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Transdermal sensor features correlate with ecological momentary assessment drinking reports and predict alcohol‐related consequences in young adults’ natural settings

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Michael A. Russell
Michael A. Russell
Michael A. Russell
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Robert J. Turrisi
Robert J. Turrisi
Robert J. Turrisi
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Joshua M. Smyth
Joshua M. Smyth
Joshua M. Smyth
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Abstract and Figures

Background Wearable transdermal alcohol concentration (TAC) sensors allow passive monitoring of alcohol concentration in natural settings and measurement of multiple features from drinking episodes, including peak intoxication level, speed of intoxication (absorption rate) and elimination, and duration. These passively collected features extend commonly used self‐reported drink counts and may facilitate the prediction of alcohol‐related consequences in natural settings, aiding risk stratification and prevention efforts. Method A total of 222 young adults aged 21–29 (M age = 22.3, 64% female, 79% non‐Hispanic white, 84% undergraduates) who regularly drink heavily participated in a 5‐day study that included the ecological momentary assessment (EMA) of alcohol consumption (daily morning reports and participant‐initiated episodic EMA sequences) and the wearing of TAC sensors (SCRAM‐CAM anklets). The analytic sample contained 218 participants and 1274 days (including 554 self‐reported drinking days). Five features—area under the curve (AUC), peak TAC, rise rate (rate of absorption), fall rate (rate of elimination), and duration—were extracted from TAC‐positive trajectories for each drinking day. Day‐ and person‐level associations of TAC features with drink counts (morning and episodic EMA) and alcohol‐related consequences were tested using multilevel modeling. Results TAC features were strongly associated with morning drink reports (r = 0.6–0.7) but only moderately associated with episodic EMA drink counts (r = 0.3–0.5) at both day and person levels. Higher peaks, larger AUCs, faster rise rates, and faster fall rates were significantly predictive of day‐level alcohol‐related consequences after adjusting for both morning and episodic EMA drink counts in separate models. Person means of TAC features added little above daily scores to the prediction of alcohol‐related consequences. Conclusions These results support the utility of TAC sensors in studies of alcohol misuse among young adults in natural settings and outline the specific TAC features that contribute to the day‐level prediction of alcohol‐related consequences. TAC sensors provide a passive option for obtaining valid and unique information predictive of drinking risk in natural settings.
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100 
|
  wileyonlinelibrary.com/journal/acer Alcohol Clin Exp Res. 2022;46:100–113.© 2022 by the Research Society on Alcoholism
Received: 22 Febru ary 2021 
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 Accepted: 4 November 2021
DOI : 10.1111/acer.14739
RESEARCH ARTICLE
Transdermal sensor features correlate with ecological
momentary assessment drinking reports and predict alcohol-
related consequences in young adults’ natural settings
Michael A. Russell  | Robert J. Turrisi | Joshua M. Smyth
Depar tment of Biobehavioral Health, The
Pennsylvania St ate Universit y, University
Park, Pennsyl vania, USA
Correspondence
Michael A. Russell, Department of
Biobehavioral Health, The Pennsylvania
State Universit y, 219 Biobehavioral He alth
Building, University Park, PA 16802, USA .
Email: mar60@psu.edu
Funding information
This research was funded by a pilot
mentoring and professional development
award through P50 DA039838 (National
Institute on Drug Abuse, PI: Collins)
and departmental funds awarded to
Michael Russell . The content is solely the
responsibilit y of the authors and does not
necessarily represent the official views of
the NIH.
Abstract
Background: Wearable transdermal alcohol concentration (TAC) sensors allow pas-
sive monitoring of alcohol concentration in natural settings and measurement of
multiple features from drinking episodes, including peak intoxication level, speed of
intoxication (absorption rate) and elimination, and duration. These passively collected
features extend commonly used self- reported drink counts and may facilitate the pre-
diction of alcohol- related consequences in natural settings, aiding risk stratification
and prevention efforts.
Method: A total of 222 young adults aged 21– 29 (M age = 22.3, 64% female, 79%
non- Hispanic white, 84% undergraduates) who regularly drink heavily participated
in a 5- day study that included the ecological momentary assessment (EMA) of alco-
hol consumption (daily morning reports and participant- initiated episodic EMA se-
quences) and the wearing of TAC sensors (SCRAM- CAM anklets). The analytic sample
contained 218 participants and 1274 days (including 554 self- reported drinking days).
Five features— area under the curve (AUC), peak TAC , rise rate (rate of absorption), fall
rate (rate of elimination), and duration— were extracted from TAC- positive trajectories
for each drinking day. Day- and person- level associations of TAC features with drink
counts (morning and episodic EMA) and alcohol- related consequences were tested
using multilevel modeling.
