WITHDRAWN: Using Ecological Momentary Assessment to Assess Risk Behavior Among Young People Who Inject Drugs

Background: Ecological momentary assessment (EMA) methods collect data in real time, in the course of everyday activities. These methods have the potential to contribute to harm reduction efforts with people who inject drugs (PWID). As a research tool, EMA reduces recall bias and allows a more nuanced analysis of behavior. EMA may also be used as a trigger for interventions.

Methods: Young PWID (18-35) were recruited for two pilot studies through Community Outreach Intervention Projects syringe exchange program in Chicago, Illinois, USA. After completing a baseline survey, participants used a mobile phone app to answer surveys for 14 days, including questions on injection and injection-related risk practices, and social networks (Social Geography Study-SGS), or mood and substance use (Mood Study).

Results: We enrolled 27 participants in SGS and 70 in the Mood Study. Participants were primarily non-Hispanic White (74%, 61%). Participants who failed to comply with the EMA surveys (18% in SGS, 13% in Mood Study) were excluded from this analysis. Reasons for noncompliance included lost/stolen phones, arrest, leaving town, and entering detox or treatment. The median number of reporting days was 13 (IQR 9-15) in the Mood Study and 12 (IQR 8-14) in SGS, with an average of 3.5 surveys per reporting day in the Mood Study (max 6), and 2.7 per day in SGS (max 5). In the Mood Study, women were more responsive than men. For both studies, reported homelessness, daily injection, syringe and equipment sharing, and recent crack use at baseline were not associated responding rates.

Conclusions: Conducting EMA studies with young PWID is challenging but feasible. Researchers should plan for a significant proportion of the initial sample to be lost for a variety of reasons. Nevertheless, most participants were at least partially compliant, and responding rates were not associated with baseline reported injection risk behaviors.