title: Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore.
abstract: BACKGROUND
  Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations.
  
  
  OBJECTIVE
  We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore.
  
  
  METHODS
  Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants' location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants' self-reported episodes of drinking.
  
  
  RESULTS
  A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score ≥16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable.
  
  
  CONCLUSIONS
  This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings.
authors.affiliation: Johns Hopkins School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, United States. cyang29@jhu.edu.
authors.forename: Cui
authors.identifier: http://orcid.org/0000-0003-0144-2575
authors.initials: C
authors.lastname: Yang
authors.forename: Beth
authors.identifier: http://orcid.org/0000-0002-0058-5147
authors.initials: B
authors.lastname: Linas
authors.forename: Gregory
authors.identifier: http://orcid.org/0000-0002-7829-1405
authors.initials: G
authors.lastname: Kirk
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-6798-6834
authors.initials: R
authors.lastname: Bollinger
authors.forename: Larry
authors.identifier: http://orcid.org/0000-0002-7005-5512
authors.initials: L
authors.lastname: Chang
authors.forename: Geetanjali
authors.identifier: http://orcid.org/0000-0002-2216-6330
authors.initials: G
authors.lastname: Chander
authors.forename: Daniel
authors.identifier: http://orcid.org/0000-0002-7805-5410
authors.initials: D
authors.lastname: Siconolfi
authors.forename: Sharif
authors.identifier: http://orcid.org/0000-0003-4038-2253
authors.initials: S
authors.lastname: Braxton
authors.forename: Abby
authors.identifier: http://orcid.org/0000-0003-1786-3307
authors.initials: A
authors.lastname: Rudolph
authors.forename: Carl
authors.identifier: http://orcid.org/0000-0002-7931-2116
authors.initials: C
authors.lastname: Latkin
keywords: African American; HIV; alcohol use; ecological momentary assessment (EMA); men who have sex with men (MSM)