CORK Bibliography: Screening Tests, Racial and Ethnic Groups

9 citations. 2003 to present

Prepared: June 2011

Brook JS; Koppel J; Pahl K. Predictors of DSM and Fagerstrom-defined nicotine dependence in African American and Puerto Rican young addults. Substance Use & Misuse 44(6): 809-822, 2009

This study examined the psychosocial predictors of nicotine dependence, as defined by a variant of the criteria employed in the DSM-IVspecifically that of the University of Michigan Composite International Diagnostic Interview (UM-CIDI)and the Fagerstrom Test for Nicotine Dependence (FTND). The study was conducted with a community sample of African American and Puerto Rican young adults (N = 475; mean age = 26). Predictor variables included physiologically based psychosocial (i.e., depressive symptoms and family problems with smoking) as well as social-behavioral psychosocial (i.e., rebelliousness and partner's problems with smoking) predictors of nicotine dependence. Using multiple regression analyses, UM-CIDI-defined dependence was predicted by each of the four psychosocial variables, while FTND-defined dependence was predicted only by the social-behavioral variables. These findings bear out the disparate dimensions of nicotine dependence each measure taps. Research and clinical implications of the findings are discussed, and the study's limitations are noted.

Cherpitel CJ; Bazargan S. Screening for alcohol problems: Comparison of the AUDIT, RAPS4 and RAPS4-QF among African American and Hispanic patients in an inner city emergency department. Drug and Alcohol Dependence 71(3): 275-280, 2003. (29 refs.)

Objective: to compare brief screening instruments for alcohol use disorders, the RAPS4, RAPS4-QF, and AUDIT, against DSM-IV criteria for alcohol dependence and alcohol abuse among African Americans and Hispanics in a sample of inner city emergency department (ED) patients. Method: a probability sample of 395 African American and Hispanic patients seeking care at King Drew Medical Center Emergency Department were interviewed regarding items related to the screening and diagnostic instruments, quantity and frequency of drinking and demographic characteristics. Results: no difference was found between the RAPS4 and AUDIT for alcohol dependence. Sensitivity of the RAPS4-QF (the RAPS4 plus a quantity item and a frequency item) was significantly better than the AUDIT for African Americans and Hispanics, and for males, but not for females, although the RAPS4-QF identified all of those women positive for alcohol abuse criteria, compared to 93% identified by the AUDIT. Conclusion: the data suggest the RAPS4 and the RAPS4-QF perform well for identifying alcohol dependence and alcohol abuse, respectively, among minority ED patients. Additional research is needed to evaluate the RAPS4-QF as a stand-alone instrument and to evaluate both instruments across gender and ethnic subgroups in other populations and in other cultural settings.

Leonardson GR; Kemper E; Ness FK; Koplin BA; Daniels MC; Leonardson GA. Validity and reliability of the AUDIT and CAGE-AID in northern plains American Indians. Psychological Reports 97(1): 161-166, 2005. (18 refs.)

According to the Indian Health Service, substance abuse and Type 2 diabetes are serious problems among Native Americans. To assess substance use in a medical setting, valid screening tests are needed so the Alcohol Use Disorders Identification Test (AUDIT), a simple brief screen for excessive drinking, and the CAGE-adapted to Include Drugs (CAGE-AID) for identifying primary care patients with alcohol and drug disorders were given 50 Northern Plains American Indians with diabetes. Both are short, easy to administer, have good sensitivity and specificity, and can be easily incorporated into a medical history protocol or intake procedure. Reliability coefficients were above .90 and appeared to have sufficient concurrent and divergent validity indicated by moderate correlations with the General Well-being Schedule (rs = -.39 and -.36), the Family-Adaptation, Partnership, Growth, Affection, & Resolve (r = -.47 and -.36), and the Beck Depression Inventory-II (r = .36 and .29).

Bedregal LE; Sobell LC; Sobell MB; Simco E. Psychometric characteristics of a Spanish version of the DAST-10 and the RAGS. Addictive Behaviors 31(2): 309-319, 2006. (44 refs.)

