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Ecological momentary assessment of drug use, decision making, and HIV risk in a sample of community-recruited cocaine users in Durham, NC

Ecological momentary assessment of drug use, decision making, and HIV risk in a sample of community-recruited cocaine users in Durham, NC

The high prevalence of HIV risk behavior among persons who use illicit drugs like cocaine may partially explained by impairments in decision-making capabilities. However, evaluating decision-making in the research lab lacks ecological validity because the lab cannot fully simulate “real world” decision-making. In this study, we used mobile health (“mHealth”) technologies to obtain behavioral, affective, and environmental data in real-time from natural settings. Participants were recruited from a cohort of active cocaine users, approximately half of whom are living with HIV. For 28 days, participants completed a daily diary and up to 4 random ecological momentary assessments each day. In the daily diary, participants reported on substance use and sexual behaviors from the prior day. The ecological momentary assessments included decision making tasks (loss aversion and delay discounting) and assessments of current intoxication, craving, social setting, and mood. To date, 37 individuals have enrolled in the study, and the goal is to enroll 50 participants by Summer 2019. Engagement in the mHealth assessments has been excellent, with an average of >80% of assessments completed. The quality of the data is also excellent including a high frequency of substance use and sexual behavior events.

Expectations

Given the large number of repeated observations across multiple participants, analysis of this data will require multi-level modeling. Potential questions to examine include: (1) determining whether “risky” decision making and HIV risk behaviors are more likely to occur in certain drug states (e.g., craving vs. withdrawal); (2) examining whether EMA measures of decision making are predictive of subsequent HIV risk behavior; and (3) testing whether the relationships between drug states, decision making, and HIV risk behavior are moderated by HIV status and contextual factors.