Society for Ambulatory Assessment

Third quarter 2014 (July to September)

Aldinger, Maren; Stopsack, Malte; Ulrich, Ines; Appel, Katja; Reinelt, Eva; Wolff, Sebastian et al. (2014): Neuroticism developmental courses - implications for depression, anxiety and everyday emotional experience; a prospective study from adolescence to young adulthood. In: BMC Psychiatry 14 (1), S. 210. DOI: 10.1186/s12888-014-0210-2.

BACKGROUND: Neuroticism is frequently discussed as a risk factor for psychopathology. According to the maturity principle, neuroticism decreases over the course of life, but not uniformly across individuals. However, the implications of differences in personality maturation on mental health have not been well studied so far. Hence, we hypothesized that different forms of neuroticism development from adolescence to young adulthood are associated with differences in depression, anxiety and everyday emotional experience at the age of 25. METHODS: A sample of 266 adolescents from the general population was examined three times over ten years (age at T0: 15, T1: 20 and T2: 25) using questionnaires, interviews and ecological momentary assessment (EMA). At all measurement points, neuroticism was assessed with the NEO inventory. At T2, diagnoses of major depression and anxiety disorders were captured with a structured clinical interview (M-CIDI). Phone-based EMA was used to assess emotional experience and affective instability over a two-week period at T2. RESULTS: The best fitting model was a latent class growth analysis with two groups of neuroticism development. Most individuals (n = 205) showed moderate values whereas 61 participants were clustered into a group with elevated neuroticism levels. In both groups neuroticism significantly changed during the ten year period with a peak at the age of 20. Individuals with a higher absolute level were at 14-fold increased risk for depression and 7-fold risk for anxiety disorders at the age of 25. In EMA, increased negative affect and arousal as well as decreased positive emotions were found in this high group. CONCLUSIONS: Other than expected, personality did not mature in our sample. However, there was a significant change of neuroticism values from adolescence to young adulthood. Further, over 20% of our participants showed a neuroticism development which was associated with adverse outcomes such as negatively toned emotional experience and a heightened risk to suffer from depressive and anxiety disorders in young adulthood. These high-risk persons need to be identified early to provide interventions supporting continuous personality maturation.

Arif, Muhammad; Bilal, Mohsin; Kattan, Ahmed; Ahamed, S. Iqbal (2014): Better physical activity classification using smartphone acceleration sensor. In: J Med Syst 38 (9), S. 95. DOI: 10.1007/s10916-014-0095-0.

Obesity is becoming one of the serious problems for the health of worldwide population. Social interactions on mobile phones and computers via internet through social e-networks are one of the major causes of lack of physical activities. For the health specialist, it is important to track the record of physical activities of the obese or overweight patients to supervise weight loss control. In this study, acceleration sensor present in the smartphone is used to monitor the physical activity of the user. Physical activities including Walking, Jogging, Sitting, Standing, Walking upstairs and Walking downstairs are classified. Time domain features are extracted from the acceleration data recorded by smartphone during different physical activities. Time and space complexity of the whole framework is done by optimal feature subset selection and pruning of instances. Classification results of six physical activities are reported in this paper. Using simple time domain features, 99 % classification accuracy is achieved. Furthermore, attributes subset selection is used to remove the redundant features and to minimize the time complexity of the algorithm. A subset of 30 features produced more than 98 % classification accuracy for the six physical activities.

Arnold, Suzanne V.; Kosiborod, Mikhail; Li, Yan; Jones, Philip G.; Yue, Patrick; Belardinelli, Luiz; Spertus, John A. (2014): Comparison of the Seattle Angina Questionnaire With Daily Angina Diary in the TERISA Clinical Trial. In: Circ Cardiovasc Qual Outcomes. DOI: 10.1161/CIRCOUTCOMES.113.000752.

BACKGROUND: As new techniques emerge to quantify patients’ health status, new opportunities are created to validate patient-reported outcome questionnaires. The Seattle Angina Questionnaire (SAQ), a widely used coronary artery disease-specific health status tool, has not been validated against daily records of angina frequency and sublingual nitroglycerin (SL NTG) use. Additional evidence supporting the validity of the SAQ could justify its broader use as an outcome for clinical studies designed to evaluate treatments that may improve patients’ symptoms, function, and quality of life. METHODS AND RESULTS: We used data from 917 patients with type 2 diabetes mellitus, coronary artery disease, and stable angina from the multinational Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina (TERISA) trial. The number of angina episodes and SL NTG used were recorded and transmitted daily using an electronic diary. In cross-sectional analyses, there was a strong relationship between the 2 SAQ angina frequency questions (ie, frequency of angina and SL NTG use) and the corresponding diary responses, with correlation coefficients of -0.64 for angina frequency (95% confidence interval,-0.68 to -0.60) and -0.69 for SL NTG use (95% confidence interval, -0.73 to -0.66). Longitudinally, changes in SAQ angina frequency scores from day 1 to week 8 also correlated with changes in angina frequency (-0.42; 95% confidence interval, -0.48 to -0.30) and SL NTG use by diary (-0.38; 95% confidence interval, -0.43 to -0.32) over the corresponding time period. Correlations were similar when stratified by age, sex, or geography. CONCLUSIONS: In a multinational cohort of patients with stable angina, the SAQ angina frequency domain was significantly correlated, both cross sectionally and longitudinally, with daily diary entries of angina frequency and SL NTG use. These data further support the validity of the SAQ angina frequency domain across a broad spectrum of patients with stable angina. CLINICAL TRIAL REGISTRATION: URL: Unique identifier: NCT01425359.

Arnold, Suzanne V.; McGuire, Darren K.; Spertus, John A.; Li, Yan; Yue, Patrick; Ben-Yehuda, Ori et al. (2014): Effectiveness of ranolazine in patients with type 2 diabetes mellitus and chronic stable angina according to baseline hemoglobin A1c. In: Am Heart J 168 (4), S. 457-465.e2. DOI: 10.1016/j.ahj.2014.06.020.

BACKGROUND: Ranolazine reduces the frequency of angina and use of sublingual nitroglycerin (SL NTG) in stable angina patients with type 2 diabetes (T2DM). Because pre-clinical data suggest that myocardial late sodium current (INaL), the target of ranolazine, is increased by hyperglycemia, we investigated whether the efficacy of ranolazine was influenced by glycemic control. METHODS: TERISA was a multinational, randomized, double-blind trial of ranolazine vs. placebo in patients with T2DM and stable angina. Anginal episodes and SL NTG use were recorded daily in an electronic diary. Health status was evaluated at baseline and 8weeks post-randomization using the Seattle Angina Questionnaire (SAQ). The interaction between baseline HbA1c and treatment effect was tested across endpoints using analysis of covariance models, with HbA1c as a continuous variable with restricted cubic splines. RESULTS: The study included 913 patients, with mean age 63.6years, 39% women, mean T2DM duration 7.4years, and mean HbA1c of 7.3%. Heterogeneity of efficacy by HbA1c was observed for the primary endpoint of angina frequency (Pinteraction = .027), the key secondary endpoint of SL NTG use (Pinteraction = .030), SAQ angina frequency (Pinteraction = .001), and SAQ treatment satisfaction (Pinteraction = .025) with greater efficacy of ranolazine in those with higher HbA1c values, increasing continuously from HbA1c levels >6.5%. CONCLUSION: Among patients with T2DM and stable angina, the therapeutic benefits of ranolazine were greater in those with higher HbA1c values. These data suggest that ranolazine is particularly beneficial in patients with stable angina who have suboptimally controlled T2DM.

Atkin, Andrew J.; Sharp, Stephen J.; Corder, Kirsten; van Sluijs, Esther M F (2014): Prevalence and Correlates of Screen time in Youth: An International Perspective. In: Am J Prev Med. DOI: 10.1016/j.amepre.2014.07.043.

BACKGROUND: Screen time (including TV viewing/computer use) may be adversely associated with metabolic and mental health in children. PURPOSE: To describe the prevalence and sociodemographic correlates of screen time in an international sample of children aged 4-17 years. METHODS: Data from the International Children’s Accelerometry Database were collected between 1997-2009 and analyzed in 2013. Participants were 11,434 children (48.9% boys; mean [SD] age at first assessment, 11.7 [3.2] years). Exposures were sex, age, weight status, maternal education, and ethnicity. The outcome was self- or proxy-reported screen time <2 or >2 hours/day. Analyses were conducted initially at study level and then combined using random-effects meta-analysis. RESULTS: Within each contributing study, at least two thirds of participants exceeded 2 hours/day of screen time. In meta-analytic models, overweight or obese children were more likely to exceed 2 hours/day of screen time than those who were non-overweight (OR=1.58, 95% CI=1.33,1.88). Girls (vs boys: 0.65; 0.54, 0.78) and participants with more highly educated mothers (vs <university level: 0.53; 0.42, 0.68) were less likely to exceed 2 hours/day of screen time. Associations of age and ethnicity with screen time were inconsistent at study level and non-significant in pooled analyses. CONCLUSIONS: Screen time in excess of public health guidelines was highly prevalent, particularly among boys, those who were overweight or obese, and those with mothers of lower educational attainment. The population-attributable risk associated with this exposure is potentially high; further efforts to understand the determinants of within- and between-country variation in these behaviors and inform the development of effective behavior change intervention programs is warranted.

Azevedo, Ana Rita Pereira; de Sousa, Hugo Manuel Lopes; Monteiro, Joaquim Antonio Faria; Lima, Aurea Rosa Nunes Pereira (2014): Future perspectives of Smartphone applications for rheumatic diseases self-management. In: Rheumatol Int. DOI: 10.1007/s00296-014-3117-9.

Rheumatic diseases (RD) self-management interventions are designed to improve health-related quality of life, health care utilization, and perceived self-efficacy. Despite these demonstrated good results, there are several issues that hinder or render less appealing these interventions. One economically and socially viable solution is exploiting the potential of Smartphone technology. This potential comes from Smartphones pervasive presence in actual society, combined with the advantages of being personal, intuitive, and computationally powerful, with capability to support applications and assist its user throughout different activities of daily living and environments persistently. With their global acceptance increasing quickly, there is a great opportunity for mobile health in using Smartphone applications for RD self-management. Besides the potential of such applications, research on the development and evaluation of such applications is in the early stages. Therefore, it is important to foresee its future applicability in order to meet the needs of the twenty-first century.

Bailey, Ryan R.; Klaesner, Joseph W.; Lang, Catherine E. (2014): An accelerometry-based methodology for assessment of real-world bilateral upper extremity activity. In: PLoS One 9 (7), S. e103135. DOI: 10.1371/journal.pone.0103135.

BACKGROUND: The use of both upper extremities (UE) is necessary for the completion of many everyday tasks. Few clinical assessments measure the abilities of the UEs to work together; rather, they assess unilateral function and compare it between affected and unaffected UEs. Furthermore, clinical assessments are unable to measure function that occurs in the real-world, outside the clinic. This study examines the validity of an innovative approach to assess real-world bilateral UE activity using accelerometry. METHODS: Seventy-four neurologically intact adults completed ten tasks (donning/doffing shoes, grooming, stacking boxes, cutting playdough, folding towels, writing, unilateral sorting, bilateral sorting, unilateral typing, and bilateral typing) while wearing accelerometers on both wrists. Two variables, the Bilateral Magnitude and Magnitude Ratio, were derived from accelerometry data to distinguish between high- and low-intensity tasks, and between bilateral and unilateral tasks. Estimated energy expenditure and time spent in simultaneous UE activity for each task were also calculated. RESULTS: The Bilateral Magnitude distinguished between high- and low-intensity tasks, and the Magnitude Ratio distinguished between unilateral and bilateral UE tasks. The Bilateral Magnitude was strongly correlated with estimated energy expenditure (rho = 0.74, p<0.02), and the Magnitude Ratio was strongly correlated with time spent in simultaneous UE activity (rho = 0.93, p<0.01) across tasks. CONCLUSIONS: These results demonstrate face validity and construct validity of this methodology to quantify bilateral UE activity during the performance of everyday tasks performed in a laboratory setting, and can now be used to assess bilateral UE activity in real-world environments.

Barmettler, Gabi; Brawn, Jennifer; Maleki, Nasim; Scrivani, Steven; Burstein, Rami; Becerra, Lino; Borsook, David (2014): A new electronic diary tool for mapping and tracking spatial and temporal head pain patterns in migraine. In: Cephalalgia. DOI: 10.1177/0333102414545892.

AIM: We present an electronic tool for collecting data on the patterns of migraine headache onset and progression. METHODS: A digitized map consisting of 44 color-coded segments was defined based on previous reports of migraine pain and the distribution of nerves in the face, head and neck. The map was overlaid on a schematic map of the face, head and neck nerves. Thirty-six patients (N = 36, 28 female/eight male), who met ICDH-II criteria for episodic migraine and had headaches for at least three years, identified all regions where pain typically started and how pain spread and subsequently progressed. RESULTS: Consistent with previous findings, throbbing was the most prevalent quality of migraine pain, always present in 70% of patients surveyed. For the 70% of the patients with throbbing pain, the temple was the onset site of throbbing pain, with no significant difference in the laterality of onset site (58.3% on the right vs. 55.6% on the left hemisphere). The tool was able to capture patterns of pain distribution for throbbing and pressure headache pain and also may be used to assess the change in the pattern of the pain distribution as the disease progresses. DISCUSSION: The pain map survey may be a useful tool for recording and tracking the temporal pattern of migraine onset both for clinical and research purposes. The tool could be used to create maps of pain locations on a large population scale and thus will be a very useful tool in correlating the temporal nature of headache symptoms with potential mechanisms of disease evolution.

Barreira, Tiago V.; Schuna, John M Jr; Mire, Emily F.; Katzmarzyk, Peter T.; Chaput, Jean-Philippe; Leduc, Genevieve; Tudor-Locke, Catrine (2014): Identifying Children’s Nocturnal Sleep Using 24-h Waist Accelerometry. In: Med Sci Sports Exerc. DOI: 10.1249/MSS.0000000000000486.

PURPOSE: The purposes of this study were (1) to add layers and features to a previously published fully automated algorithm designed to identify children’s nocturnal sleep and to exclude episodes of nighttime non-wear/wakefulness and potentially misclassified day time sleep episodes, and (2) to validate this refined sleep algorithm (RSA) against sleep logs. METHODS: Forty-five fourth-grade school children (51% female) participants were asked to log evening bedtime and morning wake time and wear an Actigraph GT3X+ accelerometer at their waist for 7 consecutive days. Accelerometers were distributed through a single school participating in the Baton Rouge, USA site of the International Study of Childhood Obesity, Lifestyle, and the Environment (ISCOLE). We compared log-based variables of sleep period time (SPT), bedtime, and wake time to corresponding accelerometer-determined variables of total sleep episode time (TSET), sleep onset, and sleep offset estimated with the RSA. In addition, SPT and sleep onset estimated using standard procedures combining sleep logs and accelerometry (Log+Accel) were compared to the RSA-derived values. RESULTS: RSA TSET (540+/-36 min) was significantly different from Log SPT (560+/-24 min), p=0.003, but not different from Log+Accel SPT (549+/-24 min), p=0.15. Significant and moderately high correlations were apparent between RSA-determined variables and those using the other methods (r=0.61 to 0.74). There were no differences between RSA and Log+Accel estimates of sleep onset (p=0.15) or RSA sleep offset and Log wake time (p=0.16). CONCLUSIONS: The RSA is a refinement of our previous algorithm, allowing researchers who use a 24 h waist-worn accelerometry protocol to distinguish children’s nocturnal sleep (including night time wake episodes) from day time activities.

BinDhim, Nasser F.; McGeechan, Kevin; Trevena, Lyndal (2014): Assessing the effect of an interactive decision-aid smartphone smoking cessation application (app) on quit rates: a double-blind automated randomised control trial protocol. In: BMJ Open 4 (7), S. e005371. DOI: 10.1136/bmjopen-2014-005371.

INTRODUCTION: In a previous study exploring the feasibility of a smoking cessation application (app), we found that about 77% of the respondents from three countries were ready to quit in the next 30 days without significant differences between countries in terms of age, operating system and number of quitting attempts. However, the efficacy of smartphone apps for smoking cessation has not yet been established. This study tests the efficacy of a smartphone smoking cessation decision-aid app compared with an app that contains only smoking cessation information. METHODS AND ANALYSIS: This is an automated double-blind, randomised controlled trial of a smoking cessation app that contains the eligibility requirements and baseline questionnaire and will randomise the participants into one of the two subapps (the intervention and the control). Participants will be recruited directly from the Apple app stores in Australia, Singapore, the UK and the USA. Daily smokers aged 18 and above will be randomised into one of the subapps after completing the baseline questionnaire. Abstinence rates will be measured at 10 days, 1 month, 3 months and 6 months, with the 1-month follow-up abstinence rate as the primary outcome. Logistic regression mixed models will be used to analyse the primary outcome. ETHICS AND DISSEMINATION: This study was approved by the University of Sydney’s Human Ethics Committee. The results of the trial will be published in peer-reviewed journals according to the CONSORT statement. TRIAL REGISTRATION NUMBER: Australian New Zealand ClinicalTrial RegistryACTRN12613000833763.

BinDhim, Nasser F.; McGeechan, Kevin; Trevena, Lyndal (2014): Who Uses Smoking Cessation Apps? A Feasibility Study Across Three Countries via Smartphones. In: JMIR Mhealth Uhealth 2 (1), S. e4. DOI: 10.2196/mhealth.2841.

BACKGROUND: Smartphone use is growing worldwide. While hundreds of smoking cessation apps are currently available in the app stores, there is no information about who uses them. Smartphones also offer potential as a research tool, but this has not previously been explored. OBJECTIVE: This study aims to measure and compare the uptake of a smoking cessation app over one year in Australia, the United Kingdom, and the United States. It also assesses the feasibility of conducting research via an app, describing respondents’ characteristics (demographics, smoking status, and other health related app use), and examining differences across countries. METHODS: This is a cross-sectional exploratory study of adults 18 years and older, passively recruited over one year in 2012, who downloaded this study app (Quit Advisor) via the two largest app stores (Apple and Android). RESULTS: The total number of app downloads after one year was 1751, 72.98% (1278/1751) of them were Apple operation system users. Of these 1751 participants, 47.68% (835/1751) were from the United States, 29.18% (511/1751) were from the United Kingdom, and 16.68% (292/1751) were from Australia. There were 602 participants, 36.75% (602/1638) that completed a questionnaire within the app. Of these 602 participants, 58.8% (354/602) were female and the mean age was 32 years. There were no significant differences between countries in terms of age, operation system used, number of quitting attempts, and language spoken at home. However, there were significant differences between countries in terms of gender and stage of change. There were 77.2% (465/602) of the respondents that were ready to quit in the next 30 days and the majority of these had never sought professional help (eg, “Quitline”). More than half had downloaded smoking cessation apps in the past and of these, three-quarters had made quitting attempts (lasted at least 24 hours) using an app before. Respondents who had attempted to quit three times or more in the previous year were more likely to have tried smoking cessation apps (OR 3.3, 95% CI 2.1-5.2). There were 50.2% (302/602) of the respondents that had used other health related apps before. Of these, 89.4% (270/302) were using health related apps at least once a week, but 77.5% (234/302) never checked the credibility of the health app publishers before downloading. CONCLUSIONS: A smartphone app was able to reach smokers across three countries that were not seeking professional help, but were ready to quit within the next 30 days. Respondents were relatively young and almost demographically similar across all three countries. They also frequently used other health related apps, mostly without checking the credibility of their publishers.

Bricker, Jonathan B.; Mull, Kristin E.; Kientz, Julie A.; Vilardaga, Roger; Mercer, Laina D.; Akioka, Katrina J.; Heffner, Jaimee L. (2014): Randomized, controlled pilot trial of a smartphone app for smoking cessation using acceptance and commitment therapy. In: Drug Alcohol Depend 143, S. 87–94. DOI: 10.1016/j.drugalcdep.2014.07.006.

