Janina Grothues

Screening questionnaires for problem drinking in adolescents: performance of AUDIT, AUDIT-C, CRAFFT and POSIT.

Background/Aims: Only rather few data on the validity of screening questionnaires to detect problem drinking in adolescents exist. The aim of this study was to compare the performance of the Alcohol Use Disorders Identification Test (AUDIT), its short form AUDIT-C, the Substance Module of the Problem Oriented Screening Instrument for Teenagers (POSIT), and CRAFFT (acronym for car, relax, alone, forget, family, and friends). Methods: The questionnaires were filled in by 9th and 10th graders from two comprehensive schools. All students received an interview using the alcohol section of the Composite International Diagnostic Interview. Alcohol abuse and alcohol dependence according to DSM-IV as well as episodic heavy drinking served as criteria to validate the screening instruments. Results: All 9th and 10th graders (n = 225) of both schools participated. No significant differences were found for areas under the receiver operating characteristic curves ranging from 0.810 to 0.872. Cronbach’s alpha was satisfactory (0.77–0.80) but poor for CRAFFT (0.64). Different cut-offs are discussed. Conclusions: Considering validity as well as reliability, AUDIT, AUDIT-C and POSIT performed well; however, the POSIT is quite lengthy. AUDIT-C showed good psychometric properties and has clear advantages because of its brevity.

Validity of overweight and obesity in a nation based on self-report versus measurement device data

Objective:To analyze overweight and obesity in a nation by self-report (SR) data and by data about the target person provided via other household members compared to measurement devices (MD). The magnitude of hypothesized under-reporting by the SR data should be estimated with adjustment for age, gender, and education.Design:Two cross-sectional studies, nationally representative health examination surveys (response rates: 61.4 and 73.2%, respectively).Setting:Adult general population of Germany aged 20–79 years.Subjects:Sample 1 included 6806 residents. Samples 2 (n=98 673) and 3 (n=34 960) included residents in the second survey.Measurements:In sample 1 MD data were collected, in sample 2 SR data were collected, and in sample 3 body weight and height information was provided from another household member living together with the target person.Results:MD data revealed higher proportions of overweight and obesity compared to SR. Among women with body mass index (BMI) 35.00 or higher, the odds ratio (OR) was 3.9 (95% confidence interval, CI, 3.2–4.7), and among men 2.8 (CI, 2.2–3.6) for MD versus SR. Data from other household members also revealed higher proportions of overweight and obesity than SR (OR for BMI 35.00 or higher 2.1, CI, 1.7–2.5, for data from other household members versus SR in women and OR 1.3, CI, 1.1–1.5, in men).Conclusions:MD data should be used when providing proportions of overweight and obesity in a nation such as Germany.

Effectiveness of brief alcohol interventions for general practice patients with problematic drinking behavior and comorbid anxiety or depressive disorders.

BACKGROUND Brief interventions (BIs) are effective methods to reduce problematic drinking. It is not known, if the effectiveness of BI differs between patients with or without comorbid depression or anxiety disorders. METHODS In a randomized controlled BI study with two intervention groups and one control condition, data were collected from 408 general practice (GP) patients with alcohol use disorders, at-risk drinking or binge drinking. 88 participants were diagnosed with comorbid anxiety and/or depressive disorders. The effectiveness of BI was assessed at a 12-month follow-up in relation to the presence and absence of comorbidity. Reduction of drinking in six ordered categories (g/alcohol) between baseline and follow-up served as the outcome variable. RESULTS BI were significantly related to reduction of drinking in the non-comorbid (-2.64 g/alcohol vs. -8.61 g/alcohol; p=.03) but not in the comorbid subsample (-22.06 g/alcohol vs. -22.09 g/alcohol; p=.76). Compared to non-comorbid participants, a significantly higher reduction of drinking was found for comorbid individuals (-6.55 g/alcohol vs. -22.08 g/alcohol; p=.01). An ordinal regression analysis revealed comorbidity to be a positive predictor for reduction of drinking (estimator=.594; CI=.175-1.013; p<.01). When entering the variables amount of drinking at baseline, intervention and classification of problematic drinking, these became significant predictors, whereas comorbidity showed only a tendency. CONCLUSION BI did not significantly effect a reduction of drinking in comorbid patients. As BI are known to be less effective for dependent drinkers, a larger proportion of dependents among the comorbid might have limited the effectiveness of BI. Future studies with larger sample sizes of comorbid problem drinkers are necessary to confirm the results.

