Ecological Momentary Assessment (EMA) is a validated data collection method that measures behaviors in real time. Despite the advantages of EMA, this method remains underutilized in substance use research. We conducted an EMA study with phone text messages among 30 substance-using men who have sex with men (SUMSM) enrolled in a 2-month pharmacologic trial. SUMSM received 3-5 text message questions daily that assessed alcohol and methamphetamine use. We calculated text message completion rates and surveyed participants' perceptions of text messages to determine the feasibility and acceptability of EMA among substance-using MSM. Our study had high completion and satisfaction rates and very few participants reported having difficulty participating in the study. EMA is a feasible and acceptable data collection method among SUMSM. Additionally, some participants reported the EMA may help them reduce their substance use. Taken together, our findings support the suitability of EMA for future substance use research studies.

1. Feasibility and acceptability
of ecological momentary
assessments among
substance-using men who
have sex with men
Caitlin Turner, MPH (c)
presenting on behalf of Glenn-Milo Santos, PhD, MPH
Substance Use Research Unit
San Francisco Department of Public Health
Did you take
naltrexone yesterday?
Yes.

2. • Glenn-Milo Santos, PhD, MPH
• Chris Rowe, MPH
• Project iN participants and research team
Acknowledgments

3. • Men who have sex with men (MSM) engage more
frequently in methamphetamine and alcohol use
compared to the general U.S. population
• Alcohol and meth use independently associated with
increased risk of HIV infection and transmission
• Substance use behaviors are dynamic and self-
reports are subject to bias
- Need for an accessible data collection method that more
accurately captures complex behaviors in “subjects’ natural
environments”
Background
SAMHSA, 2004; Finlayson et al., 2011; Shiffman, 2008 & 2009

4. • Tool designed to collect real-time data on dynamic
behaviors
• Useful for studying episodic behaviors like
alcohol/substance use
• Although use of EMA-friendly technologies has increased,
EMA is underutilized in substance use research
Ecological Momentary
Assessment (EMA)
Shiffman, 2009; Portell et al., 2015

5. EMA Example
Yang et al., 2015

6. What is the feasibility and acceptability of
EMA among substance-using MSM enrolled
in a pharmacological intervention in San
Francisco?
Research Aim

7. Methods
Feasibility, acceptability, and
tolerability of a counseling +
naltrexone intervention aimed at
reducing meth use and binge
drinking among non-dependent
MSM in San Francisco

8. • Study design: 2-month pharmacologic trial
• Sample: 30 MSM who use
methamphetamine and/or alcohol
Methods

9. • Participants received and responded to 3 – 5 daily texts that
asked about naltrexone, methamphetamine, and alcohol use
EMA Data Collection

10. Hey!
took tx yday
(12/04/12)?
1. yes
2. no
(if above is 1)
tx yday b4 ma
(12/04/12)?
1. yes, b4 ma
2. no, not b4 ma
(if above is 2)
tx yday b4 al
(12/04/12)?
1. yes, b4 al
2. no, not b4 al
(if above is 3)
tx yday b4 ma/al
(12/04/12)?
1. yes, b4 ma & al
2. yes, b4 ma only
3.yes, b4 al only
4. no, not b4 ma/al
(if above
is 4)
Thx!
Appreciat
e UR
time!
(any of
above)
Thx !
Appreciat
e UR
time!
(if above
is 1)
Thx 4
taking
tx!
(if above is
2)
Ok. There's
always next
time.
Thx 4 UR
time!
(if above
is 1)
Thx 4
taking
tx!
(if above is
2)
Ok. There's
always next
time.
Thx 4 UR
time!
(if above
is 1)
Thx 4
taking
tx!
(if above is 2)
Ok. There's
always next
time.
Thx 4 UR
time!
(if above is 2)
ma/al yday
(12/04/12)?
1. yes, ma only
2. yes, al only
3. yes, ma & al
4. no ma, no al
EMA Text
Messaging (if above is 1)
ma/al yday
(12/04/12)?
1. yes, ma only
2. yes, al only
3. yes, ma & al
4. no ma, no al

11. • Text message completion rates
• Participants’ perceptions of EMA text
messages
Outcome Measures

12. • Average response rate: 69%
• 13 out of 30 participants responded to
80% or more of their texts throughout the
duration of the study
Results

13. Results: text message
completion rates
Weekdays Weekends
75% 72%
By Time of Week

14. Results: perceptions of EMA
text messages
0 10 20 30 40 50 60 70
32% highly satisfied 28% satisfied
32% neutral 7% dissatisfied
How satisfied are you with daily EMA text messages?
60%
40%

15. Results: perceptions of EMA
text messages
0 10 20 30 40 50 60 70 80 90
64% not difficult 21% a little difficult
Neutral/somewhat difficult
How difficult was it to participate in the EMA study?
85%
15%

16. • Overall, participants reported that EMA
text messages may have helped them
reduce their methamphetamine use (43%)
and alcohol use (40%)
Results: substance/alcohol use

17. • EMA text-messaging platforms are feasible +
acceptable among substance-using MSM
– High completion and satisfaction rates
– Participants rarely report difficulty with study
• EMA texts may help participants reduce
substance + alcohol use
• Findings consistent with other studies that
support the utility of EMA for substance use
research
Discussion

18. • Small convenience sample
• Short follow-up time
• Unclear whether EMA alone would lead to
similar completion rates
Limitations

19. • Scaling up with Say When: follow-up
analyses in a larger sample of alcohol-
using MSM
• EMA implementation sensitive to
differences in engagement among
participants of various ages, cultural and
educational backgrounds
The Way Forward

20. Questions?
References
Finlayson, T. J., Le, B., Smith, A., et al. (2011). HIV risk, prevention,
and testing behaviors among men who have sex with men: National
HIV Behavioral Surveillance System, 21 US cities, United States,
2008. US Department of Health and Human Services, Centers for
Disease Control and Prevention.
Portell, M., Anguera, M. T., Hernandez-Mendo, A., & Jonsson, G. K.
(2015). Quantifying biopsychosocial aspects in everyday contexts:
An integrative methodological approach from the behavioral
sciences. Psychology Research and Behavior Management, 8, 153-
160. doi:10.2147/PRBM.S82417 [doi]
Shiffman, S., Stone, A. A., & Hufford, M. R. (2008a). Ecological
momentary assessment. Annual Review of Clinical Psychology, 4, 1-
32.
Shiffman, S. (2009b). Ecological momentary assessment (EMA) in
studies of substance use. Psychological Assessment, 21(4), 486.
Substance Use and Mental Health Services Administration. (2004).
National Survey on Drug Use and Health. Office of Applied Studies.
Yang, C., Linas, B., Kirk, G., Bollinger, R., et al. (2015). Feasibility
and Acceptability of Smartphone-Based Ecological Momentary
Assessment of Alcohol Use Among African American Men Who
Have Sex With Men in Baltimore. JMIR mHealth and uHealth, 3(2),
e67. http://doi.org/10.2196/mhealth.4344
Thank you!
• Caitlin Turner
• Caitlin.Turner@sfdph.org
• @c8turner_sfdph