BACKGROUND: There is a dual need for (1) innovative theory-based smartphone applications for smoking cessation and (2) controlled trials to evaluate their efficacy. Accordingly, this study tested the feasibility, acceptability, preliminary efficacy, and mechanism of behavioral change of an innovative smartphone-delivered acceptance and commitment therapy (ACT) application for smoking cessation vs. an application following US Clinical Practice Guidelines. METHOD: Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (n=196) that compared smartphone-delivered ACT for smoking cessation application (SmartQuit) with the National Cancer Institute’s application for smoking cessation (QuitGuide). RESULTS: We recruited 196 participants in two months. SmartQuit participants opened their application an average of 37.2 times, as compared to 15.2 times for QuitGuide participants (p<0001). The overall quit rates were 13% in SmartQuit vs. 8% in QuitGuide (OR=2.7; 95% CI=0.8-10.3). Consistent with ACT’s theory of change, among those scoring low (below the median) on acceptance of cravings at baseline (n=88), the quit rates were 15% in SmartQuit vs. 8% in QuitGuide (OR=2.9; 95% CI=0.6-20.7). CONCLUSIONS: ACT is feasible to deliver by smartphone application and shows higher engagement and promising quit rates compared to an application that follows US Clinical Practice Guidelines. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.

Brown, Harriet R.; Zeidman, Peter; Smittenaar, Peter; Adams, Rick A.; McNab, Fiona; Rutledge, Robb B.; Dolan, Raymond J. (2014): Crowdsourcing for cognitive science-the utility of smartphones. In: PLoS One 9 (7), S. e100662. DOI: 10.1371/journal.pone.0100662.

By 2015, there will be an estimated two billion smartphone users worldwide. This technology presents exciting opportunities for cognitive science as a medium for rapid, large-scale experimentation and data collection. At present, cost and logistics limit most study populations to small samples, restricting the experimental questions that can be addressed. In this study we investigated whether the mass collection of experimental data using smartphone technology is valid, given the variability of data collection outside of a laboratory setting. We presented four classic experimental paradigms as short games, available as a free app and over the first month 20,800 users submitted data. We found that the large sample size vastly outweighed the noise inherent in collecting data outside a controlled laboratory setting, and show that for all four games canonical results were reproduced. For the first time, we provide experimental validation for the use of smartphones for data collection in cognitive science, which can lead to the collection of richer data sets and a significant cost reduction as well as provide an opportunity for efficient phenotypic screening of large populations.

Cano, Miguel Ángel; Lam, Cho Y.; Chen, Minxing; Adams, Claire E.; Correa-Fernández, Virmarie; Stewart, Diana W. et al. (2014): Positive smoking outcome expectancies mediate the association between negative affect and smoking urge among women during a quit attempt. In: Experimental and Clinical Psychopharmacology 22 (4), S. 332–340.

Ecological momentary assessment was used to examine associations between negative affect, positive smoking outcome expectancies, and smoking urge during the first 7 days of a smoking quit attempt. Participants were 302 female smokers who enrolled in an individually tailored smoking cessation treatment study. Multilevel mediation analysis was used to examine the temporal relationship among the following: (a) the effects of negative affect and positive smoking outcome expectancies at 1 assessment point (e.g., time j) on smoking urge at the subsequent time point (e.g., time j + 1) in Model 1; and, (b) the effects of negative affect and smoking urge at time j on positive smoking outcome expectancies at time j + 1 in Model 2. The results from Model 1 showed a statistically significant effect of negative affect at time j on smoking urge at time j + 1, and this effect was mediated by positive smoking outcome expectancies at time j, both within- and between-participants. In Model 2, the within-participant indirect effect of negative affect at time j on positive smoking outcome expectancies at time j + 1 through smoking urge at time j was nonsignificant. However, a statistically significant indirect between-participants effect was found in Model 2. The findings support the hypothesis that urge and positive smoking outcome expectancies increase as a function of negative affect, and suggest a stronger effect of expectancies on urge as opposed to the effect of urge on expectancies.

Casey, Monica; Hayes, Patrick S.; Glynn, Fergus; OLaighin, Gearoid; Heaney, David; Murphy, Andrew W.; Glynn, Liam G. (2014): Patients’ experiences of using a smartphone application to increase physical activity: the SMART MOVE qualitative study in primary care. In: Br J Gen Pract 64 (625), S. e500-8. DOI: 10.3399/bjgp14X680989.

BACKGROUND: Regular physical activity is known to help prevent and treat numerous non-communicable diseases. Smartphone applications (apps) have been shown to increase physical activity in primary care but little is known regarding the views of patients using such technology or how such technology may change behaviour. AIM: To explore patients’ views and experiences of using smartphones to promote physical activity in primary care. DESIGN AND SETTING: This qualitative study was embedded within the SMART MOVE randomised controlled trial, which used an app (Accupedo-Pro Pedometer) to promote physical activity in three primary care centres in the west of Ireland. METHOD: Taped and transcribed semi-structured interviews with a purposeful sample of 12 participants formed the basis of the investigation. Framework analysis was used to analyse the data. RESULTS: Four themes emerged from the analysis: transforming relationships with exercise; persuasive technology tools; usability; and the cascade effect. The app appeared to facilitate a sequential and synergistic process of positive change, which occurred in the relationship between the participants and their exercise behaviour; the study has termed this the ‘Know-Check-Move’ effect. Usability challenges included increased battery consumption and adjusting to carrying the smartphone on their person. There was also evidence of a cascade effect involving the families and communities of participants. CONCLUSION: Notwithstanding technological challenges, an app has the potential to positively transform, in a unique way, participants’ relationships with exercise. Such interventions can also have an associated cascade effect within their wider families and communities.

Chaix, Basile; Kestens, Yan; Duncan, Scott; Merrien, Claire; Thierry, Benoit; Pannier, Bruno et al. (2014): Active transportation and public transportation use to achieve physical activity recommendations? A combined GPS, accelerometer, and mobility survey study. In: Int J Behav Nutr Phys Act 11 (1), S. 124. DOI: 10.1186/s12966-014-0124-x.

BackgroundAccurate information is lacking on the extent of transportation as a source of physical activity, on the physical activity gains from public transportation use, and on the extent to which population shifts in the use of transportation modes could increase the percentage of people reaching official physical activity recommendations.MethodsIn 2012 inverted question mark2013, 234 participants of the RECORD GPS Study (French Paris region, median age inverted question mark= inverted question mark58) wore a portable GPS receiver and an accelerometer for 7 consecutive days and completed a 7-day GPS-based mobility survey (participation rate inverted question mark= inverted question mark57.1%). Information on transportation modes and accelerometry data aggregated at the trip level [number of steps taken, energy expended, moderate to vigorous physical activity (MVPA), and sedentary time] were available for 7,644 trips. Associations between transportation modes and accelerometer-derived physical activity were estimated at the trip level with multilevel linear models.ResultsParticipants spent a median of 1h58min per day in transportation (8.2% of total time). Thirty-eight per-cent of steps taken, 31% of energy expended, and 33% of MVPA over 7 days were attributable to transportation. Walking and biking trips but also public transportation trips with all four transit modes examined were associated with greater steps, MVPA, and energy expenditure when compared to trips by personal motorized vehicle. Two simulated scenarios, implying a shift of approximately 14% and 33% of all motorized trips to public transportation or walking, were associated with a predicted 6 point and 13 point increase in the percentage of participants achieving the current physical activity recommendation.ConclusionsCollecting data with GPS receivers, accelerometers, and a GPS-based electronic mobility survey of activities and transportation modes allowed us to investigate relationships between transportation modes and physical activity at the trip level. Our findings suggest that an increase in active transportation participation and public transportation use may have substantial impacts on the percentage of people achieving physical activity recommendations.

Conner, Tamlin S.; Brookie, Kate L.; Richardson, Aimee C.; Polak, Maria A. (2014): On carrots and curiosity: Eating fruit and vegetables is associated with greater flourishing in daily life. In: Br J Health Psychol. DOI: 10.1111/bjhp.12113.

OBJECTIVES: Our aim was to determine whether eating fruit and vegetables (FV) is associated with other markers of well-being beyond happiness and life satisfaction. Towards this aim, we tested whether FV consumption is associated with greater eudaemonic well-being - a state of flourishing characterized by feelings of engagement, meaning, and purpose in life. We also tested associations with two eudaemonic behaviours - curiosity and creativity. DESIGN: Daily diary study across 13 days (micro-longitudinal, correlational design). METHODS: A sample of 405 young adults (67% women; mean age 19.9 [SD 1.6] years) completed an Internet daily diary for 13 consecutive days. Each day, participants reported on their consumption of fruit, vegetables, sweets, and chips, as well as their eudaemonic well-being, curiosity, creativity, positive affect (PA), and negative affect. Between-person associations were analysed on aggregated data. Within-person associations were analysed using multilevel models controlling for weekday and weekend patterns. RESULTS: Fruit and vegetables consumption predicted greater eudaemonic well-being, curiosity, and creativity at the between- and within-person levels. Young adults who ate more FV reported higher average eudaemonic well-being, more intense feelings of curiosity, and greater creativity compared with young adults who ate less FV. On days when young adults ate more FV, they reported greater eudaemonic well-being, curiosity, and creativity compared with days when they ate less FV. FV consumption also predicted higher PA, which mostly did not account for the associations between FV and the other well-being variables. Few unhealthy foods (sweets, chips) were related to well-being except that consumption of sweets was associated with greater curiosity and PA at the within-person level. Lagged data analyses showed no carry-over effects of FV consumption onto next-day well-being (or vice versa). CONCLUSIONS: Although these patterns are strictly correlational, this study provides the first evidence that FV consumption may be related to a broader range of well-being states that signal human flourishing in early adulthood. Statement of contribution What is already known on this subject? There is growing evidence that a diet rich in fruits and vegetables (FV) is related to greater happiness, life satisfaction, and positive affect. These associations are not entirely explained by demographic or health variables including socio-economic status, exercise, smoking, and body mass index (BMI). Recent experimental and daily diary research suggests that FV consumption may be a causal factor in promoting states of positive well-being. Research has examined the links between FV consumption and hedonic well-being - whether people feel good (vs. bad) and satisfied-but has not addressed links between FV consumption and eudaemonic well-being- whether people feel engaged and experience their lives as meaningful and purposeful. What does this study add? It provides the first evidence that eating FV is related to greater eudaemonic well-being in a naturalistic setting. Eating FV was also related to greater self-reported curiosity and creativity. FV consumption may underlie a broad range of experiences that signal flourishing. Future randomised controlled trials of FV should include measures of eudaemonic well-being as outcome variables.

Conroy, David E.; Ram, Nilam; Pincus, Aaron L.; Coffman, Donna L.; Lorek, Amy E.; Rebar, Amanda L.; Roche, Michael J. (2014): Daily Physical Activity and Alcohol Use Across the Adult Lifespan. In: Health Psychology.

Objective: In contrast to proposals that physical activity (PA) can be a substitute for alcohol use, people who engage in greater overall PA generally consume more alcohol on average than less-active peers. Acknowledging that both PA and alcohol use vary considerably from day-to-day, this study evaluated whether established associations reflect daily behavioral coupling within-person, are an artifact of procedures that aggregate behavior over time, or both. Methods: A life span sample of 150 adults (aged 19–89 years) completed three 21-day measurement bursts of a daily diary study. At the end of each day, they reported on their PA and alcohol consumption. Data were analyzed in a negative binomial multilevel regression. Results: As expected, both behaviors exhibited limited between-person variation. After controlling for age, gender, and seasonal and social calendar influences, daily deviations in PA were significantly associated with daily total alcohol use. Once the within-person process linking PA and alcohol use was controlled, usual PA and total alcohol use were not associated. Conclusions: The established between-person association linking PA and alcohol use reflects the aggregation of a daily process that unfolds within-people over time. Further work is needed to identify mediators of this daily association and to evaluate causality, as well as to investigate these relations in high-risk samples.

Cortez, Nathan G.; Cohen, I. Glenn; Kesselheim, Aaron S. (2014): FDA regulation of mobile health technologies. In: N Engl J Med 371 (4), S. 372–379. DOI: 10.1056/NEJMhle1403384.

Mobile health (“mHealth”) technologies that employ portable devices such as smartphones and tablets for medical purposes are rapidly transforming the medical profession. Yet adapting existing regulatory processes to ensure the safety and efficacy of this new set of products has proved challenging for the U.S. Food and Drug Administration (FDA). In this Article, we highlight issues encountered by the agency in applying its authority and its established approval and monitoring processes to this new genre of medical devices. After reviewing legislative proposals and recommendations by the FDA as to the appropriate scope of agency oversight of mHealth products, we present policy recommendations for updating the FDA’s authority. We conclude that preserving the FDA’s premarket and postmarket authority and providing the agency with additional funding and expertise provide a more promising solution than strictly limiting FDA’s authority, which could impede the agency’s ability to adapt to future innovation by tying it to existing products.

De Young, Kyle P; Lavender, Jason M.; Crosby, Ross D.; Wonderlich, Stephen A.; Engel, Scott G.; Mitchell, James E. et al. (2014): Bidirectional associations between binge eating and restriction in anorexia nervosa. An ecological momentary assessment study. In: Appetite 83C, S. 69–74. DOI: 10.1016/j.appet.2014.08.014.

This study examined the association between restrictive eating behaviors and binge eating in anorexia nervosa (AN) using data collected in the natural environment. Women (N = 118) with DSM-IV full or subthreshold AN reported eating disorder behaviors, including binge eating episodes, going >/= 8 waking hours without eating, and skipping meals, during 2 weeks of ecological momentary assessment (EMA). Time-lagged generalized estimating equations tested the following hypotheses: 1) dietary restriction would predict binge eating while controlling for binge eating the previous day; 2) binge eating would predict restriction the subsequent day while controlling for restriction the previous day. After controlling for relevant covariates, the hypotheses were not supported; however, there appeared to be a cumulative effect of repeatedly going 8 consecutive hours without eating (i.e. fasting) on the risk of binge eating among individuals who recently engaged in binge eating. In addition, skipping meals was associated with a lower risk of same day binge eating. The relationship between binge eating and dietary restriction appears to be complex and may vary by type of restrictive eating behavior. Future research should aim to further clarify the nature of the interaction of binge eating and restrictive eating among individuals with AN in order to effectively eliminate these behaviors in treatment.

Debusscher, Jonas; Hofmans, Joeri; Fruyt, Filip de (2014): The Curvilinear Relationship between State Neuroticism and Momentary Task Performance. In: PLoS One 9 (9), S. e106989. DOI: 10.1371/journal.pone.0106989.

A daily diary and two experience sampling studies were carried out to investigate curvilinearity of the within-person relationship between state neuroticism and task performance, as well as the moderating effects of within-person variation in momentary job demands (i.e., work pressure and task complexity). In one, results showed that under high work pressure, the state neuroticism-task performance relationship was best described by an exponentially decreasing curve, whereas an inverted U-shaped curve was found for tasks low in work pressure, while in another study, a similar trend was visible for task complexity. In the final study, the state neuroticism-momentary task performance relationship was a linear one, and this relationship was moderated by momentary task complexity. Together, results from all three studies showed that it is important to take into account the moderating effects of momentary job demands because within-person variation in job demands affects the way in which state neuroticism relates to momentary levels of task performance. Specifically, we found that experiencing low levels of state neuroticism may be most beneficial in high demanding tasks, whereas more moderate levels of state neuroticism are optimal under low momentary job demands.

Dedert, Eric A.; Dennis, Paul A.; Swinkels, Cindy M.; Calhoun, Patrick S.; Dennis, Michelle F.; Beckham, Jean C. (2014): Ecological momentary assessment of posttraumatic stress disorder symptoms during a smoking quit attempt. In: Nicotine & Tobacco Research 16 (4), S. 430–436. DOI: 10.1037/t00072-000;

Introduction: Smokers with posttraumatic stress disorder (PTSD) tend to lapse more quickly following a quit attempt, which might be explained by changes in PTSD symptoms during a quit attempt. The present study examines changes in PTSD symptoms, negative affect, and craving before and during a quit attempt. Methods: Participants in this study were 52 smokers with PTSD who completed random-alarm ecological momentary assessments of PTSD symptoms, negative affect, cigarette craving, and smoking behavior throughout a prequit phase of ad hoc smoking, a phase of abstinence from smoking, and a postlapse phase. Results: Relative to the prequit phase, the abstinent phase was marked by decreases in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .01). The odds of PTSD symptom or negative affect variability from one reading in the ecological momentary assessment (EMA)to the next reading was decreased in PTSD reexperiencing, avoidance, and numbing clusters (ps ≤ .02). Smoking cravings were also mildly decreased in the abstinent and postlapse phases (ps < .01), although some cravings in both phases were rated at the maximum intensity. Increased craving was predicted by the previous EMA reading of PTSD symptoms. Conclusions: Results suggested that smoking abstinence is not associated with exacerbation of PTSD symptoms, but PTSD symptoms during abstinence were related to craving levels during the quit attempt.

Derks, Daantje; Bakker, Arnold B. (2014): Smartphone use, work–home interference, and burnout: A diary study on the role of recovery. In: Applied Psychology: An International Review 63 (3), S. 411–440. DOI: 10.1037/t10797-000.

This diary study examines the impact of daily recovery experiences on daily work–home interference (WHI) and daily burnout symptoms within a group of smartphone users. A total of 69 employees using smartphones on the initiative of their employer completed a diary questionnaire on five successive workdays (N = 293 data points). We hypothesised that particularly for intensive smartphone users it would be important to engage in activities fostering psychological detachment and relaxation in order to reduce the risk of WHI. We predicted that smartphone use would be positively related to WHI. Finally, we predicted that the positive relationship between WHI and state levels of burnout would be stronger for intensive smartphone users. Overall, the results of multi‐level analyses supported these hypotheses. The findings emphasise the importance of a clear organisational policy regarding smartphone use during after‐work hours.

Derks, Daantje; Duin, Desiree; Tims, Maria; Bakker, Arnold B. (2014): Smartphone use and work–home interference: The moderating role of social norms and employee work engagement. In: Journal of Occupational and Organizational Psychology.

Work in our modern society that is facilitated by communication technology involves connectivity, immediacy, and a blurring of boundaries between work and non‐work domains. This 4‐day quantitative diary study (N = 100 employees, N = 367–400 data points) aims to shed light on the relationship between daily smartphone use and daily work–home interference (WHI). Two potential moderators of this relationship are examined: (1) (strong) social norms represented by the influence of colleagues and supervisors regarding availability after work hours and (2) work engagement. Overall, the results of multilevel analyses were in line with the hypotheses. The findings suggest that supervisors should be clear about their expectations regarding smartphone use in private hours in that they should not expect employees to be always available. In addition we conclude that engaged workers can prevent work from interfering too much with their private lives, even when they use their smartphones during evening hours. Practitioner points Employees working in an ‘always‐on’ culture experience more WHI. Important role models, such as supervisors, should be aware that the emails they send during evening hours and weekends also have recipients. Supervisors should be careful in creating expectations regarding availability when they decide to provide smartphones to their employees.

Dhingra, Lara K.; Homel, Peter; Grossman, Bella; Chen, Jack; Scharaga, Elyssa; Calamita, Steven et al. (2014): Ecological momentary assessment of smoking behavior in persistent pain patients. In: The Clinical Journal of Pain 30 (3), S. 205–213. DOI: 10.1037/t04175-000;

Objectives: Smoking is associated with chronic pain and pain-related functional impairment. Some studies suggest that pain activates smoking urges and others suggest that smoking is analgesic. We evaluated these associations using ecological momentary assessment, a method for real-time measurement of health-related phenomena. Methods: For 1 week, 36 chronic pain patients who smoked a mean of 17.5 (SD = 9.4) cigarettes per day completed multiple daily assessments on a handheld computer. Results: The sample included 67% women and 39% whites; 67% had back pain, with an average (SD) worst pain severity during the past week of 8.6 (1.5) on a 0 to 10 numeric rating scale. Patients completed an average (SD) of 44 (24) random assessments. At each assessment, the patient recorded pain “right now” on a 0 to 10 scale, whether he/she was “about to smoke,” and if he/she had “just smoked in the past 30 minutes,” pain before smoking. After controlling for other significant correlates of pain, patients who were about to smoke had more pain than at other times (M [SD] = 6.5 [2.3] vs. 5.2 [2.4]; P < 0.01), but pain before and after smoking was not different (M [SD] = 6.1 [2.2] vs. 5.9 [2.3]; P = 0.18). Discussion: These findings support the hypothesis that smoking behavior is triggered by pain, but smoking is not analgesic. Future studies should clarify potential explanatory mechanisms for this pain-related trigger and evaluate tailored cessation strategies for pain patients.

