Using Ecological Momentary Assessment (EMA) to Study Sex Events Among Very High-Risk Men Who Have Sex with Men (MSM)
- 504 Downloads
MSM continue to represent the largest share of new HIV infections in the United States each year due to high infectivity associated with unprotected anal sex. Ecological momentary assessment (EMA) has the potential to provide a unique view of how high-risk sexual events occur in the real world and can impart detailed information about aspects of decision-making, antecedents, and consequences that accompany these events. EMA may also produce more accurate data on sexual behavior by assessing it soon after its occurrence. We conducted a study involving 12 high-risk MSM to explore the acceptability and feasibility of a 30 day, intensive EMA procedure. Results suggest this intensive assessment strategy was both acceptable and feasible to participants. All participants provided response rates to various assessments that approached or were in excess of their targets: 81.0 % of experience sampling assessments and 93.1 % of daily diary assessments were completed. However, comparing EMA reports with a Timeline Followback (TLFB) of the same 30 day period suggested that participants reported fewer sexual risk events on the TLFB compared to EMA, and reported a number of discrepancies about specific behaviors and partner characteristics across the two methods. Overall, results support the acceptability, feasibility, and utility of using EMA to understand sexual risk events among high-risk MSM. Findings also suggest that EMA and other intensive longitudinal assessment approaches could yield more accurate data about sex events.
KeywordsEcological momentary assessment MSM Sex risk Assessment Alcohol use Drug use
This work was supported by Grants T32AA007459, P01AA019072, and L30AA023336.
Compliance with Ethical Standards
Conflicts of interest
The authors have no conflicts of interest to disclose.
- 2.Centers for Disease Control and Prevention. Estimated HIV incidence in the United States, 2007–2010. Atlanta: U.S. Department of Health and Human Services; 2012.Google Scholar
- 7.Gorin AA, Stone AA. Recall biases and cognitive errors in retrospective self-reports: a call for momentary assessments. In: Baum A, Revenson TA, Singer JE, editors. Handbook of health psychology, vol. 23. Mahwah: Erlbaum; 2001. p. 405–13.Google Scholar
- 9.Sobell L, Sobell M. Timeline followback user’s guide: a calendar method for assessing alcohol and drug use. Toronto: Addiction Research Foundation; 1996.Google Scholar
- 21.Parsons JT, Rendina HJ, Grov C, Ventuneac A, Mustanski B. Accuracy of highly sexually active gay and bisexual men’s predictions of their daily likelihood of anal sex and its relevance for intermittent event-driven HIV pre-exposure prophylaxis. J Acquir Immune Defic Syndr. 2015;68(4):449–55.PubMedPubMedCentralCrossRefGoogle Scholar
- 22.Mustanski BS. The relationship between mood and sexual interest, behavior, and risk-taking: ProQuest Information & Learning; 2004.Google Scholar
- 28.Smith A. Smartphone ownership—2013 update. 2013.Google Scholar
- 29.Tennen H, Affleck G, Coyne JC, Larsen RJ, DeLongis A. Paper and plastic in daily diary research: Comment on Green, Rafaeli, Bolger, Shrout, and Reis (2006). 2006.Google Scholar
- 30.Swendeman D, Comulada WS, Ramanathan N, Lazar M, Estrin D. Reliability and validity of daily self-monitoring by smartphone application for health-related quality-of-life, antiretroviral adherence, substance use, and sexual behaviors among people living with HIV. AIDS Behav. 2015;19(2):330–40.PubMedPubMedCentralCrossRefGoogle Scholar
- 32.Wray TB, Merrill JE, Monti PM. Using Ecological Momentary Assessment (EMA) to assess situation-level predictors of alcohol use and alcohol-related consequences. Alcohol Res Curr Rev. 2015;36(1):19–27.Google Scholar
- 33.Nelson RO. Assessment and therapeutic functions of self-monitoring. In: Hersen M, Eisler RM, Miller PM, editors. Progress in behavior modification, vol. 4. New York: Academic Press; 1977. p. 263–308.Google Scholar
- 35.Shiffman S. Designing protocols for ecological momentary assessment. In: Stone AA, Shiffman S, Atienza A, Nebeling L, editors. The science of real-time data capture: self-reports in health research. New York: Oxford University Press; 2007. p. 27–53.Google Scholar
- 37.Kahler CW, Wray TB, Pantalone DW, Kruis RD, Mastroleo, NR, Monti PM, et al. Daily associations between alcohol use and unprotected anal sex among heavy drinking HIV-positive men who have sex with men. AIDS Behav. 2015;19:422–30. doi: 10.1007/s10461-014-0896-7.PubMedPubMedCentralCrossRefGoogle Scholar
- 40.Yang C, Linas B, Kirk G, Bollinger R, Chang L, Chander G, et al. Feasibility and acceptability of smartphone-based ecological momentary assessment of alcohol use among African American men who have sex with men in Baltimore. JMIR mHealth uHealth. 2015;3(2):e67.PubMedPubMedCentralCrossRefGoogle Scholar
- 41.National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a clinician’s guide. Rockville: U.S. Department of Health and Human Services; 2005.Google Scholar
- 46.Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata. College Station: STATA press; 2008.Google Scholar
- 49.Parsons JT, Rendina HJ, Grov C, Ventuneac A, Mustanski B. Accuracy of highly sexually active gay and bisexual men’s predictions of their daily likelihood of anal sex and its relevance for intermittent event-driven HIV pre-exposure prophylaxis. JAIDS. 2015;68(4):449–55.PubMedPubMedCentralGoogle Scholar