Marilyn L. Piccirillo’s research while affiliated with Robert Wood Johnson Foundation and other places

The ubiquity of digital technologies has increased the assessment of individuals' thoughts, behaviors, and experiences via electronic devices. Surveys on smartphones or laptops often implement Visual Analogue Scales (VAS), recording responses on a continuous slider from 0 to 100. This is particularly relevant for data collection in daily life, such as ecological momentary assessments (EMA), repeatedly presenting items on mobile devices. However, the accuracy of digital VAS has been questioned, particularly regarding tactile precision (e.g., finger-to-screen size ratio), the consistency of scale interpretation between respondents, and over time (e.g., reactivity to repeated measurement). Participants (N = 3,761, 67.03% female; Mage = 47.09; SD = 14.41) from the Critical Incidents and Psychological Adaptation (CIPA) Study completed a 30-day EMA assessment. We investigated the accuracy of VAS in terms of (1) tactile precision, and (2) respondents’ perception of the neutral point post-EMA, and (3) test-retest consistency of affect ratings pre- and post-EMA. (1) Tactile precision was assessed by asking participants to enter exactly 31 on a 0–100 slider. Results showed high precision (M = 31.01; SD = 3.28; 87.0% scored between 30-32). (2) The neutral point was assessed by asking participants to indicate the score for feeling neutral on two affect items (unipolar and bipolar), with 82.19% and 88.89% indicating the scale midpoint (50 and 0, ± 5) as neutral point respectively. Neutral points deviating from the midpoint were strongly correlated (r = .71–.73) with the person-specific means across the EMA period on the respective item. (3) Test-retest consistency was evaluated by asking participants to rate how happy/sad, they/others would be in response to affective events (e.g., a serious argument) pre- and post-EMA. Consistency across time was high (median change = 0–5). Findings support the accuracy and consistency of digital VAS and alleviate several key concerns about potential inaccuracy.

Background Undergraduates with higher social anxiety symptoms are at risk for co‐occurring substance misuse, heavier drinking in certain contexts, and experiencing more negative alcohol‐related consequences. Among undergraduates broadly, online norms‐based interventions provide consistent and cost‐effective reductions in alcohol use and related risks. However, research on norms‐based interventions for undergraduates with higher social anxiety symptoms is limited, and less is known about the longitudinal impacts of social anxiety symptoms on the efficacy of online, norms‐based alcohol interventions. Methods Secondary analyses were conducted on data from a large randomized controlled trial (RCT) with undergraduates who reported past‐month heavy episodic drinking and were randomized to an attention control or a norms‐based intervention. Generalized linear models tested whether baseline social anxiety symptoms moderated the efficacy of receiving a norms‐based intervention versus a nonalcohol‐focused attention control condition at 3‐, 6‐, and 12‐month follow‐up. Results Social anxiety symptoms moderated intervention efficacy on the number of typical drinks consumed and descriptive norms at 3 months, as well as injunctive norms at 3 and 12 months. However, these effects appeared to be primarily driven by the individuals with higher social anxiety symptoms in the attention control group. Overall, norms‐based interventions demonstrated efficacy in reducing the number of typical drinks consumed, descriptive and injunctive norms, and negative consequences up to 12 months later, regardless of social anxiety symptoms. Conclusions Results demonstrated that online norms‐based interventions were similarly efficacious for reducing drinking, negative consequences, and normative beliefs for undergraduates, regardless of social anxiety symptoms. Further, effects were maintained up to 12 months. Thus, existing alcohol‐focused brief interventions are efficacious for those with higher social anxiety symptoms, even without adaptation for social anxiety‐specific concerns. Individuals with higher social anxiety symptoms who did not receive an active intervention reduced drinking beliefs and behaviors, although reductions were not maintained over time.

