Ecological Momentary Assessment of Substance Use and Sexual Risk Behaviors

Ecological Momentary Assessment (EMA) refers to the real-time collection of data on participants’ behaviours, experiences and contexts in their natural environments. By prompting individuals at random or event-contingent intervals via smartphone, text message or electronic diary, EMA minimises recall bias and captures the dynamic interplay between substance use (for example alcohol, stimulants or opioids) and sexual risk behaviours (such as condomless sex or multiple partners). Key strengths include the capacity to record situational triggers, affective states and social settings immediately before, during and after risk events. EMA designs range from random-prompt sampling (where participants receive multiple daily surveys at unpredictable times) to event-contingent reporting (where individuals self-initiate entries when specific behaviours occur). These methodologies have been applied globally in diverse populations—including men who have sex with men, adolescents in sub-Saharan Africa and marginalised ethnic groups—to elucidate temporal patterns of alcohol or drug use, sexual decision-making and context-specific intervention points. Challenges in EMA implementation encompass participant burden, adherence to prompts, technical barriers (such as device compatibility) and the need for ongoing technical support. Nevertheless, EMA’s capacity to link momentary states with immediate risk behaviours offers unique insights for tailoring just-in-time adaptive interventions and for informing public health strategies to reduce HIV transmission and substance-related harms.

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Ecological Momentary Assessment of Substance Use and Sexual Risk Behaviors publication trend

The graph below shows the total number of articles in ecological momentary assessment of substance use and sexual risk behaviors across all publications each year (not limited to Nature Index journals).

Technical terms

Ecological Momentary Assessment (EMA): A method for collecting real-time self-reports of behaviours, contexts and experiences in natural environments, typically via mobile devices.

Random-prompt sampling: A schedule in which participants receive notifications at unpredictable times each day to record current behaviours or states.

Event-contingent reporting: Self-initiated data entries triggered by the occurrence of specific target events, such as substance use or sexual activity.

Just-in-time adaptive intervention (JITAI): A personalised support delivered at the moment of need, informed by real-time EMA data to reduce risky behaviours.

Recall bias: Systematic error arising when participants’ retrospective self-reports misrepresent past behaviours due to forgetfulness or selective memory.

References

1. Feasibility and Acceptability of Using Ecological Momentary Assessment to Evaluate Alcohol Use with American Indian Women. International Journal of Environmental Research and Public Health (2023).
2. Ecological Momentary Assessment and mHealth Interventions Among Men Who Have Sex With Men: Scoping Review. Journal of Medical Internet Research (2021).
3. 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 and uHealth (2015).