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So R, Kariyama K, Oyamada S, Matsushita S, Nishimura H, Tezuka Y, Sunami T, Furukawa TA, Kawaguchi M, Kobashi H, Nishina S, Otsuka Y, Tsujimoto Y, Horie Y, Yoshiji H, Yuzuriha T, Nouso K. Prevalence of hazardous drinking and suspected alcohol dependence in Japanese primary care settings. Gen Hosp Psychiatry 2024; 89:8-15. [PMID: 38657355 DOI: 10.1016/j.genhosppsych.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE We aimed to assess the prevalence of hazardous drinking and potential alcohol dependence among Japanese primary care patients, and their readiness to change and awareness of others' concerns. METHODS From July to August 2023, we conducted a multi-site cross-sectional study as a screening survey for participants in a cluster randomized controlled trial. The trial included outpatients aged 20-74 from primary care clinics. Using the Alcohol Use Disorders Identification Test (AUDIT) alongside a self-administered questionnaire, we evaluated the prevalence of hazardous drinking and suspected alcohol dependence, patients' readiness to change, and their awareness of others' concerns. RESULTS Among the 1388 participants from 18 clinics, 22% (95% confidence interval (CI): 20% to 24%) were identified as engaging in hazardous drinking or suspected of being alcohol dependent. As the AUDIT scores increased, so did their readiness to change. However, only 22% (95%CI: 16% to 28%) of those with scores ranging from 8 to 14 reported that others, including physicians, had expressed concerns about their drinking during the past year. For those with scores of 15 or higher, the figure was 74%. CONCLUSIONS This study underscores the need for universal or high-risk alcohol screening and brief intervention in Japanese primary care settings. Trial registry UMIN-CTR (https://www.umin.ac.jp/ctr/) (UMIN000051388).
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Affiliation(s)
- Ryuhei So
- Okayama Psychiatric Medical Center, Okayama, Japan; CureApp, Inc., Tokyo, Japan; Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Kazuya Kariyama
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | | | - Sachio Matsushita
- National Hospital Organization Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Hiroki Nishimura
- Okayama Psychiatric Medical Center, Okayama, Japan; CureApp, Inc., Tokyo, Japan
| | - Yukio Tezuka
- Department of Psychiatry, Okinawa Rehabilitation Center Hospital, Okinawa, Japan
| | | | - Toshi A Furukawa
- Office of Institutional Advancement and Communications, Kyoto University, Kyoto, Japan; Kyoto University, Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | | | - Haruhiko Kobashi
- Department of Hepatology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Sohji Nishina
- Department of Gastroenterology and Hepatology, Kawasaki Medical School, Okayama, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasushi Tsujimoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan; Oku Medical Clinic, Osaka, Japan
| | | | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Takefumi Yuzuriha
- National Hospital Organization Hizen Psychiatric Medical Center, Saga, Japan; Chikugo Yoshii Cocoro Hospital, Fukuoka, Japan
| | - Kazuhiro Nouso
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
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2
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Hoff TA, Heller S, Reichel JL, Werner AM, Schäfer M, Tibubos AN, Simon P, Beutel ME, Letzel S, Rigotti T, Dietz P. Cigarette Smoking, Risky Alcohol Consumption, and Marijuana Smoking among University Students in Germany: Identification of Potential Sociodemographic and Study-Related Risk Groups and Predictors of Consumption. Healthcare (Basel) 2023; 11:3182. [PMID: 38132073 PMCID: PMC10742791 DOI: 10.3390/healthcare11243182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide, including among university students. To plan effective evidence-based programs to prevent the risky consumption of these substances among university students, the present study aimed to identify potential sociodemographic and study-related risk groups and predictors of consumption. (2) Methods: A cross-sectional online health survey with approximately 270 health-related items was conducted among students at the University of Mainz, Germany. Cigarette smoking, risky alcohol consumption (AUDIT-C score: female ≥ 4, male ≥ 5), and marijuana smoking were chosen as dependent variables. Of the 270 health-related items, 56 were chosen as independent variables and collated into five groups (sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior). The prevalence of cigarette smoking, risky alcohol consumption, and marijuana smoking was assessed using established and validated instruments. Pearson's chi-square test was used to analyze the differences in prevalence between the sociodemographic and study-related groups, and binary logistic regression was used for analyses with stepwise inclusion of the five variable groups. (3) Results: Of the 3991 university students who entered the analyses, 14.9% reported smoking cigarettes, 38.6% reported risky alcohol consumption, and 10.9% reported smoking marijuana. The prevalence of these differed between genders, fields of study, and aspired degree level, among other factors. Binary logistic regression analyses revealed nine significant predictors (p ≤ 0.05) of cigarette smoking (Nagelkerke R2 = 0.314), 18 significant predictors of risky alcohol consumption (Nagelkerke R2 = 0.270), and 16 significant predictors of marijuana smoking (Nagelkerke R2 = 0.239). (4) Conclusions: This study showed cigarette smoking, risky alcohol consumption, and marijuana smoking among university students in Germany to be associated with multiple factors, especially health behaviors. Furthermore, each of the substances was highly associated with each of the two other substances we examined. Other variable groups, such as psychological or psychosocial variables, seemed to play a rather minor role. Therefore, our recommendation for future prevention programs is that substance use among university students should be addressed as a whole, not just in terms of specific substances.
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Affiliation(s)
- Thilo A. Hoff
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.A.H.); (S.H.); (J.L.R.); (S.L.)
| | - Sebastian Heller
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.A.H.); (S.H.); (J.L.R.); (S.L.)
| | - Jennifer L. Reichel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.A.H.); (S.H.); (J.L.R.); (S.L.)
| | - Antonia M. Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (A.M.W.); (A.N.T.); (M.E.B.)
| | - Markus Schäfer
- Department of Communication, Johannes Gutenberg University, 55122 Mainz, Germany;
| | - Ana Nanette Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (A.M.W.); (A.N.T.); (M.E.B.)
- Nursing Science, Diagnostics in Healthcare and E-Health, Trier University, 54296 Trier, Germany
| | - Perikles Simon
- Department of Sports Medicine, Rehabilitation and Disease Prevention, Institute of Sport Science, Johannes Gutenberg University, 55122 Mainz, Germany;
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, 55131 Mainz, Germany; (A.M.W.); (A.N.T.); (M.E.B.)
| | - Stephan Letzel
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.A.H.); (S.H.); (J.L.R.); (S.L.)
| | - Thomas Rigotti
- Department of Work, Organizational and Business Psychology, Institute of Psychology, Johannes Gutenberg University, 55122 Mainz, Germany;
- Leibniz Institute of Resilience Research, 55122 Mainz, Germany
| | - Pavel Dietz
- Institute of Occupational, Social and Environmental Medicine, University Medical Centre of the Johannes Gutenberg University, 55131 Mainz, Germany; (T.A.H.); (S.H.); (J.L.R.); (S.L.)
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3
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Blake H, Yildirim M, Premakumar V, Morris L, Miller P, Coffey F. Attitudes and current practice in alcohol screening, brief intervention, and referral for treatment among staff working in urgent and emergency settings: An open, cross-sectional international survey. PLoS One 2023; 18:e0291573. [PMID: 37756359 PMCID: PMC10529549 DOI: 10.1371/journal.pone.0291573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The aim of the study was to ascertain the views and experiences of those working in urgent and emergency care (UEC) settings towards screening, brief intervention, and referral to treatment (SBIRT) for alcohol, to inform future practice. OBJECTIVES To explore i) views towards health promotion, ii) views towards and practice of SBIRT, iii) facilitators and barriers to delivering SBIRT, iv) training needs to support future SBIRT practice, and v) comparisons in views and attitudes between demographic characteristics, geographical regions, setting and occupational groups. METHODS This was an open cross-sectional international survey, using an online self-administered questionnaire with closed and open-ended responses. Participants were ≥18 years of age, from any occupational group, working in urgent and emergency care (UEC) settings in any country or region. RESULTS There were 362 respondents (aged 21-65 years, 87.8% shift workers) from 7 occupational groups including physicians (48.6%), nurses (22.4%) and advanced clinical practitioners (18.5%). Most believed that health promotion is part of their role, and that SBIRT for alcohol prevention is needed and appropriate in UEC settings. SBIRT was seen to be acceptable to patients. 66% currently provide brief alcohol advice, but fewer screen for alcohol problems or make alcohol-related referrals. The most common barriers were high workload and lack of funding for prevention, lack of knowledge and training on SBIRT, lack of access to high-quality resources, lack of timely referral pathways, and concerns about patient resistance to advice. Some views and attitudes varied according to demographic characteristics, occupation, setting or region. CONCLUSIONS UEC workers are willing to engage in SBIRT for alcohol prevention but there are challenges to implementation in UEC environments and concerns about workload impacts on already-burdened staff, particularly in the context of global workforce shortages. UEC workers advocate for clear guidelines and policies, increased staff capacity and/or dedicated health promotion teams onsite, SBIRT education/training/resources, appropriate physical spaces for SBIRT conversations and improved alcohol referral pathways to better funded services. Implementation of SBIRT could contribute to improving population health and reducing service demand, but it requires significant and sustained commitment of time and resources for prevention across healthcare organisations.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Mehmet Yildirim
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Lucy Morris
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Philip Miller
- East Midlands Academic Health Sciences Network, Nottingham, United Kingdom
| | - Frank Coffey
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
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4
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Association Between Depressive Symptoms and Cardiac Structure and Function in a Peruvian Population. Glob Heart 2022; 17:78. [DOI: 10.5334/gh.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
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5
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John B, Newstead S, Heirene R, Hodgson R, Roderique-Davies G. Does the Fast Alcohol Screening Test Accurately Distinguish Between Harmful and Severely Dependent Tiers of Alcohol Misuse? Alcohol Alcohol 2021; 56:737-745. [PMID: 33754640 PMCID: PMC8631061 DOI: 10.1093/alcalc/agab015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/06/2021] [Accepted: 02/17/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Primary aim: to determine the efficacy of FAST (the Fast Alcohol Screening Test) for detecting harmful and dependent levels of alcohol use. Secondary aim: to compare the performance of the FAST to two short forms of the Alcohol Use Disorder Identification Test (AUDIT): the AUDIT-C and AUDIT-3. METHODS Data from 3336 individuals in South Wales, compiled from full AUDIT datasets, were examined. AUROC analysis, alongside measures of sensitivity and specificity of the FAST, AUDIT-C and AUDIT-3 were utilized for the identification of harmful and dependent alcohol use. RESULTS The FAST demonstrated efficacy in the identification of harmful and dependent levels of alcohol use, with superior performance to both the AUDIT-C and AUDIT-3. CONCLUSION The present paper demonstrates the potential of the FAST as a cost- and time-effective method for appropriate screening and signposting in the stepped care model utilized by many health care and treatment services. Further studies are needed to ensure validity, both within the general population and for specific services and populations.
