ideal exposure in female students-An ecological momentary assessment study.

Etiological models of eating disorders (EDs) describe body dissatisfaction (BD)as one of the major influences fostering dysfunctional body-related behaviour and disordered eating behaviour. BD is influenced by repeated exposure to thin ideals that evoke high self-ideal discrepancy and result in body-related cognitive distortions such as thought-shape fusion body (TSF-B). The aim of this study was to investigate the covariation of daily media exposure and the experience of TSF-B in a naturalistic setting. It was further analysed whether TSF-B is associated with self-ideal discrepancy, dysfunctional body-related behaviour, and disordered eating behaviour. Moreover, person-related predictors of TSF-B were explored. Altogether, 51healthy female students (mean age 21.06years, SD = 1.76) participated in an ecological momentary assessment study with four daily surveys during 10consecutive days. Exposure with thin ideals in contrast to exposure to unspecific media contents went along with the experience of TSF-B. TSF-B was associated with higher self-ideal discrepancy and dysfunctional body-related behaviour as well as more pronounced disordered eating behaviour, suggesting that TSF-B is a common phenomenon in young healthy females' everyday life. A main effect of trait measures (e.g., pre-existing BD) on TSF-B was observable but has no moderating effect. Thus, a specific vulnerability has not been detected.

A Review of Current Ambulatory Assessment Studies in Adolescent Samples and Practical Recommendations.

The use of ambulatory assessment (AA) and related methods (experience sampling, ecological momentary assessment) has greatly increased within the field of adolescent psychology. In this guide, we describe important practices for conducting AA studies in adolescent samples. To better understand how researchers have been implementing AA study designs, we present a review of 23 AA studies that were conducted in adolescent samples from 2017. Results suggest that there is heterogeneity in how AA studies in youth are conducted and reported. Based on these insights, we provide recommendations with regard to participant recruitment, sampling scheme, item selection, power analysis, and software choice. Further, we provide a checklist for reporting on AA studies in adolescent samples that can be used as a guideline for future studies.

Feasibility and Validity of Geographically Explicit Ecological Momentary Assessment With Recall-Aided Space-Time Budgets.

We employ data from the Adolescent Health and Development in Context Study-a representative sample of urban youth ages 11-17 in and around the Columbus, OH area-to investigate the feasibility and validity of smartphone-based geographically explicit ecological momentary assessment (GEMA). Age, race, household income, familiarity with smartphones, and self-control were associated with missing global positioning systems (GPS) coverage, whereas school day was associated with discordance between percent of time at home based on GPS-only versus recall-aided space-time budget data. Fatigue from protocol compliance increases missing GPS across the week, which results in more discordance. Although some systematic differences were observed, these findings offer evidence that smartphone-based GEMA is a viable method for the collection of activity space data on urban youth.

A comparison of signal- and event-contingent ambulatory assessment of interpersonal behavior and affect in social situations.

Ambulatory assessment (e.g., ecological momentary assessment) is now widely used in psychological research, yet key design decisions remain largely informed by methodological lore as opposed to systematic inquiry. The present study experimentally tested whether signal- (e.g., random prompt) and event- (e.g., complete a survey every time a target event occurs) contingent recording procedures of interpersonal behavior and affect in social situations yield equivalent quality and quantity of data. Participants (N = 286) completed baseline questionnaires, underwent cluster randomization to either a signal- or event-contingent condition, and then completed 1 week of ambulatory assessment, during which they answered questions about their social behavior and affect tied to their social interactions. Conditions were compared on response frequency, means and variances of interpersonal behavior and affect, correlations between interpersonal behavior and affect within-subject, and associations between momentary behavior and affect and baseline variables (e.g., Big Five traits). Results indicated that signal- and event-contingent recording techniques provided equivalent data quality, suggesting that researchers can use the 2 methodologies interchangeably to draw conclusions about means, variances, and associations when examining social interactions. However, results also showed that event-contingent recording returned, on average, a higher number of reported social interactions per individual, and this was true for most time periods of the day. Thus, event-contingent recording may hold advantages for studying frequency and timing of social interactions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Context-Sensitive Ecological Momentary Assessment: Application of User-Centered Design for Improving User Satisfaction and Engagement During Self-Report.