Results: TAC features were strongly associated with morning drink reports (r = 0.6–
0.7) but only moderately associated with episodic EMA drink counts (r = 0.3– 0.5) at
both day and person levels. Higher peaks, larger AUCs, faster rise rates, and faster
fall rates were significantly predictive of day- level alcohol- related consequences after
adjusting for both morning and episodic EMA drink counts in separate models. Person
means of TAC features added little above daily scores to the prediction of alcohol-
related consequences.
Conclusions: These results support the utility of TAC sensors in studies of alcohol
misuse among young adults in natural settings and outline the specific TAC features
that contribute to the day- level prediction of alcohol- related consequences. TAC sen-
sors provide a passive option for obtaining valid and unique information predictive of
drinking risk in natural settings.
... This continuous measure allows for the estimation of drinking dynamics, including peak intoxication levels, intoxication speed, and time spent under the influence. The TAC measure has a strong association with blood alcohol concentration (r = 0.87) and also offers unique dimension of the episodes that are not captured by self-reports, such as the descending limb of a drinking episode (Richards, Glenn, et al., 2024;Russell et al., 2022;Yu et al., 2022). These sensors have been used to assess the intention-behavior (drinking) gap and whether there were differences in drinking dynamics between days in which participants intended or did not intend to drink, besides just corroboration of EMA and TAC-positive readings (Courtney & Russell, 2023). ...
... Examining this relationship is important to understand whether the different levels of affect have an effect of these dynamics potentially indicating heavier drinking episodes. Understanding these effects can inform intervention efforts that could prevent scores on these drinking dynamics which are associated with negative outcomes (e.g., high TAC; Richards, Glenn, et al., 2024;Russell et al., 2022). ...
... Implementing the TAC sensor provides another avenue of assessment for drinking behavior that does not rely on self-reports. Each of these drinking characteristics may differ across days, even when individuals self-report consuming the same number of drinks, thereby providing unique information on alcohol-related risk (Russell et al., 2022). For this study, the TAC sensor provided an objective datapoint for drinking behavior that did not rely on selfreport, helping to strengthen the inferences drawn from our analysis. ...
Drinking Intention–Behavior Links Vary by Affect Among Heavy-Drinking Young Adults: An Ecological Momentary Assessment and Transdermal Sensor Study
Article
Full-text available
  • Jan 2025
Objective: Drinking intention is a predictor of heavy-drinking episodes and could serve as a real-time target for preventive interventions. However, the association is inconsistent and relatively weak. Considering the affective context when intentions are formed might improve results by revealing conditions in which intention–behavior links are strongest and the predictive power of intentions is greatest. Method: We investigated the links between drinking intentions reported in the morning and same-day drinking behavior, moderated by positive and negative affect (PA, NA) in a sample of heavy-drinking young adults. Participants wore the SCRAM continuous alcohol monitor transdermal alcohol sensor anklet for 6 consecutive days in their natural environments and responded to daily ecological momentary assessments that included morning intentions to drink and PA/NA items. Drinking events and patterns were measured using morning-report counts and features from the sensor. Bayesian gamma-hurdle and Poisson multilevel models with noninformative priors tested day-level associations. We hypothesized that drinking intention–behavior associations would be strongest on days with high levels of PA, but we did not hypothesize directionality for the NA effect given the conflicting results in previous literature. Results: Day-level drinking intention–behavior associations were stronger on days with higher versus lower PA according to sensors features. Associations were also stronger on days with lower versus higher NA. Conclusions: The strength of intention–behavior links may partly depend on the affective contexts in which intentions are formed. Results could fine-tune intervention approaches by elucidating the affective contexts in which intentions may more clearly link to drinking behavior to reduce the intensity of an episode—better anticipating problematic drinking among young adults.
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... The dynamics of alcohol consumption can differ within an individual on different days even at equivalent number of drinks. Day-level differences in drinking dynamics can have meaningful implications for the prediction of alcohol-related consequences (Richards et al., 2024;Russell et al., 2022). ...
... The inclusion of multiple indices provides additional context for each drinking episode and related harm that present unique targets for intervention. Area under the curve (AUC) for alcohol exposure has often been used as a metric for alcohol-related risk (Gunn et al., 2021;Russell et al., 2022) that incorporates several aspects of drinking behavior (e.g., quantity, peak, speed, duration). While AUC offers a relatively simple solution, it is not very interpretable and therefore, not intervenable. ...
... There are four main "elementary" features that have been derived from TAC sensors to characterize the dynamics of a drinking episode. These features include the speed of alcohol absorption (rise rate) and elimination ( fall rate), the time spent biologically exposed to alcohol (duration), and the maximum objective intoxication level (peak; Didier et al., 2024;Fridberg et al., 2022;Leffingwell et al., 2013;Russell et al., 2022Russell et al., , 2024. Russell et al. (2022) found that each of these features is a predictor of the number of negative alcohol-related consequences experienced. ...
