Kristin E. Heron

Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments.

PURPOSE Psychosocial and health behaviour treatments and therapies can be extended beyond traditional research or clinical settings by using mobile technology to deliver interventions to individuals as they go about their daily lives. These ecological momentary interventions (EMIs) are treatments that are provided to people during their everyday lives (i.e. in real time) and in natural settings (i.e. real world). The goal of the present review is to synthesize and critique mobile technology-based EMI aimed at improving health behaviours and psychological and physical symptoms. METHODS Twenty-seven interventions using palmtop computers or mobile phones to deliver ambulatory treatment for smoking cessation, weight loss, anxiety, diabetes management, eating disorders, alcohol use, and healthy eating and physical activity were identified. RESULTS There is evidence that EMI can be successfully delivered, are accepted by patients, and are efficacious for treating a variety of health behaviours and physical and psychological symptoms. Limitations of the existing literature were identified and recommendations and considerations for research design, sample characteristics, measurement, statistical analyses, and clinical implementation are discussed. CONCLUSIONS Mobile technology-based EMI can be effectively implemented as interventions for a variety of health behaviours and psychological and physical symptoms. Future research should integrate the assessment and intervention capabilities of mobile technology to create dynamically and individually tailored EMI that are ecologically sensitive.

Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment.

The relation of mood and stress to binge eating and vomiting in the natural environments of patients with bulimia nervosa (BN) was examined using real-time data collection. Women (n = 131; mean age = 25.3 years) with BN carried a palmtop computer for 2 weeks and completed ratings of positive affect (PA), negative affect (NA), anger/hostility (AH), and stress (STRS); they also indicated binge or vomit episodes (BN-events) 6 times each day. Mixed models were used to compare mood and STRS between and within days when BN-events occurred. Between-days analyses indicated that binge and vomit days both showed less PA, higher NA, higher AH, and greater STRS than days with no BN-events. Within-day, decreasing PA, and increasing NA and AH, reliably preceded BN-events. Conversely, PA increased, and NA and AH decreased following BN-events. Demonstration of the temporal sequencing of affect, STRS, and BN-events with a large BN sample may help advance theory and clinical practice, and supports the view that binge and purge events hold negatively reinforcing properties for women with BN.

Prevalence, type, disclosure, and severity of adverse life events in college students.

Objective: Some information on the prevalence of adverse life experiences is available for the general population and college students, but the extent, nature, and severity of these events is unclear. Participants: The authors recruited undergraduate college students (N = 6,053) from diverse academic settings (public and private schools) and geographic locations. Methods: They examined the prevalence, nature, severity, and disclosure of adverse events, in addition to reports of posttraumatic stress disorder (PTSD) symptomatology within the sample. Results: Across multiple studies, prevalence rates of adverse events ranged from 55.8% to 84.5%, replicating previous findings in larger samples. In a subset of undergraduate students (n = 97) who the authors interviewed in greater depth, 9% reported symptoms of clinical PTSD and an additional 11% reported subclinical symptoms. Conclusions: Research using college samples for the study of stressful life events is a useful and reasonable strategy. The authors discuss implications for research, as well as screening and referral services at universities.

User Preferences for a Text Message–Based Smoking Cessation Intervention

Younger adults are more likely to smoke and less likely to seek treatment than older smokers. They are also frequent users of communication technology. In the current study, we conducted focus groups to obtain feedback about preferences for a text message–based smoking cessation program from potential users. Participants (N = 21, M age = 25.6 years, age range = 20-33 years) were current or recently quit smokers (M cigarettes/day = 12.8) who used text messaging. Participants completed questionnaires and participated in a 2-hour focus group. Focus groups were conducted using an a priori semistructured interview guide to promote discussion of the content and functionality of the intervention. Major themes from analysis of the focus groups included support for the acceptability of a text-based cessation program, suggestions for a more technologically broad-based program, and adjustments to the program structure. Participants recommended including social networking functions, user control of program output through an online profile, and text message features to promote interaction with the system. Interestingly, many participants suggested the program should begin on individuals’ identified quit day, challenging the procedures used in most cessation programs, which begin by preparing participants for a future quit date. Overall, younger adult smokers appear to be interested in participating in a smoking cessation program that uses text messages and web-based elements. Qualitative feedback regarding the perceived optimal features and structure of a technology-based intervention challenged traditional methods of implementing smoking cessation interventions and will inform the development of future programs.

Is intensive measurement of body image reactive? A two-study evaluation using Ecological Momentary Assessment suggests not☆

Intensive assessment methods (e.g., Ecological Momentary Assessment [EMA]) are increasingly used to capture body image experiences in daily life. One concern with EMA is multiple assessments may increase reactivity to internal or external cues, potentially biasing measurement. Reactivity to EMA was evaluated in two studies (Study 1: N=63 female undergraduates, Study 2: N=131 women with high body dissatisfaction/disordered eating). Participants completed five daily surveys on handheld computers for 1-2 weeks and body image-related questionnaires at the start and end of each study. Results showed no systematic changes in pre- and post-EMA measures or momentary EMA reports, suggesting women were not reactive to the EMA protocols. Completing 1-2 weeks of EMA does not appear to affect body dissatisfaction, mood, or attitudes in non-clinical or at-risk samples of women. These studies provide evidence that EMA methods can be used to assess real-world body image experiences without undue concern about measurement reactivity.