BACKGROUND: Ecological momentary assessment (EMA) can be a useful tool for collecting real-time behavioral data in studies of health and health behavior. However, EMA administered through mobile technology can be burdensome, and it tends to suffer from suboptimal user engagement, particularly in low health-literacy populations. OBJECTIVE: This study aimed to report a case study involving the design and evaluation of a mobile EMA tool that supports context-sensitive EMA-reporting of location and social situations accompanying eating and sedentary behavior. METHODS: An iterative, user-centered design process with obese, middle-aged women seeking care in a safety-net health system was used to identify the preferred format of self-report measures and the look, feel, and interaction of the mobile EMA tool. A single-arm feasibility field trial with 21 participants receiving 12 prompts each day for momentary self-reports over a 4-week period (336 total prompts per participant) was used to determine user satisfaction with interface quality and user engagement, operationalized as response rate. A second trial among 38 different participants randomized to receive or not to receive a feature designed to improve engagement was conducted. RESULTS: The feasibility trial results showed high interface satisfaction and engagement, with an average response rate of 50% over 4 weeks. Qualitative feedback pointed to the need for auditory alerts. We settled on 3 alerts at 10-min intervals to accompany each EMA-reporting prompt. The second trial testing this feature showed a statistically significant increase in the response rate between participants randomized to receive repeat auditory alerts versus those who were not (60% vs 40%). CONCLUSIONS: This paper reviews the design research and a set of design constraints that may be considered in the creation of mobile EMA interfaces personalized to users' preferences. Novel aspects of the study include the involvement of low health-literacy adults in design research, the capture of data on time, place, and social context of eating and sedentary behavior, and reporting prompts tailored to an individual's location and schedule. TRIAL REGISTRATION: ClinicalTrials.gov NCT03083964; https://clinicaltrials.gov/ct2/show/NCT03083964.

Developing a smartphone-based ecological momentary assessment protocol to collect biopsychosocial data with community-dwelling late-middle-aged and older adults.

Although ecological momentary assessment (EMA) has been used in youth and adult populations, very few of the studies provided evidence of the feasibility and utility of smartphone-based EMA protocols to collect biopsychosocial data from aging populations. This study aimed to describe the design and implementation of a smartphone-based EMA protocol, and to evaluate the feasibility and utility of this EMA protocol among community-dwelling late-middle-aged and older Chinese. A sample of 78 community-dwelling Chinese aged between 50 and 70 years was trained to participate in a 1-week EMA data collection, during which each participant carried an Android smartphone loaded with a researcher-developed EMA application and a smartphone-based electrocardiogram (ECG) monitor to provide psychosocial (e.g., daily activities, social interaction, affect) data and ECG recordings six times daily. Adherence was demonstrated with a total response rate of 91.5% of all scheduled assessments (n = 3,822) and a moderately high level of perceived feasibility. Female participants reported higher compliance to the study and rated the overall experience as more pleasant and interesting than male participants. Our study provided the first evidence of the feasibility and utility of smartphone-based EMA protocols among late-middle-aged and older Chinese. Key areas for improvement in future design and implementation of mobile-based EMA include the incorporation of usable technology, adequate and training, and timely assistance.

Ecological momentary assessment of various tobacco product use among young adults.

INTRODUCTION: Young adults are at high risk for using traditional and novel tobacco products. However, little is known about daily/weekly use patterns or psychosocial triggers for using various tobacco products. METHODS: This ecological momentary assessment (EMA) study examined timing, tobacco cravings, affect, social context, and other substance use (alcohol, marijuana) in relation to use of cigarettes, electronic nicotine delivery systems (ENDS), and any tobacco product (i.e., cigarettes, ENDS, cigars, hookah), respectively. We also examined interactions between these predictors, sex, and race/ethnicity. From a longitudinal study of 3418 18-25 year-olds from seven Georgia colleges/universities, we recruited 72 reporting current tobacco use to participate in the 21-day EMA study; 43 participated, of which 31 completed ≥66% assessments and were analyzed. Cravings, affect, social context, and substance use were assessed daily across four four-hour windows. RESULTS: Of the 31 participants, average age was 21.10 years (SD = 1.95), 45.2% were female, and 71.0% non-Hispanic White; 71.0% used cigarettes, 58.1% ENDS, 38.7% cigars, and 25.8% hookah (25.6% used one product, 46.5% two, 27.9% ≥ three). Predictors of cigarette use included higher anxiety, greater odds of marijuana and alcohol use, and higher boredom levels among women. Predictors of ENDS use included being non-White and greater odds of marijuana use, as well as higher tobacco cravings among women and higher boredom among men. Predictors of any tobacco product use included being non-White, higher boredom levels, and greater odds of marijuana and alcohol use. CONCLUSIONS: Distinct interventions may be needed to address use of differing tobacco products among young adults.