Differences in help seeking rates after brief intervention for alcohol use disorders in general practice patients with and without comorbid anxiety or depressive disorders.

Aims: To examine, if the utilization of help for problematic drinking after brief intervention (BI) differs between general practice (GP) patients with and without comorbid depression or anxiety disorders. Methods: Longitudinal data of 374 GP patients, who met the diagnostic criteria of alcohol dependence or abuse according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV) and criteria of at‐risk drinking or binge drinking, were drawn from a randomized controlled BI study. Participants were randomly allocated to either a control or one of two intervention groups, receiving a series of alcohol related BI. Of the sample, 88 participants were diagnosed with comorbid anxiety and/or depressive disorders. At 12‐months follow‐up, differences in utilization of formal help for drinking problems were assessed between comorbid and non‐comorbid individuals. Results: BI were significantly related to an increase in utilization of formal help in non‐comorbid patients (χ2 = 4.54; df = 1; p < 0.05) but not in comorbid individuals (χ2 = 0.40; df = 1; p = 0.60). In a logistic regression analysis, comorbidity [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.14–2.88; p = 0.01) and previous help seeking (OR = 15.98; CI = 6.10–41.85; p < 0.001) were found to be positive predictors for utilization of formal help. Conclusion: BIs do not seem to significantly support help‐seeking in the comorbid. As comorbid anxiety and depression constitute a positive predictor for help‐seeking, individuals with problematic drinking and comorbid anxiety or depressive disorders might benefit from more specialized support exceeding the low level of BI. Copyright

Severity of unhealthy alcohol consumption in medical inpatients and the general population: is the general hospital a suitable place for brief interventions?

ObjectivesEvidence for brief interventions in general hospital (GH) settings is scarce, probably due to higher rates of dependent drinkers. The present study aims to compare unhealthy drinking patterns in GH patients with the general population (GP).MethodsSample 1 consisted of 4,075 individuals randomly drawn from registration office files, representing the non-institutionalised GP of a northern mixed rural–urban German area. Sample 2 consisted of 2,949 consecutively admitted patients from a GH covering the same area.ResultsCompared to individuals from the GP, GH patients revealed higher prevalence rates of alcohol dependence (1.3 vs. 5.5%) and alcohol abuse (1.2 vs. 2.8%), but did not differ significantly concerning at-risk drinking (5.1 vs. 6.2%). Multinomial logistic regression analysis controlling for age, sex and smoking using unrisky alcohol consumption as reference category belonging to the GH group was predictive for alcohol use disorders but not for at-risk drinking.ConclusionData show that a substantial number of individuals with unhealthy drinking patterns without alcohol use disorders can easily be accessed in GH settings if appropriate screening measures are conducted.ZusammenfassungHintergrundDie Evidenz für die Wirksamkeit von Kurzinterventionen im Setting des Allgemeinkrankenhauses ist eingeschränkt, möglicherweise aufgrund des hohen Anteils Alkoholabhängiger. Die vorliegende Studie vergleicht riskante Trinkmuster bei Patienten eines Allgemeinkrankenhauses mit der Allgemeinbevölkerung.MethodenStichprobe 1 bestand aus 4075 anhand von Einwohnermeldeamtsdaten randomisiert ausgewählten Personen, welche die nicht-institutionalisierte Bevölkerung einer gemischten ländlich-städtischen Bevölkerung Norddeutschlands repräsentieren (GP). Stichprobe 2 bestand aus 2949 konsekutiv aufgenommenen Patienten eines Allgemeinkrankenhauses der selben Region (GH).ErgebnisseGegenüber Personen der GP, wiesen Personen der GH höhere Prävalenzen an Alkoholabhängigkeit (1,3% vs. 5,5%) und Alkoholmissbrauch (1,2% vs. 2,8%) auf, ohne dass sich die Stichproben in der Häufigkeit riskanten Alkoholkonsums unterschieden (5,1% vs. 6,1%). In einer multinomialen logistischen Regression war die Zugehörigkeit zur GH-Gruppe nach Kontrolle auf Alter, Geschlecht und Rauchstatus prädiktiv für das Vorliegen einer alkoholbezogenen Störung, jedoch nicht für riskanten Alkoholkonsum.SchlussfolgerungDie Daten zeigen dass eine substanzielle Gruppe von Personen mit riskantem Alkoholkonsum im Setting des Allgemeinkrankenhauses bei Verwendung geeigneter Screening-Instrumente erreicht werden kann.