Doane, Leah D.; Zeiders, Katharine H. (2014): Contextual moderators of momentary cortisol and negative affect in adolescents’ daily lives. In: Journal of Adolescent Health 54 (5), S. 536–542. DOI: 10.1037/t03592-000;

Purpose: To use an ecological momentary assessment design to examine the links between momentary negative affect and cortisol in a sample of adolescents preparing to transition to college. Guided by a risk and resilience framework, we also explored whether important ecological factors, perceived discrimination and social support, moderated the momentary associations between negative affect and youths’ cortisol. Methods: Adolescents (N = 77) provided salivary samples and diary reports of affect and experiences five times a day over 3 days. They also completed self-report questionnaires on perceived discrimination and social support from family and friends. Results: Within-person increases in momentary negative affect were associated with increases in cortisol. Perceived discrimination and social support from friends moderated this association. Adolescents who reported average and high levels of perceived discrimination experienced exaggerated cortisol responses to negative affect, whereas adolescents who reported low levels of perceived discrimination did not experience significant reactivity to negative affect. In contrast, adolescents who reported high levels of social support from friends experienced attenuated cortisol responses to negative affect compared with adolescents who reported average or low levels of social support from friends. Conclusions: This study contributes to our understanding of youths’ daily socioemotional experiences and physiological reactivity by identifying how perceived discrimination and social support from friends amplified and attenuated, respectively, the effects of negative affect on cortisol reactivity. Examining these processes within adolescents’ naturalistic environments advances our understanding of the moderating role of ecological characteristics in adolescents’ everyday lives.

Dulin, Patrick L.; Gonzalez, Vivian M.; Campbell, Kendra (2014): Results of a pilot test of a self-administered smartphone-based treatment system for alcohol use disorders: Usability and early outcomes. In: Substance Abuse 35 (2), S. 168–175.

Background: This paper provides results from a pilot study focused on assessing early-stage effectiveness and usability of a smartphone-based intervention system that provides a stand-alone, self-administered intervention option, the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A). The LBMI-A provided numerous features for intervening with ongoing drinking, craving, connection with supportive others, managing life problems, high-risk location alerting, and activity scheduling. Methods: Twenty-eight participants, ranging in age from 22 to 45, who met criteria for an alcohol use disorder used an LBMI-A–enabled smartphone for 6 weeks. Results: Participants indicated the LBMI-A intervention modules were helpful in highlighting alcohol use patterns. Tools related to managing alcohol craving, monitoring consumption, and identifying triggers to drink were rated by participants as particularly helpful. Participants also demonstrated significant reductions in hazardous alcohol use while using the system (56% of days spent hazardously drinking at baseline vs. 25% while using the LBMI-A) and drinks per day diminished by 52%. Conclusions: Implications for system improvement as well as suggestions for designing ecological momentary assessment and intervention systems for substance use disorders are discussed.

Dunton, Genevieve F.; Huh, Jimi; Leventhal, Adam M.; Riggs, Nathaniel; Hedeker, Donald; Spruijt-Metz, Donna; Pentz, Mary Ann (2014): Momentary assessment of affect, physical feeling states, and physical activity in children. In: Health Psychology 33 (3), S. 255–263.

Objective: Most research on the interplay of affective and physical feelings states with physical activity in children has been conducted under laboratory conditions and fails to capture intraindividual covariation. The current study used Ecological momentary assessment (EMA) to bidirectionally examine how affective and physical feeling states are related to objectively measured physical activity taking place in naturalistic settings during the course of children’s everyday lives. Methods: Children (N = 119, ages 9–13 years, 52% male, 32% Hispanic) completed 8 days of EMA monitoring, which measured positive affect (PA), negative affect (NA), feeling tired, and feeling energetic up to 7 times per day. EMA responses were time-matched to accelerometer assessed moderate-to-vigorous physical activity (MVPA) in the 30 min before and after each EMA survey. Results: Higher ratings of feeling energetic and lower ratings of feeling tired were associated with more MVPA in the 30 min after the EMA prompt. More MVPA in the 30 min before the EMA prompt was associated with higher ratings of PA and feeling energetic and lower ratings of NA. Between-subjects analyses indicated that mean hourly leisure-time MVPA was associated with less intraindividual variability in PA and NA. Conclusions: Physical feeling states predict subsequent physical activity levels, which in turn, predict subsequent affective states in children. Active children demonstrated higher positive and negative emotional stability. Although the strength of these associations were of modest magnitude and their clinical relevance is unclear, understanding the antecedents to and consequences of physical activity may have theoretical and practical implications for the maintenance and promotion of physical activity and psychological well-being in children.

Dzierzewski, Joseph M.; Fung, Constance H.; Jouldjian, Stella; Alessi, Cathy A.; Irwin, Michael R.; Martin, Jennifer L. (2014): Decrease in daytime sleeping is associated with improvement in cognition after hospital discharge in older adults. In: J Am Geriatr Soc 62 (1), S. 47–53.

OBJECTIVES: To examine the relationship between changes in objectively assessed sleep and global cognitive functioning from inpatient postacute rehabilitation to 6-month follow-up. DESIGN: Secondary analysis of two prospective, longitudinal studies. SETTING: Inpatient rehabilitation units at a Veterans Affairs Medical Center. PARTICIPANTS: Older adults (mean age 73.8 +/- 9.4) undergoing inpatient rehabilitation (n = 192). MEASUREMENTS: All participants completed 7 nights and days of ambulatory sleep monitoring using wrist actigraphy (yielding an estimate of nighttime wakefulness and daytime sleep) and the Mini-Mental State Examination (MMSE) during a postacute inpatient rehabilitation stay and 6 months after discharge. The 5-item Geriatric Depression Scale, Geriatric Pain Measure, and Cumulative Illness Rating Scale for Geriatrics were completed during inpatient rehabilitation. RESULTS: Growth curve modeling (controlling for baseline age, education, sex, body mass index, depression, pain, and comorbidity burden) revealed that individuals whose amount of daytime sleep decreased from inpatient postacute rehabilitation to 6-month follow-up also experienced improvements in MMSE score (beta = -0.01, t(80 = -3.22, P = .002)). Change in nighttime wakefulness was not a significant predictor of change in MMSE score. CONCLUSION: Older adults whose daytime sleeping decreased after hospital discharge also experienced improvements in cognitive functioning at 6 month follow-up. As such, daytime sleep may represent a promising candidate for targeted interventions aimed at promoting cognitive recovery after hospital discharge.

Faurholt-Jepsen, Maria; Frost, Mads; Vinberg, Maj; Christensen, Ellen Margrethe; Bardram, Jakob E.; Kessing, Lars Vedel (2014): Smartphone data as objective measures of bipolar disorder symptoms. In: Psychiatry Research 217 (1-2), S. 124–127. DOI: 10.1037/t04100-000;

The daily electronic self-monitoring Smartphone software “MONARCA” was used by 17 patients with bipolar disorder for 3 consecutive months. Patients were rated fortnightly using Hamilton Depression rating Scale 17 items (HDRS-17) and Young Mania rating Scale (YMRS) (102 ratings) with blinding for Smartphone data. Objective Smartphone measures such as physical and social activity correlated with clinically rated depressive symptoms. Self-monitored depressive symptoms correlated significantly with HDRS-17 items score.

Franklin, Michael S.; Mrazek, Michael D.; Anderson, Craig L.; Johnston, Charlotte; Smallwood, Jonathan; Kingstone, Alan; Schooler, Jonathan W. (2014): Tracking Distraction: The Relationship Between Mind-Wandering, Meta-Awareness, and ADHD Symptomatology. In: J Atten Disord. DOI: 10.1177/1087054714543494.

OBJECTIVE: Although earlier work has shown a link between mind-wandering and ADHD symptoms, this relationship has not been further investigated by taking into account recent advances in mind-wandering research. METHOD: The present study provides a comprehensive assessment of the relationship between mind-wandering and ADHD symptomatology in an adult community sample (N = 105, 71 females, M age = 23.1) using laboratory measures and experience sampling during daily life. RESULTS: Mind-wandering and detrimental mind-wandering were positively associated with ADHD symptoms. Meta-awareness of mind-wandering mediated the relationship between ADHD symptomatology and detrimental mind-wandering, suggesting that some of the negative consequences can be ameliorated by strategies that facilitate meta-awareness. Interestingly, participants with low ADHD scores showed a positive relationship between detrimental mind-wandering and useful mind-wandering; however, participants with high ADHD scores failed to engage in this type of “strategic” mind-wandering. CONCLUSION: These results provide new insights into the relationship between ADHD symptomatology and mind-wandering that could have important clinical implications.

Fuller-Tyszkiewicz, Matthew; Richardson, Ben; Skouteris, Helen; Austin, David; Castle, David; Busija, Lucy et al. (2014): Optimizing prediction of binge eating episodes: a comparison approach to test alternative conceptualizations of the affect regulation model. In: J Eat Disord 2 (1), S. 28. DOI: 10.1186/s40337-014-0028-9.

BACKGROUND: Although a wealth of studies have tested the link between negative mood states and likelihood of a subsequent binge eating episode, the assumption that this relationship follows a typical linear dose-response pattern (i.e., that risk of a binge episode increases in proportion to level of negative mood) has not been challenged. The present study demonstrates the applicability of an alternative, non-linear conceptualization of this relationship, in which the strength of association between negative mood and probability of a binge episode increases above a threshold value for the mood variable relative to the slope below this threshold value (threshold dose response model). METHODS: A sample of 93 women aged 18 to 40 completed an online survey at random intervals seven times per day for a period of one week. Participants self-reported their current mood state and whether they had recently engaged in an eating episode symptomatic of a binge. RESULTS: As hypothesized, the threshold approach was a better predictor than the linear dose-response modeling of likelihood of a binge episode. The superiority of the threshold approach was found even at low levels of negative mood (3 out of 10, with higher scores reflecting more negative mood). Additionally, severity of negative mood beyond this threshold value appears to be useful for predicting time to onset of a binge episode. CONCLUSIONS: Present findings suggest that simple dose-response formulations for the association between negative mood and onset of binge episodes miss vital aspects of this relationship. Most notably, the impact of mood on binge eating appears to depend on whether a threshold value of negative mood has been breached, and elevation in mood beyond this point may be useful for clinicians and researchers to identify time to onset.

Gaher, Raluca M.; Simons, Jeffrey S.; Hahn, Austin M.; Hofman, Nicole L.; Hansen, Jamie; Buchkoski, Jerome (2014): An Experience Sampling Study of PTSD and Alcohol-Related Problems. In: Psychol Addict Behav. DOI: 10.1037/a0037257.

Posttraumatic stress disorder (PTSD) represents a debilitating psychiatric condition that is affecting the lives of many returning veterans. PTSD and alcohol use and dependence are highly comorbid. The purpose of this study was to understand the functional mechanisms between PTSD and alcohol use and problems. Specifically, the role of negative urgency and emotional intelligence were investigated as vulnerability and resiliency factors, respectively. This study utilized experience sampling to test associations between PTSD symptoms and alcohol use and related problems in a sample of 90 OIF/OEF veterans. Participants completed 8 brief questionnaires daily for 2 weeks on palmtop computers. Elevations in PTSD symptoms during the day were associated with subsequent increases in alcohol use and associated problems that night. PTSD symptoms were associated with greater problems above and beyond the effect of drinking level at both the within- and between- person level. Emotional intelligence was associated with lower negative urgency, fewer PTSD symptoms, and less alcohol use and associated problems. The effects of emotional intelligence were primarily indirect via negative urgency and the effects of negative urgency on alcohol use and problems were indirect via its positive association with PTSD symptoms. Hypothesized cross-level effects of emotional intelligence and negative urgency were not supported. The findings suggest a functional association between PTSD symptoms and alcohol consumption. The association between PTSD symptoms and alcohol consumption is consistent with a self-medication model. However, the significant associations between PTSD symptoms and alcohol problems, after controlling for use level, suggest a broader role of dysregulation.

Gajecki, Mikael; Berman, Anne H.; Sinadinovic, Kristina; Rosendahl, Ingvar; Andersson, Claes (2014): Mobile phone brief intervention applications for risky alcohol use among university students: a randomized controlled study. In: Addict Sci Clin Pract 9, S. 11. DOI: 10.1186/1940-0640-9-11.

BACKGROUND: Brief interventions via the internet have been shown to reduce university students’ alcohol intake. This study tested two smartphone applications (apps) targeting drinking choices on party occasions, with the goal of reducing problematic alcohol intake among Swedish university students. METHODS: Students were recruited via e-mails sent to student union members at two universities. Those who gave informed consent, had a smartphone, and showed risky alcohol consumption according to the Alcohol Use Disorders Identification Test (AUDIT) were randomized into three groups. Group 1 had access to the Swedish government alcohol monopoly’s app, Promillekoll, offering real-time estimated blood alcohol concentration (eBAC) calculation; Group 2 had access to a web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants were controls. Follow-up was conducted at 7 weeks. RESULTS: Among 28574 students offered participation, 4823 agreed to join; 415 were excluded due to incomplete data, and 1932 fulfilled eligibility criteria for randomization. Attrition was 22.7-39.3 percent, higher among heavier drinkers and highest in Group 2. Self-reported app use was higher in Group 1 (74%) compared to Group 2 (41%). Per-protocol analyses revealed only one significant time-by-group interaction, where Group 1 participants increased the frequency of their drinking occasions compared to controls (p = 0.001). Secondary analyses by gender showed a significant difference among men in Group 1 for frequency of drinking occasions per week (p = 0.001), but not among women. Among all participants, 29 percent showed high-risk drinking, over the recommended weekly drinking levels of 9 (women) and 14 (men) standard glasses. CONCLUSIONS: Smartphone apps can make brief interventions available to large numbers of university students. The apps studied using eBAC calculation did not, however, seem to affect alcohol consumption among university students and one app may have led to a negative effect among men. Future research should: 1) explore ways to increase user retention, 2) include apps facilitating technical manipulation for evaluation of added components, 3) explore the effects of adapting app content to possible gender differences, and 4) offer additional interventions to high-risk users. TRIAL REGISTRATION: NCT01958398.

Galluzzi, Valerie; Herman, Ted; Shumaker, D. J.; Macinga, D. R.; Arbogast, J. W.; Segre, Elena M. et al. (2014): Electronic recognition of hand hygiene technique and duration. In: Infect Control Hosp Epidemiol 35 (10), S. 1298–1300. DOI: 10.1086/678059.

We captured 3-dimensional accelerometry data from the wrists of 116 healthcare professionals as they performed hand hygiene (HH). We then used these data to train a k-nearest-neighbors classifier to recognize specific aspects of HH technique (ie, fingertip scrub) and measure the duration of HH events.

Garcia, Carolyn; Hardeman, Rachel R.; Kwon, Gyu; Lando-King, Elizabeth; Zhang, Lei; Genis, Therese et al. (2014): Teenagers and texting: use of a youth ecological momentary assessment system in trajectory health research with latina adolescents. In: JMIR Mhealth Uhealth 2 (1), S. e3. DOI: 10.2196/mhealth.2576.

BACKGROUND: Adolescent females send and receive more text messages than any others, with an average of 4050 texts a month. Despite this technological inroad among adolescents, few researchers are utilizing text messaging technology to collect real time, contextualized data. Temporal variables (ie, mood) collected regularly over a period of time could yield useful insights, particularly for evaluating health intervention outcomes. Use of text messaging technology has multiple benefits, including capacity of researchers to immediately act in response to texted information. OBJECTIVE: The objective of our study was to custom build a short messaging service (SMS) or text messaging assessment delivery system for use with adolescents. The Youth Ecological momentary assessment System (YEMAS) was developed to collect automated texted reports of daily activities, behaviors, and attitudes among adolescents, and to examine the feasibility of YEMAS. This system was created to collect and transfer real time data about individual- and social-level factors that influence physical, mental, emotional, and social well-being. METHODS: YEMAS is a custom designed system that interfaces with a cloud-based communication system to automate scheduled delivery of survey questions via text messaging; we designed this university-based system to meet data security and management standards. This was a two-phase study that included development of YEMAS and a feasibility pilot with Latino adolescent females. Relative homogeneity of participants was desired for the feasibility pilot study; adolescent Latina youth were sought because they represent the largest and fastest growing ethnic minority group in the United States. Females were targeted because they demonstrate the highest rate of text messaging and were expected to be interested in participating. Phase I involved development of YEMAS and Phase II involved piloting of the system with Latina adolescents. Girls were eligible to participate if they were attending one of the participating high schools and self-identified as Latina. We contacted 96 adolescents; of these, 24 returned written parental consent forms, completed assent processes, and enrolled in the study. RESULTS: YEMAS was collaboratively developed and implemented. Feasibility was established with Latina adolescents (N=24), who responded to four surveys daily for two two-week periods (four weeks total). Each survey had between 12 and 17 questions, with responses including yes/no, Likert scale, and open-ended options. Retention and compliance rates were high, with nearly 18,000 texts provided by the girls over the course of the pilot period. CONCLUSIONS: Pilot results support the feasibility and value of YEMAS, an automated SMS-based text messaging data collection system positioned within a secure university environment. This approach capitalizes on immediate data transfer protocols and enables the documentation of participants’ thoughts, feelings, and behaviors in real time. Data are collected using mobile devices that are familiar to participants and nearly ubiquitous in developed countries.

Garcia, Carolyn; Zhang, Lei; Holt, Katie; Hardeman, Rachel; Peterson, Barbara (2014): Latina adolescent sleep and mood: an ecological momentary assessment pilot study. In: J Child Adolesc Psychiatr Nurs 27 (3), S. 132–141. DOI: 10.1111/jcap.12082.

PROBLEM: Sleep and mood represent two important malleable opportunities for adolescent health. This study investigated the sleep-mood relationship in adolescent girls. METHODS: Short-term, longitudinal design. Latina adolescents (N = 19, mean age 15) completed ecological momentary assessments on sleep (perceived quality, self-report quantity) and mood (negative affect, positive affect, and positivity ratio). FINDINGS: Adolescents sent 1,598 texts on sleep and mood. Bidirectional sleep-mood relationships were in expected directions; negative affect and the positivity ratio affect predicted adolescents’ sleep quality. CONCLUSIONS: Interventions should encourage sleep-mood relationship awareness, and further research should identify significant differences to inform tailored interventions with adolescents.

Gard, David E.; Sanchez, Amy H.; Cooper, Kathryn; Fisher, Melissa; Garrett, Coleman; Vinogradov, Sophia (2014): Do People With Schizophrenia Have Difficulty Anticipating Pleasure, Engaging in Effortful Behavior, or Both? In: J Abnorm Psychol. DOI: 10.1037/abn0000005.

Motivation deficits are common in schizophrenia, but little is known about underlying mechanisms, or the specific goals that people with schizophrenia set in daily life. Using neurobiological heuristics of pleasure anticipation and effort assessment, we examined the quality of activities and goals of 47 people with and 41 people without schizophrenia, utilizing ecological momentary assessment. Participants were provided cell phones and called 4 times a day for 7 days, and were asked about their current activities and anticipation of upcoming goals. Activities and goals were later coded by independent raters on pleasure and effort. In line with recent laboratory findings on effort computation deficits in schizophrenia, relative to healthy participants, people with schizophrenia reported engaging in less effortful activities and setting less effortful goals, which were related to patient functioning. In addition, patients showed some inaccuracy in estimating how difficult an effortful goal would be, which in turn was associated with lower neurocognition. In contrast to previous research, people with schizophrenia engaged in activities and set goals that were more pleasure-based, and anticipated goals as being more pleasurable than controls. Thus, this study provided evidence for difficulty with effortful behavior and not anticipation of pleasure. These findings may have psychosocial treatment implications, focusing on effort assessment or effort expenditure. For example, to help people with schizophrenia engage in more meaningful goal pursuits, treatment providers may leverage low-effort pleasurable goals by helping patients to break down larger, more complex goals into smaller, lower-effort steps that are associated with specific pleasurable rewards.