Background Personalized feedback‐based interventions for reducing high‐risk alcohol use among college students vary in length and intensity. Comprehensive multicomponent personalized feedback interventions (PFIs) include more material and have greater intensity compared to briefer, single‐component interventions such as personalized normative feedback (PNF). However, while PFIs may offer more comprehensive support, their lengthiness can potentially reduce attention and engagement with the intervention content, impacting their overall efficacy. This study examines how attentiveness—the degree to which participants engage with and process the intervention material—differs between single‐ and multicomponent interventions and how this variation moderates the efficacy of PFIs. Methods A secondary analysis of a longitudinal randomized clinical trial was conducted, involving 1137 undergraduates reporting past‐month heavy episodic drinking (63% female; mean age = 20.1 years). Assessments occurred at baseline and 3, 6, and 12 months postintervention, with primary outcomes including drinks per week and negative alcohol‐related consequences. Intervention conditions included (a) assessment‐only control (AOC), (b) multicomponent PFI, and (c) single‐component PNFs. Generalized linear mixed models were used to evaluate attentiveness as a moderator of treatment efficacy across multicomponent PFI, single‐component PNFs, and AOC conditions. Results Analysis detected significantly higher attentiveness levels in single‐component PNFs compared to the multicomponent PFI (b = 0.35, p < 0.001). A three‐way interaction (Time × Condition × Attentiveness) indicated that the efficacy of multicomponent PFI versus AOC on drinks per week was only significant for those reporting moderate‐to‐high attentiveness levels, not for those with low attentiveness. When comparing multicomponent PFI to single‐component PNF, multicomponent PFI outperformed single‐component PNF only when attentiveness was high; conversely, when attentiveness was low, single‐component PNF outperformed multicomponent PFI. Conclusions While the simplicity of PNF allows for easy implementation with minimal cognitive effort, multicomponent PFI demonstrates greater efficacy potential, particularly when comprehended thoroughly. Future research could explore strategies to enhance attentiveness with multicomponent PFI, such as sequential delivery across multiple sessions to optimize its benefits.

Background and Aims Efficacy of brief alcohol interventions for young adults with internalizing distress (i.e. symptoms of depression, anxiety and stress) is unclear. We tested the moderating effect of internalizing distress on the efficacy of alcohol single‐ and multicomponent personalized feedback interventions (PFIs). Design Secondary data were analyzed from a randomized controlled trial (RCT) testing the efficacy of single and multicomponent PFIs, compared with an attention‐only control condition. Setting Participants were sampled from two West Coast universities in the United States. All study protocols were completed online. Participants Participants ( n = 1137) were college students (63% female; M age = 20.1 years; 62.6% non‐Hispanic white) who reported on internalizing distress at baseline. Some individuals reported clinically significant symptoms (depression: mild/moderate = 24.0%, severe/extremely severe = 10.5%; anxiety: mild/moderate = 19.6%, severe/extremely severe = 11.4%; and stress: mild/moderate = 37.5%, severe/extremely severe = 6.0%). Interventions There were four different alcohol single‐component PFIs administered and an attention‐only PFI control. Alcohol PFIs varied in their complexity and single‐component PFIs (i.e. personalized normative feedback) were compared with multicomponent PFI (i.e. containing additional alcohol‐focused psychoeducation). Measurements Baseline levels of internalizing distress were measured using the summed total of the Depression, Anxiety and Stress Scales (DASS). Drinking outcomes (alcohol consumption, peak eBAC, alcohol‐related consequences) were measured at baseline, 3, 6 and 12 months post‐intervention. Findings Alcohol PFI (compared with attention‐only control) reduced alcohol consumption and related consequences at 6‐month [rate ratio (RR) Consumption = 0.85, P = 0.004] or 12‐month follow‐ups (RR Consumption = 0.76, P < 0.001; RR Consequences = 0.85, P = 0.020), regardless of baseline DASS score. Participants with higher DASS scores (compared with those with lower DASS scores) reported lower 6‐month alcohol consumption after receiving a single‐component intervention (RR = 0.80, P < 0.001). However, individuals with higher DASS scores (compared to those with lower DASS scores) reported more 6‐month alcohol‐related consequences after receiving a multicomponent intervention (RR = 0.78, P = 0.004). Conclusions Personalized feedback interventions may demonstrate efficacy towards reducing drinking in young adults and appear similarly beneficial across levels of internalizing distress, although lower‐complexity interventions may be more efficacious.