Profiles of Transdermal Alcohol Concentration and Their Prediction of Negative and Positive Alcohol-Related Consequences in Young Adults’ Natural Settings
Article
Full-text available
  • Jan 2025
Objective: Transdermal alcohol concentration (TAC) sensors provide a multidimensional characterization of drinking events that self-reports cannot. These profiles may differ in their associated day-level alcohol-related consequences, but no research has tested this. We address this using multilevel latent profile analysis. Method: Two hundred twenty-two young adults who regularly engage in heavy drinking (Mage = 22.3, 64% female, 79% non-Hispanic White) responded to surveys and wore TAC sensors for 6 consecutive days. We tested whether four previously identified TAC profiles: (1) high-fast (8.5% of days), (2) moderate-fast (12.8%), (3) low-slow (20.4%), and (4) little-to-no-drinking days (58.2%) differed in numbers of negative and positive consequences and in the odds that both consequence types occurred on the same day. Results: High-fast (incident rate ratio [IRRlow-slow] = 6.18; IRRlittle-to-no-drinking = 9.47) and moderate-fast (IRRlow-slow = 3.71; IRRlittle-to-no-drinking = 5.68) days contained more negative consequences compared to low-slow and little-to-no-drinking days. High-fast (IRR = 2.05), moderate-fast (IRR = 1.88), and low-slow (IRR = 1.43) days contained more positive consequences than little-to-no-drinking days. The odds of having only positive consequences were highest on low-slow, χ²(3) = 9.10, p < .05, days but the odds of experiencing both consequence types increased on moderate-fast and high-fast days, χ²(3) = 39.63, p < .001. Conclusions: Compared to little-to-no-drinking days, TAC profiles indicative of drinking (high-fast, moderate-fast, and low-slow) contained more negative and positive consequences. However, the odds of experiencing only positive consequences were highest among low-slow days and decreased on moderate-fast and high-fast days as the odds of negative consequences rose. These findings provide novel evidence reinforcing harm reduction approaches that seek to maximize positives and minimize negatives of alcohol consumption through emphasis on slow-paced, low-volume drinking.
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... However, concerns have been raised about self-reports during and after heavy-drinking occasions (e.g., Northcote & Livingston, 2011). Accuracy of self-reports may become diminished due to intoxication itself or to contemporaneous consequences like blackouts and differences in the alcohol by volume of each drink the participant reports consuming Northcote & Livingston, 2011;Piasecki, 2019;Richards, Glenn, et al., 2024;Russell et al., 2022). ...
... Features of these curves characterize the alcohol intoxication dynamics of the day, providing aspects of alcohol consumption events beyond the number of drinks consumed. These features include the speed of alcohol absorption (rise rate) and elimination (fall rate), the time spent biologically exposed to alcohol (duration), the maximum intoxication level (peak), and the cumulative burden of alcohol exposure (area under the curve [AUC]; Didier et al., 2024;Fridberg et al., 2022;Leffingwell et al., 2013;Russell et al., 2022Russell et al., , 2024. TAC features correspond with self-reported drink counts (r = .6-.7; Russell et al., 2022;van Egmond et al., 2020), and the unique variability of TAC features is meaningful for alcoholrelated risk. ...
... These features include the speed of alcohol absorption (rise rate) and elimination (fall rate), the time spent biologically exposed to alcohol (duration), the maximum intoxication level (peak), and the cumulative burden of alcohol exposure (area under the curve [AUC]; Didier et al., 2024;Fridberg et al., 2022;Leffingwell et al., 2013;Russell et al., 2022Russell et al., , 2024. TAC features correspond with self-reported drink counts (r = .6-.7; Russell et al., 2022;van Egmond et al., 2020), and the unique variability of TAC features is meaningful for alcoholrelated risk. TAC features predict alcohol-related consequences adjusted for drink counts (Russell et al., 2022) and provide an indirect path through which protective behavior use is associated with reduced alcohol-related consequences . ...
Profiles of Alcohol Intoxication and Their Associated Risks in Young Adults’ Natural Settings: A Multilevel Latent Profile Analysis Applied to Daily Transdermal Alcohol Concentration Data
Article
Full-text available
  • Aug 2024
Objective: Transdermal alcohol concentration (TAC) sensors capture aspects of drinking events that self-reports cannot. The multidimensional nature of TAC data allows novel classification of drinking days and identification of associated behavioral and contextual risks. We used multilevel latent profile analysis (MLPA) to create day-level profiles of TAC features and test their associations with (a) daily behaviors and contexts and (b) risk for alcohol use disorders at baseline. Method: Two hundred twenty-two regularly heavy-drinking young adults (Mage = 22.3) completed the Alcohol Use Disorders Identification Test (AUDIT) at baseline and then responded to mobile phone surveys and wore TAC sensors for six consecutive days. MLPA identified day-level profiles using four TAC features (peak, rise rate, fall rate, and duration). TAC profiles were tested as correlates of daily drinking behaviors, contexts, and baseline AUDIT. Results: Four profiles emerged: (a) high-fast (8.5% of days), (b) moderate-fast (12.8%), (c) low-slow (20.4%), and (d) little-to-no drinking days (58.2%). Profiles differed in the odds of risky drinking behaviors and contexts. The highest risk occurred on high-fast days, followed by moderate-fast, low-slow, and little-to-no drinking days. Higher baseline AUDIT predicted higher odds of high-fast and moderate-fast days. Conclusions: Days with high and fast intoxication are reflective of high-risk drinking behaviors and were most frequent among those at risk for alcohol use disorders. TAC research using MLPA may offer novel and important insights to intervention efforts.
