Feasibility and acceptability of texting school-aged adolescents to assess daily substance use among community-based black and white youth

Highlights

• High school adolescents showed high compliance with substance use assessments on personal phones.

• Black youth had a lower compliance rate than White youth but both were above the benchmark of 80%

• Acceptability of daily surveys was high and no confidentiality concerns were reported.

Abstract

Background

Ecological momentary assessment (EMA) is well-suited to measure adolescent substance use. Previous research with adolescents, particularly racially minoritized adolescents, has predominantly provided mobile devices to participants as a strategy to reduce structural barriers to technology access. This report examined feasibility and acceptability of a text-message-delivered EMA protocol to adolescents’ personal phones.

Methods

Non-Hispanic Black and White adolescents aged 14–18 years with mobile phone access and past-30-day substance use were recruited from community settings. Respondents (n = 36; 55.5 % female; 55.5 % White) completed a 14-day diary assessing substance use.

Results

Respondents completed M = 13.8 (SD = 1.36) diaries for a compliance rate of 93.5 %. Black respondents completed significantly fewer diaries (87.9 %) than White respondents (97.9 %) although compliance rates were high among both groups. Adolescents reported high acceptability of the protocol, with 97.1 % willing to participate again.

Conclusion

Findings suggest text-message-based EMA delivered to personal phones is acceptable and feasible for assessing substance use among adolescents. As the sociodemographic “digital divide” narrows among adolescents, this cost-effective and equitable method becomes more feasible.

Introduction

Adolescent substance use remains a public health concern associated with social, physical, and behavioral health consequences across the lifespan (Gil et al., 2004, Moss et al., 2014). Increasingly, research has focused on viable methods for identifying proximal mechanisms of adolescent substance use, with wide recognition of the value of daily, time-interval, and event-level ambulatory assessment strategies. These methods—referred to as ecological momentary assessment (EMA)—use mobile technology for increased accuracy of recall, to enhance ecological validity, and to capture processes influencing substance use in real-world settings (Shiffman, 2009). Although EMA has been primarily used with adults, it is well-suited for school-aged adolescents, who use mobile devices ubiquitously and may struggle with accurate retrospective reporting (Anderson & Jiang, 2021; Kamphaus & Frick, 2005).

Mobile phone-based EMA among adolescents and young adults yields high overall protocol compliance (Bonar et al., 2018, Comulada et al., 2015), suggesting that recent increases in mobile phone utilization increase the feasibility of EMA among this population. However, two recent reviews found, in contrast to studies with adults, nearly all studies using EMA with adolescents provided mobile devices rather than using participant-owned devices (Heron et al., 2017, Wen et al., 2017). Study-provided phones are utilized to reduce potential distractions from other phone applications, provide tangible participation incentives to adolescents, and mitigate structural barriers to EMA engagement that lead to inconsistent mobile phone access (i.e., financial insecurity; Comulada et al., 2015, Santa Maria et al., 2018). In addition to adolescents living in poverty or with low family income, Black Americans have historically faced a racial “digital divide”—a gap in technology access as a function of race (Anderson and Kumar, 2017, Anderson-Lewis et al., 2018). While the racial divide persists for computer and broadband access among adults, for mobile phones this divide has narrowed due to increased mobile phone use among Americans across race (Anderson-Lewis et al., 2018, Vogels, 2021a). Taken with nearly ubiquitous smartphone use by adolescents regardless of race, gender, or socioeconomic status (e.g., 95 % utilization among adolescents in 2018) (Anderson & Jiang, 2018), these data suggest increased feasibility of personal-phone EMA among diverse adolescent populations. Thus, given the documented reduction in the racial digital divide for adolescents, the current report examines the feasibility and acceptability of text-message-delivered EMA using participant’s personal phones among a sample of Black and White school-aged adolescents recruited from community (i.e., non-clinical) settings. This pilot report will provide initial evidence for the utility of EMA delivered via adolescent participants’ phones rather than via study-provided phones, the latter of which has been standard for this age group.