Ecological Momentary Assessment of Illicit Drug Use Compared to Biological and Self-Reported Methods
BACKGROUND:
The
use of mHealth methods for capturing illicit drug use and associated behaviors
have become more widely used in research settings, yet there is little research
as to how valid these methods are compared to known measures of capturing and
quantifying drug use.
OBJECTIVE:
We
examined the concordance of ecological momentary assessment (EMA) of drug use
to previously validated biological and audio-computer assisted self-interview
(ACASI) methods.
METHODS:
The
Exposure Assessment in Current Time (EXACT) study utilized EMA methods to
assess drug use in real-time in participants' natural environments. Utilizing
mobile devices, participants self-reported each time they used heroin or
cocaine over a 4-week period. Each week, PharmChek sweat patch samples were collected
for measurement of heroin and cocaine and participants answered an ACASI-based
questionnaire to report behaviors and drug using events during the prior week.
Reports of cocaine and heroin use captured through EMA were compared to weekly
biological or self-report measures through percent agreement and concordance
correlation coefficients to account for repeated measures. Correlates of
discordance were obtained from logistic regression models.
RESULTS:
A total
of 109 participants were a median of 48.5 years old, 90% African American, and
52% male. During 436 person-weeks of observation, we recorded 212 (49%) cocaine
and 103 (24%) heroin sweat patches, 192 (44%) cocaine and 161 (37%) heroin
ACASI surveys, and 163 (37%) cocaine and 145 (33%) heroin EMA reports. The
percent agreement between EMA and sweat patch methods was 70% for cocaine use
and 72% for heroin use, while the percent agreement between EMA and ACASI
methods was 77% for cocaine use and 79% for heroin use. Misreporting of drug
use by EMA compared to sweat patch and ACASI methods were different by illicit
drug type.
CONCLUSIONS:
Our
work demonstrates moderate to good agreement of EMA to biological and standard
self-report methods in capturing illicit drug use. Limitations occur with each
method and accuracy may differ by type of illicit drugs used.
Below: Reported drug use as assessed by sweat patch (green bars), EMA (orange bars) or ACASI (blue bars) methods
Below: Figure 2. Percent agreement
by drug type and week comparing EMA, sweat patch, and ACASI methods. Panel A:
Percent agreement between EMA/Sweat Patch methods (blue bars) and EMA/ACASI
methods (green bars) by week for cocaine use. Panel B: Percent agreement
between EMA/Sweat Patch methods (orange bars) and EMA/ACASI methods (yellow
bars) by week for heroin use.
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- 1Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA. Blinas@jhu.edu.
- JMIR Mhealth Uhealth. 2016 Mar 15;4(1):e27. doi: 10.2196/mhealth.4470.
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