Performance of the Pictorial Representation of Illness and Self Measure in Individuals with Alcohol Dependence, Alcohol Abuse or At-Risk Drinking

Background: The impact of chronic illnesses is not only influenced by one’s physical functioning but also by its subjective importance to the individual’s life. However, it is often difficult to asses such an impact in an appropriate way. PRISM (pictorial representation of illness and self measure) measures the perception of illness and first data on its validity have been published. The aim of the present study was to prove the applicability of PRISM regarding alcohol-dependent patients. Therefore, a comparison was made between alcohol-dependent patients, alcohol abusers and at-risk drinkers. Method: The sample consisted of 763 general practice patients, who scored above the cutoff in alcohol-related screening questionnaires. Of this sample, 330 were diagnosed as alcohol dependent, alcohol abusers (both according to DSM-IV) or at-risk drinkers. To prove the applicability, PRISM was put in context with the severity of alcohol dependence and the core constructs of the transtheoretical model of behavior change. Results: PRISM was related to the severity of the drinking problem: the severer the drinking problem, the shorter the distance between self and illness. High correlations with aspects of alcohol consumption – such as adverse consequences from drinking, temptation to drink, and self-efficacy to abstain – were found. Concerning stages of change according to the transtheoretical model of behavior change, data show a significant difference in the self-illness separation between patients in the stage of contemplation compared to those in the precontemplation or action stage. Conclusions: The PRISM task is applicable to patients with alcohol use disorders. Within this group and in contrast to other chronic diseases, PRISM reveals a significant relationship not only to the severity of drinking, but also to the readiness to change one’s drinking behavior.

Alcohol screening in general practices using the AUDIT: how many response categories are necessary?

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a common screening instrument. This study analyses if response categories of the AUDIT might be dichotomized without affecting the psychometric properties of the questionnaire. Methods: Participants between 18 and 65 years were recruited from general practices in two northern German cities. In total, 10,803 screenings were conducted (refusal rate: 5.9%). For those who were screened positive, the Munich-Composite International Diagnostic Interview (M-CIDI) was used for identification of 12-month Alcohol Use Disorders and at-risk consumption (exceeding 20/30 g per day). Abstinent subjects and screening positives without diagnostic interview were excluded from the analysis, leaving a sample of 7,112 subjects. ROC-Curves were calculated separately for each item in order to identify an optimal cut-off value. Finally, a version of the AUDIT based on dichotomized items was compared to the original version and its short-form, the AUDIT version based on three questions dealing with consumption AUDIT-C. Results: As an optimal cut-off value for items on consumption, drinking at least once a week, having more than 1–2 drinks per occasion, and drinking 6 or more drinks in one sitting at least once a month were identified. For all questions on alcohol-related problems or dependence symptoms, having ‘ever occurred’ differed best between subjects with and without Alcohol Use Disorders or at-risk consumption. Sensitivity and specificity of the dichotomized version of the AUDIT did not differ from the original version, and both full versions performed superior compared to the AUDIT-C. Conclusion: Data indicate that the AUDIT response categories may be dichotomized without affecting its validity.

