A cross‐lagged analysis of measured and self‐estimated intoxication: Mobile health data from a large United States sample examined 2016 to 2022
Yang Lu, Catharine E. Fairbairn, Jiaxu Han, Nigel BoschAbstract
Background and Aims
Feedback from mobile health technologies can facilitate self‐awareness of intoxication among substance users, thereby reducing risky decision‐making and potentially moderating consumption; however, real‐world effects of mobile device engagement among drinkers remain underexamined. The current study leveraged longitudinal data from mobile breathalyzers via cross‐lagged analyses to examine reciprocal pathways between breath alcohol concentration (BrAC) levels and BrAC self‐estimation error.
Design
Observational study analyzing BrAC data collected via mobile breathalyzers and shared by the device manufacturer.
Setting
Participants were mobile breathalyzer users located within the United States from January 1, 2016, to February 28, 2022, who voluntarily submitted data during active real‐world drinking episodes.
Participants
18 800 unique user accounts provided a total of 387 643 breathalyzer readings.
Measurements
BrAC self‐estimation error was calculated as the absolute difference between a measured BrAC level and the corresponding BrAC self‐estimation.
Results
Results of cross‐lagged models indicated an asymmetrical relationship between BrAC levels and self‐estimation error. In moment‐to‐moment analyses, a 0.02 increase in BrAC level at the preceding time point predicted a 2.35% increase in self‐estimation error at the following time point, b = 1.16, p < 0.001, 95% confidence interval (CI) [1.08, 1.25]. Conversely, after participants received BrAC feedback, a 0.02 increase in self‐estimation error predicted a subsequent 1.15% decrease in BrAC level, b = −0.58, p < 0.001, 95% CI [−0.64, −0.52]. Similarly, a tendency to underestimate at earlier time points predicted later decreases in BrAC levels, b = −0.07, p < 0.001, 95% CI [−0.08, −0.07].
Summary
There appears to be a reciprocal, albeit asymmetrical, relationship between objectively measured (via mobile breathalyzer) and subjectively self‐estimated intoxication. When drinkers are provided breath alcohol concentration feedback, inaccuracies in self‐estimated intoxication are followed by behavioral adjustments in real‐world drinking contexts.