Background: Ecological momentary assessment (EMA) involves collecting data from people in their everyday lives one or more times per day over the course of days, weeks, or months. EMA has been used in the traumatic stress field to better understand how trauma-relevant symptoms, experiences, and behaviours occur under naturalistic conditions and in relation to one another. The FAIR principles specify that data should be Findable, Accessible, Interoperable, and Reusable to maximise the knowledge gained from individual research studies. However, it is unclear how EMA design decisions and data procedures might affect the implementation of these principles. Objective: We articulate key design considerations and data procedures when performing trauma EMA research and outline some challenges and recommendations for implementing the FAIR data principles in trauma EMA research. Method and Results: Using examples from existing trauma EMA studies, we discuss the decisions made when preparing a trauma EMA study; data processing and analytic procedures performed following data collection; and challenges that exist for their implementation, as well as practices that trauma EMA researchers can incorporate into their research to promote FAIR data. Conclusions: Implementing the FAIR data principles in trauma EMA research is critical to advancing scientific knowledge. Researchers should deposit their data in reputable repositories and include documentation detailing design decisions and the steps taken to clean and prepare data. Many challenges remain for the implementation of these practices including balancing privacy concerns and efforts to make trauma EMA data readily shareable.

Young adults who engage in problematic cannabis use report lower work and interpersonal functioning yet are less likely to seek treatment, necessitating alternative methods for assessing and intervening on problematic cannabis use (e.g., mobile health applications to self-monitor drivers of cannabis use in daily life). However, previous work examining maintenance models of problematic cannabis use has primarily focused on modeling predictors of cannabis use as measured using static retrospective report rather than examining cannabis use as a series of interactions that unfold in everyday life. In this study, we analyzed ecological momentary assessment data (T = 3,230 observations) from 65 young adults who reported problematic cannabis use (Cannabis Use Disorders Identification Test-Revised: M = 10.38, SD = 4.35) and an interest in reducing their use. We used multilevel network analyses to model associations among biopsychosocial factors that aligned with social learning, self-medication, and experiential avoidance theories of substance use. Network models demonstrated consistent associations between socioenvironmental triggers and cannabis cravings, use, and intoxication that were nearly all clinically meaningful in size (bs > 0.10). Results indicated a statistically significant association between negative and positive affect with cannabis use and intoxication, respectively; however, these associations were not clinically meaningful in size. There were no clinically meaningful associations between coping strategies and cannabis use variables. Findings advance our understanding of cannabis use in everyday life, which is critical for refining more dynamic conceptualization of substance use and improving the precision of clinical assessments.

The ubiquity of digital technologies has increased the assessment of individuals' thoughts, behaviors, and experiences via electronic devices. Surveys on smartphones or laptops often implement Visual Analogue Scales (VAS), recording responses on a continuous slider from 0 to 100. This is particularly relevant for data collection in daily life, such as ecological momentary assessments (EMA), repeatedly presenting items on mobile devices. However, the accuracy of digital VAS has been questioned, particularly regarding tactile precision (e.g., finger-to-screen size ratio), the consistency of scale interpretation between respondents, and over time (e.g., reactivity to repeated measurement). Participants (N = 3,761, 67.03% female; Mage = 47.09; SD = 14.41) from the Critical Incidents and Psychological Adaptation (CIPA) Study completed a 30-day EMA assessment. We investigated the accuracy of VAS in terms of (1) tactile precision, and (2) respondents’ perception of the neutral point post-EMA, and (3) test-retest consistency of affect ratings pre- and post-EMA. (1) Tactile precision was assessed by asking participants to enter exactly 31 on a 0–100 slider. Results showed high precision (M = 31.01; SD = 3.28; 87.0% scored between 30-32). (2) The neutral point was assessed by asking participants to indicate the score for feeling neutral on two affect items (unipolar and bipolar), with 82.19% and 88.89% indicating the scale midpoint (50 and 0, ± 5) as neutral point respectively. Neutral points deviating from the midpoint were strongly correlated (r = .71–.73) with the person-specific means across the EMA period on the respective item. (3) Test-retest consistency was evaluated by asking participants to rate how happy/sad, they/others would be in response to affective events (e.g., a serious argument) pre- and post-EMA. Consistency across time was high (median change = 0–5). Findings support the accuracy and consistency of digital VAS and alleviate several key concerns about potential inaccuracy.

