Mariana Cremonte

The dimensionality of alcohol use disorders and alcohol consumption in a cross-national perspective

AIMS To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. DESIGN Cross-sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM-IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. SETTING Participants were 5195 injured and non-injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995-2001). FINDINGS Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear-cut distinction between the criteria for dependence and abuse in all sites. RESULTS from item response theory analyses showed that the current DSM-IV criteria tap people in the middle-upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM-IV diagnostic criteria to help tap the middle-lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. CONCLUSIONS DSM-IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.

Alcohol and violence in the emergency department: a regional report from the WHO collaborative study on alcohol and injuries

OBJECTIVE To determine the relative risk (RR) of non-fatal unintentional and violence-related injury associated with alcohol consumption in three emergency departments in Latin America (2001-2002). MATERIAL AND METHODS Pair-matched case-crossover was used to obtain RR estimates for alcohol in non-fatal injuries among 447 patients in Argentina (A), 489 in Brazil (B) and 455 in Mexico (M). Intentional (violence) or unintentional (non-violence) injury status were the main outcomes. RESULTS About 46% of violence-related cases involved alcohol (versus 11.5% for non-violence related cases). The risk of violence-related injury increased with drinking and had an OR= 15.0 (95% confidence interval (CI), 5.8-39.1), with an OR= 4.2 (CI= 2.7-6.5) for unintentional injuries. CONCLUSIONS Increasing amounts of drinking may have pronounced consequences on the risk of triggering an injury, especially for a violence-related injury. The RR estimates provided here can be useful for new estimates on alcohol and the burden of disease.

The Relationship Between Self-Reported Drinking and BAC Level in Emergency Room Injury Cases: Is it a Straight Line?

BACKGROUND While the validity of self-reported consumption based on blood alcohol concentration (BAC) has been found to be high in emergency room (ER) samples, little research exists on the estimated number of drinks consumed given a BAC level. Such data would be useful in establishing a dose-response relationship between drinking and risk (e.g., of injury) in those studies for which the number of drinks consumed is not available but BAC is. METHODS Several methods were used to estimate the number of drinks consumed in the 6 hours prior to injury based on BAC obtained at the time of ER admission of n = 1,953 patients who self-reported any drinking 6 hours prior to their injury and who arrived to the ER within 6 hours of the event, from the merged Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study on Alcohol and Injury across 16 countries. RESULTS The relationship between self-reported consumption and averaged BAC within each consumption level appeared to be fairly linear up to about 7 drinks and a BAC of approximately 100 mg/dl. Above about 7 reported drinks, BAC appeared to have no relationship with drinking, possibly representing longer consumption periods than only the 6 hours before injury for those reporting higher quantities consumed. Both the volume estimate from the bivariate BAC to self-report relationship as well as from a Widmark calculation using BAC and time from last drink to arrival to the ER indicated a somewhat weak relationship to actual number of self-reported drinks. CONCLUSIONS Future studies may benefit from investigating the factors suspected to be driving the weak relationships between these measures, including the actual time over which the reported alcohol was consumed and pattern of drinking over the consumption period.

PSYCHOMETRIC PROPERTIES OF ALCOHOL SCREENING TESTS IN THE EMERGENCY DEPARTMENT IN ARGENTINA, MEXICO AND THE UNITED STATES

The objective of this article is to report psychometric characteristics of the AUDIT, CAGE, RAPS4, and TWEAK and to compare them across three countries: Argentina, Mexico, and the United States which used a similar protocol and methodology. Probability samples of patients 18 years and older were drawn from emergency departments in Mar del Plata, Argentina (n=780), Pachuca, Mexico (n=1624) and Santa Clara, U.S. (n=1220). Concurrent validity was assessed by comparing their performance against a diagnosis of alcohol dependence (DSM-IV) obtained through the Composite International Diagnostic Interview, and for the briefer measures, also by their correlation with the AUDIT. The internal consistency of the CAGE, RAPS4, and TWEAK scores was estimated by the KR-20 formula and by Cronbachs Alpha for the AUDIT. Corrected item-total correlation and D-values were used as item discrimination measures. In Argentina and Mexico the AUDIT and the RAPS4 showed the highest validity. Reliability of all instruments was higher in the US than in Argentina or Mexico. In all three countries, reliability of the TWEAK was lowest, while the AUDIT was highest. With a few exceptions, all items showed good discrimination powers.