Real-time assessment of alcohol craving and naltrexone treatment responsiveness in a randomized clinical trial.

INTRODUCTION: This secondary data analysis examined whether and how the dopamine receptor D4 gene (DRD4) influenced naltrexone treatment responsiveness in a randomized clinical trial. We leveraged intensive experience sampling methods to test the hypothesis that craving recorded at drinking and non-drinking moments would mediate naltrexone effects on the likelihood of heavy drinking, but only among carriers of the DRD4 long (DRD4-L) allele. METHODS: Participants (Mage=29.8years, SD=12.1) were non-treatment seeking heavy drinkers (n=104, 54.8% female, 61.5% alcohol dependent) randomized to 3weeks of daily naltrexone (50mg) or placebo. During these 3weeks, participants used handheld electronic devices to complete real-time reports of alcohol use and craving multiple times per day in their natural environments. This approach afforded intensive repeated assessment of focal variables and provided in-the-moment data to test whether craving when not drinking or early in drinking episodes explained naltrexone effects on drinking. RESULTS: Moderated-mediation multilevel structural equation models showed that craving during non-drinking moments mediated the treatment effect of naltrexone on heavy drinking but only among carriers of the DRD4-L allele. The same pattern of associations was not shown when evaluating craving while participants were consuming alcoholic beverages. CONCLUSIONS: Findings provide the first in vivo evidence that, among carriers of the DRD4-L allele, naltrexone blunts craving in real-world settings, and this effect in turn reduces the likelihood of heavy drinking. This work highlights the utility of EMA methods for elucidating how treatments work and further demonstrates the importance of genetic factors for understanding individual differences in pharmacotherapy responsiveness.

The Role of Negative Affect and Self-Concept Clarity in Predicting Self-Injurious Urges in Borderline Personality Disorder Using Ecological Momentary Assessment.

Deficits in identity as well as negative affect have been shown to predict self-injurious and suicidal behaviors in individuals with borderline personality disorder (BPD). However, less is known about the interactive effects of these two predictors. We examined the moderating effect of a particular component of identity, self-concept, on the relationship between negative affect and self-injurious urges utilizing ecological momentary assessments. Outpatients diagnosed with either BPD (n = 36) or any anxiety disorder but no BPD (n = 18) completed surveys throughout the day over a 21-day period. Higher levels of momentary negative affect predicted greater subsequent urges to self-injure, but only when self-concept clarity was low (z = -3.60, p < .01). This effect did not differ between diagnostic groups. The results suggest that self-concept clarity has a protective effect against self-injurious urges in light of high negative affect, and that this effect may be transdiagnostic.

Response patterns and intra-dyadic factors related to compliance with ecological momentary assessment among mothers and children.

Ecological momentary assessment (EMA) is a real-time sampling strategy that may address limitations in health research, such as the inability to examine how processes unfold on a daily basis. However, EMA studies are prone to limited data availability due to difficulties in implementing sophisticated protocols and systematic non-compliance with prompts, resulting in biased estimates and limited statistical power. The objectives of this study were to describe the availability of data, to examine response patterns, and to analyze factors related to EMA prompt compliance in a dyadic EMA study with mothers and children. Participants (N = 404) each received up to eight EMA prompts (i.e., audible pings) per day for a total of 7 days. Each EMA survey consisted of items assessing affect, perceived stress, and social context. Participants responded to approximately 80% (range: 3.4%-100%) of prompted EMA surveys, and completed 92.6% of surveys once started. Mothers and children identifying as Hispanic, as well as mothers in lower-income households, were less likely to comply with any given EMA prompt. Participant dyads were more likely to comply with prompts when they were together. Understanding factors related to systematic EMA prompt non-compliance is an important step to reduce the likelihood of biased estimates and improve statistical power. Socioeconomic factors may impede mothers' compliance with EMA protocols. Furthermore, mothers' presence and involvement may enhance children's compliance with EMA protocols.