Gard, David E.; Sanchez, Amy H.; Starr, Jessica; Cooper, Shanna; Fisher, Melissa; Rowlands, Abby; Vinogradov, Sophia (2014): Using Self-Determination Theory to understand motivation deficits in schizophrenia: The ‘why’ of motivated behavior. In: Schizophrenia Research 156 (2-3), S. 217–222. DOI: 10.1037/t12916-000;

Self-Determination Theory (SDT) provides a model for understanding motivation deficits in schizophrenia, and recent research has focused on problems with intrinsic motivation. However, SDT emphasizes that motivated behavior results from three different factors: intrinsic motivators (facilitated by needs for autonomy, competency, and relatedness), extrinsic motivators (towards reward or away from punishment), or when intrinsic and extrinsic motivators are absent or thwarted a disconnect-disengagement occurs resulting in behavior driven by boredom or ‘passing time’. Using a novel approach to Ecological momentary assessment, we assessed the degree to which people with schizophrenia were motivated by these factors relative to healthy control participants. Forty-seven people with and 41 people without schizophrenia were provided with cell phones and were called four times a day for one week. On each call participants were asked about their goals, and about the most important reason motivating each goal. All responses were coded by independent raters (blind to group and hypotheses) on all SDT motivating factors, and ratings were correlated to patient functioning and symptoms. We found that, relative to healthy participants, people with schizophrenia reported goals that were: 1) less motivated by filling autonomy and competency needs, but equivalently motivated by relatedness; 2) less extrinsically rewarding, but equivalently motivated by punishment; 3) more disconnected-disengaged. Higher disconnected-disengaged goals were significantly associated with higher negative symptoms and lower functioning. These findings indicate several important leverage points for behavioral treatments and suggest the need for vigorous psychosocial intervention focusing on autonomy, competence, and reward early in the course of illness.

Giroux, Danielle; Bacon, Samantha; King, Diane K.; Dulin, Patrick; Gonzalez, Vivian (2014): Examining perceptions of a smartphone-based intervention system for alcohol use disorders. In: Telemed J E Health 20 (10), S. 923–929. DOI: 10.1089/tmj.2013.0222.

Abstract Background: This study presents results from qualitative interviews conducted with participants in a study on the effectiveness of the Location-Based Monitoring and Intervention System for Alcohol Use Disorders (LBMI-A), a smartphone-based, stand-alone intervention application (app) for adults with alcohol use disorders. MATERIALS AND METHODS: Participants were provided an LBMI-A-enabled smartphone to use during a 6-week pilot study. The LBMI-A was composed of psychoeducational modules, assessment and feedback of alcohol use patterns, geographic high-risk location monitoring and alerts, and in vivo assessment and intervention for alcohol cravings and help with managing psychological distress. Semistructured interviews were conducted with all participants following 6 weeks of interacting with the LBMI-A app (n=26). Interviews explored user perceptions of the ease and utility of LBMI-A features, module helpfulness, barriers to use, and recommendations for improvements to the program. Researchers applied a systematic qualitative coding process to transcripts that included both a priori themes identified as important by the research team and new themes that emerged during the coding process. RESULTS AND CONCLUSIONS: Narrative analysis found the emergence of five main themes identified by LBMI-A users as the most helpful functions of the phone: (1) Awareness, (2) Accountability, (3) Skill Transference, (4) Tracking Progress, and (5) Prompts. These themes are explored, and implications of these findings for future smartphone-based interventions are discussed.

Gorczynski, Paul; Faulkner, Guy; Cohn, Tony; Remington, Gary (2014): Examining Strategies to Improve Accelerometer Compliance for Individuals Living With Schizophrenia. In: Psychiatr Rehabil J. DOI: 10.1037/prj0000093.

Objective: This study examined the feasibility and effect of 2 investigator-based and 2 participant-based strategies on accelerometer wear time in individuals living with schizophrenia in order to improve accelerometry compliance. Method: Four adults with schizophrenia were asked to wear an accelerometer for 1 week during the baseline, intervention, and follow-up phases of a study that evaluated exercise counseling. To encourage participants to wear their accelerometers, investigators modeled proper accelerometer use, provided verbal and written instructions, and placed reminder phone calls. Participants were also given wear time logs and reminder magnets. Results: All participants wore their accelerometers for the required amount of time during the study. Conclusions and Implications for Practice: Researchers should use multiple techniques to help ensure compliance. Research is needed to identify the most effective combination of strategies for this population.

Grunerbl, Agnes; Muaremi, Amir; Osmani, Venet; Bahle, Gernot; Ohler, Stefan; Troester, Gerard et al. (2014): Smart-Phone Based Recognition of States and State Changes in Bipolar Disorder Patients. In: IEEE J Biomed Health Inform. DOI: 10.1109/JBHI.2014.2343154.

Today’s health care is difficult to imagine without the possibility to objectively measure various physiological parameters related to patients symptoms (from temperature through blood pressure to complex tomographic procedures). Psychiatric care remains a notable exception that heavily relies on patient interviews and self assessment. This is due to the fact that mental illnesses manifest themselves mainly in the way patients behave throughout their daily life and, until recently there were no “behavior measurement devices”. This is now changing with the progress in wearable activity recognition and sensor enabled smartphones. In this article we introduce a system, which, based on smartphone-sensing is able to recognize depressive and manic states and detect state changes of patients suffering from bipolar disorder. Drawing upon a real-life dataset of 10 patients, recorded over a time-period of 12 weeks (in total over 800 days of data tracing 17 state changes) by 4 different sensing modalities we could extract features corresponding to all disease-relevant aspects in behavior. Using these features we gain recognition accuracies of 76% by fusing all sensor modalities and state change detection precision and recall of over 97%. This article furthermore outlines the applicability of this system in the physician-patient relations in order to facilitate the life and treatment of bipolar patients.

Guidoux, Romain; Duclos, Martine; Fleury, Gerard; Lacomme, Philippe; Lamaudiere, Nicolas; Manenq, Pierre-Henri et al. (2014): A smartphone-driven methodology for estimating physical activities and energy expenditure in free living conditions. In: J Biomed Inform. DOI: 10.1016/j.jbi.2014.07.009.

This paper introduces a function dedicated to the estimation of total energy expenditure (TEE) of daily activities based on data from accelerometers integrated into smartphones. The use of mass-market sensors such as accelerometers offers a promising solution for the general public due to the growing smartphone market over the last decade. The TEE estimation function quality was evaluated using data from intensive numerical experiments based, first, on 12 volunteers equipped with a smartphone and two research sensors (Armband and Actiheart) in controlled conditions (CC) and, then, on 30 other volunteers in free-living conditions (FLC). The TEE given by these two sensors in both conditions and estimated from the metabolic equivalent tasks (MET) in CC served as references during the creation and evaluation of the function. The TEE mean gap in absolute value between the function and the three references was 7.0%, 16.4% and 2.7% in CC, and 17.0% and 23.7% according to Armband and Actiheart, respectively, in FLC. This is the first step in the definition of a new feedback mechanism that promotes self-management and daily-efficiency evaluation of physical activity as part of an information system dedicated to the prevention of chronic diseases.

Gyllensten, Illapha Cuba; Bonomi, Alberto G. (2011): Identifying types of physical activity with a single accelerometer: evaluating laboratory-trained algorithms in daily life. In: IEEE Trans Biomed Eng 58 (9), S. 2656–2663. DOI: 10.1109/TBME.2011.2160723.

Accurate identification of physical activity types has been achieved in laboratory conditions using single-site accelerometers and classification algorithms. This methodology is then applied to free-living subjects to determine activity behavior. This study is aimed at analyzing the reproducibility of the accuracy of laboratory-trained classification algorithms in free-living subjects during daily life. A support vector machine (SVM), a feed-forward neural network (NN), and a decision tree (DT) were trained with data collected by a waist-mounted accelerometer during a laboratory trial. The reproducibility of the classification performance was tested on data collected in daily life using a multiple-site accelerometer augmented with an activity diary for 20 healthy subjects (age: 30 +/- 9; BMI: 23.0 +/- 2.6 kg/m(2)). Leave-one-subject-out cross validation of the training data showed accuracies of 95.1 +/- 4.3%, 91.4 +/- 6.7%, and 92.2 +/- 6.6% for the SVM, NN, and DT, respectively. All algorithms showed a significantly decreased accuracy in daily life as compared to the reference truth represented by the IDEEA and diary classifications (75.6 +/- 10.4%, 74.8 +/- 9.7%, and 72.2 +/- 10.3%; p < 0.05). In conclusion, cross validation of training data overestimates the accuracy of the classification algorithms in daily life.

Heiy, Jane E.; Cheavens, Jennifer S. (2014): Back to basics: A naturalistic assessment of the experience and regulation of emotion. In: Emotion 14 (5), S. 878–891. DOI: 10.1037/a0037231.

Emotion regulation research links regulatory responding to important outcomes in psychological well-being, physical health, and interpersonal relations, but several fundamental questions remain. As much of the previous research has addressed generalized regulatory habits, far less is known about the ways in which individuals respond to emotions in daily life. The literature is particularly sparse in explorations of positive emotion regulation. In the current study, we provide an assessment of naturalistic experiences and regulation of emotion, both positive and negative in valence. Using an electronic experience sampling methodology, participants reported on their use of 40 regulatory strategies in response to 14 emotions for 10 consecutive days. On average, participants used 15 different regulatory strategies in response to negative emotions over this time, most frequently relying on acceptance, behavioral activation, and rumination. Participants used a similarly large repertoire of strategies, approximately 16 total, in response to positive emotions, particularly savoring, future focus, and behavioral activation. Participants’ mood ratings following strategy use, however, indicated that the most frequently used strategies were often not the most effective strategies. The results of this study provide estimates of the frequency and effectiveness of a large number of emotion regulation strategies in response to both negative and positive emotions. Such findings characterize naturalistic emotion regulation, and estimates of normative emotion regulation processes are imperative to determining the ways in which deviations (e.g., small emotion regulation repertoires, insufficient attention to regulation of positive emotions) impact emotional functioning.

Hoeppner, Bettina B.; Kahler, Christopher W.; Gwaltney, Chad J. (2014): Relationship Between Momentary Affect States and Self-Efficacy in Adolescent Smokers. In: Health Psychology.

Objective: Relapse to smoking after making a quit attempt is both common and rapid in adolescent smokers. Momentary self-efficacy (SE)—that is, momentary shifts in one’s confidence in the ability to abstain from smoking—predicts the occurrence and timing of relapse among adolescent smokers. Therefore, it is important to identify factors that are associated with changes in momentary SE early in a quit attempt. This study examined the relationship between affect states (including positive, negative, and nicotine withdrawal states) and momentary SE at various stages of a quit attempt. Method: Adolescent daily smokers interested in making a quit attempt (n = 202) completed ecological momentary assessments (EMA) each day for 1 week leading up to and 2 weeks after a quit attempt. In each assessment, they reported current SE and affect state. Results: Results of linear mixed models indicated that most of the examined affect states were related to momentary SE. Contrary to expectation, they were related to momentary SE both immediately before and after the quit attempt. Moderation effects were observed for select affect states, where higher baseline SE was related to lower momentary SE in the presence of increasing negative high activation, boredom, and difficulty concentrating. Conclusions: Our findings suggest that both positive and negative affect states are related to SE, and that thereby positive affect enhancement may be a promising, underutilized treatment target.

Hofmann, Wilhelm; Adriaanse, Marieke; Vohs, Kathleen D.; Baumeister, Roy F. (2014): Dieting and the self‐control of eating in everyday environments: An experience sampling study. In: British Journal of Health Psychology 19 (3), S. 523–539. DOI: 10.1037/t18359-000.

Objective The literature on dieting has sparked several debates over how restrained eaters differ from unrestrained eaters in their self‐regulation of healthy and unhealthy food desires and what distinguishes successful from unsuccessful dieters. We addressed these debates using a four‐component model of self‐control that was tested using ecological momentary assessment, long‐term weight change, and a laboratory measure of inhibitory control. Design A large sample of adults varying in dietary restraint and inhibitory control (as measured by a Stroop task) were equipped with smartphones for a week. They were beeped on random occasions and provided information on their experience and control of healthy and unhealthy food desires in everyday environments. Main outcome measures The main outcome measures were desire strength, experienced conflict, resistance, enactment of desire, and weight change after a 4‐month follow‐up. Results and conclusions Dietary restraint was unrelated to desire frequency and strength, but associated with higher conflict experiences and motivation to use self‐control with regard to food desires. Most importantly, relationships between dietary restraint and resistance, enactment of desire, and long‐term weight change were moderated by inhibitory control: Compared with dieters low in response inhibition, dieters high in response inhibition were more likely to attempt to resist food desires, not consume desired food (especially unhealthy food), and objectively lost more weight over the ensuing 4 months. These results highlight the combinatory effects of aspects of the self‐control process in dieters and highlight the value in linking theoretical process frameworks, experience sampling, and laboratory‐based assessment in health science.

Hofmann, Wilhelm; Wisneski, Daniel C.; Brandt, Mark J.; Skitka, Linda J. (2014): Morality in everyday life. In: Science 345 (6202), S. 1340–1343. DOI: 10.1126/science.1251560.

The science of morality has drawn heavily on well-controlled but artificial laboratory settings. To study everyday morality, we repeatedly assessed moral or immoral acts and experiences in a large (N = 1252) sample using ecological momentary assessment. Moral experiences were surprisingly frequent and manifold. Liberals and conservatives emphasized somewhat different moral dimensions. Religious and nonreligious participants did not differ in the likelihood or quality of committed moral and immoral acts. Being the target of moral or immoral deeds had the strongest impact on happiness, whereas committing moral or immoral deeds had the strongest impact on sense of purpose. Analyses of daily dynamics revealed evidence for both moral contagion and moral licensing. In sum, morality science may benefit from a closer look at the antecedents, dynamics, and consequences of everyday moral experience.

Holmes, Millicent; Fuller-Tyszkiewicz, Matthew; Skouteris, Helen; Broadbent, Jaclyn (2014): Improving Prediction of Binge Episodes by Modelling Chronicity of Dietary Restriction. In: Eur Eat Disord Rev. DOI: 10.1002/erv.2315.

This study evaluates the influences of chronicity of, and time lag between, dietary restriction and binge outcome for predicting binge episode onset. Sixty-two women aged 18 to 40 years old completed an online survey at random intervals seven times daily for a 7-day period. Participants self-reported engagement in dietary restriction and/or binging, and temptation to binge. Consecutive instances of reported dietary restriction better predicted subsequent binges than single instances. As the time lag between the first report of dietary restriction and binge onset increased, a clear linear trend emerged, such that the value of restriction for predicting binges increased with the number of consecutive assessments in which they reported dietary restriction. A similar pattern was found when predicting temptation to binge. Present findings suggest that duration of restriction is a crucial determinant of binge onset. These findings have implications for clinical practice by highlighting the time course from dietary restriction to binging. Copyright (c) 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Huh, Jimi; Shin, Heesung; Leventhal, Adam M.; Spruijt-Metz, Donna; Abramova, Zarina; Cerrada, Christian et al. (2014): Momentary negative moods and being with friends precede cigarette use among Korean American emerging adults. In: Nicotine & Tobacco Research 16 (9), S. 1248–1254. DOI: 10.1037/t04295-000.

Introduction: The objective of this study was to determine contextual antecedents to smoking among Korean American emerging adult (KAEA) smokers using ecological momentary assessment. Based on extant theory and data documenting the importance of negative affect (NA) and social context, we examined the extent to which being with friends and NA independently and concomitantly were associated with the likelihood of subsequent smoking, over and beyond other known situational correlates of smoking. Methods: Twenty-two KAEA daily smokers recorded their smoking events in real time and participated in short surveys implemented on mobile phones for 7 days. Individual, interpersonal, and situational contexts immediately preceding and during smoking events were examined in comparison to nonsmoking events using a within-subject modeling approach. Results: Both NA and being with friends independently were correlated with increased likelihood of smoking. We also found an interaction showing that the effects of NA on smoking were significant only in presence of friends. Conclusions: Unlike more established smokers, these younger smokers may be strongly influenced by peer contexts as well as unpleasant affect. The interaction between social contexts and NA highlights a potential window for intervention for the population of KAEA smokers.

Hundert, Amos S.; Huguet, Anna; McGrath, Patrick J.; Stinson, Jennifer N.; Wheaton, Mike (2014): Commercially available mobile phone headache diary apps: a systematic review. In: JMIR Mhealth Uhealth 2 (3), S. e36. DOI: 10.2196/mhealth.3452.

BACKGROUND: Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. OBJECTIVE: This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. METHODS: The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. RESULTS: Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. CONCLUSIONS: Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps.

Husky, Mathilde; Olie, Emilie; Guillaume, Sebastien; Genty, Catherine; Swendsen, Joel; Courtet, Philippe (2014): Feasibility and validity of ecological momentary assessment in the investigation of suicide risk. In: Psychiatry Res. DOI: 10.1016/j.psychres.2014.08.019.

Ecological momentary assessment has been used to investigate a wide range of behaviors and psychiatric conditions. Previous investigations have consistently obtained promising results with high acceptance and compliance rates, and with only minor reactive effects for specific variables. Despite the promise of this methodology for the study of severe psychiatric populations, little is known about its feasibility in samples at risk for suicide. In the present study, four samples at varying risk for suicide completed an Ecological momentary assessment study by responding to five electronic assessments per day over a one-week period. Samples included healthy controls (n=13), affective controls (n=21), past suicide attempters (n=20), and recent suicide attempters (n=42). The results demonstrate satisfactory participation rates and high compliance with daily life repeated assessments across all groups. Importantly, negative thoughts or suicidal ideation were not reactive to the duration of the study, indicating that the repeated assessment of such cognitions in daily life have little or no effect on their frequency. The findings provide support for the use of Ecological momentary assessment in the study of suicidal ideation and suggest that mobile technologies represent new opportunities for the assessment of high-risk cognitive states experienced by patients in daily life.

Hutchesson, Melinda J.; Rollo, Megan E.; Callister, Robin; Collins, Clare E. (2014): Self-Monitoring of Dietary Intake by Young Women: Online Food Records Completed on Computer or Smartphone Are as Accurate as Paper-Based Food Records but More Acceptable. In: J Acad Nutr Diet. DOI: 10.1016/j.jand.2014.07.036.

Adherence and accuracy of self-monitoring of dietary intake influences success in weight management interventions. Information technologies such as computers and smartphones have the potential to improve adherence and accuracy by reducing the burden associated with monitoring dietary intake using traditional paper-based food records. We evaluated the acceptability and accuracy of three different 7-day food record methods (online accessed via computer, online accessed via smartphone, and paper-based). Young women (N=18; aged 23.4+/-2.9 years; body mass index 24.0+/-2.2) completed the three 7-day food records in random order with 7-day washout periods between each method. Total energy expenditure (TEE) was derived from resting energy expenditure (REE) measured by indirect calorimetry and physical activity level (PAL) derived from accelerometers (TEE=REExPAL). Accuracy of the three methods was assessed by calculating absolute (energy intake [EI]-TEE) and percentage difference (EI/TEEx100) between self-reported EI and TEE. Acceptability was assessed via questionnaire. Mean+/-standard deviation TEE was 2,185+/-302 kcal/day and EI was 1,729+/-249 kcal/day, 1,675+/-287kcal/day, and 1,682+/-352 kcal/day for computer, smartphone, and paper records, respectively. There were no significant differences between absolute and percentage differences between EI and TEE for the three methods: computer, -510+/-389 kcal/day (78%); smartphone, -456+/-372 kcal/day (80%); and paper, -503+/-513 kcal/day (79%). Half of participants (n=9) preferred computer recording, 44.4% preferred smartphone, and 5.6% preferred paper-based records. Most participants (89%) least preferred the paper-based record. Because online food records completed on either computer or smartphone were as accurate as paper-based records but more acceptable to young women, they should be considered when self-monitoring of intake is recommended to young women.

Javelot, Herve; Spadazzi, Anne; Weiner, Luisa; Garcia, Sonia; Gentili, Claudio; Kosel, Markus; Bertschy, Gilles (2014): Telemonitoring with respect to mood disorders and information and communication technologies: overview and presentation of the PSYCHE project. In: Biomed Res Int 2014, S. 104658. DOI: 10.1155/2014/104658.