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Affiliation(s)
- Bev John
- Corresponding author: Addictions Research Group, School of
Psychology & Therapeutic Studies, University of South Wales, Pontypridd,
Rhondda Cynon Taff CF37 1DL, UK. Tel.: (01443) 654145; E-mail:
| | - Simon Newstead
- Addictions Research Group, School
of Psychology & Therapeutic Studies, University of
South Wales, Pontypridd CF37 1DL, UK
| | - Robert Heirene
- Brain & Mind Centre, School of
Psychology, Science Faculty, University of
Sydney, Sydney, NSW 2050, Australia
| | - Ray Hodgson
- Addictions Research Group, School
of Psychology & Therapeutic Studies, University of
South Wales, Pontypridd CF37 1DL, UK
| | - Gareth Roderique-Davies
- Addictions Research Group, School
of Psychology & Therapeutic Studies, University of
South Wales, Pontypridd CF37 1DL, UK
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Gonzales KL, Jiang L, Garcia-Alexander G, Jacob MM, Chang J, Williams DR, Bullock A, Manson SM. Perceived Discrimination, Retention, and Diabetes Risk Among American Indians and Alaska Natives in a Diabetes Lifestyle Intervention. J Aging Health 2021; 33:18S-30S. [PMID: 34167349 PMCID: PMC8647809 DOI: 10.1177/08982643211013188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: To examine the association of perceived discrimination with participant retention and diabetes risk among American Indians and Alaska Natives. Methods: Data were drawn from the Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project (N = 2553). Results: Perceived discrimination was significantly and negatively associated with short-term and long-term retention and diabetes risk without adjusting. After controlling for socioeconomic characteristics and clinical outcomes, perceived discrimination was not associated with retention but was significantly associated with less improvement in body mass index (BMI) and high-density lipoprotein (HDL) cholesterol. Every unit increase in the perceived discrimination score was associated with 0.14 kg/m2 less BMI reduction (95% CI: [0.02, 0.26], p = 0.0183) and 1.06 mg/dl lower HDL at baseline (95% CI: [0.36, 1.76], p = 0.0028). Discussion: Among racialized groups, improving retention and health in lifestyle interventions may require investigating perceived discrimination and the broader context of structural racism and colonialism.
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Affiliation(s)
- Kelly L. Gonzales
- Oregon Health & Science University-Portland State University joint School of Public Health, Portland, OR, USA
| | - Luohua Jiang
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | | | | | - Jenny Chang
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - David R. Williams
- Florence Sprague Norman and Laura Smart Norman Professor of Public Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Gondek D, Bann D, Brown M, Hamer M, Sullivan A, Ploubidis GB. Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort. BMC Public Health 2021; 21:1319. [PMID: 34315472 PMCID: PMC8317357 DOI: 10.1186/s12889-021-11291-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to: [1] estimate the prevalence of multimorbidity at age 46-48 in the 1970 British Cohort Study-a nationally representative sample in mid-life; and [2] examine the association between early-life characteristics and mid-life multimorbidity. METHOD A prospective longitudinal birth cohort of a community-based sample from the 1970 British Cohort Study (BCS70). Participants included all surviving children born in mainland Britain in a single week in April 1970; the analytical sample included those with valid data at age 46-48 (n = 7951; 2016-2018). The main outcome was multimorbidity, which was operationalised as a binary indicator of two or more long-term health conditions where at least one of these conditions was of physical health. It also included symptom complexes (e.g., chronic pain), sensory impairments, and alcohol problems. RESULTS Prevalence of mid-life multimorbidity was 33.8% at age 46-48. Those with fathers from unskilled social occupational class (vs professional) at birth had 43% higher risk of mid-life multimorbidity (risk ratio = 1.43, 95% confidence interval 1.15 to 1.77). After accounting for potential child and family confounding, an additional kilogram of birthweight was associated with 10% reduced risk of multimorbidity (risk ratio = 0.90, 95% confidence interval 0.84 to 0.96); a decrease of one body mass index point at age 10 was associated with 3% lower risk (risk ratio = 1.03, 95% confidence interval 1.01 to 1.05); one standard deviation higher cognitive ability score at age 10 corresponded to 4% lower risk (risk ratio = 0.96, 95% confidence interval 0.91 to 1.00); an increase of one internalising problem at age 16 was equated with 4% higher risk (risk ratio = 1.04, 95% confidence interval 1.00 to 1.08) and of one externalising problem at age 16 with 6% higher risk (risk ratio = 1.06, 1.03 to 1.09). CONCLUSION Prevalence of multimorbidity was high in mid-life (33.8% at age 46-48) in Britain. Potentially modifiable early-life exposures, including early-life social circumstances, cognitive, physical and emotional development, were associated with elevated risk of mid-life multimorbidity.
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Affiliation(s)
- Dawid Gondek
- Centre for Longitudinal Studies (UCL Institute of Education), 55-59 Gordon Square, London, WC1H 0NU, UK.
| | - David Bann
- Centre for Longitudinal Studies (UCL Institute of Education), 55-59 Gordon Square, London, WC1H 0NU, UK
| | - Matt Brown
- Centre for Longitudinal Studies (UCL Institute of Education), 55-59 Gordon Square, London, WC1H 0NU, UK
| | - Mark Hamer
- Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, UK
| | - Alice Sullivan
- Centre for Longitudinal Studies (UCL Institute of Education), 55-59 Gordon Square, London, WC1H 0NU, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies (UCL Institute of Education), 55-59 Gordon Square, London, WC1H 0NU, UK
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Delgado MK, Shofer F, Wetherill R, Curtis B, Hemmons J, Spencer E, Branas C, Wiebe DJ, Kranzler HR. Accuracy of Consumer-marketed smartphone-paired alcohol breath testing devices: A laboratory validation study. Alcohol Clin Exp Res 2021; 45:1091-1099. [PMID: 33966283 DOI: 10.1111/acer.14597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although alcohol breath testing devices that pair with smartphones are promoted for the prevention of alcohol-impaired driving, their accuracy has not been established. METHODS In a within-subjects laboratory study, we administered weight-based doses of ethanol to two groups of 10 healthy, moderate drinkers aiming to achieve a target peak blood alcohol concentration (BAC) of 0.10%. We obtained a peak phlebotomy BAC and measured breath alcohol concentration (BrAC) with a police-grade device (Intoxilyzer 240) and two randomly ordered series of 3 consumer smartphone-paired devices (6 total devices) with measurements every 20 min until the BrAC reached <0.02% on the police device. Ten participants tested the first 3 devices, and the other 10 participants tested the other 3 devices. We measured mean paired differences in BrAC with 95% confidence intervals between the police-grade device and consumer devices. RESULTS The enrolled sample (N = 20) included 11 females; 15 white, 3 Asian, and 2 Black participants; with a mean age of 27 and mean BMI of 24.6. Peak BACs ranged from 0.06-0.14%. All 7 devices underestimated BAC by >0.01%, though the BACtrack Mobile Pro and police-grade device were consistently more accurate than the Drinkmate and Evoc. Compared with the police-grade device measurements, the BACtrack Mobile Pro readings were consistently higher, the BACtrack Vio and Alcohoot measurements similar, and the Floome, Drinkmake, and Evoc consistently lower. The BACtrack Mobile Pro and Alcohoot were most sensitive in detecting BAC driving limit thresholds, while the Drinkmate and Evoc devices failed to detect BAC limit thresholds more than 50% of the time relative to the police-grade device. CONCLUSIONS The accuracy of smartphone-paired devices varied widely in this laboratory study of healthy participants. Although some devices are suitable for clinical and research purposes, others underestimated BAC, creating the potential to mislead intoxicated users into thinking that they are fit to drive.
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Affiliation(s)
- Mucio Kit Delgado
- Behavioral Science & Analytics For Injury Reduction (BeSAFIR) Lab, Department of Emergency Medicine & the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Frances Shofer
- Behavioral Science & Analytics For Injury Reduction (BeSAFIR) Lab, Department of Emergency Medicine & the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Reagan Wetherill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brenda Curtis
- Technology and Translational Research Unit, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Jessica Hemmons
- Behavioral Science & Analytics For Injury Reduction (BeSAFIR) Lab, Department of Emergency Medicine & the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Evan Spencer
- Behavioral Science & Analytics For Injury Reduction (BeSAFIR) Lab, Department of Emergency Medicine & the Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles Branas
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Douglas J Wiebe
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Crescenz VA Medical Center, Philadelphia, PA, USA
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Minian N, Lingam M, deRuiter WK, Dragonetti R, Selby P. Co-designing Behavior Change Resources With Treatment-Seeking Smokers: Engagement Events' Findings. Front Public Health 2021; 9:555449. [PMID: 33791263 PMCID: PMC8005552 DOI: 10.3389/fpubh.2021.555449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Primary care organizations are well-suited to help patients change their unhealthy behaviors. Evidence shows that risk communication and self-monitoring of behavior are is an effective strategy practitioners can use to promote health behavior change with their patients. In order for this evidence to be actionable, it is important to understand how patients would like this information to be communicated and to operationalize the self-monitoring resources. The objective of this study was to co-create resources that encourage behavior change based on the scientific evidence and from patients with lived experiences. Materials and Methods: Twenty-seven individuals who participated in a smoking cessation program and engaged in at least one other unhealthy behavior joined one of two engagement events. Each event was 3 h in duration and consisted of two exercises that provided support to participants in reaching a consensus about the types of messages they would like to receive from their practitioner as well as self-monitoring resources they would prefer to use. The first exercise followed an adapted version of the Consensus Methodology developed by the Institute of Cultural Affairs Canada, while the second exercise was in accordance to the Nominal Group Technique. Results: Participants' preference was to have practitioners convey messages to promote health behavior change that include positive affirmation and to monitor all their health behaviors using a single self-reported tracking sheet. Conclusions: This paper features the use of engagement events to reflect upon and identify potential resources that treatment seeking smokers prefer to receive while attempting to modify unhealthy behaviors. These resources can be used by health care providers in primary care settings to support health promotion interventions and assist their patients to increase their likelihood of adopting positive changes to risk behaviors.