Although Hispanics/Latinos constitute the largest ethnic minority group in the United States, there are few culturally and linguistically valid Spanish language clinical assessment instruments. This shortage is even more critical in the addictions field. This article presents the psychometric characteristics of two drug abuse screening instruments; the Drug Abuse Screening Test (DAST-10), and the Reduce Annoyed Guilty Start (RAGS) test that were translated into Spanish. Participants included 60 drug abusers, 35 alcohol abusers, and 127 individuals with no alcohol and/or drug problem. Results indicated that the Spanish versions of the two drug abuse screening instruments were reliable and unidimensional and differentiated drug abusers from non-substance abusers and from alcohol abusers.

Donovan DM; Marlatt GA, eds. Assessment of Addictive Behaviors, 2nd edition. New York: Guilford Press, 2005. (Chapter refs.)

This edited volume, with 13 chapters and 33 contributors, examines the assessment issues related to addictive disorders and compulsive behaviors. Interestingly it begins with consideration of relapse prevention and assessment issues to accomplish this. The following chapter deals with the epidemiology of addictive disorders in racial and ethnic groups. The next six chapters focus upon assessment for those involved with a specific drug -- alcohol, nicotine, cocaine, amphetamines, opioids, marijuana -- followed by one dealing with hallucinogens, inhalants and steroid use. The concluding four chapters deal with assessment, not of psychoactive drugs, but with compulsive behaviors -- gambling, disordered eating and obesity, sexual offender relapse, and high risk sexual behavior. Incorporated within the discussion is consideration of screening and assessment tools, as well as assessment of comorbid psychiatric disorders and other related medical co-occurring conditions.

Robin RW; Saremi A; Albaugh B; Hanson RL; Williams D; Goldman D. Validity of the SMAST in two American Indian tribal populations. Substance Use & Misuse 39(4): 601-624, 2004. (47 refs.)

The standardized evaluation of alcoholism and other psychopathologies in minority populations, particularly American Indians, has long been questioned. This study investigated the validity of one of the most commonly applied assessments for alcoholism-the Short Michigan Alcohol Screening Test (SMAST)-in two distinct American Indian tribal groups. We analyzed data collected from 1989 to 1995 from largely community representative samples of 456 Southwestern and 214 Plains Indians ages 21 or older. For comparison, alcohol dependence was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria from a detailed, modified version of the Schedule for Affective Disorders and Schizophrenia-Lifetime (SADS-L). Accuracy of the SMAST was quantified as sensitivity, specificity, likelihood ratios, and the area under the curve for receiver operating characteristics, using the DSM-III-R diagnosis as the reference. The standard SMAST cutoff score of greater than or equal to3 had a demonstrated sensitivity 86% to 95%, but did not perform well in terms of specificity (23%-47%). Significantly higher cutoff scores (greater than or equal to 5 for both genders in the Southwestern tribe and 8 and greater than or equal to 6 for men and women in the Plains tribe) were required to demonstrate acceptable levels of specificity in both tribes. The findings suggest that the SMAST is not a valid tool to screen for alcohol misuse in these two tribal populations. The highly elevated and different thresholds required from one population to the next and from one gender to the next constitute a significant obstacle to the use of the instrument.

Wilson CR; Sherritt L; Gates E; Knight JR. Are clinical impressions of adolescent substance use accurate? Pediatrics 114(5): E536-E540, 2004. (22 refs.)