This paper reviews what we know about prediction in relation to mood disorders from the perspective of clinical, biological, and physiological markers. It then also presents how information and communication technologies have developed in the field of mood disorders, from the first steps, for example, the transition from paper and pencil to more sophisticated methods, to the development of ecological momentary assessment methods and, more recently, wearable systems. These recent developments have paved the way for the use of integrative approaches capable of assessing multiple variables. The PSYCHE project stands for Personalised monitoring SYstems for Care in mental HEalth.

Jones, Michelle D.; Crowther, Janis H.; Ciesla, Jeffrey A. (2014): A naturalistic study of fat talk and its behavioral and affective consequences. In: Body Image 11 (4), S. 337–345. DOI: 10.1016/j.bodyim.2014.05.007.

Fat talk is a style of verbal expression among young women involving negative self-statements, complaints about physical appearance, and weight management. This research used ecological momentary assessment to examine the impact of naturalistic fat talk experiences on body dissatisfaction, body checking, negative affect, and disordered eating behaviors. We examined trait self-objectification as a moderator. Sixty-five female college students completed a baseline questionnaire and responded to questions when randomly prompted by palm pilot devices for five days. Results indicated fat talk is common and associated with greater body dissatisfaction, body checking, negative affect, and disordered eating behaviors. Fat talk participation was associated with greater body checking than overhearing fat talk. Greater trait self-objectification was associated with greater body dissatisfaction and body checking following fat talk. These results suggest that fat talk negatively impacts the cognitions, affect, and behavior of young women and has increased negative effects for women higher in self-objectification.

Kardous, Chucri A.; Shaw, Peter B. (2014): Evaluation of smartphone sound measurement applications. In: J Acoust Soc Am 135 (4), S. EL186. DOI: 10.1121/1.4865269.

This study reports on the accuracy of smartphone sound measurement applications (apps) and whether they can be appropriately employed for occupational noise measurements. A representative sample of smartphones and tablets on various platforms were acquired, more than 130 iOS apps were evaluated but only 10 apps met our selection criteria. Only 4 out of 62 Android apps were tested. The results showed two apps with mean differences of 0.07 dB (unweighted) and -0.52 dB (A-weighted) from the reference values. Two other apps had mean differences within +/-2 dB. The study suggests that certain apps may be appropriate for use in occupational noise measurements.

Kelly, Nichole R.; Cotter, Elizabeth W.; Mazzeo, Suzanne E. (2014): Examining the role of distress tolerance and negative urgency in binge eating behavior among women. In: Eat Behav 15 (3), S. 483–489. DOI: 10.1016/j.eatbeh.2014.06.012.

The current study examined whether distress tolerance and negative urgency moderate the link between depressive symptoms and binge eating frequency, and between disordered eating attitudes and binge eating frequency. Young adult women (N=186) completed questionnaires assessing depressive symptoms, cognitive restraint, eating, shape and weight concerns, distress tolerance, impulsivity (including negative urgency), and binge eating. After controlling for body mass index, race/ethnicity, and other domains of impulsivity, negative urgency was significantly associated with binge eating above and beyond the influence of disordered eating attitudes and depressive symptoms. Distress tolerance, in contrast, was not associated with binge eating. In addition, neither negative urgency nor distress tolerance moderated the associations between disordered eating attitudes and binge eating frequency, or between depressive symptoms and binge eating. Results support the additive role of difficulties responding adaptively to distress in binge eating frequency, above and beyond the influence of emotional distress. Findings highlight the potential value of focusing on negative urgency in targeted treatments for binge eating among women. Importantly, results from the current study differ from those of previous research; these discrepancies could be the result of variations in sample characteristics and approaches to the assessment of binge eating behavior. Additional research, including longitudinal studies and research using “real-time” assessment strategies, such as ecological momentary assessment, is necessary to elucidate further the role of various emotion regulation strategies in maintaining binge eating behavior in adult women.

Keyes, Alexandra; Woerwag-Mehta, Sabine; Bartholdy, Savani; Koskina, Antonia; Middleton, Benita; Connan, Frances et al. (2014): Physical activity and the drive to exercise in anorexia nervosa. In: Int J Eat Disord. DOI: 10.1002/eat.22354.

OBJECTIVES: To investigate physical activity (PA) and drive for exercise in anorexia nervosa (AN) in relation to eating disorder (ED) pathology and anxiety. METHOD: Female participants were recruited into four groups: AN outpatients (n = 37), AN inpatients (n = 18), an anxiety group (n = 34), and healthy controls (HCs; n = 30). PA was measured by actigraphy and self-report together with drive/reasons for exercise, ED pathology, anxiety, depression, stress, BMI, and body composition. RESULTS: ED psychopathology, general psychopathology, and physiological measures were consistent with diagnosis. All groups showed a wide range in activity, especially on self-report. No significant group differences were observed in objective PA levels, yet AN groups reported 57-92% higher total activity than HCs. Outpatients reported more walking and moderate exercise than HCs, and inpatients reported more walking but less moderate and vigorous activity than all other groups. AN groups had significantly higher drive to exercise and valued “improving tone” as important and health and enjoyment as less important reasons to exercise. DISCUSSION: Self-perceived activity rather than objective data may partly explain the increased activity reported in AN. Drive to exercise in AN appears to be more related to ED pathology than to anxiety. (c) 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014).

Kimhy, David; Vakhrusheva, Julia; Liu, Ying; Wang, Yuanjia (2014): Use of mobile assessment technologies in inpatient psychiatric settings. In: Asian J Psychiatr 10, S. 90–95. DOI: 10.1016/j.ajp.2014.04.004.

Mobile electronic devices (i.e., PDAs, cellphones) have been used successfully as part of research studies of individuals with severe mental illness living in the community. More recently, efforts have been made to incorporate such technologies into outpatient treatments. However, few attempts have been made to date to employ such mobile devices among hospitalized psychiatric patients. In this article, we evaluate the potential use of such devices in inpatient psychiatric settings using 33 hospitalized patients with schizophrenia. Employing an Experience Sampling Method approach, we provide support for the feasibility of using such devices, along with examples of potentially clinically-relevant information that can be obtained using such technologies, including assessment of fluctuations in the severity of psychotic symptoms and negative mood in relation to social context, unit location, and time of day. Following these examples, we discuss issues related to the potential use of mobile electronic devices by patients hospitalized at inpatient psychiatric settings including issues related to patients’ compliance, assessment schedules, questionnaire development, confidentiality issues, as well as selection of appropriate software/hardware. Finally, we delineate some issues and areas of inquiry requiring additional research and development.

Konen, Tanja; Dirk, Judith; Schmiedek, Florian (2014): Cognitive benefits of last night’s sleep: daily variations in children’s sleep behavior are related to working memory fluctuations. In: J Child Psychol Psychiatry. DOI: 10.1111/jcpp.12296.

BACKGROUND: Recent studies have suggested substantial fluctuations of cognitive performance in adults both across and within days, but very little is known about such fluctuations in children. Children’s sleep behavior might have an important influence on their daily cognitive resources, but so far this has not been investigated in terms of naturally occurring within-person variations in children’s everyday lives. METHODS: In an ambulatory assessment study, 110 elementary school children (8-11 years old) completed sleep items and working memory tasks on smartphones several times per day in school and at home for 4 weeks. Parents provided general information about the children and their sleep habits. RESULTS: We identified substantial fluctuations in the children’s daily cognitive performance, self-reported nightly sleep quality, time in bed, and daytime tiredness. All three facets were predictive of performance fluctuations in children’s school and daily life. Sleep quality and time in bed were predictive of performance in the morning, and afternoon performance was related to current tiredness. The children with a lower average performance level showed a higher within-person coupling between morning performance and sleep quality. CONCLUSIONS: Our findings contribute important insights regarding a potential source of performance fluctuations in children. The effect of varying cognitive resources should be investigated further because it might impact children’s daily social, emotional, and learning-related functioning. Theories about children’s cognitive and educational development should consider fluctuations on micro-longitudinal scales (e.g., day-to-day) to identify possible mechanisms behind long-term changes.

Kubiak, Thomas; Zahn, Daniela; Siewert, Kerstin; Jonas, Cornelia; Weber, Hannelore (2014): Positive beliefs about rumination are associated with ruminative thinking and affect in daily life: Evidence for a metacognitive view on depression. In: Behavioural and Cognitive Psychotherapy 42 (5), S. 568–576. DOI: 10.1037/t12149-000.

Background: Self-regulatory executive function theory (Wells and Matthews, 1994; Wells, 2008) stresses the role of metacognitions in the development of emotional disorders. Within this metacognitive model, positive beliefs about ruminative thinking are thought to be a risk factor for engaging in rumination and subsequently for depression. However, most of the existing research relies on retrospective self-report trait measures. Aims: The aim of the present study was to examine the theory’s predictions with an Ecological momentary assessment approach capturing rumination as it occurs in daily life. Method: Non-clinical participants (N = 93) were equipped with electronic diaries and completed four signal-contingent momentary self-reports per day for 4 weeks. A multilevel mediation model was computed to examine associations between positive beliefs about rumination and ruminative thinking and negative affect in daily life. Results: Positive beliefs about rumination were significantly associated with ruminative thinking as it occurs in daily life. We further found evidence for a negative association with positive affect that was completely mediated via ruminative thinking in daily life occurring in response to negative emotions. Conclusions: Our results add ecologically valid corroborating evidence for the metacognitive model of emotional disorders within the framework of self-regulatory executive function theory.

Lehman, Barbara J.; Cane, Arianna C.; Tallon, Shannon J.; Smith, Stephanie F. (2014): Physiological and Emotional Responses to Subjective Social Evaluative Threat in Daily Life. In: Anxiety Stress Coping, S. 1–31. DOI: 10.1080/10615806.2014.968563.

Background and Objectives. This study examined concurrent and delayed emotional and cardiovascular correlates of naturally occurring experiences with subjective social evaluative threat (SSET), and tested whether individual differences in social interaction anxiety moderated those associations. Methods. Sixty-eight participants wore ambulatory blood pressure monitors for three days. Following each blood pressure reading participants reported on SSET and negative emotions, yielding 1,770 momentary measures. Results. Multilevel modeling suggested that reports of greater SSET uniquely predicted elevations in anxiety and embarrassment, with elevations in anxiety, embarrassment, and shame extending to the hour following SSET. Reports of concurrent and previous-hour SSET also predicted cardiovascular elevations. Linkages between SSET and anxiety and shame, but not cardiovascular measures, were moderated by social interaction anxiety. Those higher in social interaction anxiety showed especially strong associations between SSET and both concurrent and delayed anxiety and greater delayed shame. Conclusions. This research suggests an important role for anxiety, embarrassment, and shame as emotional consequences of naturally occurring evaluative threat, especially for those who are more socially anxious. Further, this work replicates other naturalistic studies that have documented increased blood pressure at times of SSET, and extends that work by documenting cardiovascular responses into the following hour.

Li, Haocheng; Staudenmayer, John; Carroll, Raymond J. (2014): Hierarchical functional data with mixed continuous and binary measurements. In: Biometrics. DOI: 10.1111/biom.12211.

Motivated by objective measurements of physical activity, we take a functional data approach to longitudinal data with simultaneous measurement of a continuous and a binary outcomes. The regression structures are specified as smooth curves measured at various time-points with random effects that have a hierarchical correlation structure. The random effect curves for each variable are summarized using a few important principal components, and the association of the two longitudinal variables is modeled through the association of the principal component scores. We use penalized splines to model the mean curves and the principal component curves, and cast the proposed model into a mixed effects model framework for model fitting, prediction and inference. Via a quasilikelihood type approximation for the binary component, we develop an algorithm to fit the model. Data-based transformation of the continuous variable and selection of the number of principal components are incorporated into the algorithm. The method is applied to the motivating physical activity data and is evaluated empirically by a simulation study. Extensions for different types of outcomes are also discussed.

Lien, René; Neijts, Melanie; Willemsen, Gonneke; Geus, Eco J. C. (2014): Ambulatory measurement of the ecg t‐wave amplitude. In: Psychophysiology.

Abstract Ambulatory recording of the preejection period (PEP) can be used to measure changes in cardiac sympathetic nervous system (SNS) activity under naturalistic conditions. Here, we test the ECG T‐wave amplitude (TWA) as an alternative measure, using 24‐h ambulatory monitoring of PEP and TWA in a sample of 564 healthy adults. The TWA showed a decrease in response to mental stress and a monotonic decrease from nighttime sleep to daytime sitting and more physically active behaviors. Within‐participant changes in TWA were correlated with changes in the PEP across the standardized stressors (r = .42) and the unstandardized naturalistic conditions (mean r = .35). Partialling out changes in heart rate and vagal effects attenuated these correlations, but they remained significant. Ambulatory TWA cannot replace PEP, but simultaneous recording of TWA and PEP provides a more comprehensive picture of changes in cardiac SNS activity in real‐life settings.

Losa-Iglesias, Marta Elena; Becerro-de-Bengoa-Vallejo, Ricardo; Becerro-de-Bengoa-Losa, Klark Ricardo (2014): Reliability and concurrent validity of a peripheral pulse oximeter and health-app system for the quantification of heart rate in healthy adults. In: Health Informatics J. DOI: 10.1177/1460458214540909.

There are downloadable applications (Apps) for cell phones that can measure heart rate in a simple and painless manner. The aim of this study was to assess the reliability of this type of App for a Smartphone using an Android system, compared to the radial pulse and a portable pulse oximeter. We performed a pilot observational study of diagnostic accuracy, randomized in 46 healthy volunteers. The patients’ demographic data and cardiac pulse were collected. Radial pulse was measured by palpation of the radial artery with three fingers at the wrist over the radius; a low-cost portable, liquid crystal display finger pulse oximeter; and a Heart Rate Plus for Samsung Galaxy Note(R). This study demonstrated high reliability and consistency between systems with respect to the heart rate parameter of healthy adults using three systems. For all parameters, ICC was > 0.93, indicating excellent reliability. Moreover, CVME values for all parameters were between 1.66-4.06 %. We found significant correlation coefficients and no systematic differences between radial pulse palpation and pulse oximeter and a high precision. Low-cost pulse oximeter and App systems can serve as valid instruments for the assessment of heart rate in healthy adults.

Luczak, Susan E.; Rosen, I. Gary (2014): Estimating BrAC from transdermal alcohol concentration data using the BrAC estimator software program. In: Alcohol Clin Exp Res 38 (8), S. 2243–2252. DOI: 10.1111/acer.12478.

BACKGROUND: Transdermal alcohol sensor (TAS) devices have the potential to allow researchers and clinicians to unobtrusively collect naturalistic drinking data for weeks at a time, but the transdermal alcohol concentration (TAC) data these devices produce do not consistently correspond with breath alcohol concentration (BrAC) data. We present and test the BrAC Estimator software, a program designed to produce individualized estimates of BrAC from TAC data by fitting mathematical models to a specific person wearing a specific TAS device. METHODS: Two TAS devices were worn simultaneously by 1 participant for 18 days. The trial began with a laboratory alcohol session to calibrate the model and was followed by a field trial with 10 drinking episodes. Model parameter estimates and fit indices were compared across drinking episodes to examine the calibration phase of the software. Software-generated estimates of peak BrAC, time of peak BrAC, and area under the BrAC curve were compared with breath analyzer data to examine the estimation phase of the software. RESULTS: In this single-subject design with breath analyzer peak BrAC scores ranging from 0.013 to 0.057, the software created consistent models for the 2 TAS devices, despite differences in raw TAC data, and was able to compensate for the attenuation of peak BrAC and latency of the time of peak BrAC that are typically observed in TAC data. CONCLUSIONS: This software program represents an important initial step for making it possible for non mathematician researchers and clinicians to obtain estimates of BrAC from TAC data in naturalistic drinking environments. Future research with more participants and greater variation in alcohol consumption levels and patterns, as well as examination of gain scheduling calibration procedures and nonlinear models of diffusion, will help to determine how precise these software models can become.

Marszalek, Jolanta; Morgulec-Adamowicz, Natalia; Rutkowska, Izabela; Kosmol, Andrzej (2014): Using ecological momentary assessment to evaluate current physical activity. In: Biomed Res Int 2014, S. 915172. DOI: 10.1155/2014/915172.

OBJECTIVE: The purpose of this study was to assess the value of ecological momentary assessment in evaluating physical activity among children, adolescents, and adults. It also determines whether ecological momentary assessment fulfills the criteria of validity, reliability, objectivity, norms, and standardization applied to the tools used for the evaluation of physical activity. METHODS: The EBSCO-CINHAL, Medline, PsycINFO, PubMed, and SPORTDiscuss databases were reviewed in December 2012 for articles associated with EMA. RESULTS: Of the 20 articles examined, half (10) used electronic methods for data collection, although various methods were used, ranging from pen and paper to smartphone applications. Ten studies used objective monitoring equipment. Nineteen studies were performed over 4 days. While the validity of the EMA method was discussed in 18 studies, only four found it to be objective. In all cases, the EMA procedures were precisely documented and confirmed to be feasible. CONCLUSIONS: Ecological momentary assessment is a valid, reliable, and feasible approach to evaluate activity and sedentary behavior. Researchers should be aware that while ecological momentary assessment offers many benefits, it simultaneously imposes many limitations which should be considered when studying physical activity.

Martikainen, Silja; Pesonen, Anu-Katriina; Lahti, Jari; Heinonen, Kati; Pyhala, Riikka; Tammelin, Tuija et al. (2014): Physical activity and hypothalamic-pituitary-adrenocortical axis function in adolescents. In: Psychoneuroendocrinology 49, S. 96–105. DOI: 10.1016/j.psyneuen.2014.06.023.

Little is known about the associations between physical activity (PA) and hypothalamic-pituitary-adrenocortical axis (HPAA) activity in adolescents. This knowledge could offer insight into the links between PA and well-being in youth. We studied whether objectively-measured PA is associated with diurnal salivary cortisol responses and morning salivary cortisol responses after a low-dose overnight dexamethasone suppression test (DST) in adolescent girls and boys. We conducted a cross-sectional birth cohort study in Helsinki, Finland. At a mean age of 12.4 (SD=0.5) years, 150 girls and 133 boys wore wrist-worn accelerometers over at least 4 days to measure PA. Their salivary cortisol was measured across 1 day and upon awakening after a low-dose overnight DST (3mug/kg of weight). Girls with higher overall PA and vigorous PA (VPA), and less sedentary time had lower salivary cortisol upon awakening and/or after (decreases between |0.17| and |0.25| SDs per SD increase in overall PA, VPA and decrease in sedentary time; P-values<0.039). Boys with higher overall PA, and less sedentary time had greater suppression of salivary cortisol following overnight DST (suppression between |0.24| and |0.27| SDs per SD increase in overall PA and decrease in sedentary time; P-values<0.012). Overall PA, VPA and sedentary time did not associate with DST suppression in girls or with diurnal salivary cortisol in boys. These results show that PA is associated with altered HPAA function in early adolescents, and that the associations are sex specific.

Middelweerd, Anouk; Mollee, Julia S.; van der Wal, C; Brug, Johannes; Te Velde, Saskia J (2014): Apps to promote physical activity among adults: a review and content analysis. In: Int J Behav Nutr Phys Act 11 (1), S. 97. DOI: 10.1186/s12966-014-0097-9.

BackgroundIn May 2013, the iTunes and Google Play stores contained 23,490 and 17,756 smartphone applications (apps) categorized as Health and Fitness, respectively. The quality of these apps, in terms of applying established health behavior change techniques, remains unclear.MethodsThe study sample was identified through systematic searches in iTunes and Google Play. Search terms were based on Boolean logic and included AND combinations for physical activity, healthy lifestyle, exercise, fitness, coach, assistant, motivation, and support. Sixty-four apps were downloaded, reviewed, and rated based on the taxonomy of behavior change techniques used in the interventions. Mean and ranges were calculated for the number of observed behavior change techniques. Using nonparametric tests, we compared the number of techniques observed in free and paid apps and in iTunes and Google Play.ResultsOn average, the reviewed apps included 5 behavior change techniques (range 2 inverted question mark8). Techniques such as self-monitoring, providing feedback on performance, and goal-setting were used most frequently, whereas some techniques such as motivational interviewing, stress management, relapse prevention, self-talk, role models, and prompted barrier identification were not. No differences in the number of behavior change techniques between free and paid apps, or between the app stores were found.ConclusionsThe present study demonstrated that apps promoting physical activity applied an average of 5 out of 23 possible behavior change techniques. This number was not different for paid and free apps or between app stores. The most frequently used behavior change techniques in apps were similar to those most frequently used in other types of physical activity promotion interventions.

