Background: Environmental exposures such as heat and air pollution are critical determinants of health, yet traditional assessment methods rely on stationary monitors or residential address proxies that fail to capture the exposures that individuals experience throughout the day. Objective: This pilot study aimed to assess the #feasibility of integrating ecological momentary assessment (EMA), wearable devices, and continuous GPS tracking to capture real-time environmental exposures and to explore associations with concurrent health outcomes. Methods: In total, 7 young adults (aged approximately 16 to 24 years; 5/7, 71% female) wore Fitbit Charge 6 watches from July 2025 to August 2025 (mean 28.1, SD 1.1 days), recording sleep quality and duration, resting heart rate, breathing rate, heart rate variability, and physical activity. GPS location measured at up to 5-minute intervals (mean 19.7, SD 25.8 measurements per day) was linked to ambient temperature, humidity, and air pollution data (particulate matter

Background: Depressive symptoms in older adults are amplified by social isolation and limited access to clinic-based mental health care. Ecological momentary assessment (EMA) enables remote self-monitoring and unobtrusively captures response times (RTs), which may serve as indicators of psychomotor and cognitive functioning. Objective: This study investigated the use of EMA-based RT dynamics for predicting symptom change and profiling potential responders for repeated self-monitoring in late-life depression. Methods: Forty-nine community-dwelling adults aged 65 years or older (mean age 70.7, SD 5.8 years; female: 35; male: 14) with a history of major depressive disorder received case management incorporating daily EMA. Participants provided self-reports of mood, appetite, sleep quality, and general well-being. Preassessment and postassessment included the 15-item Short Geriatric Depression Scale (GDS-15), the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), the 9-item Patient Health Questionnaire, and the Beck Anxiety Inventory. RTs were cleaned with an asymmetric IQR rule, standardized within-person × response level, and modeled with exponential decay curves over successive EMA trials. The efficacy of EMA-adjunctive care was evaluated using pre-post comparisons of symptom scales. We then examined associations between RT-derived features and symptom change using correlational analyses. Finally, Bayesian multilevel modeling was applied to assess the clinical relevance of RT dynamics, including group differences in adaptation patterns. Results: Older adults at risk for depression showed significant symptom reductions over the 4-week EMA-adjunctive care period across all 4 psychological scales (CESD-R: mean Δ 11.5; rank-biserial =0.78; GDS-15: mean Δ 2.14, Cohen =0.76), alongside high EMA adherence (>90%). In correlational analyses, descriptive EMA score metrics and raw RTs showed modest, symptom-specific associations with symptom change (ΔCESD-R: ||≈0.29; Δ9-item Patient Health Questionnaire: ||≈0.32; ΔBeck Anxiety Inventory: ||≈0.35) but were not significantly related to change in geriatric depression (ΔGDS-15: ||≈0.24). In contrast, exponential-decay model parameters derived from standardized RT were significantly associated with geriatric depressive symptom change (Δ GDS-15), with the strongest effects observed for the feeling item (eg, decay rate : =−0.398, asymptote : =−0.321). Bayesian multilevel modeling further indicated that EMA-adjunctive care responders showed faster RT adaptation than nonresponders (median decay-rate ratio≈4.9, 95% credible interval 1.44-14.31), whereas differences in postadaptation RT levels were smaller and uncertain (median postadaptation RT ratio≈1.25, 95% credible interval 0.95-1.58). Sensitivity analyses showed consistent decay-rate effects across alternative specifications. Conclusions: Dynamic characteristics of EMA-based RTs emerged as a sensitive proxy for monitoring changes in depressive symptoms among older adults at risk. These findings highlight the potential use of RTs as digital biomarkers derived from brief, low-burden EMA self-monitoring, supporting the development of scalable and personalized mental health interventions for geriatric populations.