Momentary assessment of impulsive choice and impulsive action: Reliability, stability, and correlates.

Impulsivity is associated with substance use, including tobacco use. The degree to which impulsivity fluctuates over time within persons, and the degree to which such intra-individual changes can be measured reliably and validly in ambulatory assessments is not known, however. The current study evaluated two novel ambulatory measures of impulsive choice and impulsive action. Impulsive choice was measured with an eight-item delay discounting task designed to estimate the subjective value of delayed monetary rewards. Impulsive action was measured with a two-minute performance test to assess behavioral disinhibition (the inability to inhibit a motor response when signaled that such a response will not be rewarded). Valid data on impulsive choice were collected at 70% of scheduled reports and valid data on impulsive action were collected on 55% of scheduled reports, on average. Impulsive choice and action data were not normally distributed, but models of relations of these measures with within- and between-person covariates were robust across distributional assumptions. Intra-class correlations were substantial for both impulsive choice and action measures. Between persons, random intercepts in impulsive choice and action were significantly related to laboratory levels of their respective facets of impulsivity, but not self-reported or other facets of impulsivity. Validity of the ambulatory measures is supported by associations between abstinence from smoking and increased impulsivity, but challenged by an association between strong temptations to smoke and reduced impulsive choice. Results suggest that meaningful variance in impulsive choice and action can be captured using ambulatory methods, but that additional measure refinement is needed.

Momentary smoking context as a mediator of the relationship between SES and smoking.

There is a well-established socioeconomic gradient in smoking behavior: those with lower socioeconomic status smoke more. However, much less is known about the mechanisms explaining how SES is linked to smoking. This study takes a social-ecological perspective by examining whether socioeconomic status affects smoking behavior by differential exposure to places where smoking is allowed. Exposure to smoking restrictions was assessed in real-time using Ecological Momentary Assessment methods. A sample of 194 daily smokers, who were not attempting to quit, recorded their smoking and information about situational and contextual factors for three weeks using an electronic diary. We tested whether a smoker's momentary context mediated the relationship between socioeconomic status (educational attainment) and cigarettes smoked per day (CPD). Momentary context was operationalized as the proportion of random assessments answered in locations where smoking was allowed versus where smoking was not allowed. Data were analysed using multilevel regression (measurements nested within participants) with a lower level mediation model (2-1-1 mediation). Although no significant direct effect of SES on CPD were observed, there was a significant indirect effect of SES on CPD via the momentary context. Compared to participants with higher education, lower educated participants were more likely to encounter places where smoking was allowed, and this in turn, was associated with a higher number of CPD. These findings suggest that SES is associated with smoking at least partially via differential exposure to smoking-friendly environments, with smokers from lower SES backgrounds accessing more places where smoking is allowed. Implications for current smoke-free legislation are discussed.

Assessment of alcohol intake: Retrospective measures versus a smartphone application.

INTRODUCTION: Research investigating problem drinking often relies on retrospective measures to assess alcohol consumption behaviour. Limitations associated with such instruments can, however, distort actual consumption levels and patterns. We developed the smartphone application (app), CNLab-A, to assess alcohol intake behaviour in real-time. METHODS: Healthy individuals (N=671, M age 23.12) completed demographic questions plus the Alcohol Use Questionnaire and a 21-day Timeline Followback before using CNLab-A for 21days. The app asked participants to record alcohol consumption details in real time. We compared data reported via retrospective measures with that captured using CNLab-A. RESULTS: On average, participants submitted data on 20.27days using CNLab-A. Compared to Timeline Followback, a significantly greater percentage of drinking days (24.79% vs. 26.44%) and significantly higher total intake (20.30 vs. 24.26 standard drinks) was recorded via the app. CNLab-A captured a substantially greater number of high intake occasions at all levels from 8 or more drinks than Timeline Followback. Additionally, relative to the Alcohol Use Questionnaire, a significantly faster rate of consumption was recorded via the app. CONCLUSIONS: CNLab-A provided more nuanced information regarding quantity and pattern of alcohol intake than the retrospective measures. In particular, it revealed higher levels of drinking than retrospective reporting. This will have implications for how particular at-risk alcohol consumption patterns are identified in future and might enable a more sophisticated exploration of the causes and consequences of drinking behaviour.