Minami, Haruka; Tran, Lisa T.; McCarthy, Danielle E. (2014): Using Ecological Measures of Smoking Trigger Exposure to Predict Smoking Cessation Milestones. In: Psychol Addict Behav. DOI: 10.1037/adb0000017.

This study used ecological momentary assessment data from adult daily smokers attempting to quit smoking to assess relations between exposure to contextual risk factors and cessation failure, latency to a first smoking lapse, or progression from lapse to relapse (smoking 7 days in a row). Participants were adult, daily smokers enrolled in a randomized controlled clinical trial of bupropion SR and individual counseling who were followed to 1 year postquit. Participants reported exposure to high-risk contexts and behaviors, including being where cigarettes were available or smoking was permitted, being around others smoking in prospective, real-time assessment for 2 weeks pre- and 4 weeks postquit. Results showed that greater exposure to contextual risk factors during the prequit did not predict cessation failure. However, Cox regression survival analyses revealed that spending a greater proportion of time where cigarettes were easily available following at least 1 day of abstinence predicted shorter latency to a first lapse, even after controlling for baseline risk factors such as gender, nicotine dependence, depressive symptoms, and living with a smoker. Greater cigarette availability following a lapse was not associated with progression from lapse to relapse with or without baseline risk factors in the model. This suggests that postquit environmental risk factors, such as cigarette availability, increase lapse risk, and stable risk factors, such as living with smokers and higher baseline carbon monoxide level or depressive symptoms, remain potent predictors of progression to relapse. Real-time contextual risk assessments postquit predict lapse above and beyond stable, baseline risk factors.

Mitchell, John T.; Schick, Robert S.; Hallyburton, Matt; Dennis, Michelle F.; Kollins, Scott H.; Beckham, Jean C.; McClernon, F. Joseph (2014): Combined ecological momentary assessment and global positioning system tracking to assess smoking behavior: A proof of concept study. In: Journal of Dual Diagnosis 10 (1), S. 19–29.

Objective: Ecological momentary assessment (EMA) methods have provided a rich assessment of the contextual factors associated with a wide range of behaviors including alcohol use, eating, physical activity, and smoking. Despite this rich database, this information has not been linked to specific locations in space. Such location information, which can now be easily acquired from global positioning system (GPS) tracking devices, could provide unique information regarding the space-time distribution of behaviors and new insights into their determinants. In a proof of concept study, we assessed the acceptability and feasibility of acquiring and combining EMA and GPS data from adult smokers with attention deficit hyperactivity disorder (ADHD). Methods: Participants were adults with ADHD who were enrolled in a larger EMA study on smoking and psychiatric symptoms. Among those enrolled in the latter study who were approached to participate (N = 11), 10 consented, provided daily EMA entries, and carried a GPS device with them during a 7-day assessment period to assess aspects of their smoking behavior. Results: The majority of those eligible to participate were willing to carry a GPS device and signed the consent (10 out of 11, 91%). Of the 10 who consented, 7 participants provided EMA entries and carried the GPS device with them daily for at least 70% of the sampling period. Data are presented on the spatial distribution of smoking episodes and ADHD symptoms on a subset of the sample to demonstrate applications of GPS data. Conclusions: We conclude by discussing how EMA and GPS might be used to study the ecology of smoking and make recommendations for future research and analysis.

Monk, Rebecca L.; Heim, Derek (2014): A real-time examination of context effects on alcohol cognitions. In: Alcohol Clin Exp Res 38 (9), S. 2454–2459. DOI: 10.1111/acer.12504.

BACKGROUND: This research used context aware experiential sampling to investigate the effect of contexts on in vivo alcohol-related outcome expectancies. METHODS: A time-stratified random sampling strategy was adopted to assess 72 students and young professionals at 5 daily intervals over the course of a week using a specifically designed smartphone application. This application recorded respondents’ present situational and social contexts, alcohol consumption, and alcohol-related cognitions in real-time. RESULTS: In vivo social and environmental contexts and current alcohol consumption accounted for a significant proportion of variance in outcome expectancies. For instance, prompts which occurred while participants were situated in a pub, bar, or club and in a social group of friends were associated with heightened outcome expectancies in comparison with other settings. CONCLUSIONS: Alcohol-related expectancies do not appear to be static but instead demonstrate variation across social and environmental contexts. Modern technology can be usefully employed to provide a more ecologically valid means of measuring such beliefs.

Nast, Daniel R.; Speer, William S.; Le Prell, Colleen G (2014): Sound level measurements using smartphone “apps”: Useful or inaccurate? In: Noise Health 16 (72), S. 251–256. DOI: 10.4103/1463-1741.140495.

Many recreational activities are accompanied by loud concurrent sounds and decisions regarding the hearing hazards associated with these activities depend on accurate sound measurements. Sound level meters (SLMs) are designed for this purpose, but these are technical instruments that are not typically available in recreational settings and require training to use properly. Mobile technology has made such sound level measurements more feasible for even inexperienced users. Here, we assessed the accuracy of sound level measurements made using five mobile phone applications or “apps” on an Apple iPhone 4S, one of the most widely used mobile phones. Accuracy was assessed by comparing application-based measurements to measurements made using a calibrated SLM. Whereas most apps erred by reporting higher sound levels, one application measured levels within 5 dB of a calibrated SLM across all frequencies tested.

Olesen, Line Gronholt; Kristensen, Peter Lund; Ried-Larsen, Mathias; Grontved, Anders; Froberg, Karsten (2014): Physical activity and motor skills in children attending 43 preschools: a cross-sectional study. In: BMC Pediatr 14 (1), S. 229. DOI: 10.1186/1471-2431-14-229.

BACKGROUND: Little is known about health characteristics and the physical activity (PA) patterns in children attending preschools. The objective of this study was to describe the gender differences in relation to body mass index (BMI), motor skills (MS) and PA, including PA patterns by the day type and time of day. Additionally, the between-preschool variation in mean PA was estimated using the intraclass correlation. METHODS: We invited 627 children 5-6 years of age attending 43 randomly selected preschools in Odense, Denmark. Aiming and catching MS was assessed using subtests of the Movement Assessment Battery for Children (Second Edition) and motor coordination MS was assessed by the Kiphard-Schilling body coordination test, Korperkoordination Test fur Kinder. PA was measured using accelerometry. The PA patterns were analysed using mixed models. RESULTS: No gender differences in the BMI or norm-referenced MS risk classification, or the average weekly PA level or patterns of PA were observed. However, boys performed better in the aiming and catching score (p < 0.01) and in the motor coordination score (p < 0.05) on average. Girls performed better in the balance subtest (p < 0.001). Relative to the norm-referenced classification of MS, the Danish sample distribution was significantly well for aiming and catching but poorer for the motor coordination test.The total sample and the least active children were most active on weekdays, during preschool time and in the late afternoon at the weekend. However, a relatively larger decrease in PA from preschool to weekday leisure time was observed in children in the lowest PA quartile compared to children in the highest PA quartile. Finally, the preschool accounted for 19% of the total variance in PA, with significant gender differences. CONCLUSIONS: Results of this study could provide a valuable reference material for studies monitoring future trends in obesity, MS and PA behaviour in Denmark and other countries.Knowledge about sources of variation in PA among preschool children is scarce and our findings need to be replicated in future studies. A potentially important finding is the large between-preschool variation in PA, indicating that especially girls are very susceptible to the environment offered for PA during preschool attendance.

Ortiz-Tudela, Elisabet; Martinez-Nicolas, Antonio; Diaz-Mardomingo, Carmen; Garcia-Herranz, Sara; Pereda-Perez, Inmaculada; Valencia, Azucena et al. (2014): The characterization of biological rhythms in mild cognitive impairment. In: Biomed Res Int 2014, S. 524971. DOI: 10.1155/2014/524971.

INTRODUCTION: Patients with dementia, especially Alzheimer’s disease, present several circadian impairments related to an accelerated perturbation of their biological clock that is caused by the illness itself and not merely age-related. Thus, the objective of this work was to elucidate whether these circadian system alterations were already present in patients with mild cognitive impairment (MCI), as compared to healthy age-matched subjects. METHODS: 40 subjects (21 patients diagnosed with MCI, 74.1 +/- 1.5 y.o., and 19 healthy subjects, 71.7 +/- 1.4 y.o.) were subjected to ambulatory monitoring, recording wrist skin temperature, motor activity, body position, and the integrated variable TAP (including temperature, activity, and position) for one week. Nonparametrical analyses were then applied. RESULTS: MCI patients exhibited a significant phase advance with respect to the healthy group for the following phase markers: temperature M5 (mean +/- SEM: 04:20 +/- 00:21 versus 02:52 +/- 00:21) and L10 (14:35 +/- 00:27 versus 13:24 +/- 00:16) and TAP L5 (04:18 +/- 00:14 versus 02:55 +/- 00:30) and M10 (14:30 +/- 00:18 versus 13:28 +/- 00:23). CONCLUSIONS: These results suggest that significant advances in the biological clock begin to occur in MCI patients, evidenced by an accelerated aging of the circadian clock, as compared to a healthy population of the same age.

Pasyugina, Irina; Koval, Peter; Leersnyder, Jozefien de; Mesquita, Batja; Kuppens, Peter (2014): Distinguishing between level and impact of rumination as predictors of depressive symptoms: An experience sampling study. In: Cogn Emot, S. 1–11. DOI: 10.1080/02699931.2014.932755.

Rumination-repetitively thinking about one’s emotional state, its causes and consequences-exacerbates negative mood and plays an important role in the aetiology and maintenance of depression. Yet, it is unclear whether increased vulnerability to depression is associated with simply how much a person ruminates, or the short-term impact rumination has on a person’s negative mood. In the current study, we distinguish between the level versus the impact of rumination, and we examine how each uniquely predicts changes in depressive symptoms over time in an undergraduate sample. Using experience sampling, we assessed students’ (N = 101) subjective experiences of positive and negative affect and their use of rumination and distraction in daily life for seven days. Participants also reported their depressive symptoms before and after the experience sampling. Increases in depressive symptoms over the week were predicted by how much people ruminated, but not by its impact on negative mood.

Phillips, Karran A.; Epstein, David H.; Vahabzadeh, Massoud; Mezghanni, Mustapha; Lin, Jia-Ling; Preston, Kenzie L. (2014): Substance use and hepatitis C: an ecological momentary assessment study. In: Health Psychol 33 (7), S. 710–719. DOI: 10.1037/hea0000087.

OBJECTIVE: The objective of this study was to assess craving and mood related to opioid and cocaine use among asymptomatic hepatitis C virus (HCV)+ and HCV- methadone patients who have not started antiviral treatment. METHODS: In this 28-week prospective ecological momentary assessment (EMA) study, 114 methadone-maintained, heroin- and cocaine-abusing individuals reported from the field in real time on their mood, craving, exposure to drug-use triggers, and drug use via handheld computers. RESULTS: Sixty-one percent were HCV+; none were overtly symptomatic or receiving HCV treatment. HCV status was not associated with age, sex, race, or past-30-day or lifetime heroin or cocaine use. In event-contingent EMA entries, HCV+ individuals more often attributed use to having been bored, worried, or sad; feeling uncomfortable; or others being critical of them compared with HCV- participants. In randomly prompted EMA entries, HCV+ participants reported significantly more exposure to drug-use triggers, including handling >/=$10, seeing cocaine or heroin, seeing someone being offered/use cocaine or heroin, being tempted to use cocaine, and wanting to see what would happen if they used just a little cocaine or heroin. CONCLUSIONS: HCV+ individuals experienced more negative moods and more often cited these negative moods as causes for drug use. HCV+ individuals reported greater exposure to environmental drug-use triggers, but they did not more frequently cite these as causes for drug use. The EMA data reported here suggest that HCV+ intravenous drug users may experience more labile mood and more reactivity to mood than HCV- intravenous drug users. The reason for the difference is not clear, but HCV status may be relevant to tailoring of treatment.

Piasecki, Thomas M.; Cooper, M. Lynne; Wood, Phillip K.; Sher, Kenneth J.; Shiffman, Saul; Heath, Andrew C. (2014): Dispositional drinking motives: Associations with appraised alcohol effects and alcohol consumption in an ecological momentary assessment investigation. In: Psychological Assessment 26 (2), S. 363–369.

Alcohol use can be understood as a strategic behavior, such that people choose to drink based on the anticipated affective changes produced by drinking relative to those produced by alternative behaviors. This study investigated whether people who report drinking for specific reasons via the Drinking Motives Questionnaire–Revised (DMQ-R; Cooper, 1994) actually experience the alcohol effects they purportedly seek. As a secondary goal, we examined relations between drinking motives and indices of the amount of alcohol consumed. Data were drawn from 3,272 drinking episodes logged by 393 community-recruited drinkers during a 21-day Ecological momentary assessment investigation. After accounting for selected covariates, DMQ-R enhancement motives uniquely predicted real-time reports of enhanced drinking pleasure. DMQ-R coping motives were associated with reports of increased drinking-contingent relief and punishment. Enhancement motives uniquely predicted consuming more drinks per episode and higher peak intra-episode estimated blood alcohol concentration. The findings extend the evidence for the validity of the DMQ-R motive scores by demonstrating that internal drinking motives (enhancement and coping) are related to the experienced outcomes of drinking in the manner anticipated by theory.

Ramgopal, Sriram; Thome-Souza, Sigride; Jackson, Michele; Kadish, Navah Ester; Sanchez Fernandez, Ivan; Klehm, Jacquelyn et al. (2014): Seizure detection, seizure prediction, and closed-loop warning systems in epilepsy. In: Epilepsy Behav 37C, S. 291–307. DOI: 10.1016/j.yebeh.2014.06.023.

Nearly one-third of patients with epilepsy continue to have seizures despite optimal medication management. Systems employed to detect seizures may have the potential to improve outcomes in these patients by allowing more tailored therapies and might, additionally, have a role in accident and SUDEP prevention. Automated seizure detection and prediction require algorithms which employ feature computation and subsequent classification. Over the last few decades, methods have been developed to detect seizures utilizing scalp and intracranial EEG, electrocardiography, accelerometry and motion sensors, electrodermal activity, and audio/video captures. To date, it is unclear which combination of detection technologies yields the best results, and approaches may ultimately need to be individualized. This review presents an overview of seizure detection and related prediction methods and discusses their potential uses in closed-loop warning systems in epilepsy.

Ranzenhofer, Lisa M.; Engel, Scott G.; Crosby, Ross D.; Anderson, Micheline; Vannucci, Anna; Cohen, L. Adelyn et al. (2014): Using ecological momentary assessment to examine interpersonal and affective predictors of loss of control eating in adolescent girls. In: Int J Eat Disord. DOI: 10.1002/eat.22333.

OBJECTIVE: Pediatric loss of control (LOC) eating is predictive of partial- and full-syndrome binge eating disorder. The interpersonal model proposes that LOC eating is used to cope with negative mood states resulting from interpersonal distress, possibly on a momentary level. We therefore examined temporal associations between interpersonal problems, negative affect, and LOC eating among overweight adolescent girls using ecological momentary assessment (EMA). METHOD: Thirty overweight and obese (>/=85th body mass index (BMI) percentile; BMI: M = 36.13, SD = 7.49 kg/m2 ) adolescent females (Age: M = 14.92, SD = 1.54 y; 60.0% African American) who reported at least two LOC episodes in the past month completed self-report momentary ratings of interpersonal problems, state affect, and LOC eating for 2 weeks. A series of 2-level multilevel models with centering within subjects was conducted. RESULTS: Between- and within-subjects interpersonal problems (p’s < .05), but not between- (p = .12) or within- (p = .32) subjects negative affect predicted momentary LOC eating. At the between-subjects level, interpersonal problems significantly predicted increases in negative affect (p < 001). DISCUSSION: Naturalistic data lend support to the predictive value of interpersonal problems for LOC eating among adolescents. Interventions targeting interpersonal factors on a momentary basis may be useful during this developmental stage. (c) 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014;).

Real, Ruben G L; Dickhaus, Thorsten; Ludolph, Albert; Hautzinger, Martin; Kubler, Andrea (2014): Well-being in amyotrophic lateral sclerosis: a pilot experience sampling study. In: Front Psychol 5, S. 704. DOI: 10.3389/fpsyg.2014.00704.

OBJECTIVE: The aim of this longitudinal study was to identify predictors of instantaneous well-being in patients with amyotrophic lateral sclerosis (ALS). Based on flow theory well-being was expected to be highest when perceived demands and perceived control were in balance, and that thinking about the past would be a risk factor for rumination which would in turn reduce well-being. METHODS: Using the experience sampling method, data on current activities, associated aspects of perceived demands, control, and well-being were collected from 10 patients with ALS three times a day for two weeks. RESULTS: RESULTS show that perceived control was uniformly and positively associated with well-being, but that demands were only positively associated with well-being when they were perceived as controllable. Mediation analysis confirmed thinking about the past, but not thinking about the future, to be a risk factor for rumination and reduced well-being. DISCUSSION: Findings extend our knowledge of factors contributing to well-being in ALS as not only perceived control but also perceived demands can contribute to well-being. They further show that a focus on present experiences might contribute to increased well-being.

Robbins, Megan L.; López, Ana María; Weihs, Karen L.; Mehl, Matthias R. (2014): Cancer conversations in context: Naturalistic observation of couples coping with breast cancer. In: Journal of Family Psychology 28 (3), S. 380–390. DOI: 10.1037/t02175-000;

This study explored the feasibility and potentials of a naturalistic observation approach to studying dyadic coping in everyday life. Specifically, it examined the natural context and content of the spontaneous cancer conversations of couples coping with cancer, and how they relate to patients’ and spouses’ psychological adjustment. Women with breast cancer (N = 56) and their spouses wore the electronically activated recorder (EAR), an unobtrusive observation method that periodically records snippets of ambient sounds, over one weekend to observe the couples’ cancer conversations in their natural context. Both patients and spouses completed self-reported measures of psychological adjustment at baseline and at a 2-month follow-up. Cancer was a topic of approximately 5% of couples’ conversations. Cancer conversations occurred more often within the couple than with friends and family, and they were more often informational than emotional or supportive. Consistent with research on the social cognitive processing model (Lepore & Revenson, 2007), spouses’ engagement in emotional disclosure and informational conversation with patients predicted better patient adjustment. This first naturalistic observation study of dyadic coping revealed that the EAR method can be implemented with high compliance and relatively low obtrusiveness within the sensitive context of couples coping with cancer, and having a spouse who discussed cancer in an emotional or informational way predicted better patient adjustment. As a complement to in-lab and other momentary assessment methods, a naturalistic observation approach with a method such as the EAR can contribute to a more comprehensive understanding of the role that communication processes play in coping with cancer.

Rullier, Laetitia; Atzeni, Thierry; Husky, Mathilde; Bouisson, Jean; Dartigues, Jean‐François; Swendsen, Joel; Bergua, Valerie (2014): Daily life functioning of community‐dwelling elderly couples: An investigation of the feasibility and validity of ecological momentary assessment. In: International Journal of Methods in Psychiatric Research 23 (2), S. 208–216. DOI: 10.1037/t15771-000;

Abstract Although ambulatory data collection techniques have been used in elderly populations, their feasibility and validity amongst elderly individuals with cognitive impairment and amongst couples remains unexplored. The main objective of this study is to examine the validity of Ecological momentary assessment (EMA) in elderly persons with or without cognitive impairment and their spouses. The sample included 58 retired farmers (mean 77.3 years, standard deviation [SD] 5.5) with or without cognitive impairment, recruited within a French cohort and 60 spouses (mean 73.4 years, SD 6.9). The presence of cognitive impairment determining by a panel of specialized neurologists permitted to define two groups: “The Cognitive Impairment Group” and “The Control Group”. EMA procedures consisted of repeated telephone interviews five times per day during four days for each spouse. Our results demonstrate the validity of EMA procedures through a 92.1% level of compliance, the absence of fatigue effects, and the lack of evidence for major reactivity to the methods. However, the specificity of our sample may explain the acceptance (42%) and response (75%) rates and may reduce the generalizability of the results to the general population of elderly individuals. Finally, the validation of such techniques may contribute to future research examining community‐dwelling elderly individuals and their spouses.