Background: HIV incidence has continued to increase among men who have sex with men (MSM) in Peru, despite intervention efforts. Addressing stigma, risky behaviors, and low medication adherence is key to reducing incidence rates. Ecological momentary assessment (EMA) allows for collection of discrete, real-time data on stigmatized, risky behaviors while reducing recall bias. Objective: The aim of this study was to develop and assess the #usability of an EMA smartphone app among MSM with HIV in Peru, which tracks daily health risk behaviors to determine ease of use, usefulness, and satisfaction with the app. Methods: A mixed-method 3-phase study was conducted with 10 MSM with HIV, which included a #usability test, 10-day field testing, and a debriefing focus group. Quantitative survey data and user analytics allowed for assessments of acceptability and user compliance. Qualitative interview and focus group data were thematically analyzed for in-depth assessments of user satisfaction. Results: Acceptability of the EMA app was high, with a mean #usability rating of 6.4 of 7.0 (SD 0.62), indicating high user satisfaction, ease of use, and usefulness. A 10-day field test demonstrated a high average compliance rate of 93% (93/100), which suggests high #feasibility of the app for daily tracking of health risk behaviors among MSM with HIV. Interview and focus group findings indicated that the app was navigable, time-efficient, and holds promise for long-term use, particularly with the inclusion of daily reminders and incentives for prolonged use. Conclusions: EMA apps can provide valuable real-time data while protecting users’ privacy. This formative work lays the foundation for future larger-scale EMAs of substance use and sexual risk behaviors among high-risk HIV populations, and for the development of just-in-time interventions to address stigma, improve medication adherence, and reduce risky behaviors.

Background: Ecological momentary assessments (EMAs) are an increasingly popular tool used to measure real-time symptom burden within mental health care, including for obsessive-compulsive disorder (OCD). However, prior studies in the literature have been limited by brief assessment periods, high participant burden, and heterogeneity in both sampling and symptom assessment methodologies. Objective: This study aimed to validate a 12-item EMA questionnaire of OCD symptoms by evaluating its psychometric properties over an extended monitoring period. Methods: Adults with OCD (22/41, 53.7%) and demographically matched healthy controls (19/41, 46.3%) completed up to 70 daily smartphone-delivered EMA surveys assessing the frequency and emotional impact of obsessions and compulsions. Participants with OCD also underwent clinician-administered Yale-Brown Obsessive-Compulsive Scale evaluations at weeks 0, 2, and 10. Results: Our scale demonstrated high internal consistency (Cronbach α=0.96) and convergent validity, with significant correlation with Yale-Brown Obsessive-Compulsive Scale scores at week 2 (ρ=0.59; =.004) and week 10 (ρ=0.53; =.01). Participant retention (89.1%) and questionnaire completion rate (89%) were also higher than those seen in the literature (75.2% and 74.2%, respectively). Conclusions: Overall, we provide initial psychometric support for the use of a low-burden EMA tool to capture day-to-day OCD symptom fluctuations over extended periods. Such tools may enhance longitudinal symptom monitoring, improve treatment response tracking, and address limitations inherent in traditional retrospective assessments.

Background: Smartphone-based ecological momentary assessment (EMA) methods highlight the impact of minority stress and socialization (eg, discrimination, social support) on smoking behaviors in LGBTQ+ adults, however studies among LGBTQ+ adolescents are limited. The Puff Break EMA protocol was developed to address this gap. Objective: The purpose of this study is to report on the acceptability, #feasibility, and appropriateness of the Puff Break EMA protocol. Methods: We utilized a multi-method design to evaluate the acceptability, #feasibility and appropriateness of the Puff Break EMA protocol. Participants who reported tobacco/nicotine or cannabis product use within the last 30 days engaged in a two-week EMA trial, receiving five daily assessments measuring tobacco, nicotine and cannabis use, stress and socialization, and product craving. Post trial, participants completed a 15-minute exit survey and 60 minute semi-structured exit interview. The exit survey utilized the 12-item Weiner (2017) Acceptability, Appropriateness, and #feasibility measures and 6-item Mobile Application Rating Scale (MARS), App Specific Subscale and also included 7 open-ended responses. The exit interview focused on a review of participant’s data to help understand smoking patterns and experiences with the Puff Break EMA protocol along with questions guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to understand how a future EMA mobile intervention aimed at monitoring and reducing tobacco, nicotine, and cannabis product use could effectively be disseminated to, accessed by, and implemented with LGBTQ+ adolescents. Lastly, lessons learned were obtained through feedback and data collected throughout the study. Results: Fifty adolescents between the ages of 15-19 (M=17.82, SD=1.19) were enrolled in the study August 2023 and July 2024. Participants predominantly reported using vaporized tobacco and nicotine products (94.0%), followed by cannabis products (78%). The study sample was diverse regarding sexual orientation and gender identities with 32% identifying as gay or lesbian, 32% bisexual or pansexual, and 14% transgender (neither transmasculine nor transfeminine). The median EMA response rate was 75%. Results indicated high #feasibility (M=4.43), acceptability (M=4.15), and appropriateness (M=4.46), of the Puff Break EMA protocol. The MARS subscale also indicated high acceptability and #feasibility for the EMA method to increase knowledge, awareness, and intentions to monitor tobacco/nicotine use (M=4.14). Triangulated results from closed and open-ended survey responses identified 5 key themes related to #feasibility, acceptability, and appropriateness. Participants highlighted the ease of the Puff Break EMA protocol, prompt survey reminders, and increased product use awareness. Key feedback from exit interviews included increased flexibility for survey timing, better response-option alignment, and appropriate only for populations interested in monitoring or reducing their product use. Conclusions: Findings indicate that using EMA methods to understand the impact of stress and socialization experiences on smoking behaviors in LGBTQ+ adolescents are feasible, appropriate, and acceptable. Clinical Trial: Not Applicable