Performance of Screening Instruments for Alcohol Use Disorders in Emergency Department Patients in Argentina

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The studys limitations are noted.

The Marketing Potential of Corporate Social Responsibility Activities: The Case of the Alcohol Industry in Latin America and the Caribbean

AIMS The aims were to: (1) identify, monitor and analyse the Corporate Social Responsibility (CSR) practices of the alcohol industry in Latin America and the Caribbean (LAC) and (2) examine whether the alcohol industry is using these actions to market their products and brands. METHODS Nine health experts from Argentina, Brazil and Uruguay conducted a content analysis of 218 CSR activities using a standardized protocol. A content rating procedure was used to evaluate the marketing potential of CSR activities as well as their probable population reach and effectiveness. The LEAD procedure (longitudinal, expert and all data) was applied to verify the accuracy of industry-reported descriptions. RESULTS A total of 55.8% of the actions were found to have a marketing potential, based on evidence that they are likely to promote brands and products. Actions with marketing potential were more likely to reach a larger audience than actions classified with no marketing potential. Most actions did not fit into any category recommended by the World Health Organization; 50% of the actions involving classroom and college education for young people were found to have marketing potential; 62.3% were classified as meeting the definition of risk management CSR. CONCLUSION Alcohol industry Corporate Social Responsibility activities in Latin America and the Caribbean appear to have a strategic marketing role beyond their stated philanthropic and public health purpose.

Escala de Motivos para Cesar/Reducir el Consumo de Alcohol: propiedades psicométricas

El objetivo de este estudio fue evaluar las propiedades psicometricas de una escala de motivos para cesar o reducir el consumo de alcohol en jovenes universitarios, en cuanto a dimensionalidad, nivel del item, consistencia interna y validez concurrente. Participaron del estudio 377 estudiantes de psicologia de la Universidad Nacional de Mar del Plata. Mediante un cuestionario anonimo y confidencial, se indagaron motivos para cesar o reducir el consumo de alcohol con una escala de 20 items, desarrollados a partir de respuestas cualitativas. Se incluyeron como criterios de validez la cantidad habitual de alcohol consumida y una regla de motivacion al cambio. Se realizaron analisis factoriales exploratorios, confirmatorios, de confiabilidad y bivariados. Los analisis factoriales exploratorios y confirmatorios apuntaron a una estructura de tres dimensiones llamadas: rechazo del alcohol, salud y cambios vitales, y consecuencias severas del consumo de alcohol. Los coeficientes de confiabilidad fueron adecuados. Se encontraron relaciones entre las dos primeras dimensiones y la cantidad de alcohol consumida, y entre la motivacion al cambio y la dimension salud y cambios vitales. Se discute la diferencia entre motivos hipoteticos y reales para el cambio, y el rol de las consecuencias graves del consumo en grupos de mayor ingesta de alcohol.

Alcohol use disorders in Argentinian girls and women 12 months before delivery: comparison of DSM-IV, DSM-5, and ICD-10 diagnostic criteria

Background: The evidence of important problems related to prenatal alcohol exposure has faced researchers with the problem of understanding and screening alcohol use in this population. Although any alcohol use should be considered risky during pregnancy, identifying alcohol-drinking problems (ADPs) could be especially important because women with ADPs could not benefit from a simple advice of abstinence and because their offsprings are subjected to a higher risk of problems related with prenatal alcohol exposure. In this context, we aim to study the prevalence and characteristics of ADPs in pregnant women, evaluating the performance of different diagnostic systems in this population. Objectives: The aims of the study were to describe the prevalence of ADPs obtained with the criteria of the Diagnostic and Statistical Manual of Mental Disorders in its fourth (DSM-IV) and fifth edition (DSM-5), and the International Classification of Diseases (ICD)-10, in Argentinean females aged 13 to 44 years, 12 months before delivery; to evaluate the level of agreement between these classification systems; and to analyze the performance of each diagnosis criterion in this population. Methods: Data were collected through personal interviews of a probability sample of puerperal women (N = 641) in the city of Santa Fe (Argentina), between October 2010 and February 2011. Diagnoses compatible with DSM-IV, DSM-5, and ICD-10 were obtained through the Composite International Diagnostic Interview. Agreement among diagnostic systems was measured through Cohen kappa. Diagnosis criteria performance were analyzed considering their prevalence and discriminating ability (D value). Results: Total ADP prevalence was 6.4% for DSM-IV (4.2% abuse and 2.2% dependence), 8.1% for DSM-5 (6.4% mild, 0.8% moderate, and 0.9% severe alcohol use disorder), and 14.1% for the ICD-10 (11.9% harmful use and 2.2% dependence). DSM-5 modifications improved agreement between DSM and ICD. The least prevalent and worst discriminating ability diagnostic criterion was “legal problems.” The most prevalent and 1 of the best discriminating ability diagnostic criterion was ‘“health issues.” Conclusions: DSM-IV and ICD-10 dependence prevalence was similar to that of previous studies in pregnant women, whereas abuse prevalence was surprisingly higher. Our results indicate a better performance of the DSM-5 alcohol use disorder category relative to the DSM-IV dual categorization. Nevertheless, the poor diagnostic performance of some DSM-5 criteria in this population could evidence their intercultural variability.