Sama, Preethi R.; Eapen, Zubin J.; Weinfurt, Kevin P.; Shah, Bimal R.; Schulman, Kevin A. (2014): An evaluation of mobile health application tools. In: JMIR Mhealth Uhealth 2 (2), S. e19. DOI: 10.2196/mhealth.3088.

BACKGROUND: The rapid growth in the number of mobile health applications could have profound significance in the prevention of disease or in the treatment of patients with chronic disease such as diabetes. OBJECTIVE: The objective of this study was to describe the characteristics of the most common mobile health care applications available in the Apple iTunes marketplace. METHODS: We undertook a descriptive analysis of a sample of applications in the “health and wellness” category of the Apple iTunes Store. We characterized each application in terms of its health factor and primary method of user engagement. The main outcome measures of the analysis were price, health factors, and methods of user engagement. RESULTS: Among the 400 applications that met the inclusion criteria, the mean price of the most frequently downloaded paid applications was US $2.24 (SD $1.30), and the mean price of the most currently available paid applications was US $2.27 (SD $1.60). Fitness/training applications were the most popular (43.5%, 174/400). The next two most common categories were health resource (15.0%, 60/400) and diet/caloric intake (14.3%, 57/400). Applications in the health resource category constituted 5.5% (22/400) of the applications reviewed. Self-monitoring was the most common primary user engagement method (74.8%, 299/400). A total of 20.8% (83/400) of the applications used two or more user engagement approaches, with self-monitoring and progress tracking being the most frequent. CONCLUSIONS: Most of the popular mobile health applications focus on fitness and self-monitoring. The approaches to user engagement utilized by these applications are limited and present an opportunity to improve the effectiveness of the technology.

Sanchez, Amy H.; Lavaysse, Lindsey M.; Starr, Jessica N.; Gard, David E. (2014): Daily life evidence of environment-incongruent emotion in schizophrenia. In: Psychiatry Res. DOI: 10.1016/j.psychres.2014.07.041.

Researchers have recently hypothesized that negative emotion in positive situations may be one mechanism for understanding emotion dysfunction in schizophrenia. Using ecological momentary assessment, we examined the relationship between emotion experience and environmental context in the daily lives of participants with and without schizophrenia. Participants with (n=47) and without schizophrenia (n=41) were provided a cellular telephone and called four times a day for one week. During each call participants rated their emotion experiences, described their current activities, and rated enjoyment from those activities. In line with previous research, participants with schizophrenia reported higher negative emotion overall relative to participants without schizophrenia, but equivalent levels of positive emotion and activity enjoyment. In line with the environment-incongruent negative emotion hypothesis, participants with schizophrenia evidenced a weaker relationship between reported enjoyment of current activities and current negative emotion compared to participants without schizophrenia. In addition, lower neurocognition predicted this weak relationship between negative emotion and context in the schizophrenia group. These findings provide ecologically valid support for environment-incongruent negative emotion in schizophrenia, and suggest that people with schizophrenia with more impaired neurocognition may have more difficulties regulating negative emotion.

Santangelo, Philip; Reinhard, Iris; Mussgay, Lutz; Steil, Regina; Sawitzki, Günther; Klein, Christoph et al. (2014): Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. In: Journal of Abnormal Psychology 123 (1), S. 258–272. DOI: 10.1037/t02080-000;

Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses.

Sartori, Raffaela D G; Marelli, Marco; Garavaglia, Paolo; Castelli, Lucia; Busin, Silvano; Delle Fave, Antonella (2014): The assessment of patients’ quality of experience: autonomy level and perceived challenges. In: Rehabil Psychol 59 (3), S. 267–277. DOI: 10.1037/a0036519.

PURPOSE/OBJECTIVE: Motor rehabilitation programs in hospital aim at promoting patients’ highest attainable recovery of body functions and capabilities. Well-being is predominantly identified with physical autonomy, yet the psychological dimensions of rehabilitation are often overlooked. RESEARCH METHOD/DESIGN: To partially fill this gap, the quality of daily experience reported by 50 adult participants hospitalized in an Italian rehabilitation unit was investigated. Data were gathered through Experience Sampling Method, (ESM), providing repeated real-time assessments of the experience associated with daily activities. Before analysis, participants were divided into 3 groups, according to their low, moderate, or high levels of autonomy assessed through Barthel Index. RESULTS: Participants predominantly associated rehabilitation activities with optimal experience, characterized by high concentration, engagement, control of the situation, and by the perception of high challenges matched with adequate personal skills. During personal care and leisure-the most frequent daily activities-participants reported instead low challenging experiences of apathy and boredom. During social interactions perceived high challenges prevailed. Multilevel analysis showed that the type of activity performed was a significant predictor of participants’ quality of experience, and the level of autonomy had a modest impact on it. CONCLUSIONS/IMPLICATIONS: Results highlighted the potential added value of rehabilitation tasks as opportunities to promote patients’ well-being. The predominantly negative experiences associated with the other daily activities point instead to the need for changes in hospital organization in order to more effectively promote patients’ autonomy and resource mobilization.

Schott, Timm Cornelius; Ludwig, Bjorn (2014): Microelectronic wear-time documentation of removable orthodontic devices detects heterogeneous wear behavior and individualizes treatment planning. In: Am J Orthod Dentofacial Orthop 146 (2), S. 155–160. DOI: 10.1016/j.ajodo.2014.04.020.

INTRODUCTION: The aim of this study was to investigate whether microelectronic wear-time documentation can contribute to individualized orthodontic management. METHODS: The wear times and behaviors of 281 patients undergoing orthodontic treatment with removable appliances were quantified and analyzed using the TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) over a 6-month treatment period. RESULTS: The 281 study participants wore their removable appliances for a median of 9.0 hours per day, compared with the 12 to 15 hours per day prescribed. Wear behavior was variable and heterogeneous in patients with almost identical median wear times, with fluctuating and numerous zero wear-time periods observed. CONCLUSIONS: Both the duration of daily wear time and the wear behavior need to be considered to individualize the prescription for wear time; this is made possible with microelectronic wear-time documentation. Individual prescription changes based on the wear-time documentation can be arranged with patients in a shared decision-making process to achieve effective and successful treatment progress.

Schwerdtfeger, Andreas R.; Gerteis, Ann Kathrin S. (2014): The manifold effects of positive affect on heart rate variability in everyday life: Distinguishing within-person and between-person associations. In: Health Psychology 33 (9), S. 1065–1073. DOI: 10.1037/t03592-000.

Objective: Positive affect (PA) has been related to better health. However, the biological pathways underlying this link are not well understood. Different facets of PA (e.g., low activated vs. high activated) and both state and trait PA might have different effects on physiology. Method: This study aimed to relate low- and high-activated facets of momentary assessed (i.e., state) and aggregated (i.e., trait-like) PA to cardiac vagal tone (heart rate variability; HRV) in everyday life (N = 122, with 3 successive recording days). Results: Aggregated activated PA was associated with higher ambulatory HRV, whereas activated momentary PA was accompanied by lower HRV. Moreover, momentary deactivated PA was accompanied by higher HRV, but aggregated deactivated PA was not. Findings were independent of negative affect and various other demographic and behavioral confounds. Conclusions: Together the findings suggest a more complex picture of the health-related effects of PA. Whereas state-related fluctuations in PA seem to exert both activating and deactivating effects on the heart, activated PA on an aggregated level seems to dampen cardiac arousal, thus suggesting beneficial effects for health.

Scott, Stacey B.; Sliwinski, Martin J.; Mogle, Jacqueline A.; Almeida, David M. (2014): Age, stress, and emotional complexity: Results from two studies of daily experiences. In: Psychol Aging 29 (3), S. 577–587. DOI: 10.1037/a0037282.

Experiencing positive and negative emotions together (i.e., co-occurrence) has been described as a marker of positive adaptation during stress and a strength of socioemotional aging. Using data from daily diary (N = 2,022; ages 33-84) and ecological momentary assessment (N = 190; ages 20-80) studies, we evaluate the utility of a common operationalization of co-occurrence, the within-person correlation between positive affect (PA) and negative affect (NA). Then we test competing predictions regarding when co-occurrence will be observed and whether age differences will be present. Results indicate that the correlation is not an informative indicator of co-occurrence. Although correlations were stronger and more negative when stressors occurred (typically interpreted as lower co-occurrence), objective counts of emotion reports indicated that positive and negative emotions were 3 to 4 times more likely to co-occur when stressors were reported. This suggests that co-occurrence reflects the extent to which negative emotions intrude on typically positive emotional states, rather than the extent to which people maintain positive emotions during stress. The variances of both PA and NA increased at stressor reports, indicating that individuals reported a broader not narrower range of emotion during stress. Finally, older age was associated with less variability in NA and a lower likelihood of co-occurring positive and negative emotions. In sum, these findings cast doubt on the utility of the PA-NA correlation as an index of emotional co-occurrence, and question notion that greater emotional co-occurrence represents either a typical or adaptive emotional state in adults.

Sharp, Darren B.; Allman-Farinelli, Margaret (2014): Feasibility and validity of mobile phones to assess dietary intake. In: Nutrition 30 (11-12), S. 1257–1266. DOI: 10.1016/j.nut.2014.02.020.

Current limitations of conventional dietary assessment methods restrict the establishment of diet-disease relationships and efficacy of dietary interventions. Technology, in particular the use of mobile phones, may help resolve methodologic limitations, in turn improving the validity of dietary assessment and research and associated findings. This review aims to evaluate the validity, feasibility, and acceptability of dietary assessment methods that have been deployed on mobile phone platforms. In August 2013, electronic databases for health sciences were searched for English, peer-reviewed, full-text articles, published from January 1, 2001 onward; and accompanied by a hand search of available relevant publications from universities and government bodies. Studies were not limited by design, length, setting, or population group. Of 194 articles, 12 met eligibility criteria: mobile phone as the dietary recording platform and validation of energy and/or macronutrient intake against another dietary or biological reference method. Four dietary recoding methods had been validated on mobile phone platforms: electronic food diary, food photograph-assisted self-administered, 24 h recall, food photograph analysis by trained dietitians, and automated food photograph analysis. All mobile phone dietary assessment methods showed similar, but not superior, validity or reliability when compared with conventional methods. Participants’ satisfaction and preferences for mobile phone dietary assessment methods were higher than those for conventional methods, indicating the need for further research. Validity testing in larger and more diverse populations, over longer durations is required to evaluate the efficacy of these methods in dietary research.

Shin, Hangsik; Cho, Jaegeol (2014): Unconstrained snoring detection using a smartphone during ordinary sleep. In: Biomed Eng Online 13, S. 116. DOI: 10.1186/1475-925X-13-116.

BACKGROUND: Snoring can be a representative symptom of a sleep disorder, and thus snoring detection is quite important to improving the quality of an individual’s daily life. The purpose of this research is to develop an unconstrained snoring detection technique that can be integrated into a smartphone application. In contrast with previous studies, we developed a practical technique for snoring detection during ordinary sleep by using the built-in sound recording system of a smartphone, and the recording was carried out in a standard private bedroom. METHOD: The experimental protocol was designed to include a variety of actions that frequently produce noise (including coughing, playing music, talking, rining an alarm, opening/closing doors, running a fan, playing the radio, and walking) in order to accurately recreate the actual circumstances during sleep. The sound data were recorded for 10 individuals during actual sleep. In total, 44 snoring data sets and 75 noise datasets were acquired. The algorithm uses formant analysis to examine sound features according to the frequency and magnitude. Then, a quadratic classifier is used to distinguish snoring from non-snoring noises. Ten-fold cross validation was used to evaluate the developed snoring detection methods, and validation was repeated 100 times randomly to improve statistical effectiveness. RESULTS: The overall results showed that the proposed method is competitive with those from previous research. The proposed method presented 95.07% accuracy, 98.58% sensitivity, 94.62% specificity, and 70.38% positive predictivity. CONCLUSION: Though there was a relatively high false positive rate, the results show the possibility for ubiquitous personal snoring detection through a smartphone application that takes into account data from normally occurring noises without training using preexisting data.

Shiyko, Mariya P.; Burkhalter, Jack; Li, Runze; Park, Bernard J. (2014): Modeling nonlinear time-dependent treatment effects: An application of the generalized time-varying effect model (TVEM). In: Journal of Consulting and Clinical Psychology 82 (5), S. 760–772.

Objective: The goal of this article is to introduce to social and behavioral scientists the generalized time-varying effect model (TVEM), a semiparametric approach for investigating time-varying effects of a treatment. The method is best suited for data collected intensively over time (e.g., experience sampling or ecological momentary assessments) and addresses questions pertaining to effects of treatment changing dynamically with time. Thus, of interest is the description of timing, magnitude, and (nonlinear) patterns of the effect. Method: Our presentation focuses on practical aspects of the model. A step-by-step demonstration is presented in the context of an empirical study designed to evaluate effects of surgical treatment on quality of life among early stage lung cancer patients during posthospitalization recovery (N = 59; 61% female, M age = 66.1 years). Frequency and level of distress associated with physical symptoms were assessed twice daily over a 2-week period, providing a total of 1,544 momentary assessments. Results: Traditional analyses (analysis of covariance [ANCOVA], repeated-measures ANCOVA, and multilevel modeling) yielded findings of no group differences. In contrast, generalized TVEM identified a pattern of the effect that varied in time and magnitude. Group differences manifested after Day 4. Conclusions: Generalized TVEM is a flexible statistical approach that offers insight into the complexity of treatment effects and allows modeling of nonnormal outcomes. The practical demonstration, shared syntax, and availability of a free set of macros aim to encourage researchers to apply TVEM to complex data and stimulate important scientific discoveries.

Shrier, Lydia A.; Scherer, Emily Blood (2014): It depends on when you ask: Motives for using marijuana assessed before versus after a marijuana use event. In: Addict Behav 39 (12), S. 1759–1765. DOI: 10.1016/j.addbeh.2014.07.018.

BACKGROUND: Marijuana use motives are typically evaluated retrospectively using measures that summarize or generalize across episodes of use, which may compromise validity. Using Ecological momentary assessment data, we examined the main reason for a specific marijuana use event measured both prospectively and retrospectively. We then determined reason types, event characteristics, and user characteristics that predicted change in reason. METHODS: Thirty-six medical outpatients age 15 to 24 years who used marijuana two times a week or more used a handheld computer to select their main reason for use from the five categories of the Marijuana Motives Measure (Simons, Correia, & Carey, 1998) just before and after each time they used marijuana over two weeks (n=263 events with before/after reason). The reasons were examined individually and according to dimensions identified in motivational models of substance use (positive/negative, internal/external). RESULTS: The reason assessed before use changed to a different reason after use for 20% of events: 10% of events for pleasure; 21%, to cope; 35%, to be more social; 55%, to expand my mind; and 100%, to conform. In the multivariable model, external and expansion reasons each predicted change in reason for use (p<0.0001 and p=0.001, respectively). Youth were also more likely to change their reason if older (p=0.04), if male (p=0.02), and with weekend use (p=0.002). CONCLUSION: Retrospective assessments of event-specific motives for marijuana use may be unreliable and therefore invalid for a substantial minority of events, particularly if use is for external or expansion reasons.

Skirrow, C.; Ebner-Priemer, U.; Reinhard, I.; Malliaris, Y.; Kuntsi, J.; Asherson, P. (2014): Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability. In: Psychol Med, S. 1–13. DOI: 10.1017/S0033291714001032.

BACKGROUND: Emotional lability (EL), characterized by negative emotional traits and emotional instability, is frequently reported in children and adults with attention deficit hyperactivity disorder (ADHD). However, EL is primarily assessed using retrospective self-report, which is subject to reporting bias and does not consider the potential influence of positive and negative everyday experiences. METHOD: Ambulatory assessment was carried out in 41 men with ADHD without co-morbidity, current medication or substance abuse, and 47 healthy control participants. Reports of negative and positive emotions (irritability, frustration, anger, happiness, excitement) and the occurrence of bad and good events were completed eight times daily during a working week. Group differences in emotional intensity and instability were investigated using multilevel models, and explored in relation to bad and good events and the Affective Lability Scale - Short Form (ALS-SF), an EL questionnaire. RESULTS: The ADHD group reported significantly more frequent bad events, heightened intensity and instability of irritability and frustration, and greater intensity of anger. The results for positive emotions were equivocal or negative. Bad events significantly contributed to the intensity and instability of negative emotions, and showed a stronger influence in the ADHD group. However, covariation for their effect did not eliminate group differences. Small-to-moderate correlations were seen between intensity and instability of negative emotions and the ALS-SF. CONCLUSIONS: Adults with ADHD report heightened intensity and instability of negative emotions in daily life. The results suggest two components of EL in ADHD: a reactive component responsive to bad events and an endogenous component, independent of negative everyday events.

Smyth, Joshua M.; Zawadzki, Matthew J.; Santuzzi, Alecia M.; Filipkowski, Kelly B. (2014): Examining the effects of perceived social support on momentary mood and symptom reports in asthma and arthritis patients. In: Psychology & Health 29 (7), S. 813–831. DOI: 10.1037/t29468-000.

Objective: Social support has been linked to beneficial effects on health directly (main effect) and as a buffer to stress. Most research, however, has examined these relationships using global and retrospective assessments of health and stress, which may be subject to recall biases. This study used ambulatory ecological momentary assessment (EMA) methods to test the main and stress-buffering effects of social support on the daily health and well-being of asthma and rheumatoid arthritis (RA) patients.Design: Community volunteers with asthma (n = 97) or RA (n = 31) responded to EMA prompts five times daily for one week.Main outcomes: Baseline perceived social support was obtained, and then, participants reported mood, stress and symptoms using EMA. Multilevel mixed-modeling examined whether social support predicted mood and symptoms directly or via stress-reducing effects.Results: Supporting a main effect, more perceived social support predicted decreased negative mood and stress severity. Supporting a stress-buffering effect, more perceived social support resulted in fewer reported symptoms when stress was present.Conclusion: Results suggest perceived social support directly relates to better ambulatory status and dynamically buffers individuals against the negative effects of stressors, and highlight the importance of studying social support across different temporal and contextual levels.

Sokolovsky, Alexander W.; Mermelstein, Robin J.; Hedeker, Donald (2014): Factors predicting compliance to ecological momentary assessment among adolescent smokers. In: Nicotine & Tobacco Research 16 (3), S. 351–358. DOI: 10.1037/t02942-000.

Introduction: Ecological momentary assessments (EMAs) are increasingly used in smoking research to understand contextual and individual differences related to smoking and changes in smoking. To date, there has been little detailed research into the predictors of EMA compliance. However, patterns or predictors of compliance may affect key relationships under investigation and introduce sources of bias in results. The purpose of this study was to investigate predictors of compliance to random prompts among a sample of adolescents who had ever smoked. Methods: Data for this study were drawn from a sample of 461 adolescents (9th and 10th graders at baseline) participating in a longitudinal study of smoking escalation. We examined 2 outcomes: subject-level EMA compliance (overall rate of compliance over a week-long EMA wave), and in-the-moment prompt-level compliance to the most proximal random prompt. We investigated several covariates including gender, race, smoking rate, alcohol use, psychological symptomatology, home composition, mood, social context, time in study, inter-prompt interval, and location. Results: At the overall subject level, higher mean negative affect, smoking rate, alcohol use, and male gender predicted lower compliance with random EMA prompts. At the prompt level, after controlling for significant subject-level predictors of compliance, increased positive affect, being outside of the home, and longer inter-prompt interval predicted lower momentary compliance. Conclusions: This study identifies several factors associated with overall and momentary EMA compliance among a sample of adolescents participating in a longitudinal study of smoking. We also propose a conceptual framework for investigating the contextual and momentary predictors of compliance within EMA studies.

Tay, Louis; Chan, David; Diener, Ed (2014): The metrics of societal happiness. In: Social Indicators Research 117 (2), S. 577–600.

