January 4, 2012 — A 3-question survey probing alcohol consumption identifies youth with alcohol-related problems, according to a study published online January 4, 2012, in Pediatrics.
The American Academy of Pediatrics recommends routine screening of adolescents for alcohol use and related problems. In the current study, Tammy Chung, PhD, from the University of Pittsburgh Medical Center in Pennsylvania, and colleagues adapted existing tools designed to screen adults for alcohol abuse or for abuse of any substance to screen for alcohol problems among adolescents.
One screen, the Alcohol Use Disorder Identification Test, has already been shown to identify youth with an alcohol use disorder (AUD), largely because of a question about frequency of consumption. However, the screen has not been tested in a population-based sample.
Therefore, Dr. Chung and colleagues tested the performance of a very brief, 3-question screen in identifying youth with AUD and youth with risky drinking before AUD begins. They also investigated age and/or sex differences in alcohol use
The questions minimized subjective reporting with their clear language, detail, and computerized delivery. The frequency question was: "Think about the past 12 months. We want to know how many days you've had a drink of an alcoholic beverage in the past 12 months." The quantity question defined a drink (a beer; wine cooler or glass of wine, champagne, or sherry; a shot of liquor; a mixed drink; or a cocktail). The third item defined heavy episodic drinking as 5 or more drinks.
The questions were posed by computer and included in the National Survey on Drug Use and Health, which had a sample size of 166,165 individuals aged 12 to 18 years from 2000 to 2007. The questions asked about frequency of drinking in the past year, quantity consumed per occasion, and heavy episodic drinking during the most recent month. The 2 outcome measures were any Diagnostic and Statistical Manual, Fourth Edition, alcohol symptom and Diagnostic and Statistical Manual, Fourth Edition, alcohol dependence.
As predicted, the researchers found that the frequency question was more predictive of AUD than quantity consumed or episodes of heavy drinking. "Frequency of drinking had higher sensitivity and specificity in identifying both outcomes, compared with quantity per occasion and heavy episodic drinking frequency," the authors write.
For both outcomes, the prevalence of an alcohol-related symptom or dependence increased with age, from 1.4% (at age 12 years) to 29.2% (at age 18 years) for any AUD symptom, and from 0.2% (at age 12 years) to 5.3% (at age 18 years) for alcohol dependence.
The cut points found in the study were similar for boys and girls at each age. The use of age-specific cut points, however, maximizes screening performance. For example, "easy-to-remember" cut points based on the study results are, for any AUD symptom, at least 1 drink day during the past year for ages 12 to 15 years, at least 6 days for ages 16 to 17 years, and at least 12 days per year at age 18 years. The values are higher for alcohol dependence.
A limitation of the study, the researchers write, is the self-reporting without biochemical verification. They conclude that the screen, particularly the question about drinking frequency, "provides an empirically validated, efficient screening tool to initially identify youth with alcohol-related problems."
The researchers have disclosed no relevant financial relationships.
Pediatrics. Published online January 4, 2012. Abstract
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