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... Wearable alcohol biosensor monitors (ABM) are electrochemical devices that measure alcohol vapour secreted transdermally in perspiration indirectly measuring the blood alcohol content, and thus, by inference, alcohol consumption [1]. Compared to self-report, ABMs can improve on inaccuracies in self-report, provide continuous estimations of alcohol use (e.g., including peak and duration of alcohol levels) not obtainable with self-report, and could reduce user burden [2]. In treatment settings such accuracy could improve the monitoring of outcomes and appropriateness of treatment planning. ...
What hepatology clinicians and their patients with alcohol-related liver disease think of wearable alcohol biosensors to aid abstinence from alcohol: A qualitative study
Article
Full-text available
  • Dec 2024
  • DRUG ALCOHOL REV
Introduction We aimed to determine acceptability and feasibility of innovative wearable alcohol biosensor monitors (ABM) for patients with alcohol‐related liver disease (ALD) and their clinicians. Methods Patients and clinicians at a tertiary care centre participated in qualitative interviews on usability, acceptability, feasibility, efficiency/effectiveness, impact of device on behaviour/clinical practice and preferences/barriers. Interviews were audiotaped, transcribed and coded using a constant comparison method for category themes. Results Patients ( n = 23) were 56% female, mean 44 years old, 87% White, with moderate–severe liver disease. Some felt the ABMs appearance was unappealing; others felt it provided an opportunity for openness and education of others. While some found it feasible to wear, others felt it was unrealistic to wear 24/7. Importantly, there were many positive themes on effectiveness/efficiency—participants felt the ABM could better record their alcohol use and patterns of use than they could remember. Patients felt wearing the ABM motivated abstinence, gave accountability and was a source of security. Clinicians ( n = 13) were mostly hepatologists (77%), seeing on average 38 ALD patients/month. Clinicians felt seeing patterns and amounts of alcohol use could inform clinical decision making and treatments but expressed concern over the volume and complexity of data. Discussion and Conclusions Perspectives on ABMs for managing ALD were mixed among patients and providers. Future device designs may overcome acceptability barriers due to device appearance. However, for clinicians, the logistics of data gathering plus the complexity and volume of data produced by the ABM device requires considerable thought to make this an efficient tool for clinical use. Clinicaltrials.gov identifier NCT03533660: Alcohol biosensor monitoring for alcohol liver disease.
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The Association Between Internal Restlessness, Drinking Motives, and Alcohol Use Outcomes in College Students
Article
Background ADHD and alcohol use are prevalent among college students, but few studies have examined internal restlessness (i.e., the mental discomfort experienced when suppressing hyperactive behaviors) in relation to alcohol use. Consequently, the current study sought to examine a path model testing associations between internal restlessness, drinking motives (i.e., coping, social, enhancement, and conformity), alcohol use, and consequences in college students. Methods Two hundred and ninety-one college students completed an online survey regarding their use of alcohol. Results After controlling for ADHD diagnosis, there were significant positive associations between internal restlessness and coping ( B = 0.025, p = .004), socializing ( B = 0.026, p = .004), enhancement ( B = 0.038, p < .001), and conformity ( B = 0.026, p < .001). Two significant indirect effects were found for the association between internal restlessness and consequences through enhancement (95% CI [0.001, 0.009]) and coping (95% CI [0.000, 0.011]) motives and alcohol use, respectively. All other indirect pathways were nonsignificant. Conclusions Findings revealed that internal restlessness was associated with the four drinking motives; however, greater internal restlessness was related to more alcohol consequences to the extent that they also reported strong coping and enhancement motives. Findings can be used to tailor intervention and prevention efforts to target emotional regulation and to reduce risk for college students who experience internal restlessness.
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Response Rates, Reliability, and Convergent Validity in Experience Sampling Data
Article
This study examined associations of compliance rate with the reliability and convergent validity of intoxication and negative affect assessments in experience sampling method (ESM) data in three samples (Veterans, Sexual Minority Men, and College Students). Convergent validity was operationalized as within-person associations between daily aggregates of random in situ assessments and retrospective daily assessments or transdermal alcohol assessments. Measures with lower ICC require more assessments for a reliable aggregate (e.g., daily mean). In this regard, the number of completed assessments and intraclass correlation (ICC), rather than compliance with the protocol per se, determines reliability. Although convergent validity was correlated with compliance rate, the relatively weak associations reflect that there are individuals with excellent compliance yet poor convergent validity as well as individuals with poor compliance and excellent convergent validity. The pattern of results does not show a clear threshold for compliance (e.g., 80%) that differentiates good versus poor validity.