Background: Patient-reported outcomes, including ecological momentary assessments (EMAs), are acquired from patients via repeated self-reports of their perceived momentary physical and emotional states before and after medical procedures. Patient-reported outcomes are used to measure health outcomes and quality of care. However, certain observable states or behaviors (eg, moods such as fatigue, hope, or medication adherence), or behaviors suggestive of health decline (eg, depression, cognitive decline), are not easily measured via self-reports in certain situations (eg, patients undergoing certain medical procedures, patients with dementia, and others). The peer-ceived momentary assessment (PeerMA) method involves support persons or peers (eg, family members and friends) to report their perception of a patient’s subjective physical and emotional states and has been validated in healthy populations. Objective: We examined the value of the PeerMA method in assessing the disease progression and recovery pathways of patients undergoing liver transplantation. Herein, the PeerMA method is operationalized via the patient’s informal caregivers and the patient-based EMA, and wearable-based physical activity datasets from the patients. We report the #feasibility results and human factors influencing the acceptance and reliability of the PeerMA method in a small study comprising 8 patients and support persons. Methods: We conducted a longitudinal observational study of 6 months (autumn 2019 to spring 2020), collecting EMA/self-reports from 8 patients (at the liver transplant clinic at Stanford University Hospital, California) about their perceived levels of hope, sleep, fatigue, depression, and pain in addition to PeerMA-based reports of the same aspects from 7 caregivers. We collected physical activity records from 5 patients using a Fitbit bracelet. Participants completed pre- and poststudy surveys, contributing qualitative data. We implemented the PeerMA method using a smartphone app, making it easy to use by both patients and support persons. Results: We collected 1142 patient-days and 976 support person–days. On average, each patient received 103 EMAs and responded to 64 (63%) of them, while support persons received 87 PeerMAs and responded to 64 (74%) of them. We report empirical evidence about the methodological #feasibility of PeerMA, showing its dual and unique information streams unavailable by EMA alone. We show examples where support person assessments and physical activity data can inform health professionals about the actual state of a patient regarding outcomes such as hope, sleep quality, fatigue, pain, and depression. We discuss human factors influencing the acceptance of the method and make methodological recommendations. Conclusions: It is possible to leverage data acquired via the PeerMA method and a wearable activity monitor to complement EMA. The PeerMA method incorporates frequent observations from support persons in patients’ daily lives, which can be compared and analyzed next to the patient’s self-reports. Such data may help to study and assist patients during disease recovery, which is beneficial for patients recovering from an organ transplant. Trial Registration:

