eng Science and Education Publishing American Journal of Public Health Research 2327-6703 2014-11-24 2 6 232 238 10.12691/ajphr-2-6-3 AJPHR2014263 article John Bellettiere jbellettiere@cbeachsdsu.org 1 Suzanne C. Hughes 1 Sandy Liles 1 Marie Boman-Davis 1 Neil E. Klepeis 1 Elaine Blumberg 1 Jeff Mills 1 Vincent Berardi 1 2 Saori Obayashi 2 T. Tracy Allen 3 Melbourne F. Hovell 3 Graduate School of Public Health, San Diego State University, San Diego, USA EME Systems LLC, Berkeley, USA Real-time sensing and computing technologies are increasingly used in the delivery of real-time health behavior interventions. Auditory signals play a critical role in many of these interventions, impacting not only behavioral response but also treatment adherence and participant retention. Yet, few behavioral interventions that employ auditory feedback report the characteristics of sounds used and even fewer design signals specifically for their intervention. This paper describes a four-step process used in developing and selecting auditory warnings for a behavioral trial designed to reduce indoor secondhand smoke exposure. In step one, relevant information was gathered from ergonomic and behavioral science literature to assist a panel of research assistants in developing criteria for intervention-specific auditory feedback. In step two, multiple sounds were identified through internet searches and modified in accordance with the developed criteria, and two sounds were selected that best met those criteria. In step three, a survey was conducted among 64 persons from the primary sampling frame of the larger behavioral trial to compare the relative aversiveness of sounds, determine respondents' reported behavioral reactions to those signals, and assess participant's preference between sounds. In the final step, survey results were used to select the appropriate sound for auditory warnings. Ultimately, a single-tone pulse, 500 milliseconds (ms) in length that repeats every 270 ms for three cycles was chosen for the behavioral trial. The methods described herein represent one example of steps that can be followed to develop and select auditory feedback tailored for a given behavioral intervention. http://pubs.sciepub.com/ajphr/2/6/3/ajphr-2-6-3.pdf real-time feedback warning sounds behavioral intervention auditory alerts immediate feedback auditory warning design alarm design