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mathangee Lingam
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Wayne K deRuiter
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Erford BT, Sriken J, Sherman MF, Hibbs JS, Smith HL, Kipper-Smith A, Niarhos F. Psychometric Analysis, Internal Structure, and Measurement Invariance of the Alcohol Use Disorders Identification Test (AUDIT) Scores From a Large University Sample. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2020. [DOI: 10.1080/07481756.2020.1770101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | - Jessica S. Hibbs
- Chesapeake Health Care, Wicomico County Schools, Wicomico, MD, USA
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11
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Kim J, Hendershot CS. A review of performance indicators of single-item alcohol screening questions in clinical and population settings. J Subst Abuse Treat 2020; 111:73-85. [DOI: 10.1016/j.jsat.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
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Minian N, Ivanova A, Voci S, Veldhuizen S, Zawertailo L, Baliunas D, Noormohamed A, Giesbrecht N, Selby P. Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1024. [PMID: 32041190 PMCID: PMC7037372 DOI: 10.3390/ijerph17031024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/11/2022]
Abstract
Although brief alcohol intervention can reduce alcohol use for both men and women, health care providers (HCPs) are less likely to discuss alcohol use or deliver brief intervention to women compared to men. This secondary analysis examined whether previously reported outcomes from a cluster randomized trial of a clinical decision support system (CDSS)-prompting delivery of a brief alcohol intervention (an educational alcohol resource) for patients drinking above cancer guidelines-were moderated by patients' sex. Patients (n = 5702) enrolled in a smoking cessation program at primary care sites across Ontario, Canada, were randomized to either the intervention (CDSS) or control arm (no CDSS). Logistic generalized estimating equations models were fit for the primary and secondary outcome (HCP offer of resource and patient acceptance of resource, respectively). Previously reported results showed no difference between treatment arms in HCP offers of an educational alcohol resource to eligible patients, but there was increased acceptance of the alcohol resource among patients in the intervention arm. The results of this study showed that these CDSS intervention effects were not moderated by sex, and this can help inform the development of a scalable strategy to overcome gender disparities in alcohol intervention seen in other studies.
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON M6J 1H4, Canada
| | - Anna Ivanova
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
| | - Sabrina Voci
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
| | - Scott Veldhuizen
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
- Department of Pharmacology and Toxicology, University of Toronto, 1 King’s College Cir, Toronto, ON M5S 1A8, Canada
| | - Dolly Baliunas
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
- Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON M5T 3M7, Canada
| | - Aliya Noormohamed
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
| | - Norman Giesbrecht
- Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON M5T 3M7, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell St, Toronto, ON M5S 2S1, Canada
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 175 College St, Toronto, ON M5T 1P7, Canada; (N.M.); (A.I.); (S.V.); (S.V.); (L.Z.); (D.B.); (A.N.)
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON M6J 1H4, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
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Short-term risk of suicide attempt associated with patterns of patient-reported alcohol use determined by routine AUDIT-C among adults receiving mental healthcare. Gen Hosp Psychiatry 2020; 62:79-86. [PMID: 31874300 PMCID: PMC7047881 DOI: 10.1016/j.genhosppsych.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the association between alcohol use routinely reported during outpatient mental healthcare visits and short-term risk of subsequent suicide attempt. METHODS Using a longitudinal retrospective-cohort design, electronic health records identified adult outpatient visits to a mental health provider (1/1/2010-6/30/2015) at Kaiser Permanente Washington with a documented Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]. Suicide attempts within 90 days of AUDIT-C documentation were defined using death certificate cause-of-death and diagnosis codes (non-lethal). Visit-level analyses used generalized estimating equations to account for correlation between multiple AUDIT-Cs for individuals. Separate models evaluated the association between (1) level of consumption and (2) frequency of heavy drinking episodes and suicide attempts, adjusted for visit year, demographics, depressive symptom, and suicidal ideation. RESULTS Of 59,382 patient visits, 0.62% (N = 371) were followed by a suicide attempt within 90 days. Patients reporting high-level alcohol use were 1.77 times (95% CI, 1.22-2.57) more likely to attempt suicide than those reporting low-level use. Patients reporting daily or almost daily heavy drinking episodes were 2.33 times (95% CI, 1.38-3.93) more likely to attempt suicide than those reporting none. CONCLUSIONS AND RELEVANCE The AUDIT-C is a valuable tool for assessing patterns of patient-reported alcohol use associated with subsequent suicide attempt.
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Tuunanen M, Aalto M, Levola J, Seppä K. The FAST in screening for at-risk drinking among middle-aged women. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1630679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mervi Tuunanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Physiatry and Rehabilitation, South Ostrobothnia Hospital District, Seinäjoki, Finland
| | - Mauri Aalto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, South Ostrobothnia Hospital District, Seinäjoki, Finland
| | - Jonna Levola
- Unit of Pyschiatry, Hyvinkää Area, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Kaija Seppä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, Tampere University Hospital, Tampere, Finland
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Minian N, Baliunas D, Noormohamed A, Zawertailo L, Giesbrecht N, Hendershot CS, Le Foll B, Rehm J, Samokhvalov AV, Selby PL. The effect of a clinical decision support system on prompting an intervention for risky alcohol use in a primary care smoking cessation program: a cluster randomized trial. Implement Sci 2019; 14:85. [PMID: 31443663 PMCID: PMC6708174 DOI: 10.1186/s13012-019-0935-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/15/2019] [Indexed: 01/31/2023] Open
Abstract
Background Clinical decision support systems (CDSSs) may promote practitioner adherence to evidence-based guidelines. This study examined if the addition of a CDSS influenced practitioner delivery of a brief intervention with treatment-seeking smokers who were drinking above recommended alcohol consumption guidelines, compared with practitioners who do not receive a CDSS prompt. Methods This was a cluster randomized controlled trial conducted in primary health care clinics across Ontario, Canada, implementing the Smoking Treatment for Ontario Patients (STOP) smoking cessation program. Clinics randomized to the intervention group received a prompt when a patient reported consuming alcohol above the Canadian Cancer Society (CCS) guidelines; the control group did not receive computer alerts. The primary outcome was an offer of an appropriate educational alcohol resource, an alcohol reduction workbook for patients drinking above the CCS guidelines, and an abstinence workbook to patients scoring above 20 points in the AUDIT screening tool; the secondary outcome was patient acceptance of the resource. The tertiary outcome was patient abstinence from smoking, and alcohol consumption within CCS guidelines, at 6-month follow-up. Results were analyzed using a generalized estimation approach for fitting logistic regression using a population-averaged method. Results Two hundred and twenty-one clinics across Ontario were randomized for this study; 110 to the intervention arm and 111 to the control arm. From the 15,222 patients that enrolled in the smoking cessation program, 15,150 (99.6% of patients) were screened for alcohol use and 5715 patients were identified as drinking above the CCS guidelines. No statistically significant difference between groups was seen in practitioner offer of an educational alcohol resource to appropriate patients (OR = 1.19, 95% CI 0.88–1.64, p = 0.261) or in patient abstinence from smoking and drinking within the CCS guidelines at 6-month follow-up (OR = 0.93, 95% CI 0.71–1.22, p = 0.594). However, a significantly greater proportion of patients in the intervention group accepted the alcohol resource offered to them by their practitioner (OR = 1.48, 95% CI 1.01–2.16, p = 0.045). Conclusion A CDSS may not increase the likelihood of practitioners offering an educational alcohol resource, though it may have influenced patients’ acceptance of the resource. Trial registration This trial is registered with ClinicalTrials.gov, number NCT03108144, registered on April 11, 2017, “retrospectively registered”. Electronic supplementary material The online version of this article (10.1186/s13012-019-0935-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T1P7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Dolly Baliunas
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T1P7, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON, M5T 3M7, Canada
| | - Aliya Noormohamed
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T1P7, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T1P7, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell St, Toronto, ON, M5S 2S1, Canada
| | - Christian S Hendershot
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Bernard Le Foll
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Jürgen Rehm
- Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON, M5T 3M7, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell St, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 3K1, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Andriy V Samokhvalov
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell St, Toronto, ON, M5S 2S1, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 3K1, Canada
| | - Peter L Selby
- Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College St, Toronto, ON, M5T1P7, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College, Toronto, ON, M5T 3M7, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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Russell DW, Kazman J, Russell CA. Body Composition and Physical Fitness Tests Among US Army Soldiers: A Comparison of the Active and Reserve Components. Public Health Rep 2019; 134:502-513. [PMID: 31394052 PMCID: PMC6852058 DOI: 10.1177/0033354919867069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES US Army reserve soldiers and active-duty soldiers differ in their daily work demands and supporting resources, yet research on reservists' health and fitness is lacking. The objectives of this study were to (1) determine whether physical test failure rates and health behaviors differed between active-duty soldiers and reserve soldiers and (2) establish which demographic and health behavioral factors were associated with failing physical tests. METHODS We analyzed a sample of 239 329 US Army active-duty and reserve soldiers surveyed from September 2013 through March 2015 using the Global Assessment Tool. We extracted data on soldier demographic characteristics and health behaviors, as well as Body Composition Test (BCT) and Army Physical Fitness Test (APFT) results. We compared the 2 groups using the active-to-reserve adjusted odds ratio (aOR) for each variable. We used logistic regression models to determine which variables were associated with failing these tests. RESULTS The odds of failing the BCT (aOR = 0.76; 95% confidence interval [CI], 0.73-0.78) or the APFT (aOR = 0.31; 95% CI, 0.30-0.32) were lower among active-duty soldiers than among reservists, and the odds of doing high levels of high-intensity interval training (aOR = 1.47; 95% CI, 1.42-1.51), resistance training (aOR = 1.45; 95% CI, 1.42-1.48), and vigorous physical activity (aOR = 2.92; 95% CI, 2.86-2.98) were higher among active-duty soldiers than among reservists. The odds of using tobacco (aOR = 1.37; 95% CI, 1.35-1.40), binge drinking alcohol (aOR = 1.11; 95% CI, 1.09-1.13), having insomnia (aOR = 1.46; 95% CI, 1.43-1.48) or mild depression (aOR = 1.50; 95% CI, 1.48-1.53), and sustaining a physical activity-related injury (aOR = 2.52; 95% CI, 2.47-2.57) were higher among active-duty soldiers than among reservists. CONCLUSIONS Policy makers and military leaders could use this information to implement health screenings and tailor health-promotion, intervention, and treatment programs.