Background: LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and other diverse sexual and gender identities) young adults may experience discrimination based on their sexual and gender minority status, which results in LGBTQ+ population health disparities. Although the health effects of minority stress have been studied for more than 30 years, most research relies on retrospective and cross-sectional designs. These methods limit the ability to establish causal links and to capture the fluctuating and time-sensitive nature of stress responses. In contrast, ecological momentary assessment (EMA) and wearable sensors allow for real-time tracking of stress exposures and their resulting physiological effects, enhancing data accuracy and ecological validity. Objective: The EMA and sensor protocol of the Stress and Heart Study was developed to capture real-time physiological responses to minority stress experiences among LGBTQ+ young adults. This pilot study aims to evaluate the acceptability and #feasibility of the Stress and Heart Study protocol. Methods: Participants who identified as LGBTQ+ between the ages of 18 and 30 years who reported experiencing LGBTQ+ discrimination in the past 30 days in a screening survey were invited to participate in a 2-week EMA and sensor study. Participants received 4 daily EMA surveys and one end-of-day (EOD) survey on their smartphones, assessing general and minority stress experiences, positive and negative emotional states, and substance use. Heart rate variability was continuously recorded using a wearable sensor. Upon completion, participants completed a short exit survey to evaluate their study experience and satisfaction. Results: Twenty participants aged 18 to 27 (mean 21.7, SD 2.6) years were enrolled, representing diverse sexual orientations (8 lesbian/gay, 2 bisexual, 4 pansexual, and 6 queer), gender identities (10 cisgender, 3 transgender, and 7 non-binary), and racial/ethnic backgrounds (9 non-Hispanic [NH] White, 5 Latinx, 2 NH Black, and 4 NH Asian). Participants completed 89.4% (1001/1120) of EMA daily surveys and 92.1% (258/280) of EOD surveys. On average, participants wore the sensor for 74.6% (SD 24%) of the expected time (179/240 hours). The overall EMA daily and EOD surveys completion rate was 89.9% (1259/1400), with individual participation ranging from 70% (49/70) to 98.6% (69/70). A total of 85% (n=17) of participants reported wearing the sensor daily. In the exit survey, all participants indicated that the study’s time commitment met their expectations. Additionally, 90% (n=18) of participants reported that the sensor was comfortable and that the EMA app was user-friendly, with appropriately timed questions. Conclusions: This study supports the #feasibility and acceptability of the Stress and Heart Study protocol using smartphones and wearable sensors to collect real-time data on minority stress experiences and physiological response. Further research is needed to validate the use of this protocol in larger observational and intervention studies aimed at addressing the adverse health impacts of minority stress among LGBTQ+ populations. Trial Registration:

Background: Adolescent depression is a significant public health concern. The presentation of depressive symptoms varies widely among individuals, fluctuating in intensity over time. EMA offers a unique advantage by enhancing ecological validity and reducing recall bias, allowing for a more accurate and nuanced understanding of MDD symptoms. This methodology provides valuable insights into the fluctuating nature of depression, which could inform more personalized and timely interventions. Objective: This study aims to: (1) evaluate the #feasibility of collecting smartphone-based Ecological Momentary Assessment (EMA) data alongside activity and sleep tracking in adolescents with depression; (2) investigate the severity and variability of mood symptoms reported over time; and (3) explore the relationship between mood, activity, and sleep. Methods: Thirty-six participants (23 with Major Depressive Disorder (MDD), 13 unaffected controls; 75% female, mean age 19.50 years) completed twice-daily EMA check-ins over two weeks, complemented by continuous activity and sleep monitoring using FitBit Charge 3 devices. The study examined #feasibility, #usability of EMA app, symptom severity and variability, and relationships between mood, activity, and sleep. We applied linear mixed-effects regression to the data to examine relationships between variables. Results: Participants completed a total of 923 unique checkins (mean check-ins per participant = 25.60). Overall compliance rates were high (91.57%) indicating the approach is highly feasible. MDD participants demonstrated greater symptom severity and variability over time compared to controls (β = 34.48, p = 2.17x10-06). Individuals with MDD exhibited greater diurnal variation (β = -2.54, p = 5.14x10-03) with worse mood in the morning and worse mood than anxiety scores over time (β = -6.93, p = 5.95x10-06). Life stress was a significant predictor of more severe EMA scores (β = 24.50, p = 9.99x10-03). MDD cases exhibited more inconsistent sleep patterns (β = 32.14, p = 5.44x10-04), shorter total sleep times (β = -94.38, p = 2.82x10-03), and a higher frequency of naps (β = 14.05, p = 4.02x10-03). MDD cases took fewer steps per day (mean = 5828.64, sd = 6188.85) than controls (mean = 7088.47, sd = 5378.18) over the course of the study, but this difference was not significant (p = 0.33), activity levels were not significantly predictive of EMA score (p = 0.75). Conclusions: This study demonstrates the #feasibility of integrating smartphone-based EMA with wearable activity tracking in adolescents with depression. High compliance rates support the practicality of this approach, while EMA data provide valuable insights into the dynamic nature of depressive symptoms, particularly in relation to sleep and life stress. Future studies should validate these findings in larger, more diverse samples. Clinically, EMA and wearable tracking may enhance routine assessments and inform personalized interventions by capturing symptom variability and external influences in real time.