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Self-Determined Motivation for Alcohol Use and Drinking Frequency, Intensity, and Consequences
Article
Objective: Drinking motives predict drinking behaviors and outcomes among adults. Drinking motives are rarely studied using self-determination theory (SDT), which aligns with harm-reduction approaches to alcohol use, but SDT can offer a complementary theoretical framework to existing drinking motives frameworks that may help explain the observed heterogeneity in drinking motives and account for more variance in drinking outcomes. This study examined the associations between five SDT-based drinking motives with drinking frequency, intensity, and consequences. Method: A total number of 630 adults (Mage = 21.5, 55% female, 88% undergraduates) rated drinking motives using the Comprehensive Relative Autonomy Index for Drinking (CRAI-Drinking) and the Drinking Motives Questionnaire (DMQ), typical alcohol consumption, and negative and positive drinking consequences. Results: Poisson regressions indicated that intrinsic (IRR = 1.13) and identified (IRR = 1.11) regulations were significantly associated with drinking frequency, identified (IRR = 0.94) and positive introjected (IRR = 1.07) regulations were significantly associated with drinking intensity, and amotivation (IRR = 1.16) and intrinsic regulation (IRR = 1.09) were associated with negative and positive consequences, respectively, after controlling for other CRAI-Drinking and DMQ scores, sex, and drinking intensity. After accounting for DMQ scores and sex, CRAI-Drinking scores accounted for 1.7%-9.9% additional deviance in drinking behaviors and consequences. Conclusions: Adults high in autonomous reasons for drinking reported low-risk, high-enjoyment drinking experiences. In contrast, adults with higher scores for amotivation for drinking reported more negative consequences, even after accounting for drinking intensity, suggesting that high amotivation for drinking may be a novel signal for future alcohol-related risks. These findings support the idea that SDT provides a useful framework for understanding drinking motives, behaviors, and consequences.
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Understanding Alcohol Consumption and Its Antecedents and Consequences in Daily Life: The Why and the How
Article
  • Jul 2024
Most of the scientific research on alcohol consumption behavior in humans is laboratory-based, as reflected by the ratio of laboratory vs. real-life contributions to this handbook. Studies in daily life, although having a long history in addiction research (Shiffman et al., Ann Behav Med 16:203–209, 1994), are in the minority. This is surprising, given that patients with substance use disorders are suffering in daily life and not in the laboratory setting. In other words, drinking patterns and symptoms of alcohol use disorder evolve not in the lab but in daily life, where patients show difficulties in limiting their alcohol intake accompanied with all kinds of related problems. The ultimate goal of all interventions, independent of being tailored toward restricted drinking or abstinence, is again an altered behavior in real life. Translated to practice, patients’ behavior in the lab may not translate to daily life, often showing minimal ecological validity. Therefore, we have to question to which degree lab-based research findings translate into daily life. Fortunately, the current digital revolution provided us with more and more tools, enabling us to monitor, analyze, and change behavior in human everyday life. Our chapter does not intend to give a comprehensive overview of the daily life research on alcohol consumption over the last few decades as others do (Morgenstern et al., Alcohol Res Curr Rev 36:109, 2014; Piasecki, Alcohol Clin Exp Res 43:564–577, 2019; Shiffman, Psychol Asses 21:486–497, 2009; Votaw and Witkiewitz, Clin Psychol Sci 9:535–562, 2021; Wray et al., Alcohol Res Curr Rev 36:19–27, 2014). Instead, we aim at the following: first, to highlight the key advantages of ecological momentary assessment to motivate scientists to add daily life research components to their laboratory research and, second, to provide some guidance on how to begin with daily life research.