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Affiliation(s)
- Dale W. Russell
- Consortium for Health & Military Performance, Department of Military
& Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services
University, Bethesda, MD, USA
| | - Joshua Kazman
- Consortium for Health & Military Performance, Department of Military
& Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services
University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine,
Bethesda, MD, USA
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López V, Paladines B, Vaca S, Cacho R, Fernández-Montalvo J, Ruisoto P. Psychometric properties and factor structure of an Ecuadorian version of the Alcohol Use Disorders Identification Test (AUDIT) in college students. PLoS One 2019; 14:e0219618. [PMID: 31291363 PMCID: PMC6619822 DOI: 10.1371/journal.pone.0219618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Alcohol Use Disorders Identification Test (AUDIT) is the gold standard in assessing harmful alcohol intake, which is responsible for substantial morbidity and mortality. OBJECTIVE The goal of this study is to evaluate the psychometric properties and factor structure of an Ecuadorian adaptation of a Spanish translation of the AUDIT in a large sample of college students in Ecuador. METHODS A total of 7905 students, including 46.26% males, and 53.75% females, from 11 universities in Ecuador, were surveyed. The questionnaire was tested for two- and three-factor structures, reliability, and correlations with other health related measures. RESULTS The Kaiser-Meyer-Olkin test for sampling adequacy was satisfactory (.0885), and Bartlett´s test for sphericity was significant (p < .001). Although both models showed a good fit to the data, the two-factor model was preferred based on the high correlations between the factors 2 and 3 within the three-factor model (.86 for the total sample, .77 for females, and .91 for males). The reliability for the two-factor model was good, as indicated by Cronbach´s α = .806 (factor I) and .716 (factor II) for the total sample, .808 (factor I) and .667 (factor II) for females, and .787 (factor I) and .728 (factor II) for males. Additionally, the AUDIT scores positively correlated with several health-related measures: stress, psychological inflexibility, loneliness and depression/anxiety symptomatology. CONCLUSION The Ecuadorian adaptation of the Spanish version of the AUDIT has good reliability, and internal consistency and correlates with other health related measures, proving to be a reliable tool that can be used by researchers and clinicians to screen hazardous alcohol intake in college students.
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Affiliation(s)
- Víctor López
- Department of Psychology, Technical Particular University of Loja, Loja, Ecuador
| | - Belén Paladines
- Department of Psychology, Technical Particular University of Loja, Loja, Ecuador
| | - Silvia Vaca
- Department of Psychology, Technical Particular University of Loja, Loja, Ecuador
| | - Raúl Cacho
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | | | - Pablo Ruisoto
- Faculty of Psychology, University of Salamanca, Salamanca, Spain
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Ramirez-Castillo D, Garcia-Roda C, Guell F, Fernandez-Montalvo J, Bernacer J, Morón I. Frustration Tolerance and Personality Traits in Patients With Substance Use Disorders. Front Psychiatry 2019; 10:421. [PMID: 31258496 PMCID: PMC6588127 DOI: 10.3389/fpsyt.2019.00421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/28/2019] [Indexed: 12/26/2022] Open
Abstract
Previous research has suggested the prevalence of certain personality traits, some of which are related to a disorganized attachment, in substance abuse disorders. Further, frustration tolerance (FT) has been proposed as an important factor in addiction, both at the inception-following the "self-medication" hypothesis-and regarding treatment compliance. In turn, an inadequate response to frustrating events has been also associated with a disrupted attachment. Our goal is to explore the mediational role of FT in the relationship between personality traits and two different treatments for substance addiction: therapeutic community (TC) and ambulatory treatment (AT). Eighty-four subjects with substance abuse disorder were recruited in total (22 female), including 46 volunteers (13 female) in TC and 38 (9 female) in AT. They were assessed with Rosenzweig's test for FT and the Millon Clinical Multiaxial Inventory-III (MCMI-III) test to evaluate personality factors. By comparing with a control sample (335 volunteers, 268 female), we found that FT was lower in patients. Between therapeutic groups, FT was significantly lower in TC. Depressive, antisocial, sadistic, negativistic, schizotypal, borderline, paranoid, anxiety, dysthymia, alcohol use, drug use, posttraumatic stress disorder (PTSD), thought disorder, and delusional disorder traits were suggestive of pathology in the clinical samples and were significantly different between control, AT, and TC groups. Further, anxiety and PTSD traits were higher in TC than in AT. A mediational analysis revealed that the effect of anxiety and PTSD scales on therapeutic group was partially mediated by FT. In conclusion, FT and its interplay with personality traits commonly related to disorganized attachment (anxiety and PTSD) might be important factors to consider within therapeutic programs for persons with substance addiction.
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Affiliation(s)
- David Ramirez-Castillo
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Carlos Garcia-Roda
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Francisco Guell
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | | | - Javier Bernacer
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Ignacio Morón
- Department of Psychobiology and Research Center for Mind, Brain, and Behavior (CIMCYC), University of Granada, Granada, Spain
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Sallis A, Attwood S, Harper H, Larsen J, Berry D, Vlaev I, Sanders M, Chadborn T. A randomised trial of the effect of appearance versus health-framed messages on engagement with an online brief screening and alcohol reduction intervention. Psychol Health 2019; 34:922-942. [PMID: 30917673 DOI: 10.1080/08870446.2019.1579911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To compare the impact of appearance versus health-framed messages on engagement in a brief web-based risk screening and alcohol reduction intervention. Design: Randomised trial delivered via Drinkaware's website. Visitors were exposed to appearance (n = 51,588) or health-framed messages (n = 52,639) directing them towards an AUDIT-C risk screening questionnaire. Users completing this questionnaire were given feedback on their risk level and extended frame-congruent information. Outcomes: The primary outcome is completion of the AUDIT-C questionnaire. The secondary outcome is whether the participant accessed any of four further resources. Results: The appearance-framed message led to a small but significant increase in the number of users completing the AUDIT-C compared to the health-framed message (n = 3,537, 6.86% versus n = 3,355, 6.37%, p < 0.01). Conversely, following subsequent risk feedback, users exposed to extended health-framed information were more likely to access further resources (n = 1,146, 2.17% versus n = 942, 1.83%, p < 0.01). Conclusions: Physical appearance-framed messages increased the likelihood of engagement with an online alcohol screening and brief intervention tool, whereas health-framed messages increased the likelihood of accessing further resources. This highlights the potential for the use of multi-level approaches in alcohol reduction interventions.
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Affiliation(s)
- Anna Sallis
- a Behavioural Insights, Public Health England , London , UK
| | | | - Hugo Harper
- c The Behavioural Insights Team , London , UK
| | | | - Dan Berry
- b Department of Health and Social Care , London , UK
| | - Ivo Vlaev
- e Warwick Business School University of Warwick , Coventry , UK
| | | | - Tim Chadborn
- a Behavioural Insights, Public Health England , London , UK
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Perioperative Management of the Orthopaedic Patient and Alcohol Use, Abuse, and Withdrawal. J Am Acad Orthop Surg 2019; 27:e249-e257. [PMID: 30499892 DOI: 10.5435/jaaos-d-17-00708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Alcohol is one of most commonly abused substances in the United States, and it has contributed to a growing epidemic of medical ailments, including cirrhosis, neurologic and psychosocial disorders, impairment to fertility, and cancer. Moreover, acute and chronic alcohol use represent a significant risk factor for orthopaedic injury and postoperative complications. Yet, relatively little is known about the clinical implications of alcohol abuse in common orthopaedic procedures. Acute withdrawal from alcohol is potentially fatal, particularly in the orthopaedic inpatient whose abstinence is mandated by the hospital setting. The aim of this review is to address the screening, diagnostic, and therapeutic tools available to appropriately manage acute alcohol withdrawal in the orthopaedic inpatient. The influence of chronic alcohol consumption on bone metabolism, fracture healing, and surgical fixation will also be reviewed because this information may guide surgical decision making.
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Hill CM, Williams EC, Ornelas IJ. Help Wanted: Mental Health and Social Stressors Among Latino Day Laborers. Am J Mens Health 2019; 13:1557988319838424. [PMID: 30880547 PMCID: PMC6438433 DOI: 10.1177/1557988319838424] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/28/2019] [Accepted: 02/22/2019] [Indexed: 12/22/2022] Open
Abstract
Latino day laborers may be especially vulnerable to poor mental health due to stressful life experiences, yet few studies have described patterns of mental health outcomes and their correlates in this population. Patterns of depression (PHQ-9) and anxiety (GAD-7), and associations with demographic characteristics, social stressors, and substance use in a recruited sample of male Latino day laborers ( n = 101) are described. High rates of depression and anxiety were identified. Specifically, 39% screened positive for moderate or severe depression and 25% for moderate or severe anxiety. Higher levels of depression and anxiety symptoms were associated with being single, being homeless or in temporary housing, experiencing discrimination, acculturation stress, and marijuana use. While tobacco and unhealthy alcohol use were common in this sample (39% and 66%, respectively), they were not associated with depression and anxiety. These findings suggest that depression and anxiety are common among Latino day laborers and associated with stressful life experiences. Future research should further assess ways to ameliorate social stressors and reduce risk for poor mental health.
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Affiliation(s)
- Clara M. Hill
- Veterans Health Administration (VA),
Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care, VA
Puget Sound Health Services Research & Development, Seattle, WA, USA
- Department of Health Services,
University of Washington, Seattle, WA, USA
| | - Emily C. Williams
- Veterans Health Administration (VA),
Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care, VA
Puget Sound Health Services Research & Development, Seattle, WA, USA
- Department of Health Services,
University of Washington, Seattle, WA, USA
| | - India J. Ornelas
- Department of Health Services,
University of Washington, Seattle, WA, USA
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O'Connor EA, Perdue LA, Senger CA, Rushkin M, Patnode CD, Bean SI, Jonas DE. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 320:1910-1928. [PMID: 30422198 DOI: 10.1001/jama.2018.12086] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. OBJECTIVE To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018. STUDY SELECTION Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes. RESULTS One hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, -1.6 [95% CI, -2.2 to -1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful. CONCLUSIONS AND RELEVANCE Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan Rushkin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Minian N, Baliunas D, Zawertailo L, Noormohamed A, Giesbrecht N, Hendershot CS, Le Foll B, Rehm J, Samokhvalov A, Selby PL. Combining alcohol interventions with tobacco addictions treatment in primary care-the COMBAT study: a pragmatic cluster randomized trial. Implement Sci 2017; 12:65. [PMID: 28521782 PMCID: PMC5437645 DOI: 10.1186/s13012-017-0595-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/05/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Tobacco and alcohol use present multiplicative risk for aerodigestive cancers. Reducing alcohol consumption improves smoking cessation outcomes and reduces cancer risk. Risky alcohol consumption and smoking are often treated separately despite concurrent treatment potentially leading to better outcomes for each. However, no rapidly scalable program exists for combined interventions in primary care clinics spread across wide geographic areas. This cluster randomized trial aims to report on the effects of a novel clinical decision support system (CDSS) on intervention rates by primary care practitioners addressing risky alcohol use in a smoking cessation program. METHODS/DESIGN We will be implementing a clinical decision support system (CDSS) in 221 primary care sites participating in the Smoking Treatment for Ontario Patients (STOP) program across Ontario, Canada. Sites will be blindly allocated to one of two clinical decision support systems guiding practitioners to provide a risky alcohol use intervention to smokers attempting to quit using nicotine replacement therapy (NRT). Risky alcohol use is defined as drinking above the Canadian Cancer Society's low-risk drinking guidelines. Primary analysis will measure the proportion of risky drinkers offered an alcohol intervention in each CDSS arm at baseline. Patients will be contacted by phone or email to track smoking cessation and alcohol consumption rates at 6- and 12-month follow-up. DISCUSSION Upon completion of the trial, the effect of different clinical decision support systems on practitioner behaviour, and on client tobacco and alcohol use, will be discussed. If the CDSS successfully promotes SBIRT for risky alcohol use in a primary care setting and/or improves patient-level outcomes, including smoking cessation rates and alcohol use reduction, this tool can be used as a model for other web-based behaviour change interventions integrated into primary care practice. TRIAL REGISTRATION ClinicalTrials.gov NCT03108144.