Background: Parents often juggle multiple conflicting responsibilities, including work, childcare, and the household, making them a particularly burdened group. However, the impact of daily routines and associated (poor) well-being among parents has received relatively little attention. Ecological Momentary Assessment (EMA) is increasingly being used to capture real-time data and can help address this research gap. Objective: This study aims to examine compliance rates and the #feasibility of EMA for measuring daily well-being and time use among parents. Methods: An exploratory mixed-methods study was conducted with 74 German parents (57/74, 77% women, (age: mean 37.6, SD 5.9 years). Participants completed a baseline questionnaire, followed by 4 daily EMA surveys (at 7:30 AM, 12 PM, 16:30 PM, and 21:30 PM) over a 1-week period, and a follow-up questionnaire. A subset of parents was also subsequently interviewed. Sociodemographic background and expected #feasibility (open-ended questions) were surveyed at baseline, and #feasibility was assessed at follow-up (closed- and open-ended questions) and in the interviews. State well-being (affective and cognitive), state stress, state as well as retrospective time-use were measured in the EMA surveys. Compliance and #feasibility were examined using a combination of quantitative (descriptive analyses) and qualitative methodologies. Results: Participants completed an average of 83% (SD 13%) of the daily surveys. Compliance varied by gender and age, where men (90% vs 80%) and older parents showed higher rates. Participants generally found the survey frequency and length manageable, though some suggested adjustments to the study period depending on their individual routines. The 7:30 AM survey was reported as the most challenging due to childcare drop-offs (40%-49%), followed by the 16:30 PM survey for similar reasons (7%-17%). The qualitative analysis further revealed additional points for improvement, for instance, the need for personalization (eg, individual adjustment of the survey timings and intervals), technical support, and the incorporation of gamification elements. Most interviewees (46% vs 23%) found the used measurement of well-being and stress to be appropriate. Regarding time use, they felt that the predefined activity groups (eg, personal care, working) were suitable (46%) but noted challenges assigning less frequent activities (eg, medical appointments) (5%-54%). Reporting the timings of time-use via consecutive questions (ie, specifying the duration or start and end times of an activity) was perceived as confusing (9%-69%), with participants expressing a preference for a visual overview, such as a Gantt chart. Conclusions: The study demonstrates that, when accounting for certain sociodemographic and study design factors, EMA can be a feasible method for data collection regarding daily well-being and time use, even in highly time-constrained populations like parents. This shows great potential for future research, such as exploring work-family conflict or performative gender roles and complementing established methods (eg, retrospective daily diaries). Trial Registration: OSF Registries osf.io/8qj3d; https://osf.io/8qj3d