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Ecological Momentary Assessment of Alcohol Consumption and Its Concordance with Transdermal Alcohol Detection and Timeline Follow‐Back Self‐report Among Adults Experiencing Homelessness
Article
Full-text available
  • Mar 2021
Background Studies of alcohol use presume valid assessment measures. To evaluate this presumption, we examined the concordance of alcohol use as measured by ecological momentary assessment (EMA) self‐reports, transdermal alcohol concentration readings via the Secure Continuous Remote Alcohol Monitor (SCRAM), and retrospective self‐reports via the Timeline Follow‐Back (TLFB) among adults experiencing homelessness. Methods Forty‐nine adults who reported alcohol misuse (mean age = 47, SD = 9; 57% Black; 82% men) were recruited from a homeless shelter. For 4 weeks, alcohol use was assessed: (i) 5 times or more per day by EMA, (ii) every 30 minutes by a SCRAM device worn on the ankle, and (iii) by TLFB for the past month at the end of the study period. There were 1,389 days of observations of alcohol use and alcohol use intensity for 49 participants. Results EMA and SCRAM alcohol use data agreed on 73% of days, with an interrater agreement Kappa = 0.46. A multilevel analysis of concordance of 3 measures for alcohol use yielded statistically significant correlations of 0.40 (day level) and 0.63 (person level) between EMA and SCRAM. Alcohol use was detected on 49, 38, and 33% of days by EMA, SCRAM, and TLFB, respectively. For alcohol use intensity, EMA and SCRAM resulted in statistically significant correlations of 0.46 (day level) and 0.78 (person level). The concordance of TLFB with either EMA or SCRAM was weak, especially at the day level. Conclusions This is the first study to examine concordance of alcohol use estimates using EMA, SCRAM, and TLFB methods in adults experiencing homelessness. EMA is a valid approach to quantifying alcohol use, especially given its relatively low cost, low participant burden, and ease of use. Furthermore, any stigma associated with wearing the SCRAM or reporting alcohol use in person may be attenuated by using EMA, which may be appealing for use in studies of stigmatized and underserved populations.
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Wearable Transdermal Alcohol Monitors: A Systematic Review of Detection Validity, and Relationship Between Transdermal and Breath Alcohol Concentration and Influencing Factors
Article
Full-text available
  • Oct 2020
Background Research on alcohol consumption mostly relies on self‐reported data, which are subject to recall bias. Wearable transdermal alcohol concentration (TAC) monitors address this limitation by continuously measuring the ethanol excreted via the skin. This systematic review aims to provide an overview of TAC monitors’ reliability to detect alcohol consumption and methods to estimate breath alcohol concentration (BrAC) and number of standard drinks consumed in a given time frame. Methods The databases MEDLINE, PsycINFO, SCOPUS, Engineering Village, and CINAHL were systematically searched to identify 1,048 empirical research papers published from 2013 onwards, of which 13 were included after full‐text screening. The selected studies included 3 TAC monitors: SCRAM™, WristTAS™, and Skyn™. Results TAC measures of SCRAM, WrisTAS, and Skyn are found to be positively correlated with BrAC (r = 0.56 to 0.79) and/or self‐reports (r = 0.62). Using the AMS criteria for detection results in low sensitivity, adjusted criteria can increase the sensitivity of the SCRAM from 39.9 to 68.5%. The WrisTAS and an early prototype of the Skyn showed high failure rates (17 to 38%). Recent advances toward transforming the TAC data into more clinically relevant measures have led to the development of mathematical models and the BrAC Estimator Software. Using TAC data, both approaches produce estimates explaining 70 to 82% of actual BrAC and self‐reported drinking or to highly correlate with the actual BrAC measures (β = 0.90 to 0.91). Conclusions Transdermal alcohol monitors offer an opportunity to measure alcohol consumption in a valid and continuous way with mathematical models and software estimating BrAC values improving interpretation of TAC data. However, the SCRAM seems unable to detect low‐to‐moderate drinking levels using the thresholds and criteria set by the manufacturer. Moreover, the WrisTAS and the Skyn prototype show a high failure rate, raising questions about reliability. Future studies will assess the validity of new‐generation wristbands, including the next Skyn generations.
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Affect Relative to Day-Level Drinking Initiation: Analyzing Ecological Momentary Assessment Data With Multilevel Spline Modeling
Article
Full-text available
  • Jan 2020
Affect regulation models state that affect both motivates and reinforces alcohol use. We aimed to examine whether affect levels and rates of change differed across drinking versus nondrinking days in a manner consistent with affect regulation models. Four hundred four regularly drinking adults, aged 18-70 years, completed ecological momentary assessments over 3 weeks. Participants provided positive affect (PA; enthusiastic, excited, happy) and negative affect (NA; distressed, sad) reports during all prompts; alcohol consumption reports were also provided. Multilevel spline models revealed that on drinking days, PA was higher and NA was lower both before and after drinking compared to matched times on nondrinking days. PA and NA were also higher and lower, respectively, both before and after drinking, when heavy drinking days were compared to moderate drinking days. Examination of affect rates of change revealed that (a) accelerating increases in PA and accelerating decreases in NA preceded drinking initiation, (b) PA increases and NA decreases were seen up to 2 hr after drinking initiation, and (c) pre- and postdrinking PA increases were larger on heavy versus moderate drinking days, whereas only postdrinking NA decreases were larger on heavy drinking days. Results supported affect regulation models while adding nuance, showing accelerating changes in predrinking affect on drinking days and pre- and postdrinking differences in affect levels and rates of change across days of varying drinking intensity. Beyond theory, our results suggest that accelerating changes in affect may provide a clue to future commencement of heavy drinking, which may aid momentary intervention development. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Temporal Dynamics of Transdermal Alcohol Concentration Measured via New‐Generation Wrist‐Worn Biosensor