Objective. To compare providers' impressions of adolescents' level of substance use with diagnostic classifications from a structured diagnostic interview. Methods. Secondary analysis of data was conducted from a validation study of the CRAFFT substance abuse screening test of 14- to 18-year-old medical clinic patients (n = 533) and their corresponding medical care providers (n = 109) at an adolescent clinic affiliated with a large tertiary care pediatric hospital. Medical care providers completed a form that recorded their clinical impressions of patients' level of alcohol and drug involvement (none, minimal, problem, abuse, dependence) and demographic characteristics. The form included brief diagnostic descriptions for each level of use. After the medical visit, patients completed the Adolescent Diagnostic Interview (ADI), a structured diagnostic interview that yields diagnoses of abuse and dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). On the basis of their past 12 months of alcohol and drug use on the ADI interview, adolescents were classified into 5 mutually exclusive diagnostic groups. "None" was defined by no reported use of alcohol or drugs during the past year. "Minimal use" was defined as use of alcohol or drugs but no report of any substance-related problems. "Problem use" was defined as reporting 1 or more substance-related problems but no diagnosis of abuse or dependence. "Abuse" was defined by meeting any 1 of 4 DSM-IV diagnostic criteria for either alcohol or drug abuse but no diagnosis of dependence. "Dependence" was defined by meeting any 3 of 7 diagnostic criteria for either alcohol or drug dependence, with or without a diagnosis of abuse. Proportions were compared using Fisher exact test. Agreement was assessed with the weighted kappa, and these analyses were stratified by substance used (ie, alcohol vs drug) and demographic characteristics. Sensitivity, specificity, and positive and negative predictive values were calculated from 2 x 2 tables. Results. Compared with the criterion standard interview, providers identified significantly fewer patients with problem use and abuse and no patients with dependence. Of >100 patients whom the ADI classified with substance problem use, providers correctly identified 18. Of 50 patients who were classified with a diagnosis of alcohol or drug abuse, providers correctly identified 10. Of 36 patients who were classified with a diagnosis of alcohol or drug dependence, providers correctly identified none. For the 86 adolescents who were classified with a substance-related disorder (ie, abuse or dependence), providers' impressions were "none" (24.4%), "minimal use" (50%), "problem use" (15.1%), "abuse" (10.5%), and "dependence" (0%). There was only marginal agreement between providers' impressions and diagnoses related to alcohol use (kappa = .29), drug use (kappa = .31), and any substance use (kappa = .30). Kappa was not significantly affected by the patient's age, but it was by gender. Among boys, kappa was significantly higher for impressions of drug use versus alcohol use (kappa = .48 vs kappa = .27); and, among drug users, kappa was significantly higher among boys compared with girls (kappa = .48 vs kappa = .24). Kappa did not differ significantly across race/ethnicity subgroups, although there is a suggestive trend toward higher agreement for black non-Hispanic compared with white non-Hispanic adolescents (kappa = .35 vs kappa = .21). Kappa did not differ significantly on the basis of the visit type, but the size of this difference (kappa = .36 vs kappa = .24) suggests that the longer well-child visit yielded greater identification of substance-related pathology. Providers' impressions had a sensitivity of .63 for identifying use of alcohol or drugs. However, sensitivity was poor for identification of problem use (.14), abuse (.10), and dependence (0), whereas specificity and positive predictive values were high. Of the 86 adolescents with a diagnosis of abuse or dependence, 75.6% were correctly identified by providers as using substances; however, the level of use in 50% of these adolescents was reported by providers as minimal. Conclusions. In this study, clinical impressions of adolescents' alcohol/drug involvement underestimated substance-related pathology. When providers thought that use was present, there was a very high likelihood that a problem or disorder existed. The use of structured screening devices would likely improve identification of adolescents with substance-related pathology in primary care settings and should be considered for use with all adolescent patients, rather than only those who are perceived to be at higher risk.

Johnson EO; Morgan-Lopez AA; Breslau N; Hatsukami DK; Bierut LJ. Test of measurement invariance of the FTND across demographic groups: Assessment, effect size, and prediction of cessation. Drug and Alcohol Dependence 93(3): 260-270, 2008. (37 refs.)

Background: Measurement non-invariance of the Fagerstrom Test for Nicotine Dependence (FTND) across demographic groups could significantly bias group comparisons and screening for recruitment into treatment and genetic studies. Here clinically meaningful bias in the FTND across European-American and African-American men and women was assessed by: (1) testing measurement invariance; (2) estimating effect sizes of non-invariance; and (3) assessing impact of adjusting for bias on the association between FTND and cessation. Methods: European-American and African-American current and former smokers (it = 8301) were identified from a community-based telephone screening of 25,265 individuals from metropolitan Detroit, MI and St. Louis, MO. The FTND was administered to measure current dependence and lifetime dependence when smoking the most. Cessation was measured as having smoked 100 or more cigarettes but not smoked in the past 30 days. Results: Statistically significant measurement non-invariance for the FTND was found and more pronounced for lifetime than current dependence. However, the magnitude of effects appeared negligible. The largest variance in item response explained by measurement non-invariance was 3.1%. Adjusting for measurement non-invariance made no difference in the associations between nicotine dependence and quitting smoking across groups. Conclusions: Although European-American and African-American men and women often report different scores on the FTND and have different response patterns to items on the FTND, it does not appear that such differences result from meaningful item-level measurement bias.

