Ecological momentary assessment of smoking behaviors with Native Hawaiian Pacific Islanders

Background: Ecological momentary assessment (EMA) comprises repeated sampling of research participants’ behaviors and experiences in real time and real-life context, thus minimizing recall bias and maximizing validity. As part of formative development for a smoking cessation intervention for young adult Native Hawaiian Pacific Islanders (NHPIs), we initiated an EMA pilot study to understand smoking behavior and reinforcing psychosocial and environmental cues in this population with high smoking prevalence.

Methods:  Participants included 20 NHPIs (12 males, 8 females), 18-29 years who had smoked 100 cigarettes lifetime and currently smoked at least 10 cigarettes daily. Over 9 consecutive days (2 weekends and 5 week days), 5 daily randomly scheduled assessments were conducted on iPhones programmed with survey items about smoking habits, mood, and cues from the physical and social environment.

Results: After adjusting for gender, age, and nicotine dependence, craving, feeling happy, having fun/celebrating, and wanting a cigarette while drinking alcohol or coffee were consistently associated with a variety of smoking measures (e.g. average number of cigarettes smoked or proportion of smoked at least 3-4 cigarettes) across time blocks within an EMA assessment day (ps<0.05). Significant positive relationships were also observed between some but not all smoking measures, such as being either at school, alone, or with another smoker, or feeling angry, anxious or relaxed (ps<0.05).

Conclusions: Findings contributed to our understanding of the internal and external influences that encourage smoking among young adults NHPIs and informed the text messaging and online education module content of our smoking cessation program.