Eating behaviors and negative affect in college women's everyday lives

OBJECTIVE A growing body of research seeks to understand the relationship between mood and eating behaviors. Ecological Momentary Assessment (EMA) methods provide a method for assessing these processes in natural settings. We used EMA to examine the relationship between mood and eating behaviors in everyday life among women with subclinical disordered eating behaviors. METHOD Participants (N = 127, age M = 19.6 years, BMI M = 25.5) completed five daily EMA reports on palmtop computers for 1 week. Assessments included measures of negative affect (NA) and eating-related behavior during eating (eating large amounts of food, loss of control over eating, and restricting food intake) and noneating episodes (skip eating to control weight/shape). Time-lagged multilevel models tested mood-eating behavior relationships. RESULTS Higher NA did not precede any unhealthy eating and weight control behaviors. However, NA was higher when women reported eating large quantities of food, losing control over eating, and restricting food intake during their most recent eating episode, but not after skipping eating to control weight/shape. DISCUSSION These findings elucidate the processes in daily life that may influence the development and maintenance of unhealthy eating and weight control behaviors that, in turn, can inform interventions.

Early adversity, personal resources, body dissatisfaction, and disordered eating

OBJECTIVE Early adverse experiences have been associated with disordered eating, but the mechanisms underlying that association are not well understood. The purpose of this study is to test a structural equation model in which early adversity is associated with disordered eating via intrapersonal resources, interpersonal resources, and body dissatisfaction. METHOD Female university students (n = 748) completed a series of questionnaires online, including measures of early adverse experiences, intrapersonal resources (self-esteem and personal growth initiative), interpersonal resources (gratitude and social support), body dissatisfaction, and disordered eating and exercising to lose weight. RESULTS Structural equation modeling indicated that early adverse experiences were negatively associated with interpersonal and intrapersonal resources. Intrapersonal resources were negatively associated with body dissatisfaction, whereas interpersonal resources were positively associated with body dissatisfaction (although negative bivariate correlations in this latter case suggest possible suppression effects). Finally, body dissatisfaction was associated with a range of disordered eating behaviors and exercise. DISCUSSION Early adverse experiences are important to consider in models of disordered eating. The results of this study highlight potential points of early prevention efforts, such as improving personal resources for those who experience early adversity, to help reduce the risk of body dissatisfaction and disordered eating in young women.

Ecological Momentary Assessment (EMA) in Family Research

Family researchers are often interested in dynamic complex processes that are present in daily life and regular activities, occur both within and between individuals, and unfold over various periods of time. Ecological Momentary Assessment (EMA) and other approaches for intensive, real-world data collection enable researchers to collect large amounts of information in people’s natural environments. We provide an overview of the rationale and benefits of using EMA methods and discuss the types of questions in family research that can be addressed with such intensive assessment strategies. There are many design and practical issues that researchers must consider when implementing EMA studies, and a brief overview of such considerations is provided. Finally, we discuss areas in family research where we believe it may be particularly useful to incorporate EMA methods, such as in interventions.

Assessing Body Image in Young Children

The purpose of this study was to examine body image discrepancies in elementary-age children in a racially diverse sample. Body image and body image discrepancy were measured in elementary school children (N = 58) of various racial groups (35% Hispanic, 33% African American, 16% Caucasian, 14% other). Each participant was shown a set of silhouette figure drawings and reported current and ideal body sizes. Children’s body discrepancies appear to change between Grades 1 and 2. Notable discrepancies between their current and ideal figures, and their current figure and those that they believe are most attractive, are largely absent in Grade 1, but are evident in Grade 2 and older children. No substantive racial or gender differences in body image perceptions or dissatisfaction were observed in this sample. Body image dissatisfaction may begin as early as second grade in both girls and boys of various racial and ethnic backgrounds. These findings provide preliminary evidence that body discrepancies may begin much earlier than previously thought.

Using Mobile-Technology-Based Ecological Momentary Assessment (EMA) Methods With Youth: A Systematic Review and Recommendations

Ecological momentary assessment (EMA) methods are increasingly used in social and health sciences, but the feasibility and best practices for using EMA with youth are not yet clear. We conducted a systematic review of studies that used self-report EMA methods with youth; the goal was to identify common approaches and challenges to implementation and develop recommendations for future research. We examined 54 peer-reviewed papers that reported on 24 unique studies. Papers were evaluated using a standardized, three-dimensional coding scheme focused on the following: (1) sample characteristics; (2) EMA data collection methods (sampling duration, frequency, hardware/software); (3) study implementation methods (technical/logistical challenges, training participants, compliance). Overall, the research suggests EMA can be successfully implemented with youth (age ∼ ≥7) from diverse backgrounds, but protocol adaptations may be necessary for younger children. Study design and implementation challenges and recommendations for research on youth are provided.