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Affiliation(s)
- Nadia Minian
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
| | - Dolly Baliunas
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
| | - Aliya Noormohamed
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
| | - Norman Giesbrecht
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
| | | | - Bernard Le Foll
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
| | - Andriy Samokhvalov
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
| | - Peter L. Selby
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON M6J1H4 Canada
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Burdick TE, Kessler RS. Development and use of a clinical decision support tool for behavioral health screening in primary care clinics. Appl Clin Inform 2017; 8:412-429. [PMID: 28447101 PMCID: PMC6241740 DOI: 10.4338/aci-2016-04-ra-0068] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/16/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Screening, brief intervention, and referral for treatment (SBIRT) for behavioral health (BH) is a key clinical process. SBIRT tools in electronic health records (EHR) are infrequent and rarely studied. Our goals were 1) to design and implement SBIRT using clinical decision support (CDS) in a commercial EHR; and 2) to conduct a pragmatic evaluation of the impact of the tools on clinical outcomes. METHODS A multidisciplinary team designed SBIRT workflows and CDS tools. We analyzed the outcomes using a retrospective descriptive convenience cohort with age-matched comparison group. Data extracted from the EHR were evaluated using descriptive statistics. RESULTS There were 2 outcomes studied: 1) development and use of new BH screening tools and workflows; and 2) the results of use of those tools by a convenience sample of 866 encounters. The EHR tools developed included a flowsheet for documenting screens for 3 domains (depression, alcohol use, and prescription misuse); and 5 alerts with clinical recommendations based on screening; and reminders for annual screening. Positive screen rate was 21% (≥1 domain) with 60% of those positive for depression. Screening was rarely positive in 2 domains (11%), and never positive in 3 domains. Positive and negative screens led to higher rates of documentation of brief intervention (BI) compared with a matched sample who did not receive screening, including changes in psychotropic medications, updated BH terms on the problem list, or referral for BH intervention. Clinical process outcomes changed even when screening was negative. CONCLUSIONS Modified workflows for BH screening and CDS tools with clinical recommendations can be deployed in the EHR. Using SBIRT tools changed clinical process metrics even when screening was negative, perhaps due to conversations about BH not captured in the screening flowsheet. Although there are limitations to the study, results support ongoing investigation.
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Affiliation(s)
- Timothy E Burdick
- Timothy E. Burdick MD MSc, Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth, HB 7250, Hanover, NH 03755, , Phone: 802-272-5931
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Predicting the onset of hazardous alcohol drinking in primary care: development and validation of a simple risk algorithm. Br J Gen Pract 2017; 67:e280-e292. [PMID: 28360074 DOI: 10.3399/bjgp17x690245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/04/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Little is known about the risk of progressing to hazardous alcohol use in abstinent or low-risk drinkers. AIM To develop and validate a simple brief risk algorithm for the onset of hazardous alcohol drinking (HAD) over 12 months for use in primary care. DESIGN AND SETTING Prospective cohort study in 32 health centres from six Spanish provinces, with evaluations at baseline, 6 months, and 12 months. METHOD Forty-one risk factors were measured and multilevel logistic regression and inverse probability weighting were used to build the risk algorithm. The outcome was new occurrence of HAD during the study, as measured by the AUDIT. RESULTS From the lists of 174 GPs, 3954 adult abstinent or low-risk drinkers were recruited. The 'predictAL-10' risk algorithm included just nine variables (10 questions): province, sex, age, cigarette consumption, perception of financial strain, having ever received treatment for an alcohol problem, childhood sexual abuse, AUDIT-C, and interaction AUDIT-C*Age. The c-index was 0.886 (95% CI = 0.854 to 0.918). The optimal cutoff had a sensitivity of 0.83 and specificity of 0.80. Excluding childhood sexual abuse from the model (the 'predictAL-9'), the c-index was 0.880 (95% CI = 0.847 to 0.913), sensitivity 0.79, and specificity 0.81. There was no statistically significant difference between the c-indexes of predictAL-10 and predictAL-9. CONCLUSION The predictAL-10/9 is a simple and internally valid risk algorithm to predict the onset of hazardous alcohol drinking over 12 months in primary care attendees; it is a brief tool that is potentially useful for primary prevention of hazardous alcohol drinking.
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Letourneau B, Sobell LC, Sobell MB, Agrawal S, Gioia CJ. Two Brief Measures of Alcohol Use Produce Different Results: AUDIT-C and Quick Drinking Screen. Alcohol Clin Exp Res 2017; 41:1035-1043. [PMID: 28247424 DOI: 10.1111/acer.13364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several psychometrically sound measures of alcohol use have been developed to assess drinking. The Alcohol Use Disorders Identification Test (AUDIT) and its shorter counterpart the AUDIT-C, which contains the first 3 AUDIT questions, were developed by the World Health Organization and have become the preferred brief measures for screening and evaluating problem severity. This study compared the first 3 questions on the AUDIT with another psychometrically sound brief measure of alcohol use, the Quick Drinking Screen (QDS). METHODS Data were obtained from a randomized controlled trial of a mail-based intervention promoting self-change with 472 alcohol abusers (n = 280, no prior alcohol treatment; n = 192, prior alcohol treatment). Participants' retrospective self-reports of alcohol consumption were collected using the QDS and the 3 AUDIT-C questions and compared. Although both measures contain similar questions (2 quantity-frequency and 1 binge drinking), they differ in 2 important ways: (i) temporal interval over which data are collected, and (ii) formatting of response options (i.e., a continuous number vs. categorical). RESULTS Intraclass correlations for drinking variables were moderate to moderately high. A repeated-measures MANOVA using treatment condition and gender as variables revealed significant differences in absolute values between the 2 drinking measures with the QDS showing greater consumption on almost all variables. Participants' numerical answers on the QDS were compared to their categorical answers to the similar alcohol use questions on the AUDIT-C. The comparison revealed that participants' answers on the AUDIT-C were associated with extreme variability compared to their QDS answers. This variability suggests the AUDIT-C would be unreliable as a quantitative measure of alcohol consumption. CONCLUSIONS The differences between the 3 alcohol use questions on the AUDIT-C and the same questions on the QDS may reflect the imprecision of the AUDIT-C's drinking response categories. Results suggest that the QDS can be used to identify risky drinking and to provide a more informative characterization of a drinker's alcohol consumption than that provided by the AUDIT-C.
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Affiliation(s)
- Brian Letourneau
- College of Psychology, Nova Southeastern University, Fort Lauderdale, Florida
| | - Linda Carter Sobell
- College of Psychology, Nova Southeastern University, Fort Lauderdale, Florida
| | - Mark B Sobell
- College of Psychology, Nova Southeastern University, Fort Lauderdale, Florida
| | | | - Christopher J Gioia
- Department of Psychology, Brogden Hall, University of Wisconsin-Madison, Madison, Wisconsin
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Halkjelsvik T, Storvoll EE. Andel av befolkningen i Norge med et risikofylt alkoholkonsum målt gjennom Alcohol Use Disorders Identification Test (AUDIT). NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.1515/nsad-2015-0008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims To estimate the proportion of the Norwegian population that according to the World Health Organization (WHO) guidelines should be followed up by primary health care, based on three levels of risk drinking. We also investigated the relationship between risky drinking and demographic variables (gender, age and education). MaterialS & METHODS – In 2012 and 2013 Statistics Norway conducted 4048 telephone interviews on a random sample of the population aged 16–79 (55.3% response rate). The Alcohol Use Disorders Identification Test (AUDIT), a screening instrument for primary health care, was used to identify potential problem drinking. We used descriptive statistics and linear regression analysis. Results Approximately 17% of the sample scored within the WHO-recommended limits for simple advice and/or further monitoring. Of these, 2% scored above the limit for the two most serious risk categories. Risky drinking was most prevalent among men, especially those aged 16–50. Among women, there was most risky drinking in the 16–30 age group. The regression analysis showed that age, gender and education predicted AUDIT sum scores. Conclusion A large proportion scored within the least serious risk group, where simple advice to cut down on alcohol is the recommended measure. This group mostly consisted of younger respondents (16–30 years), and a large majority were men (age categories 20 and older). These are individuals who do not necessarily have an alcohol problem, but are at increased risk for negative consequences such as injury during intoxication, and/or developing misuse or dependence over time.
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Larsson K, Nehlin C. Screening accuracy of brief alcohol screening instruments in a general hospital setting. Scand J Public Health 2016; 44:599-603. [DOI: 10.1177/1403494816651779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/16/2022]
Abstract
Aim: The aim of this study was to examine the screening accuracy of four brief alcohol screening instruments in a general hospital setting. Methods: Ten outpatient clinics were recruited to ensure a representative mix of demographics (e.g. sex, age and diagnosis). The staff at the reception desk handed out pre-sorted envelopes with questionnaires and information letters to the visitors. The questionnaires consisted of the 10-item Alcohol Use Disorders Identification Test (AUDIT), the Weekly Consumption Question (WCQ), the Heavy Episodic Drinking (HED) question and two questions on sex and age. Sensitivity and specificity were calculated for the AUDIT-C, AUDIT-3, WCQ and HED using the full 10-item AUDIT for comparison, with cut-off points of ⩾6 for women and ⩾8 for men. Results: In all, 898 questionnaires were included (52% women). According to the full AUDIT, 12.0% of the women and 14.8% of the men were drinking above the hazardous level. Corresponding percentages for the brief screening instruments for women and men, respectively, were as follows: AUDIT-C: 17.2% and 27.4%; the AUDIT-3: 6% and 16.2%; the WCQ: 2% and 1.6%; and the HED screener: 12.9% and 21.2%. Conclusions: The AUDIT-C may be used as a brief screener in a general hospital setting. The WCQ, as a stand-alone screening tool, may underestimate hazardous drinking habits. Screening results from the AUDIT-3 and the HED should be interpreted with caution when applied to women because of the risk of underestimation.
