An Ecological Momentary Assessment Protocol to Measure Stress, Socialization, and Other Contributors to Smoking Behaviors Among LGBTQ+ Adolescents: Multimethod Evaluation of Feasibility, Acceptability, and Appropriateness From the Puff Break Research Study
Bibliographic record
Abstract
Background: Smartphone-based ecological momentary assessment (EMA) methods highlight the impact of minority stress and socialization (eg, discrimination and social support) on smoking behaviors in lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adults; however, studies among LGBTQ+ adolescents are limited. The Puff Break EMA protocol was developed to address this gap. Objective: This study aims to report on the acceptability, feasibility, and appropriateness of the Puff Break EMA protocol. Methods: We utilized a multimethod 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 2-week EMA trial, receiving 5 daily assessments measuring tobacco, nicotine, and cannabis use, stress and socialization, and product craving. Posttrial, participants completed a 15-minute exit survey and 60-minute semistructured exit interview. The exit survey used the 12-item Weiner acceptability, appropriateness, and feasibility measures and 6-item Mobile Application Rating Scale, app-specific subscale and also included 7 open-ended responses. The exit interview focused on a review of participants' 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: All 50 adolescents between the ages of 15-19 (mean 17.82, SD 1.19) were enrolled in the study August 2023 and July 2024. Participants predominantly reported using vaporized tobacco and nicotine products (47/50, 94%), followed by cannabis products (39/50, 78%). The study sample was diverse regarding sexual orientation and gender identities with 32% (16/50) identifying as gay or lesbian, 32% (16/50) bisexual or pansexual, and 14% (7/50) transgender (neither transmasculine nor transfeminine). The median EMA response rate was 75% (~53 of 70 EMA surveys). Results indicated high feasibility (mean 4.43, SD 0.77), acceptability (mean 4.15, SD 0.83), and appropriateness (mean 4.46, SD 0.67) of the Puff Break EMA protocol. The Mobile Application Rating Scale app-specific subscale also indicated high acceptability and feasibility for the EMA method to increase knowledge, awareness, and intentions to monitor tobacco/nicotine use (mean 4.14, SD 1.01). 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 is feasible, appropriate, and acceptable.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.055 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".