Identifying Modifiable Momentary Predictors of Substance Use in High Risk Emergency Medical Services Clinicians - PROJECT SUMMARY First responders are at risk of substance use from exposure to frequent, chronic job-related stressors. Among all first responder career types, Emergency Medical Services (EMS) clinicians have the highest prevalence of chronic stress, mental health problems, and substance use. Cross-sectional studies suggest that higher stress exposures have been associated with higher substance use in first responders, including EMS clinicians. Stress responses can be effectively managed through positive self-regulatory strategies, but the majority of EMS clinicians struggle to cope effectively which increases the risk of maladaptive substance use. Few studies have examined alcohol use among EMS clinicians and no studies have examined cannabis use in any first responders, however cannabis and alcohol are two of the most commonly used psychoactive substances in the U.S. with 16% and 53% of adults reporting past 30-day use, respectively. While studies to date in EMS clinicians have only used cross-sectional survey methods, a within-person approach is needed to capture intensive longitudinal data through ecological momentary assessments (EMAs) within real life environments and test temporal relations between key momentary risk factors for substance use. This study will recruit a national sample of 110 full-time EMS clinicians who completed the preliminary study in partnership with the U.S. National Registry of EMTs and endorse using cannabis and/or alcohol >2 times per week. Participants will complete EMAs at 5 semi-random times per day for 28 days which will contain validated measures on stress, self-regulation, and substance use. Multilevel structural equation models will be used to identify acute within-person temporal impacts between dependent and independent variables in three specific aims: (Aim 1) stress and self-regulation, (Aim 2) stress and substance use (cannabis, alcohol, and nicotine), and (Aim 3) self-regulation and substance use. The main hypotheses are that individuals experiencing more stress based on their own daily average will report lower self-regulation, and individuals experiencing more stress or less self-regulation will be more likely to report substance use. This exceptional mentor team has expertise in substance use and self-regulation (Drs. Stanger and Marsch), intensive longitudinal data methods (Dr. Jacobson), first responder stress and coping (Dr. Watson), national EMS recruitment and engagement (Dr. Panchal), and local EMS community engagement (Dr. Gray). The training plan outlines four short-term goals: (1) interface with EMS clinicians, (2) train on intensive longitudinal analysis, (3) learn about digital therapeutics, and (4) career development and grant writing. This work will inform Mr. Plaitano’s long-term goal of becoming an NIH-funded investigator using intensive longitudinal designs to identify key momentary risk factors for substance use and using these findings to design, pilot, and evaluate future digital health interventions.