Verbesserung der medizinischen Versorgung durch die Förderung der Intention zur Änderung gesundheitsriskanten Verhaltens

ZusammenfassungEin sehr großer Anteil an Krankheiten und Todesfällen ließe sich durch Verhaltensänderung vermeiden, wenn wirksame Programme angewendet werden könnten, insbesondere zu Tabakrauchen, Adipositas und riskantem Alkoholkonsum. Praxistaugliche Ansätze basieren u. a. auf dem Transtheoretischen Modell der Verhaltensänderung. In dessen Mittelpunkt steht die Förderung der Intention zur Änderung gesundheitsriskanter Verhaltensweisen. Das Modell ermöglicht, auch bevölkerungsweit Risikofaktoren für verbreitete Krankheiten zu reduzieren. Empirische Untersuchungen über die Förderung der Intention zur Veränderung gesundheitsriskanten Verhaltens zeigen Interventionserfolge, z. B. beim Beenden des Tabakrauchens. Die Effekte wachsen mit der Zeit. Interventionen, die auf die Förderung der Änderung gesundheitsriskanter Verhaltensweisen ausgerichtet sind, können zur Verbesserung medizinischer Versorgung beitragen.AbstractA large proportion of disease and death cases could be prevented, if efficacious programs, particularly concerning tobacco smoking, obesity, and alcohol risk drinking, could be applied. Feasible approaches are based, among others, on the Transtheoretical Model of intentional health behavior change. This model allows to develop practical approaches to reduce risk factors of common diseases at the general population level. Evidence about the promotion of the intention to change health risk behaviors revealed successes, e. g., according to smoking cessation. The effects are growing by time. Intervention that is focused at the promotion of change of health risk behaviors can add to the improvement of health care.

The Impact of Having a Loved One With Alcohol Consumption-Related Problems on Subjective Health Status and Health-Risk Behaviors in a General Hospital Sample

Consecutively admitted inpatients of a general hospital in Northern Germany (N = 2903) completed a standardized screening questionnaire in 2005–2006 containing questions about alcohol consumption-related problems in loved ones, their own alcohol consumption, and other health-related aspects. Almost 26.2% reported having a loved one with alcohol consumption-related problems. The proportions of smokers and those who screened positively for at-risk consumption or alcohol abuse were significantly higher in those patients; they were significantly younger and reported worse overall states of health and emotional health. Since those patients showed a high risk of numerous health problems, psychological interventions were implemented. The studys limitation noted.

Improvement of medical care by supporting the intention to change health risk behavior

ZusammenfassungEin sehr großer Anteil an Krankheiten und Todesfällen ließe sich durch Verhaltensänderung vermeiden, wenn wirksame Programme angewendet werden könnten, insbesondere zu Tabakrauchen, Adipositas und riskantem Alkoholkonsum. Praxistaugliche Ansätze basieren u. a. auf dem Transtheoretischen Modell der Verhaltensänderung. In dessen Mittelpunkt steht die Förderung der Intention zur Änderung gesundheitsriskanter Verhaltensweisen. Das Modell ermöglicht, auch bevölkerungsweit Risikofaktoren für verbreitete Krankheiten zu reduzieren. Empirische Untersuchungen über die Förderung der Intention zur Veränderung gesundheitsriskanten Verhaltens zeigen Interventionserfolge, z. B. beim Beenden des Tabakrauchens. Die Effekte wachsen mit der Zeit. Interventionen, die auf die Förderung der Änderung gesundheitsriskanter Verhaltensweisen ausgerichtet sind, können zur Verbesserung medizinischer Versorgung beitragen.AbstractA large proportion of disease and death cases could be prevented, if efficacious programs, particularly concerning tobacco smoking, obesity, and alcohol risk drinking, could be applied. Feasible approaches are based, among others, on the Transtheoretical Model of intentional health behavior change. This model allows to develop practical approaches to reduce risk factors of common diseases at the general population level. Evidence about the promotion of the intention to change health risk behaviors revealed successes, e. g., according to smoking cessation. The effects are growing by time. Intervention that is focused at the promotion of change of health risk behaviors can add to the improvement of health care.