Article
Full-text available
  • Aug 2019
Background The development of a transdermal alcohol biosensor could represent a tremendous advance toward curbing problematic drinking. But several factors limit the usefulness of extant transdermal technology, including relatively lengthy delays between blood alcohol concentration (BAC) and transdermal alcohol concentration (TAC), as well as the large/bulky designs of currently available transdermal sensors (e.g., ankle monitors). The current research examined the lag time between BAC and TAC using a prototype of BACtrack Skyn—a new‐generation wrist‐worn transdermal sensor featuring a compact design and smartphone integration. Methods Participants (N = 30) received either a dose of alcohol (target BAC 0.08%) or a nonalcoholic beverage in the laboratory while wearing both the AMS SCRAM ankle monitor and a Skyn prototype. Participants were monitored in the laboratory until breath alcohol concentration (BrAC) dropped below 0.025%. Results Device failure rates for Skyn prototypes were relatively high (18 to 38%) compared with nonprototype SCRAM devices (2%). Among participants with usable data, both Skyn‐ and SCRAM‐measured TAC showed strong correlations with BrAC, and both Skyn and SCRAM devices detected alcohol within 30 minutes of first alcohol administration. Skyn‐measured TAC peaked over 1 hour earlier than SCRAM‐measured TAC (54 versus 120 minutes after peak BrAC, respectively), and time‐series models suggested that, on average across all measured portions of the BrAC curve, Skyn TAC lagged behind BrAC by 24 minutes, whereas SCRAM TAC lagged behind BrAC by 69 minutes—all differences statistically significant at p < 0.001. Conclusions Results provide preliminary evidence for the validity of a new‐generation wrist‐worn transdermal sensor under controlled laboratory conditions and further suggest favorable properties of this sensor as they pertain to the latency of transdermal alcohol detection. The prototype version of Skyn employed here displayed a higher failure rate compared with SCRAM, and, in future, more reliable and robust Skyn prototypes will be required suitable to field testing across diverse environmental conditions.
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The Fixed Versus Random Effects Debate and How It Relates to Centering in Multilevel Modeling
Article
Full-text available
  • Oct 2019
In many disciplines researchers use longitudinal panel data to investigate the potentially causal relationship between 2 variables. However, the conventions and concerns vary widely across disciplines. Here we focus on 2 concerns, that is: (a) the concern about random effects versus fixed effects, which is central in the (micro)econometrics/sociology literature; and (b) the concern about grand mean versus group (or person) mean centering, which is central in the multilevel literature associated with disciplines like psychology and educational sciences. We show that these 2 concerns are actually addressing the same underlying issue. We discuss diverse modeling methods based on either multilevel regression modeling with the data in long format, or structural equation modeling with the data in wide format, and compare these approaches with simulated data. We extend the multilevel model with random slopes and discuss the consequences of this. Subsequently, we provide guidelines on how to choose between the diverse modeling options. We illustrate the use of these guidelines with an empirical example based on intensive longitudinal data, in which we consider both a time-varying and a time-invariant covariate. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Wrist-worn alcohol biosensors: Applications and usability in behavioral research
Article
  • Feb 2021
  • ALCOHOL
Wrist-worn alcohol biosensor technology has developed rapidly in recent years. These devices are light, easy to wear, relatively inexpensive, and resemble commercial fitness trackers. As a result, they may be more suitable for a wide range of clinical and research applications. In this paper, we describe three pilot projects examining the associations between reported drinking behavior and transdermal alcohol concentration (TAC) derived from a new, wrist-worn alcohol biosensor (BACtrack Skyn) in diverse participant groups and settings. Study 1 (N = 3) compared Skyn-derived TAC with that from an ankle-worn alcohol sensor (SCRAM CAM) and breath alcohol concentration (BrAC) in a laboratory setting. Study 2 (N = 10) compared Skyn TAC with BrAC during a naturalistic drinking episode in the field. Study 3 (N = 12) used the Skyn to monitor alcohol use in the field for two weeks. Study 2 and 3 also collected usability and acceptability data from participants. The results of Study 1 showed that the Skyn produced a TAC curve that closely resembled that of the validated SCRAM CAM anklet. In Study 2, Skyn detected drinking for all 10 participants (peak BrAC range: 0.02-0.21) with an average delay of 35.6±10.2 minutes after the start of self-reported drinking. In Study 3, Skyn reliably recorded continuous TAC data showing multiple drinking episodes over the monitoring period. Participants in Studies 2 and 3 both reported Skyn as highly acceptable. Collectively, the results of these pilot studies show that the Skyn was able to reliably detect drinking events in the laboratory and natural environments. We offer suggestions for further refinements of alcohol biosensors and accompanying analytic software that may facilitate adoption of these devices as cost-effective, user-friendly, and reliable tools to passively and accurately assess alcohol use in the field.
