Short reportExploring multiple drug use by integrating mobile health and qualitative mapping methods - An individual case study
Introduction
Social science contributions to understanding multiple drug use have lagged behind those from the natural sciences (Kataja, Tigerstedt, & Hakkarainen, 2018). The regular and combined use of multiple substances is disproportionately practiced by some minority and socially marginalized groups, such as gender minority individuals (Benotsch et al., 2013). The particular risks (e.g., overdose) and benefits (e.g., enhanced capacities) associated with multiple drug use demand a better understanding of its unique characteristics, including its specific patterns, combinations, intentions, and contexts (Kataja et al., 2018). We use the term multiple drug use to encompass both ‘drug use repertoires’ and ‘drug use combinations’. Drug use repertoires refer to the variety of substances a person ingests during a particular timeframe (Boys et al., 1999). ‘Drug use combinations’ refer to the ingestion of two or more substances at the same time or in close temporal proximity so that overlapping psychoactive effects are produced (Hakkarainen, O'Gorman, Lamy, & Kataja, 2019).
Prominent methods for researching multiple drug use include retrospective surveys that inventory participants’ drug use repertoires over the past month or year, and in-depth interviews and ethnographic field work that examine practices and experiences of drug use combinations. Increasingly, mobile and geo-enabled technologies (e.g., smartphones, geographic information systems) are being integrated with qualitative research methods (e.g., in-depth interviews) to ground drug use practices and experiences in their social and physical environments (Mennis, Mason, & Cao, 2013; Valdez & Sifaneck, 2010). In the spirit of creative research methods like these (Kara, 2015), we integrated geo-enabled smartphone survey data collection with a qualitative mapping interview method and piloted it to explain tobacco use disparities among bisexual young adults. The pilot study revealed smoking patterns and situations that reflect young adult smokers, generally, but also the unique roles that smoking plays for bisexual young adults as they navigate differently sexualized spaces in everyday life (McQuoid, Thrul, & Ling, 2018; McQuoid, Thrul, Ozer, Ramo, & Ling, 2019). This brief report draws from preliminary data to demonstrate how the method may also provide integrated insights into the unique patterns, intentions, and socio-structural contexts of multiple drug use for different groups of people.
Section snippets
Integrating mobile health and qualitative mapping methods
Smartphone apps that repeatedly administer surveys to participants and record their locations over time are often used to research recurring and episodic behaviours. These approaches can ‘reach into’ the fabric of everyday life to collect data within participants’ natural environments and routines (Kirchner & Shiffman, 2016). Smartphone ownership is increasingly ubiquitous even among low income and rural groups, making this approach feasible with diverse populations. Mobile health (mHealth)
Findings: Patterns, intentions, and contexts of multiple drug use
‘Jason’ was a transgender man in his mid-twenties who lived in a rural community, had a history of homelessness, and reported having autism spectrum disorder (ASD). He worked part-time in constrution and lived with his partner in a small house. Jason completed 70% of all prompted surveys during his 30 days of data collection. Jason's mHealth survey data indicated that he smoked a daily average of 6.5 cigarettes. He most often smoked alone, and frequently smoked at home, in a vehicle, or at
Discussion and conclusions
This one individual's mHealth and map-led interview data set offered an integrated understanding of the complex use patterns, combinations, and intentions within his drug use repertoire (Hakkarainen et al., 2019; Kataja et al., 2018), and linked these to his intersecting identities and the particular social and structural characteristics of his environment. Specifically, it revealed relationships between how and why he uses multiple drugs and his day-to-day experiences as a transgender person
Declarations of Interest
The authors report no conflict of interest.
Acknowledgements
We are grateful to the participant whose data we presented in this brief report for his time and generosity in sharing his experiences, and to the anonymous reviewers for their helpful input. This work was funded by the California Tobacco-Related Disease Research Program (27IR-0042; T29FT0436), Oklahoma Tobacco Settlement Endowment Trust (TSET) Grant R21-02, and NCI Cancer Center Support Grant P30CA225520 awarded to the Stephenson Cancer Center.
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