Feasibility of Ecological Momentary Assessment of Daily Sexting and Substance Use Among Young Adult African American Gay and Bisexual Men: A Pilot Study.
BACKGROUND
Recent evidence suggests that sexualized text communication ("sexting") is associated with substance use and sexual risk behaviors among young adults, yet little is known about this relationship among young adult African American gay and bisexual men, a population disproportionately impacted by HIV in the United States. Rapid advances in mobile phone technology indicate a clear need for research using mobile health (mHealth) methods such as ecological momentary assessment (EMA) to serve as a viable counterpart to retrospective evaluation methods by using real-time data collection to assess sexting and substance use among this population.


OBJECTIVE
The objective of this pilot study was to (1) describe the EMA study design and protocol, (2) characterize the study population, and (3) assess the feasibility of a random prompt text message-based thrice-daily EMA over 14 days, as a means of prospectively studying sexting, marijuana, and alcohol use among a sample of young adult African American gay and bisexual men ages 21 to 25.


METHODS
Participants were recruited through flyers and snowball sampling during spring and summer 2015 at a community-based HIV/AIDS prevention, care, and support organization in Washington, DC. Eligible participants were enrolled in a one-time in-person study visit that consisted of informed written consent to participate in the study, a self-administered survey, a semi-structured interview, and enrollment and training in EMA data collection. Commencing the day after the study visit, a random prompt survey was texted to participants on their personal mobile phones 3 times a day over a 14-day data collection period assessing mood, texts sent, texts received, sexts sent, sexts received, marijuana want, marijuana use, and alcohol use.


RESULTS
EMA feasibility was tested with 25 self-identified African American gay (n=16) and bisexual (n=9) men (mean age of 23.48 years, SD 1.5). Each random prompt survey had 8 questions with responses including yes/no and Likert scale options. There were 104 total days of EMA observation, and the retention rate was 72% (18 out of 25 participants). Participants responded to the random prompt surveys with a 57.3% compliance rate providing a total of 544 completed surveys out of 949 surveys. The overall mean response time to complete a survey was 6.1 minutes. There were significant positive associations between EMA texts sent and received questions (ρ 0.84, P<.001) as well as sexts sent and received queries (ρ 0.72, P<.001).


CONCLUSIONS
The use of an EMA protocol has the potential to be a very useful research tool for understanding episodic behaviors such as sexting and substance use in this relatively understudied and underserved population, and has implications for practice. Additional research is needed on how to maximize survey compliance.
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, United States.
Sabrina L
http://orcid.org/0000-0003-3202-7534
SL
Smiley
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, United States.
Hoda
http://orcid.org/0000-0001-6117-5646
H
Elmasry
Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
Monica
http://orcid.org/0000-0002-5520-6191
M
Webb Hooper
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, United States.|Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.|Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States.
Raymond S
http://orcid.org/0000-0002-0856-3540
RS
Niaura
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.|Veterans Administration Greater Los Angeles Healthcare System, Veterans Administration Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, United States.
Alison B
http://orcid.org/0000-0003-3998-7212
AB
Hamilton
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.
Norweeta G
http://orcid.org/0000-0002-1004-0415
NG
Milburn
African American men; alcohol; ecological momentary assessment; gay and bisexual; marijuana; mobile phone; sexting; text messaging; young adult