Gender and Alcohol Use Disorders Diagnostic Criteria in Emergency Department Patients of Argentina

ABSTRACT Background: Alcohol consumption and its related consequences are not equal for women and men, although related studies do not frequently include gender analysis. Objective: Our aim was to characterize differences in endorsement of ICD-10 and DSM 5 alcohol use disorder (AUD) criteria by gender in an Argentinean emergency department population. Methods: A probability sample of patients (N = 923) from the largest emergency department in the city of Mar del Plata, Argentina (44% were females, aged 16 to 86, M (SD) = 37.31(15.20) was collected. Using a structured questionnaire, diagnostic criteria for alcohol use disorders, alcohol consumption, and socio-demographic variables were obtained. Bivariate and multivariate analyses were used to assess differences in the endorsement of each diagnostic criterion by gender. Results: Women were less likely to endorse each of the criteria for each of the diagnostic schemes. Even after controlling alcohol consumption, socio-demographic variables, severity of alcohol use disorders and adjusting for multiple comparisons females had a lower probability than males of endorsing withdrawal and impaired control. Conclusions: gender differences in the endorsement of diagnostic criteria for both the DSM 5 and ICD-10 were found. Some differences in endorsement but not all, might be partially explained by alcohol consumption patterns and socio-demographic factors, and same remained after controlling severity of the AUD. Results also suggest a differential functioning of DSM 5 and ICD-10 AUD criteria for women and men.

Data quality in surveys on alcohol consumption among university students

Diferentes modalidades de encuesta han sido desarrolladas para medir el consumo de alcohol y los problemas relacionados. La investigacion sobre la calidad de los datos en distintas modalidades de encuesta es escasa en Latinoamerica. El objetivo de este estudio es evaluar la calidad de los datos sobre consumo de alcohol resultante de tres modalidades de encuesta: auto-administrada online, auto-administrada en papel y lapiz y entrevistas cara a cara. Los datos se obtuvieron de tres muestras probabilisticas (n = 60 cada una) de estudiantes de la Universidad Nacional de Mar del Plata, Argentina, usando el mismo cuestionario. Para cada modalidad, la calidad de los datos se estimo con la tasa de respuesta global, tasa de respuesta al item y la precision. La precision fue evaluada con el porcentaje de consumo excesivo episodico, resultado positivo del AUDIT, y consistencia interna del AUDIT. Las tasas de respuesta global y al item fueron menores en la modalidad online, y similares en las restantes dos. No se encontraron diferencias en la precision de las respuestas entre las modalidades.Different survey modalities have been developed to assess alcohol consumption and related problems. Research that compares data quality between survey modalities is scarce in Latin America. The aim of this study was to assess data quality in three survey modalities on alcohol consumption: self-administered online, self-administered hard-copy, and face-to-face interviews. Data were obtained from three probabilistic samples of students (n = 60 each) from the National University of Mar del Plata, Argentina, using the same questionnaire. Data quality was measured for each modality by overall response rate, item response rate, and accuracy. Data accuracy was evaluated as the percentage of self-reported binge drinking, positive results on AUDIT, and internal consistency of AUDIT for each modality. The overall and item response rates were lower in the online modality and similar between the other two. No differences were found between modalities in the accuracy of responses.