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Affiliation(s)
- Kjerstin Larsson
- Department of Public Health and Caring Sciences, Section of Social Medicine and Epidemiology, Uppsala University, Sweden
- Department of Neurobiology, Care Sciences and Society, Section of Social Work, Karolinska Institutet, Sweden
| | - Christina Nehlin
- Department of Neuroscience, Psychiatry; Uppsala University, Sweden
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Mueller G, Schumacher P, Wetzlmair J, Pallauf M. Screening questionnaires to identify problem drinking in the primary care setting: a systematic review. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0694-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Blank ML, Connor J, Gray A, Tustin K. Screening for hazardous alcohol use among university students using individual questions from the Alcohol Use Disorders Identification Test-Consumption. Drug Alcohol Rev 2015; 34:540-548. [PMID: 25867022 DOI: 10.1111/dar.12272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 02/17/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Abbreviated versions of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) instrument have not been investigated among students. We compared a modified second item (AUDIT-2*) (typical quantity per occasion as the number of drinks, rather than categorical responses) and the third item (AUDIT-3) (heavy episodic drinking frequency) with AUDIT-C scores and described their associations with sociodemographic variables. DESIGN AND METHODS We analysed cross-sectional data from the 2011 baseline of the Graduate Longitudinal Study New Zealand, including respondents aged up to 25 years (n = 5082, response rate 65%). Hazardous drinking was defined as an AUDIT-C score of seven or greater for men and five or greater for women. We calculated the area under receiver operating characteristic curves, sensitivities, specificities, and positive and negative predictive values for the AUDIT-2* and AUDIT-3. Odds ratios and 95% confidence intervals were calculated to describe the associations between drinking patterns and sociodemographic factors. RESULTS Based on the sex-specific AUDIT-C cut-points, 36% of participants reported drinking at hazardous levels. For the AUDIT-2*, the best combination of sensitivity and specificity was obtained for a cut-point of five standard drinks. The best cut-point for the AUDIT-3 was for monthly heavy episodic drinking. Positive and negative predictive values were above 0.80 for both cut-points. Consumption was associated with age, degree level, domestic/international status, accommodation type, relationship status and employment. DISCUSSION AND CONCLUSIONS The AUDIT-2* and the AUDIT-3 appear to be promising standalone screening items for detecting hazardous drinking in this population of heavy-drinking students. [Blank M-L, Connor J, Gray A, Tustin K. Screening for hazardous alcohol use among university students using individual questions from the Alcohol Use Disorders Identification Test-Consumption. Drug Alcohol Rev 2015;34:540-8].
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Affiliation(s)
- Mei-Ling Blank
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew Gray
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Karen Tustin
- Department of Psychology, University of Otago, Dunedin, New Zealand.,National Centre for Lifecourse Research, University of Otago, Dunedin, New Zealand
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Yip BHK, Chung RY, Chung VCH, Kim J, Chan IWT, Wong MCS, Wong SYS, Griffiths SM. Is Alcohol Use Disorder Identification Test (AUDIT) or its shorter versions more useful to identify risky drinkers in a Chinese population? A diagnostic study. PLoS One 2015; 10:e0117721. [PMID: 25756353 PMCID: PMC4355485 DOI: 10.1371/journal.pone.0117721] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022] Open
Abstract
Objective To examine the diagnostic performance of shorter versions of Alcohol Use Disorder Identification Test (AUDIT), including Alcohol Consumption (AUDIT-C), in identifying risky drinkers in primary care settings using conventional performance measures, supplemented by decision curve analysis and reclassification table. Study design and Setting A cross-sectional study of adult males in general outpatient clinics in Hong Kong. The study included only patients who reported at least sometimes drinking alcoholic beverages. Timeline follow back alcohol consumption assessment method was used as the reference standard. A Chinese translated and validated 10-item AUDIT (Ch-AUDIT) was used as a screening tool of risky drinking. Results Of the participants, 21.7% were classified as risky drinkers. AUDIT-C has the best overall performance among the shorter versions of Ch-AUDIT. The AUC of AUDIT-C was comparable to Ch-AUDIT (0.898 vs 0.901, p-value = 0.959). Decision curve analysis revealed that when the threshold probability ranged from 15–30%, the AUDIT-C had a higher net-benefit than all other screens. AUDIT-C improved the reclassification of risky drinking when compared to Ch-AUDIT (net reclassification improvement = 0.167). The optimal cut-off of AUDIT-C was at ≥5. Conclusion Given the rising levels of alcohol consumption in the Chinese regions, this Chinese translated 3-item instrument provides convenient and time-efficient risky drinking screening and may become an increasingly useful tool.
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Affiliation(s)
- Benjamin H. K. Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China, Address: 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Roger Y. Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China, Address: 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Vincent C. H. Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China, Address: 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, China
- * E-mail:
| | - Jean Kim
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China, Address: 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Iris W. T. Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China, Address: 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Martin C. S. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China, Address: 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Samuel Y. S. Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China, Address: 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Sian M. Griffiths
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China, Address: 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, China
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Toward Efficient Screening for DSM-5 Alcohol Use Disorders in College Students. ADDICTIVE DISORDERS & THEIR TREATMENT 2015. [DOI: 10.1097/adt.0000000000000038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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López-Pelayo H, Wallace P, Segura L, Miquel L, Díaz E, Teixidó L, Baena B, Struzzo P, Palacio-Vieira J, Casajuana C, Colom J, Gual A. A randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR Spain): the study protocol. BMJ Open 2014; 4:e007130. [PMID: 25552616 PMCID: PMC4281557 DOI: 10.1136/bmjopen-2014-007130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Early identification (EI) and brief interventions (BIs) for risky drinkers are effective tools in primary care. Lack of time in daily practice has been identified as one of the main barriers to implementation of BI. There is growing evidence that facilitated access by primary healthcare professionals (PHCPs) to a web-based BI can be a time-saving alternative to standard face-to-face BIs, but there is as yet no evidence about the effectiveness of this approach relative to conventional BI. The main aim of this study is to test non-inferiority of facilitation to a web-based BI for risky drinkers delivered by PHCP against face-to-face BI. METHOD AND ANALYSIS A randomised controlled non-inferiority trial comparing both interventions will be performed in primary care health centres in Catalonia, Spain. Unselected adult patients attending participating centres will be given a leaflet inviting them to log on to a website to complete the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol screening questionnaire. Participants with positive results will be requested online to complete a trial module including consent, baseline assessment and randomisation to either face-to-face BI by the practitioner or BI via the alcohol reduction website. Follow-up assessment of risky drinking will be undertaken online at 3 months and 1 year using the full AUDIT and D5-EQD5 scale. Proportions of risky drinkers in each group will be calculated and non-inferiority assessed against a specified margin of 10%. Assuming reduction of 30% of risky drinkers receiving standard intervention, 1000 patients will be required to give 90% power to reject the null hypothesis. ETHICS AND DISSEMINATION The protocol was approved by the Ethics Commmittee of IDIAP Jordi Gol i Gurina P14/028. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02082990.
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Affiliation(s)
- Hugo López-Pelayo
- GRAC, Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Fundació Clínic Recerca Biomèdica (FCRB), RETICS, University of Barcelona, Barcelona, Spain
| | - Paul Wallace
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lidia Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Laia Miquel
- GRAC, Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETICS, University of Barcelona, Barcelona, Spain
| | - Estela Díaz
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Lidia Teixidó
- GRAC, Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Fundació Clínic Recerca Biomèdica (FCRB), RETICS, University of Barcelona, Barcelona, Spain
| | - Begoña Baena
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Pierliugio Struzzo
- Region Friuli Venezia Giulia, Regional Centre for the Training in Primary Care, Monfalcone, Italy
| | - Jorge Palacio-Vieira
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Cristina Casajuana
- GRAC, Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETICS, University of Barcelona, Barcelona, Spain
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Antoni Gual
- GRAC, Addictions Unit, Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), RETICS, University of Barcelona, Barcelona, Spain
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Upshur CC, Weinreb L, Bharel M. Homeless women and hazardous drinking: screening results in a primary health care setting. Am J Addict 2014; 23:117-22. [PMID: 25187047 DOI: 10.1111/j.1521-0391.2013.12072.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 02/20/2013] [Accepted: 02/23/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Screening for alcohol use in primary care is underutilized, especially for women. The current study implemented systematic women's alcohol use screening in a health care for the homeless primary care program. METHODS All women (n=541) seeking care over 12 months were screened. RESULTS Of the 541 screening forms returned, 80 women refused to answer the alcohol use questions. Of 461 completed screens, over 40% reported no alcohol use, while 43.8% reported hazardous drinking. Hazardous drinking was significantly associated with younger age, African American race, and living on the street or in a shelter. DISCUSSION AND CONCLUSIONS High rates of drinking were identified among women in different housing situations and use of systematic screening was beneficial to providers. SCIENTIFIC SIGNIFICANCE AND FUTURE DIRECTIONS Health care settings are important sites to identify hazardous drinking as well as alcohol disorders among women with unstable housing histories. The growing integration of behavioral health care into primary care, and the medical home concept, both provide opportunities for brief interventions for at-risk drinkers, as well as treatment options for those with alcohol use disorders that may be particularly appealing to women. Findings support further investigation of the relationship of housing stability to drinking, and suggest African American women may need special attention.
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Affiliation(s)
- Carole C Upshur
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts
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Abstract
Little is known about alcohol misuse and depression among Latino day laborers despite the fact that they encounter multiple stressors (e.g., job instability, unsafe work environments). A structural equation model tested the relationships among laborer stress, social support, health status, current alcohol misuse, and depression. A sample of 89 male, urban Latino day laborers completed measures assessing these constructs in 2011. Stress was negatively related to physical health status, which was associated with depression. Findings suggest that stressors specific to being a day laborer resulting from their work and living conditions generate and maintain health disparities in this vulnerable population.