Cummins LH; Chan KK; Burns KM; Blume AW; Larimer M; Marlatt GA. Validity of the CRAFFT in American-Indian and Alaska-native adolescents: Screening for drug and alcohol risk. Journal of Studies on Alcohol 64(5): 727-732, 2003. (36 refs.)

Objective: Native-American adolescents are reported to be at high risk for drug and alcohol use and related negative consequences. A brief screening instrument that is culturally and developmentally appropriate can aid clinicians who work with Native youth in determining whether more extensive assessment of substance use is necessary The CRAFFT has been shown to be a valid and reliable screen among general adolescent outpatient clinic samples. Method: Data were collected as part of the Journeys of the Circle project, a collaborative effort between the Seattle Indian Health Board (SIHB) and the University of Washington's Addictive Behaviors Research Center. Psychometric properties of the CRAFFT were examined in 70 American-Indian and Alaska-Native youths ages 13 to 19 recruited from public schools and SIHBs outpatient clinics. Results: The CRAFFT demonstrated good internal consistency (alpha = 0.81). A score of 2 or higher on the CRAFFT was found to be optimal for capturing youths with high alcohol-related problems (sensitivity, 0.95; specificity, 0.86), frequent alcohol use (sensitivity, 1.00; specificity, 0.72) and frequent marijuana use (sensitivity, 1.00; specificity, 0.75). A cut-point of 3 was appropriate for identifying adolescents with frequent other drug use (sensitivity, 0.86; specificity, 0.76). Conclusions: The CRAFFT may be a valid instrument for identifying Native youths at risk for alcohol and other drug problems. This brief screen can be effective in helping providers determine the need for further assessment and treatment or prevention services for Native-American adolescents.

Peters RH; Wexler HK. Substance Abuse Treatment for Adults in the Criminal Justice System. Treatment Improvement Protocol (TIP) 44. Rockville MD: Center for Substance Abuse Treatment, 2005. (648 refs.)

This Treatment Improvement Protocol (TIP) dealing with treatment of adults in the criminal justice system is a revision of three previous of TIPs, numbers 7, 12, and 17. This revision provides state-of-the-art treatment guidelines for counselors and others working with clients involved in criminal justice system, whether in institutional settings or community agencies dealing with persons on probation, parole, or pretrial release. It is organized into eleven chapters: Chapter 1: Introduction. Following an overview, the chapter outlines the purpose of the volume, intended audiences, and contents. Chapter 2: "Screening and Assessment" defines key terms, sets for guidelines for screening and assessment, and central issues to be addressed, and guidelines for selecting instruments. Chapter 3 : "Triage and Placement in Treatment Services" defines levels and components of treatment, potential barriers to service, and issues to be addressed in establishing a triage and placement system. Chapter 4: "Substance Abuse Treatment Planning" considers efforts to assess the level of severity of substance use disorders as well as co-occurring psychiatric conditions. Within the discussion is consideration of criminality and psychopathology, examination of client motivation and readiness to make change, and engaging in treatment planning. Chapter 5 "Major Treatment Issues and Approaches" discusses clinical strategies, and key program components. Chapter 6 "Adapting Offender Treatment for Specific Populations" examines the rationale for altering treatment to specific population groups. Among the major topics addressed are concerns related to cultural minorities; treatment issues for women; men's treatment needs; and central points in working with violent offenders. It also considers treatment needs based on sexual orientation, client disabilities, as well of those from rural areas, or the elderly, as well as those with co-occurring substance use and psychiatric disorders. Chapter 7 "Treatment Issues in Pretrial and Diversion Settings" addresses the unique features of these settings, characteristics of this population, trial and post verdict periods, and treatment concerns. Chapter 8 "Treatment Issues Specific to Jails" provides an overview of treatment services in jails, central treatment issues, coordination with other agencies, and treatment recommendations. Chapter 9 "Treatment Issues Specific to Prisons" described the characteristics of treatment services in these settings, and central issues in program planning. Chapter 10 "Treatment for Offenders under Community Supervision" describes the population, and particular needs of those in different settings, whether probationers or those on parole. The concluding chapter "Key Issues in Program Development" reviews the range of issues relevant to program design, such as balancing public safety and public health concerns, coordination with other agencies, cost issues, and research and evaluation. There are five appendices as well as a number of tables and figures, and clinician summary boxes.