Growing interest in the measurement of subjective well-being (SWB) has also been accompanied by scientific debate on the optimal method for measuring SWB. The momentary perspective, which is represented by the ecological momentary assessment (EMA) and day reconstruction method (DRM), emphasizes the momentary experiences and aims to measure SWB in an objective manner via the aggregation of happiness levels over time and activities. The global reporting perspective emphasizes the subjective evaluation of life experiences and aims to capture the overall evaluation using retrospection or global evaluations. We discuss the strengths and weaknesses of these different perspectives and methods by examining conceptual, methodological, and practical issues. We propose adopting a multi-method assessment approach to SWB that uses both perspectives and the corresponding methods in a theory-driven and complementary manner. For the purposes of measuring and tracking SWB of societies, we also call for more research on the reliability and validity of EMA and DRM.

Thompson, Wesley K.; Gershon, Anda; O’Hara, Ruth; Bernert, Rebecca A.; Depp, Colin A. (2014): The prediction of study‐emergent suicidal ideation in bipolar disorder: A pilot study using ecological momentary assessment data. In: Bipolar Disorders.

Objectives Bipolar disorder is associated with idiosyncratic precursors of clinically important states such as suicidal ideation. Ecological momentary assessment (EMA) – high frequency data collection in a subject’s usual environment – provides the potential for development of temporal, individualized prediction of risk states. The present study tested the ability of EMA data to predict individual symptom change in clinician‐rated suicidal ideation. Methods Thirty‐five adults diagnosed with inter‐episode bipolar disorder completed daily measures of affect in their home environments using diaries administered over an eight‐week assessment timeline. Suicidal ideation was assessed monthly at in‐person visits using the Inventory of Depressive Symptomatology–Clinician Rated. We used a novel application of functional linear models (FLMs) to generate prospective predictions of suicidal ideation at in‐person clinician assessments based on intensively sampled trajectories of daily affect. Results Eight instances of suicidal ideation scores > 0 were recorded during the study period on six participants. Utilizing trajectories of negative and positive affect, cross‐validated predictions attained 88% sensitivity with 95% specificity for elevated suicidal ideation one week prior to in‐person clinician assessment. This model strongly outperformed prediction models using cross‐sectional data obtained at study visits alone. Conclusions Utilizing EMA data with FLM prediction models substantially increases the accuracy of prediction of study‐emergent suicidal ideation. Prediction algorithms employing intensively sampled longitudinal EMA data could sensitively detect the warning signs of suicidal ideation to facilitate improved suicide risk assessment and the timely delivery of preventative interventions.

Tobin, Erin T.; Kane, Heidi S.; Saleh, Daniel J.; Naar-King, Sylvie; Poowuttikul, Pavadee; Secord, Elizabeth et al. (2014): Naturalistically Observed Conflict and Youth Asthma Symptoms. In: Health Psychology.

Objective: To investigate the links between naturalistically observed conflict, self-reported caregiver−youth conflict, and youth asthma symptoms. Method: Fifty-four youth with asthma (age range: 10–17 years) wore the Electronically Activated Recorder (EAR) for a 4-day period to assess interpersonal conflict and caregiver−youth conflict as they occur in daily life. Conflict also was assessed with baseline self-report questionnaires and daily diaries completed by youth participants and their caregivers. Asthma symptoms were assessed using daily diaries, baseline self-reports, and wheezing, as coded from the EAR. Results: EAR-observed measures of conflict were strongly associated with self-reported asthma symptoms (both baseline and daily diaries) and wheezing coded from the EAR. Further, when entered together in regression analyses, youth daily reports of negative caregiver−youth interactions and EAR-observed conflict uniquely predicted asthma symptoms; only EAR-observed conflict was associated with EAR-observed wheezing. Conclusion: These findings demonstrate the potential impact of daily conflict on youth asthma symptoms and the importance of assessing conflict as it occurs in everyday life. More broadly, they point to the importance of formulating a clear picture of family interactions outside of the lab, which is essential for understanding how family relationships “get under the skin” to affect youth health.

Tomko, Rachel L.; Solhan, Marika B.; Carpenter, Ryan W.; Brown, Whitney C.; Jahng, Seungmin; Wood, Phillip K.; Trull, Timothy J. (2014): Measuring impulsivity in daily life: The Momentary Impulsivity Scale. In: Psychological Assessment 26 (2), S. 339–349.

Impulsivity is a core feature of many psychiatric disorders. Traditionally, impulsivity has been assessed using retrospective questionnaires or laboratory tasks. Both approaches neglect intraindividual variability in impulsivity and do not capture impulsivity as it occurs in real-world settings. The goal of the current study was to provide a method for assessing impulsivity in daily life that provides both between-individual and within-individual information. Participants with borderline personality disorder (BPD; n = 67) or a depressive disorder (DD; n = 38) carried an electronic diary for 28 days and responded to 9 impulsivity items up to 6 times per day. Item distributions and iterative exploratory factor analysis (EFA) results were examined to select the items that best captured momentary impulsivity. A brief 4-item scale was created that can be used for the assessment of momentary impulsivity. Model fit was good for both within- and between-individual EFA. As expected, the BPD group showed significantly higher scores on our Momentary Impulsivity Scale than the DD group, and the resulting scale was moderately correlated with common trait impulsivity scales.

Waller, Jennifer M.; Silk, Jennifer S.; Stone, Lindsey B.; Dahl, Ronald E. (2014): Co-rumination and co-problem solving in the daily lives of adolescents with major depressive disorder. In: J Am Acad Child Adolesc Psychiatry 53 (8), S. 869–878. DOI: 10.1016/j.jaac.2014.05.004.

OBJECTIVE: This study examines differences in the prevalence and nature of co-rumination during real-world social interactions with peers and parents among adolescents with major depressive disorder (MDD) compared to healthy controls. METHOD: A total of 60 youth (29 with current MDD and 31 controls without psychopathology) completed a self-report measure of co-rumination and a 3-week ecological momentary assessment (EMA) protocol that measured the nature of face-to-face social interactions with peers and parents after a negative event in the adolescents’ daily lives. Specifically, EMA was used to assess rates of problem talk, including both co-rumination and co-problem solving. Group differences in self-report and EMA measures were examined. RESULTS: Adolescents with MDD reported co-ruminating more often than adolescents with no Axis 1 disorders during daily interactions with both parents (Cohen’s d = 0.78) and peers (d = 1.14), and also reported more co-rumination via questionnaire (d = 0.58). Adolescents with MDD engaged in co-problem solving with peers less often than did healthy controls (d = 0.78), but no group differences were found for rates of co-problem solving with parents. CONCLUSIONS: Results are consistent with previous research linking co-rumination and depression in adolescence and extend these self-report-based findings to assessment in an ecologically valid context. Importantly, the results support that MDD youth tend to co-ruminate more and to problem-solve less with peers in their daily lives compared to healthy youth, and that co-rumination also extends to parental relationships. Interventions focused on decreasing co-rumination with peers and parents and improving problem-solving skills with peers may be helpful for preventing and treating adolescent depression.

Waters, Andrew J.; Szeto, Edwin H.; Wetter, David W.; Cinciripini, Paul M.; Robinson, Jason D.; Li, Yisheng (2014): Cognition and craving during smoking cessation: An ecological momentary assessment study. In: Nicotine & Tobacco Research 16 (Supp2), S. S111. DOI: 10.1037/t05449-000;

Introduction: Some studies using ecological momentary assessment (EMA) have revealed an association between craving for cigarettes and relapse. It is therefore important to understand the correlates of craving during smoking cessation. Attentional bias to smoking cues is a potential correlate of craving, but it has not previously been assessed using EMA during smoking cessation. Methods: Smokers enrolled in a research smoking cessation study were offered the opportunity to take part in an EMA study. Volunteers carried around a personal digital assistant (PDA) for the first week of their quit attempt. They completed up to 4 random assessments (RAs) per day as well as assessments when they experienced a temptation to smoke and when they relapsed. Craving for cigarettes was assessed with a single item (1–7 scale). Attentional bias was assessed with a smoking Stroop task (a reaction time task) at every other assessment, as was self-reported attention to cigarettes. Results: Data were available from 119 participants. Across 882 assessments, participants exhibited a significant smoking Stroop effect. Linear mixed models revealed a significant between-subject association between craving and the smoking Stroop effect. Individuals with higher levels of craving exhibited greater attentional bias. The within-subject association was not significant. Similar results were obtained for the relationship between self-reported attention to cigarettes and attentional bias. Conclusions: Attentional bias can be assessed in the natural environment using EMA during smoking cessation, and attentional bias is a correlate of craving during the early stages of a quit attempt.

Wharton, Christopher M.; Johnston, Carol S.; Cunningham, Barbara K.; Sterner, Danielle (2014): Dietary self-monitoring, but not dietary quality, improves with use of smartphone app technology in an 8-week weight loss trial. In: J Nutr Educ Behav 46 (5), S. 440–444. DOI: 10.1016/j.jneb.2014.04.291.

OBJECTIVE: Dietary self-monitoring is linked to improved weight loss success. Mobile technologies, such as smartphone applications (apps), might allow for improved dietary tracking adherence. The authors assessed the use of a popular smartphone app for dietary self-monitoring and weight loss by comparing it with traditional diet counseling and entry methods. METHODS: Diet tracking and weight loss were compared across participants during an 8-week weight loss trial. Participants tracked intake using 1 of 3 methods: the mobile app “Lose It!”, the memo feature on a smartphone, or a traditional paper-and-pencil method. RESULTS: App users (n = 19) recorded dietary data more consistently compared with the paper-and-pencil group (n = 15; P = .042) but not the memo group (n = 13). All groups lost weight over the course of the study (P = .001), and no difference in weight loss was noted between groups. CONCLUSIONS AND IMPLICATIONS: Smartphone apps could represent a novel and feasible dietary self-monitoring method for individuals.

Winters, Meghan; Voss, Christine; Ashe, Maureen C.; Gutteridge, Kaitlyn; McKay, Heather; Sims-Gould, Joanie (2014): Where do they go and how do they get there? Older adults’ travel behaviour in a highly walkable environment. In: Soc Sci Med. DOI: 10.1016/j.socscimed.2014.07.006.

Mobility-the ability to move about in one’s neighbourhood and maintain independence-is essential for older adults’ wellbeing. Neighbourhood environments support or hinder mobility especially as health declines and physical vulnerability increases with age. Linkages between mobility and planning and policy are key to designing age-friendly neighbourhoods with destinations that encourage older adults to get out and be physically active. We describe the mobility of older adults who live in a highly walkable neighbourhood. Specifically, we address the questions of ‘where do older adults go?’ (destinations) and ‘how they get there?’ (travel mode, physical activity). We recruited older adults (age 60+) who live in Vancouver’s downtown core, an area acknowledged to be highly walkable (Walk Score(R): 94-97/100), and who leave their houses most days of the week. Participants (n = 184) recorded travel in diaries and wore an ActiGraph GT3X + accelerometer for 7 days during September to October 2012. We classified reported destinations according to the North American Industry Classification System, and analysed mobility [trip rates (overall and walking), steps, moderate to vigorous physical activity (MVPA)] and associations between travel and physical activity-related mobility measures. Key destinations were grocery stores (13.6% of trips), restaurants (7.2%), malls/marketplaces (5.5%), and others’ homes (5.4%). Participants made 4.6 (std: 2.5) one-way trips/day, took 7910.1 (3871.1) steps/day, and accrued 39.2 (32.9) minutes/day of MVPA. Two-thirds of trips were by active modes (62.8% walk, 3.2% bike) and 22.4% were by car. Trip rates were significantly associated with physical activity outcomes. Older adults living in highly walkable neighbourhoods were very mobile and frequently used active transportation. Travel destinations signify the importance of nearby commercial and social opportunities, even in a highly walkable environment. The high rates of active travel and physical activity in a walkable neighbourhood suggest that when provided compelling destinations, community dwelling older adults walk more and may achieve health benefits through daily travel.

Witkiewitz, Katie; Desai, Sruti A.; Bowen, Sarah; Leigh, Barbara C.; Kirouac, Megan; Larimer, Mary E. (2014): Development and evaluation of a mobile intervention for heavy drinking and smoking among college students. In: Psychol Addict Behav 28 (3), S. 639–650. DOI: 10.1037/a0034747.

Nearly all college student smokers also drink alcohol, and smoking and heavy episodic drinking (HED) commonly co-occur. However, few studies have examined the factors that concurrently influence smoking and HED among college students and, to date, no interventions have been developed that target both HED and smoking in this population. The objective of the current study was to develop and evaluate a mobile feedback intervention that targets HED and smoking. Participants (N = 94) were non-treatment-seeking college students (Mage = 20.5 years, SD = 1.7) who engaged in at least a single HED episode in the past 2 weeks and reported concurrent smoking and drinking at least once a week. Participants were randomized to receive either the mobile intervention for 14 days, complete mobile assessments (without intervention) for 14 days, or complete minimal assessments (without intervention or mobile assessments). At a 1-month follow-up, compared with the minimal assessment condition, we observed significant reductions in the number of cigarettes per smoking day in both the mobile intervention (d = 0.55) and mobile assessment (d = 0.45) conditions. Among those randomized to the mobile intervention, receiving more modules of the intervention was significantly associated with a lower likelihood of any drinking during the 14-day assessment period and significant reductions in smoking at 1-month follow-up. The mobile intervention did not result in significant reductions in HED or concurrent smoking and drinking. Future research should continue to examine ways of using technology and the real-time environment to improve interventions for HED and smoking.

Wonderlich, Joseph A.; Lavender, Jason M.; Wonderlich, Stephen A.; Peterson, Carol B.; Crow, Scott J.; Engel, Scott G. et al. (2014): Examining convergence of retrospective and ecological momentary assessment measures of negative affect and eating disorder behaviors. In: International Journal of Eating Disorders.

ABSTRACT Objective Data gathered via retrospective forms of assessment are subject to various recall biases. Ecological momentary assessment (EMA) is an alternative approach involving repeated momentary assessments within a participant’s natural environment, thus reducing recall biases and improving ecological validity. EMA has been used in numerous prior studies examining various constructs of theoretical relevance to eating disorders. Method This investigation includes data from three previously published studies with distinct clinical samples: (a) women with anorexia nervosa (N = 118), (b) women with bulimia nervosa (N = 133), and (c) obese men and women (N = 50; 9 with current binge eating disorder). Each study assessed negative affective states and eating disorder behaviors using traditional retrospective assessments and EMA. Spearman rho correlations were used to evaluate the concordance of retrospective versus EMA measures of affective and/or behavioral constructs in each sample. Bland–Altman plots were also used to further evaluate concordance in the assessment of eating disorder behaviors. Results There was moderate to strong concordance for the measures of negative affective states across all three studies. Moderate to strong concordance was also found for the measures of binge eating and exercise frequency. The strongest evidence of concordance across measurement approaches was found for purging behaviors. Discussion Overall, these preliminary findings support the convergence of retrospective and EMA assessments of both negative affective states and various eating disorder behaviors. Given the advantages and disadvantages associated with each of these assessment approaches, the specific questions being studied in future empirical studies should inform decisions regarding selection of the most appropriate method. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014)

Zenk, Shannon N.; Horoi, Irina; McDonald, Ashley; Corte, Colleen; Riley, Barth; Odoms-Young, Angela M. (2014): Ecological momentary assessment of environmental and personal factors and snack food intake in African American women. In: Appetite. DOI: 10.1016/j.appet.2014.09.008.

This study examined contributions of environmental and personal factors (specifically, food availability and expense, daily hassles, self-efficacy, positive and negative affect) to within-person and between-person variations in snack food intake in 100 African American women. Participants were signaled at random five times daily for seven days to complete a survey on a study-provided smartphone. Women reported consuming snack foods at 35.2% of signals. Easier food availability accounting for one’s usual level was associated with higher snack food intake. Being near outlets that predominately sell snacks (e.g., convenience stores), while accounting for one’s usual proximity to them, was associated with higher snack food intake. Accounting for one’s usual daily hassle level, we found that on days with more frequent daily hassles snack food intake was higher. The positive association between within-person daily hassles frequency and snack food intake was stronger when foods were easily available. Public and private policies to curb ubiquitous food availability and mobile health interventions that take into account time-varying influences on food choices and provide real-time assistance in dealing with easy food availability and coping with stressors may be beneficial in improving African American women’s day to day food choices.

Zhang, Melvyn Wb; Ho, Cyrus Sh; Fang, Pan; Lu, Yanxia; Ho, Roger Cm (2014): Usage of social media and smartphone application in assessment of physical and psychological well-being of individuals in times of a major air pollution crisis. In: JMIR Mhealth Uhealth 2 (1), S. e16. DOI: 10.2196/mhealth.2827.

BACKGROUND: Crisis situations bring about many challenges to researchers, public institutions, and governments in collecting data and conducting research in affected individuals. Recent developments in Web-based and smartphone technologies have offered government and nongovernment organizations a new system to disseminate and acquire information. However, research into this area is still lacking. The current study focuses largely on how new social networking websites and, in particular, smartphone technologies could have helped in the acquisition of crucial research data from the general population during the recent 2013 Southeast Asian Haze. This crisis lasted only for 1 week, and is unlike other crisis where there are large-scale consequential after-effects. OBJECTIVE: To determine whether respondents will make use of Internet, social media, and smartphone technologies to provide feedback regarding their physical and psychological wellbeing during a crisis, and if so, will these new mechanisms be as effective as conventional, technological, Internet-based website technologies. METHODS: A Web-based database and a smartphone application were developed. Participants were recruited by snowball sampling. The participants were recruited either via a self-sponsored Facebook post featuring a direct link to the questionnaire on physical and psychological wellbeing and also a smartphone Web-based application; or via dissemination of the questionnaire link by emails, directed to the same group of participants. Information pertaining to physical and psychological wellbeing was collated. RESULTS: A total of 298 respondents took part in the survey. Most of them were between the ages of 20 to 29 years and had a university education. More individuals preferred the option of accessing and providing feedback to a survey on physical and psychological wellbeing via direct access to a Web-based questionnaire. Statistical analysis showed that demographic variables like age, gender, and educational levels did not influence the mechanism of access. In addition, the participants reported a mean number of 4.03 physical symptoms (SD 2.6). The total Impact of Event Scale-Revised (IES-R) score was 18.47 (SD 11.69), which indicated that the study population did experience psychological stress but not post-traumatic stress disorder. The perceived dangerous Pollutant Standards Index (PSI) level and the number of physical symptoms were associated with higher IES-R Score (P<.05). CONCLUSIONS: This is one of the first few studies demonstrating the use of Internet in data collection during an air-pollution crisis. Our results demonstrated that the newer technological modalities have the potential to acquire data, similar to that of conventional technologies. Demographic variables did not influence the mechanism of usage. In addition, our findings also suggested that there are acute physical and psychological impacts on the population from an air-pollution crisis.

Zielke, Desiree Joy (2014): Ecological momentary assessment versus traditional retrospective self-reports as predictors of health-relevant outcomes. In: Dissertation Abstracts International: Section B: The Sciences and Engineering 74 (7-B(E)).

Ecological momentary assessment (EMA) has been asserted by proponents of the technique as being superior to standard paper-and-pencil measurements in terms of the reliability and validity of the information obtained; however, this claim has not yet been fully evaluated in the literature. Accordingly, the purpose of this study was to evaluate one aspect of this assertion by comparing the utility of EMA and retrospective measures of depressive symptoms in predicting health-relevant biological and behavioral outcomes. It was hypothesized that (1) the EMA measure will have better predictive utility when examining objective sleep quality (a biological outcome), and that (2) the retrospective measure will have better predictive utility when examining blood donation intention (a behavioral outcome). Ninety-six undergraduate females participated in this 2-week study. Depressive symptoms were measured momentarily and retrospectively using the Center for Epidemiological Studies-Depression Scale (CES-D). The biological outcome was assessed by actigraphy, whereas the behavioral outcome was measured via a self-report questionnaire. Unfortunately, it was not possible to fully test these hypotheses due to the failure to observe relationships between the predictor variables and the outcomes. The reported results, although limited, did not provide support for the hypotheses. Supplemental analyses revealed a moderate to high amount of shared variance between the EMA and retrospective measures, a similar extent of random error in both measures, and potentially a greater degree of systematic error in the retrospective measure. Due to the paucity of literature examining the claim of superior reliability and validity of EMA versus retrospective measures, as well as the failure of the current study to evaluate this assertion sufficiently, it appears that this claim remains unfounded. Therefore, suggestions for future research are provided.

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