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How much and how fast: Alcohol consumption patterns, drinking-episode affect, and next-day consequences in the daily life of underage heavy drinkers
Article
  • Nov 2020
  • DRUG ALCOHOL DEPEN
Background Understanding how alcohol consumption patterns are associated with negative and positive outcomes can inform efforts to reduce negative consequences through modification of those patterns. This is important in underage drinkers, many of whom drink heavily despite negative consequences. Most work has focused on the amount of alcohol consumed, but amount provides limited information about consumption patterns compared to rate of consumption, or how fast individuals drink. We therefore examined associations of both amount and rate of consumption with negative and positive outcomes (immediate affective states and next-morning consequences) in daily life. Method Ninety-five college students aged 18–20 years completed ecological momentary assessment over 28 days. Participants reported number of standard drinks consumed and positive and negative affect hourly within drinking episodes. Estimated blood alcohol concentration (eBAC) values were used to create amount and rate of consumption indicators. Each morning after drinking, participants reported negative (e.g., blackout, hangover) and positive (e.g., new friend, making others laugh) consequences. Results Within drinking episodes, multilevel models showed faster consumption was associated with reduced negative affect and both larger amount and faster consumption were associated with greater positive affect. Further, amount and rate were both associated with greater likelihood of a negative consequence the next morning. Rate, but not amount, was associated with more positive consequences. Conclusions Not only how much but also how fast individuals drink may be important for the positive and negative outcomes they experience. Interventions to reduce negative alcohol-related outcomes should consider not only amount, but also rate of consumption.
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Combining transdermal and breath alcohol assessments, real-time drink logs and retrospective self-reports to measure alcohol consumption and intoxication across a multi-day music festival
Article
  • Nov 2020
  • DRUG ALCOHOL REV
Introduction and Aims Comprehensively investigating alcohol‐related behaviours in the context of a dynamic multi‐day alcohol‐licensed event is important for understanding and minimising patron risk. We aimed to assess the measurement utility of implementing a multi‐dimensional alcohol assessment battery using biometric data collection, real‐time drink logs and retrospective self‐report measures over the course of a 4‐day music festival. Methods Fourteen adults participated (n = 7 male, mean age 21.9 years). Breath and transdermal alcohol concentration (BrAC and TAC, respectively) were measured using breathalysers and transdermal alcohol bracelets. A real‐time drink log was completed via smartphones on initiating each drink, and a retrospective questionnaire was administered up to twice daily throughout the event (6 timepoints total). Results While almost all participants (92.9%) logged significantly fewer drinks in real‐time than they retrospectively reported via the twice‐daily questionnaires, logs provided important contextual information including the types of drinks consumed and drinking intensity. Compared to BrAC, TAC provided a better understanding of the time course of intoxication, indicating highest alcohol consumption outside of static BrAC assessment windows. However, BrAC provided a better assessment of present state: all participants were 0.00% BrAC at departure despite over two‐fifths (42.9%) of the sample's last TAC reading exceeding 0.00%. Conclusions As standalone assessments, each method possessed limitations. As a combined battery, they were successfully administered simultaneously, resulting in a more comprehensive overview of alcohol consumption/intoxication over the prolonged drinking session. However, the marked burden of simultaneous administration should be considered, and measures should be chosen judiciously based on research needs.
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Negative Alcohol-Related Consequences Experienced by Young Adults in the Past 12 Months: Differences by College Attendance, Living Situation, Binge Drinking, and Sex
Article
  • Jun 2020
  • ADDICT BEHAV
Purpose: This study estimated the prevalence of negative consequences associated with alcohol use in a national sample of young adults one or two years after graduating from high school, focusing on differences by college attendance, living situation, binge drinking, and sex. Methods: A subsample (N = 1068) of U.S. nationally representative Monitoring the Future study 12th grade students from 2006 to 2016 cohorts was followed-up at modal age 19 or 20 (in 2008-2017) and asked about negative consequences related to their own alcohol use during the past 12 months. Differences in prevalence were estimated and multivariable models examined associations with college attendance, living situation, binge drinking, and sex. Results: Half of surveyed U.S. 19/20 year-old alcohol users (a third of non-binge drinkers and almost three-quarters of binge drinkers) experienced negative consequences in the past year. The likelihood of experiencing several consequence types was significantly associated with college attendance prior to controlling for living situation. In multivariable models controlling for living situation, unsafe driving due to drinking remained more likely for students attending 2-year colleges or vocational/technical schools than for 4-year college students or non-attenders. In general, negative consequence risk was elevated among young adults not living with parents (vs. those living with parents) and women (vs. men). Conclusion: Negative consequences from alcohol use are prevalent among young adults and differ by college attendance, living situation, binge drinking, and sex. Students at 2-year/vocational/technical schools are at particular risk for unsafe driving, warranting specific research attention and targeted intervention.
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