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Affiliation(s)
- Guadalupe Bacio
- 1Department of Psychology, University of California, Los Angeles, California, USA
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Peltzer K, Simbayi L, Kalichman S, Jooste S, Cloete A, Mbelle N. Alcohol Use in Three Different Inner Cities in South Africa: AUDIT-C and CAGE. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2007.10820151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Karl Peltzer
- Human Sciences Research Council & University of Limpopo
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Delaney KE, Lee AK, Lapham GT, Rubinsky AD, Chavez LJ, Bradley KA. Inconsistencies between alcohol screening results based on AUDIT-C scores and reported drinking on the AUDIT-C questions: prevalence in two US national samples. Addict Sci Clin Pract 2014; 9:2. [PMID: 24468406 PMCID: PMC3946205 DOI: 10.1186/1940-0640-9-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/23/2013] [Indexed: 12/02/2022] Open
Abstract
Background The AUDIT-C is an extensively validated screen for unhealthy alcohol use (i.e. drinking above recommended limits or alcohol use disorder), which consists of three questions about alcohol consumption. AUDIT-C scores ≥4 points for men and ≥3 for women are considered positive screens based on US validation studies that compared the AUDIT-C to “gold standard” measures of unhealthy alcohol use from independent, detailed interviews. However, results of screening—positive or negative based on AUDIT-C scores—can be inconsistent with reported drinking on the AUDIT-C questions. For example, individuals can screen positive based on the AUDIT-C score while reporting drinking below US recommended limits on the same AUDIT-C. Alternatively, they can screen negative based on the AUDIT-C score while reporting drinking above US recommended limits. Such inconsistencies could complicate interpretation of screening results, but it is unclear how often they occur in practice. Methods This study used AUDIT-C data from respondents who reported past-year drinking on one of two national US surveys: a general population survey (N = 26,610) and a Veterans Health Administration (VA) outpatient survey (N = 467,416). Gender-stratified analyses estimated the prevalence of AUDIT-C screen results—positive or negative screens based on the AUDIT-C score—that were inconsistent with reported drinking (above or below US recommended limits) on the same AUDIT-C. Results Among men who reported drinking, 13.8% and 21.1% of US general population and VA samples, respectively, had screening results based on AUDIT-C scores (positive or negative) that were inconsistent with reported drinking on the AUDIT-C questions (above or below US recommended limits). Among women who reported drinking, 18.3% and 20.7% of US general population and VA samples, respectively, had screening results that were inconsistent with reported drinking. Limitations This study did not include an independent interview gold standard for unhealthy alcohol use and therefore cannot address how often observed inconsistencies represent false positive or negative screens. Conclusions Up to 21% of people who drink alcohol had alcohol screening results based on the AUDIT-C score that were inconsistent with reported drinking on the same AUDIT-C. This needs to be addressed when training clinicians to use the AUDIT-C.
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Affiliation(s)
| | | | | | | | | | - Katharine A Bradley
- VA HSR&D Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle WA, USA.
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Pecoraro A, Ewen E, Horton T, Mooney R, Kolm P, McGraw P, Woody G. Using the AUDIT-PC to predict alcohol withdrawal in hospitalized patients. J Gen Intern Med 2014; 29:34-40. [PMID: 23959745 PMCID: PMC3889973 DOI: 10.1007/s11606-013-2551-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 12/11/2012] [Accepted: 06/27/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol withdrawal syndrome (AWS) occurs when alcohol-dependent individuals abruptly reduce or stop drinking. Hospitalized alcohol-dependent patients are at risk. Hospitals need a validated screening tool to assess withdrawal risk, but no validated tools are currently available. OBJECTIVE To examine the admission Alcohol Use Disorders Identification Test-(Piccinelli) Consumption (AUDIT-PC) ability to predict the subsequent development of AWS among hospitalized medical-surgical patients admitted to a non-intensive care setting. DESIGN Retrospective case–control study of patients discharged from the hospital with a diagnosis of AWS. All patients with AWS were classified as presenting with AWS or developing AWS later during admission. Patients admitted to an intensive care setting and those missing AUDIT-PC scores were excluded from analysis. A hierarchical (by hospital unit) logistic regression was performed and receiver-operating characteristics were examined on those developing AWS after admission and randomly selected controls. Because those diagnosing AWS were not blinded to the AUDIT-PC scores, a sensitivity analysis was performed. PARTICIPANTS The study cohort included all patients age ≥18 years admitted to any medical or surgical units in a single health care system from 6 October 2009 to 7 October 2010. KEY RESULTS After exclusions, 414 patients were identified with AWS. The 223 (53.9 %) who developed AWS after admission were compared to 466 randomly selected controls without AWS. An AUDIT-PC score ≥4 at admission provides 91.0 % sensitivity and 89.7 % specificity (AUC=0.95; 95 % CI, 0.94–0.97) for AWS, and maximizes the correct classification while resulting in 17 false positives for every true positive identified. Performance remained excellent on sensitivity analysis (AUC=0.92; 95 % CI, 0.90–0.93). Increasing AUDIT-PC scores were associated with an increased risk of AWS (OR=1.68, 95 % CI 1.55–1.82, p<0.001). CONCLUSIONS The admission AUDIT-PC score is an excellent discriminator of AWS and could be an important component of future clinical prediction rules. Calibration and further validation on a large prospectivecohort is indicated.
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Affiliation(s)
- Anna Pecoraro
- />Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- />NIDA Clinical Trials Network, Delaware Valley Node, Philadelphia, PA USA
| | - Edward Ewen
- />Department of Medicine,, Christiana Care Health System, Newark, DE USA
| | - Terry Horton
- />NIDA Clinical Trials Network, Delaware Valley Node, Philadelphia, PA USA
- />Department of Medicine,, Christiana Care Health System, Newark, DE USA
| | - Ruth Mooney
- />Department of Nursing,, Christiana Care Health System, Newark, DE USA
| | - Paul Kolm
- />Center for Outcomes Research,, Christiana Care Health System, Newark, DE USA
| | - Patty McGraw
- />Department of Medicine,, Christiana Care Health System, Newark, DE USA
| | - George Woody
- />Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- />NIDA Clinical Trials Network, Delaware Valley Node, Philadelphia, PA USA
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Dhital R. Alcohol screening and brief intervention by community pharmacists: Benefits and communication methods. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/cih.2008.1.1.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Santos WSD, Fernandes DP, Grangeiro ASDM, Lopes GS, Sousa EMPD. Medindo consumo de álcool: análise fatorial confirmatória do Alcohol Use Disorder Identification Test (AUDIT). PSICO-USF 2013. [DOI: 10.1590/s1413-82712013000100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O presente estudo buscou verificar a adequação dos modelos uni e multifatoriais do AUDIT, bem como verificar sua validade convergente e de critério. Participaram da pesquisa 386 pessoas da população geral com idade média de 27,7 anos (dp=10,5). Além do AUDIT, os participantes responderam a dois instrumentos correlatos e a perguntas biossociodemográficas. As análises indicaram a adequação do modelo de três fatores, com índices de qualidade de ajuste (χ²/gl=63,29, CFI=0,98, AGFI=0,98 e RMSEA=0,05) estatisticamente superiores às estruturas uni e bifatoriais. Finalmente, por meio de correlações r de Pearson e da comparação de médias foram atestadas a validade convergente e de critério do AUDIT, assegurando sua proposta de medir o consumo de álcool e demonstrando sua aplicabilidade na triagem de bebedores-problema.
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Tuunanen M, Aalto M, Seppä K. Mean-weekly alcohol questions are not recommended for clinical work. Alcohol Alcohol 2013; 48:308-11. [PMID: 23518790 DOI: 10.1093/alcalc/agt018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study was to evaluate middle-aged men's willingness to answer short, clinically feasible alcohol-related questions and to discuss changing their drinking habits. METHODS All 45-year-old male inhabitants of the city of Tampere, Finland, were invited to a health screening. Of these, 664 (55.1%) agreed to participate and 615 drank alcohol. The mailed health questionnaire also included mean-weekly (M-W), quantity-frequency (Q-F) and structured frequency-quantity (AUDIT-FQ) questions based on the Alcohol Use Disorders Identification Test (AUDIT). Based on the Q-F, drinkers were classified as moderate, risky and heavy episodic drinkers. RESULTS Q-F was answered by 90.2%, the AUDIT by 96.6% and the M-W by 45.5%. In all drinker categories, Q-F gave higher consumption levels compared with M-W and AUDIT-FQ. Willingness to discuss and change alcohol drinking was low in all drinker categories. CONCLUSION Choosing a method preferred by patients may increase their willingness to talk about alcohol. Also, a method giving high consumption values may be the most truthful, because patients often underestimate their drinking. This is why Q-F questions should be favoured over M-W and AUDIT-FQ in patient interviews.
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Affiliation(s)
- Mervi Tuunanen
- School of Medicine, University of Tampere, Tampere FIN-33014 Finland.
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So K, Sung E. A Validation Study of the Brief Alcohol Use Disorder Identification Test (AUDIT): A Brief Screening Tool Derived from the AUDIT. Korean J Fam Med 2013; 34:11-8. [PMID: 23372901 PMCID: PMC3560334 DOI: 10.4082/kjfm.2013.34.1.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/28/2012] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of alcohol use disorder (AUD) is very high in Korea. To identify AUD in the busy practice setting, brevity of screening tools is very important. We derived the brief Alcohol Use Disorders Identification Test (AUDIT) and evaluated its performance as a brief screening test. Methods One hundred male drinkers from Kangbuk Samsung Hospital primary care outpatient clinic and psychiatric ward for alcoholism treatment completed questionnaires including the AUDIT, cut down, annoyed, guilty, eye-opener (CAGE), and National Alcoholism Screening Test (NAST) from April to July, 2007. AUD (alcohol abuse and dependence), defined by a physician in accordance with Diagnostic and Statistical Manual of Mental Disorders-IV, was used as a diagnostic criteria. To derive the brief AUDIT, factor analysis was performed using the principal component extraction method with a varimax rotated solution. Receiver operating characteristic (ROC) curve analysis was performed to investigate the discrimination ability of the brief AUDIT. Areas under the ROC curve were compared performance of screening questionnaires with 95% confidence intervals. Results The derived brief AUDIT consists of 4 items: frequency of heavy drinking (item 3), impaired control over drinking (item 4), increased salience of drinking (item 5), and alcohol-related injury (item 9). Brief AUDIT exhibited an AUD screening accuracy better than CAGE, and equally to that of NAST. Areas under the ROC curves were 0.87 (0.80-0.94), 0.76 (0.66-0.85), and 0.81 (0.73-0.90) for the brief AUDIT, CAGE, and NAST for AUD, and 0.97 (0.95-0.99), 0.93 (0.88-0.98) and 0.93 (0.88-0.98) for alcohol dependence. Conclusion The new brief AUDIT seems to be effective in detecting male AUD in the primary care setting in Korea. Further evaluation for women and different age groups is needed.
