A geographically explicit ecological momentary assessment (GEMA) mixed method for understanding substance use

Abstract

Tobacco use is increasingly concentrated within marginalized groups, including LGBTQ+ young adults. Developing tailored interventions to reduce tobacco-related health disparities requires understanding the mechanisms linking individual and contextual factors associated with tobacco use to behavior. This paper presents an in-depth exploration of three cases from a novel mixed method study designed to identify the situational factors and place-based practices of substance use among high-risk individuals. We combined geographically explicit ecological momentary assessment (GEMA) with an adapted travel diary-interview method. Participants (young adult bisexual smokers, ages 18-26) reported on non-smoking and smoking situations for 30 days with a smartphone app. GEMA surveys captured internal and external situational factors (e.g., craving intensity, location type, seeing others smoking). Continuous locational data was collected via smartphone GPS. Subsequently, participants completed in-depth interviews reviewing maps of their own GEMA data. GEMA data and transcripts were analyzed separately and integrated at the case level in a matrix. Using GEMA maps to guide the interview grounded discussion in participants' everyday smoking situations and routines. Interviews clarified participant interpretation of GEMA measures and revealed experiences and meanings of smoking locations and practices. The GEMA method identified the most frequent smoking locations/times for each participant (e.g., afternoons at university). Interviews provided description of associated situational factors and perceptions of smoking contexts (e.g., peer rejection of bisexual identity) and the roles of smoking therein (e.g., physically escape uncomfortable environments). In conclusion, this mixed method contributes to advancing qualitative GIS and other hypothesis-generating approaches working to reveal the richness of individuals' experiences of the everyday contexts of health behavior, while also providing reliable measures of situational predictors of behaviors of interest, such as substance use. Limitations of and future directions for the method are discussed.

Real-time predictors of smoking among sexual minority and heterosexual young adults: An ecological momentary assessment study

“…Incentives ranged from $0 to $180 gift cards according to participant compliance in completing the EMA surveys. More information about the EMA data collection protocol is provided elsewhere (McQuoid et al, 2018). …”

“…All Facebook and Instagram recruitment ads were posted from a Facebook page that was specifically set up for this study (“Smartphone Smoking Study”). To conduct a nested qualitative substudy (McQuoid et al, 2018), we oversampled women identifying as a sexual minority. Eligible participants were 18–26 years of age, had smoked at least 100 cigarettes in their lifetime, currently smoked at least one cigarette per day at least three days per week, and made daily use of a smartphone with Global Positioning System capabilities.…”

“…A quantitative study in which daily EMA assessments were conducted among 50 sexual minority adults reported that discrimination was associated with nicotine use (Livingston et al, 2017). Additionally, an EMA mixed-methods study described situational factors, perceptions of smoking contexts, and the roles of smoking therein among bisexual smokers (McQuoid et al, 2018). These studies, however, did not measure both internal and external factors and did not include a comparison group (i.e., heterosexual individuals).…”

It’s Just Steam: a qualitative analysis of New Zealand ENDS users’ perceptions of secondhand aerosol

“…Future work could also explore whether people who smoke and vape in different spaces vary in their perceptions of SHS and SHA, and their support for vaping restrictions. Longitudinal approaches, such as ecological momentary assessments, could also extend our findings by examining the speed at which perceptions of SHS and SHA evolve 43…”

Combining Real-Time Ratings With Qualitative Interviews to Develop a Smoking Cessation Text Messaging Program for Primary Care Patients (Preprint)

“…This is similar to prior work combining behavioral smoking data from ecological momentary assessments with qualitative data to understand substance use behaviors. [30] Thus, we aimed to gather insights into primary are patients' reactions to messages in the context of their daily lives and to understand their experiences with and barriers to using NRT. Specifically, we examined three text messaging intervention components: (1) the language and content included in an existing national text messaging campaign, (2) new content for smokers not ready to quit consisting of motivational advice and encouragement to practice quitting, and (3) new content promoting NRT use.…”