Ecological Momentary Assessment of Illicit Drug Use Compared to Biological and Self-Reported Methods

Abstract

Background: The use of mHealth methods for capturing illicit drug use and associated behaviors have become more widely used in research settings, yet there is little research as to how valid these methods are compared to known measures of capturing and quantifying drug use.

Objective: We examined the concordance of ecological momentary assessment (EMA) of drug use to previously validated biological and audio-computer assisted self-interview (ACASI) methods.

Methods: The Exposure Assessment in Current Time (EXACT) study utilized EMA methods to assess drug use in real-time in participants' natural environments. Utilizing mobile devices, participants self-reported each time they used heroin or cocaine over a 4-week period. Each week, PharmChek sweat patch samples were collected for measurement of heroin and cocaine and participants answered an ACASI-based questionnaire to report behaviors and drug using events during the prior week. Reports of cocaine and heroin use captured through EMA were compared to weekly biological or self-report measures through percent agreement and concordance correlation coefficients to account for repeated measures. Correlates of discordance were obtained from logistic regression models.

Results: A total of 109 participants were a median of 48.5 years old, 90% African American, and 52% male. During 436 person-weeks of observation, we recorded 212 (49%) cocaine and 103 (24%) heroin sweat patches, 192 (44%) cocaine and 161 (37%) heroin ACASI surveys, and 163 (37%) cocaine and 145 (33%) heroin EMA reports. The percent agreement between EMA and sweat patch methods was 70% for cocaine use and 72% for heroin use, while the percent agreement between EMA and ACASI methods was 77% for cocaine use and 79% for heroin use. Misreporting of drug use by EMA compared to sweat patch and ACASI methods were different by illicit drug type.

Conclusions: Our work demonstrates moderate to good agreement of EMA to biological and standard self-report methods in capturing illicit drug use. Limitations occur with each method and accuracy may differ by type of illicit drugs used.

Keywords: ACASI; ecological momentary assessment; illicit drug use; mHealth; sweat patch.

Figure 1

Reported drug use as assessed by sweat patch (green bars), EMA (orange bars) or ACASI (blue bars) methods.

Figure 2

Percent agreement by drug type and week comparing EMA, sweat patch, and ACASI methods. Panel A: Percent agreement between EMA/Sweat Patch methods (blue bars) and EMA/ACASI methods (green bars) by week for cocaine use. Panel B: Percent agreement between EMA/Sweat Patch methods (orange bars) and EMA/ACASI methods (yellow bars) by week for heroin use.