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Affiliation(s)
- Kyungseop So
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Vera M, Juarbe D, Hernández N, Obén A, Pérez-Pedrogo C, Chaplin WF. Probable Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Latino Primary Care Patients in Puerto Rico. ACTA ACUST UNITED AC 2013; 1:124. [PMID: 25635240 PMCID: PMC4307810 DOI: 10.4172/2167-1044.1000124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The present investigation was designed to study PTSD among inner city primary care patients in Puerto Rico. Specifically, we examined the rate of probable PTSD, PTSD co-morbidity with MDD and GAD, and the association of probable PTSD and co-occurring disorders with demographic, treatment, and alcohol related factors. Methods We screened 3,568 patients at primary care practices serving primarily low-income patients. The presence of probable PTSD was assessed with the Primary Care PTSD screen, major depression with the PHQ-9, and generalized anxiety disorder with the GAD Q-IV. Results Fourteen percent of our sample screened positive for probable PTSD. Among this group, 12% met criteria for co-morbid GAD without MDD and 15.9% for co-morbid MDD with/without GAD, whereas 72% of the patients with probable PTSD did not meet criteria for co-morbidity. Over 80% of the patients with probable PTSD indicated they were not receiving mental health treatment. Multiple logistic regression findings show that there were no significant differences in demographic and alcohol related factors by PTSD status. Multinomial logistic regression analysis revealed significant differences in the use of mental health treatment among the subgroups of patients with probable PTSD. As compared to patients with only probable PTSD, the use of mental health services was 4 times higher among patients with probable PTSD and MDD and over 2 1/2 times higher among patients with probable PTSD and GAD. Conclusion The prevalence rate of probable PTSD in our sample was similar to the rates reported for soldiers after returning from deployment and for Latinos after the September 11 attacks. The high prevalence of probable PTSD and low use of mental health treatment among inner city primary care patients in our study, highlight the need of future research to obtain information on how to effectively target and treat Latino primary care patients in need of treatment for PTSD.
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Affiliation(s)
- Mildred Vera
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Deborah Juarbe
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Norberto Hernández
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Adriana Obén
- Center for Evaluation and Sociomedical Research, School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Pecoraro A, Horton T, Ewen E, Becher J, Wright PA, Silverman B, McGraw P, Woody GE. Early data from Project Engage: a program to identify and transition medically hospitalized patients into addictions treatment. Addict Sci Clin Pract 2012. [PMID: 23185969 PMCID: PMC3507657 DOI: 10.1186/1940-0640-7-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Patients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients. Methods Program-level data on treatment entry after discharge were examined retrospectively. Insurance claims data for two small cohorts who entered treatment after discharge (2009, n = 18, and 2010, n = 25) were reviewed over a six-month period in 2009 (three months pre- and post-Project Engage), or over a 12-month period in 2010 (six months pre- and post-Project Engage). These data provided descriptive information on health-care utilization and costs. (Data on those who participated in Project Engage but did not enter treatment were unavailable). Results Between September 1, 2008, and December 30, 2010, 415 patients participated in Project Engage, and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009, and November 30, 2009 (n = 18), insurance claims demonstrated a 33% ($35,938) decrease in inpatient medical admissions, a 38% ($4,248) decrease in emergency department visits, a 42% ($1,579) increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% ($847) increase in outpatient BH/SA admissions, for an overall decrease of $37,760. For a small cohort who participated between June 1, 2010, and November 30, 2010 (n = 25), claims demonstrated a 58% ($68,422) decrease in inpatient medical admissions; a 13% ($3,308) decrease in emergency department visits; a 32% ($18,119) decrease in BH/SA inpatient admissions, and a 32% ($963) increase in outpatient BH/SA admissions, for an overall decrease of $88,886. Conclusions These findings demonstrate that a large percentage of patients entered SUD treatment after participating in Project Engage, a novel intervention with facilitated referral to treatment. Although the findings are limited by the retrospective nature of the data and the small sample sizes, they do suggest a potentially cost-effective addition to existing hospital services if replicated in prospective studies with larger samples and controls.
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Affiliation(s)
- Anna Pecoraro
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Holt SR, Ramos J, Harma M, Cabrera F, Louis-Ashby C, Dinh A, Fiellin DA, Tetrault JM. Physician detection of unhealthy substance use on inpatient teaching and hospitalist medical services. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 39:121-9. [PMID: 22992028 DOI: 10.3109/00952990.2012.715703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Screening, brief intervention, and referral to treatment for substance use depends on reliable identification. The goal of this study was to determine the rate of detection of unhealthy substance use by physicians on teaching and nonteaching medical services at a community teaching hospital. METHODS This cross-sectional study was conducted from February to June 2009. All new medicine admissions to the Teaching Service or the nonteaching Hospitalist Service were assessed for unhealthy substance use using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and Drug Abuse Screening Test (DAST). All patients identified with substance use completed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Medical record review was also performed to assess physician documentation. RESULTS Of 442 eligible patients, 414 consented to participate. Patients on the Teaching Service were more likely to be male, younger, unmarried, non-white, uninsured or receiving publicly funded insurance, and current smokers (p < .01 for all comparisons). Overall, the detection rate for unhealthy substance use was 64.3% (63 of 98 confirmed cases), with service-specific rates of 73.4% for the Teaching Service, compared with 47.1% for the Hospitalist Service (p = .011). ICD-9 coding accounted for 53.1% of identified cases on the Teaching Service and 14.7% of identified cases on the Hospitalist Service (p < .001). Assignment to the Hospitalist Service, being married, and isolated unhealthy drug use were independently associated with decreased physician detection rates. CONCLUSIONS Our study suggests that unhealthy substance use is more likely to be detected on a Teaching Service than on a Hospitalist Service.
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Affiliation(s)
- Stephen R Holt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA.
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Kim JW, Lee BC, Lee DY, Seo CH, Kim S, Kang TC, Choi IG. The 5-item Alcohol Use Disorders Identification Test (AUDIT-5): An Effective Brief Screening Test for Problem Drinking, Alcohol Use Disorders and Alcohol Dependence. Alcohol Alcohol 2012; 48:68-73. [DOI: 10.1093/alcalc/ags082] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Burnett-Zeigler I, Walton MA, Ilgen M, Barry KL, Chermack ST, Zucker RA, Zimmerman MA, Booth BM, Blow FC. Prevalence and correlates of mental health problems and treatment among adolescents seen in primary care. J Adolesc Health 2012; 50:559-64. [PMID: 22626481 DOI: 10.1016/j.jadohealth.2011.10.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 10/06/2011] [Accepted: 10/08/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE In this study, we describe the characteristics of adolescents with mental health problems among those presenting to primary care clinics in urban areas. METHODS The sample included 1,076 adolescents aged 12-18 years who presented to federally qualified community health clinics in urban cities in the Midwest. Bivariate and multivariate logistic regression analyses were conducted to examine the associations between having a mental health problem with demographic characteristics, health-related variables, and other risk and promotive factors. We also examined the use of health services and involvement in activities among those with mental health problems. RESULTS Approximately 14% of adolescents screened positive for a mental health problem; among those with a mental health problem, 42.8% received mental health services in the past 3 months. In the multivariate logistic regression analysis, adolescents who were female, with poorer grades, fair to poor self-reported health, using drugs, and lower parental monitoring were more likely to have a mental health problem. In bivariate analyses, adolescents with mental health problems were less likely to participate in school activities and community activities and more likely to use emergency room services. CONCLUSIONS Adolescents with mental health problems were more likely to have several other difficulties including poor grades, poor self-rated health, drug/alcohol use, and sexual activity. This study highlights the importance of screening youth with multidimensional needs and referring them to the appropriate services.
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Henriquez-Gonzalez O, Patton R. Prevalence of tobacco, cocaine and alcohol use amongst patients attending for methadone-maintenance therapy in a rural setting. JOURNAL OF SUBSTANCE USE 2012. [DOI: 10.3109/14659891.2012.675399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Holt SR, Ramos J, Harma MA, Cabrera F, Louis-Ashby C, Dinh A, Tetrault JM, Fiellin DA. Prevalence of unhealthy substance use on teaching and hospitalist medical services: implications for education. Am J Addict 2012; 21:111-9. [PMID: 22332853 DOI: 10.1111/j.1521-0391.2011.00207.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prevalence of unhealthy substance use (USU) among medical inpatients can vary, and prior research has not characterized the prevalence of USU among patients cared for by a teaching service (TS) and a nonteaching hospitalist service (NTHS). The objective of this study was to compare the prevalence of USU among patients cared for by a TS and an NTHS. We conducted a cross-sectional study from February to June 2009 at a community teaching hospital. Within 24 hours of admission, all eligible internal medicine admissions to the TS or NTHS were screened for USU, using the Alcohol Use Disorders Identification Test-Consumption and Drug Abuse Screening Test. Patients screening positive then underwent a diagnostic interview and blinded chart review to increase case finding and to assess whether each patient's admission was related to USU. There were 414 eligible and consenting patients out of 656 patients identified. Patients on the TS were younger and more likely to be current smokers, male, unmarried, non-white, and unemployed (p<.01 for all comparisons). TS patients were more likely to have evidence of USU (29.2% vs. 12.3%; p<.01). Among all admissions to the TS, 22.2% were deemed to be probably or possibly due to USU, as compared with only 3.7% of admissions to the NTHS (p<.01). Medical TSs care for a greater share of patients with USU as compared with an NTHS. These data highlight the need for expanded medical resident training in the diagnosis and management of USU.
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Affiliation(s)
- Stephen R Holt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
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Towers A, Stephens C, Dulin P, Kostick M, Noone J, Alpass F. Estimating older hazardous and binge drinking prevalence using AUDIT-C and AUDIT-3 thresholds specific to older adults. Drug Alcohol Depend 2011; 117:211-8. [PMID: 21402452 DOI: 10.1016/j.drugalcdep.2011.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 01/20/2011] [Accepted: 02/06/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to provide hazardous and binge drinking prevalence, odds and risk attributable to specific demographic correlates in community dwelling older adults using both the standard and new older-specific AUDIT-C thresholds. METHODS Hazardous drinking was assessed using the AUDIT-C in a cross-sectional postal survey of 6662 New Zealanders aged 55-70 years old (m=60.94, SD=4.70) randomly selected from the New Zealand Electoral Roll. Prevalence data is presented for whole sample and stratified by key demographic correlates using standard and older-specific threshold scores on the AUDIT-C. Hazardous drinking prevalence using the standard AUDIT-C threshold was 56.01%, as compared to 42.28% and 50.20% under two older-specific thresholds. RESULTS Being younger, male, and wealthy were consistent drinking predictors across thresholds but the older-specific thresholds substantially altered the prevalence and risk for females, Asians, and poorer people. Past-month binge prevalence of 18.18% was considerably lower than the past-year prevalence of 33.51%, but change from past-month to past-year binge threshold had no significant effect on the demographic composition of binge drinkers. The standard AUDIT-C threshold over-estimates hazardous drinking prevalence in older adults by up to 33%, but even the most conservative rates in this study are cause for concern regarding the level of drinking by older people in New Zealand. CONCLUSION Older hazardous drinkers are predominantly younger, wealthier, white, partnered males, whichever threshold is used, but binge drinkers are more likely to be rural, Māori, and lack tertiary education. Further efforts are needed to determine factors underpinning hazardous drinking, especially in older Māori.
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Affiliation(s)
- Andy Towers
- School of Psychology, Massey University, Palmerston North 4442, New Zealand.
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