Background: Despite known gender/sex differences in the prevalence of posttraumatic stress disorder (PTSD), potential differences in the associations among PTSD symptoms between men and women in the early post-trauma period are not well-characterized. Objective: This study utilized network analysis to assess potential differences in the associations among PTSD symptom clusters between men and women during the early post-trauma period. Method: We included n = 475 participants (57.5% self-identified women) who recently (≤2 months) experienced an interpersonal or motor vehicle potential traumatic event in the Netherlands. Past month PTSD symptoms were measured with the PTSD Checklist for DSM-5 (PCL-5) and composited according to the five-node PTSD symptom cluster dysphoric arousal model. We estimated the network as well as indices of centrality (strength and predictability) and assessed the stability of the modelled networks in subsamples of men (n = 202) and women (n = 273). We compared network structures using the Network Comparison Test (NCT). Results: Results largely demonstrated adequate correlation stability for the estimated network structures for women and men. For both men and women, avoidance symptoms were among the strongest nodes with greatest predictability in the networks. In men, anxious arousal additionally showed high strength whereas re-experiencing showed high predictability. In women, re-experiencing symptoms demonstrated both high strength and predictability. The NCT demonstrated nonsignificant differences in global network structure (M = 0.08, p = .054) and strength (S = .073, p = .067). Post hoc comparisons showed an association of re-experiencing symptoms with negative alterations in cognitions and mood in men but not women (E = .038, p = .005). Conclusion: Results demonstrated possible modest gender differences in aspects of network structure although most elements of the network structure were similar across genders. These results help to characterize gender differences in associations among PTSD symptom clusters during the early post-trauma period, which may inform the potential relevance of future gender-sensitive early intervention strategies to ameliorate the risk for long-term PTSD.

Clinical researchers using ecological momentary assessment (EMA) typically aim to maximize assessment richness and minimize burden, often sacrificing the scope, temporal granularity, and observational power of resultant data, based on limited empirical evidence. The present mixed-methods study queried participant preferences on EMA design and expectancies prior to completing an EMA protocol (Sample 1, N = 1495). We collected survey and qualitative interview data assessing implementation outcomes from a subset of individuals reporting clinical levels of anxiety/stress and frequent alcohol use who enrolled and completed at least two weeks EMA (Sample 2; n = 59). Participants completed three EMA surveys for up to 112 days (M = 76.8 days, SD = 37.88) with an average compliance of 73.8% (SD = 17.18). Descriptive statistics and a hybrid inductive-deductive coding approach were used to analyzed quantitative and qualitative data, respectively. Participants perceived daily variability in most health-related domains (e.g., mental health symptoms, rest), and frequently reported positive expectations for EMA (e.g., anticipated increased awareness). Most participants reported that completing EMA surveys helped them gain awareness of their daily patterns (n = 37, 62.7%) but that study protocols were long and burdensome (n = 44, 74.6%). Qualitative themes of acceptability, adoption, appropriateness, feasibility, and fidelity were identified; the nature and frequency of themes varied by level of average compliance. Results help to scaffold ways to leverage preferences for protocol design, expectations for tracking using EMA, and experiences during EMA to guide future work in EMA protocol design, ultimately improving momentary assessment of complex behaviors.