Background: Ecological momentary assessment methods have recently been adapted for use on smartwatches. One particular class of these methods, developed to minimize participant burden and maximize engagement and compliance, is referred to as microinteraction-based ecological momentary assessment (μEMA). Objective: This study explores the #feasibility of using these smartwatch-based μEMA methods to capture longitudinal, high-temporal-density self-report data about alcohol consumption in a nonclinical population selected to represent high- and low-socioeconomic position (SEP) groups. Methods: A total of 32 participants from the Avon Longitudinal Study of Parents and Children (13 high and 19 low SEP) wore a smartwatch running a custom-developed μEMA app for 3 months between October 2019 and June 2020. Every day over a 12-week period, participants were asked 5 times a day about any alcoholic drinks they had consumed in the previous 2 hours, and the context in which they were consumed. They were also asked if they had missed recording any alcoholic drinks the day before. As a comparison, participants also completed fortnightly online diaries of alcohol consumed using the Timeline Followback (TLFB) method. At the end of the study, participants completed a semistructured interview about their experiences. Results: The compliance rate for all participants who started the study for the smartwatch μEMA method decreased from around 70% in week 1 to 45% in week 12, compared with the online TLFB method which was flatter at around 50% over the 12 weeks. The compliance for all participants still active for the smartwatch μEMA method was much flatter, around 70% for the whole 12 weeks, while for the online TLFB method, it varied between 50% and 80% over the same period. The completion rate for the smartwatch μEMA method varied around 80% across the 12 weeks. Within high- and low-SEP groups there was considerable variation in compliance and completion at each week of the study for both methods. However, almost all point estimates for both smartwatch μEMA and online TLFB indicated lower levels of engagement for low-SEP participants. All participants scored “experiences of using” the 2 methods equally highly, with “willingness to use again” slightly higher for smartwatch μEMA. Conclusions: Our findings demonstrate the acceptability and potential utility of smartwatch μEMA methods for capturing data on alcohol consumption. These methods have the benefits of capturing higher-temporal-density longitudinal data on alcohol consumption, promoting greater participant engagement with less missing data, and potentially being less susceptible to recall errors than established methods such as TLFB. Future studies should explore the factors impacting participant attrition (the biggest reason for reduced engagement), latency issues, and the validity of alcohol data captured with these methods. The consistent pattern of lower engagement among low-SEP participants than high-SEP participants indicates that further work is warranted to explore the impact and causes of these differences.

Background: Ecological momentary assessment (EMA) provides insight into the effectiveness and #feasibility of smoking-related interventions. Objective: To assess adherence to an EMA protocol and compare EMA-derived responses with measures collected through multiple surveys. Methods: A sub-analysis was conducted using data from a 12-week, open-label and two-arm pilot randomized clinical trial among adult smokers with chronic obstructive pulmonary disease, coronary artery disease, peripheral vascular disease, or asthma in the last 12 months (n=109). Participants were randomized to either electronic cigarette (EC) or nicotine replacement therapy (NRT) treatment arms. We compared EMA data collected via automated SMS prompts sent to participants four times daily for 12 weeks, including cigarettes per day (CPD), craving and satisfaction to survey data collected at 12 weeks. Convergent validity between survey- and EMA-reported measures was evaluated using Pearson correlation and paired t-tests. CPD was modeled using negative binomial regression. Relative rates (RR) of reaching at least 50%, 75%, and 100% CPD reduction between two arms were calculated using both EMA and survey data. Results: The majority of participants were non-Hispanic White (58%), female (55%), with median age of 60 (IQR 54-65). Among the 109 participants, 59.6% were consistently adherent to the EMA protocol over the 12-week period. Median weekly EMA response rate remained high over the 12-week study period even though a modest decline was observed (week 1, 97.8%; week 12, 89.4%). The mean CPD declined significantly (week 1, 14.2 (SD = 9.9); week 12 , 4.6 (SD = 6.7), (p < .001)). EMA-derived and survey-based CPD measurements were positively correlated (r = 0.73; 95% CI 0.60, 0.82) as were measures of craving (r = 0.38; 95% CI 0.17, 0.56). No significant paired difference in CPD was observed between EMA measurements and surveys. A significant effect of time on CPD EMA data (Incidence rate ratio (IRR) 1-week change = 0.93, p 0) and 20.7% mostly switched (defined as a reduction in CPD > 75% and EC use > 0) in week 12. Conclusions: EMA is a suitable method to collect recall-based smoking-related data. Though results from mixed effect modeling and RR comparisons were similar using EMA or survey data, EMA provides unique advantages, namely greater granularity in the time and the capability to detect switching patterns in near real-time. These findings provide the #feasibility of EMA in developing smoking cessation interventions in the future tobacco harm reduction research. Clinical Trial: ClinicalTrials.gov Identifier NCT04465318; https://clinicaltrials.gov/study/NCT04465318

Background: The landscape of substance use behavior among young adults has observed rapid changes over time. Intensive longitudinal designs are ideal for examining and intervening in substance use behavior in real time but rely on high participant…