Sion K. Harris, PhD, Lon Sherritt, MPH, Erin B. Gibson MPH, Laura Grubb, MD MPH, Ronald Samuels, MD, Thomas Silva, MD, Louis Vernacchio, MD MSc,
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1 Sion K. Harris, PhD, Lon Sherritt, MPH, Erin B. Gibson MPH, Laura Grubb, MD MPH, Ronald Samuels, MD, Thomas Silva, MD, Louis Vernacchio, MD MSc, Wendy Wornham, MD, Jesse Boggis, BA, John R. Knight, Jr., MD
2 Grants R01AA021904/R34AA from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Other support provided by: Grant R01AA from NIAAA Grants #T71NC0009 (SKH) from the Maternal and Child Health Bureau, HRSA, USDHHS
3 Conflict of interest statement: I have no commercial relationships to disclose I will not be discussing any unapproved uses of pharmaceuticals or devices My views do not necessarily reflect those of any of these bodies, or my academic institution
4 Partnership for Adolescent Substance Use Research Site-PIs: Traci Brooks MD 1,2, Laura Grubb MD MPH 3 Ronald Samuels MD 4, Tom Silva MD 5, Louis Vernacchio MD 6, Wendy Wornham MD 7 CeASAR Staff: Sarah Bliss, Jesse Boggis, Erin Bray Gibson, Gardner Butterworth, Paula Carroll, Jill Finlayson, Amy Flynn, Kateryna Kuzubova, Victoria Rhines, Jessica Tauber INSTITUTIONS: 1 Division of Adolescent/Young Adult Medicine, Boston Children s Hospital, Boston, MA; 2 Cambridge Health Alliance, Cambridge, MA; 3 Tufts Medical Center - Floating Hospital for Children, Boston, MA; 4 Division of General Pediatrics, Boston Children s Hospital, Boston, MA; 5 East Boston Neighborhood Health Center, East Boston, MA; 6 Longwood Pediatrics, Boston, MA; 7 Lexington Pediatrics, Lexington, MA.
5 Recommends conducting alcohol screening and brief counseling with all youth ages 9-18 Ultra-brief screen: 1) friends use and 2) own use; question order and timeframe differs by age Risk level determined (lower, moderate, higher) based on age and gender
6 Elementary School (Ages 9-11) Middle School (Ages 11-14) High School (Ages 14-18) Friends drinking in past year Own lifetime drinking (any) Friend s drinking in past year Own drinking days in past year Own drinking days in past year Friends usual # of drinks
7
8 Moderate/Highest Risk thresholds by Age 9-15 years: >1 day in past 12 months years: >6 days in past 12 months 18 years: >12 days in past 12 months
9 Evaluate reliability and validity of the NIAAA Youth Screening Guide (NIAAA YSG) in detecting alcohol use and alcohol use disorder (AUD) among adolescents presenting for an annual well-visit in pediatric primary care offices Told their provider may see their responses
10 5 Study Sites in Massachusetts, USA: 2 pediatricians offices 1 urban hospital adolescent clinic 1 urban hospital pediatric clinic 1 community health center
11 February 2015 to September 2016 Recruited age-gender-balanced sample of English-speaking 9-18 year-olds presenting for annual well-visit Informed assent for 12- to 17-year-olds; consent for 18-year-olds $15 store gift card for baseline IRB approval from all sites, with waiver of parental consent
12 Study Flow Diagram Participant Assent/ Consent Computerized screening before seeing PCP Subsample invited = 468 (oversampled users) Re-test through secure website (outside of clinic) <2 weeks post-visit Completers = 353 (75.4% response) Confidential Interview w/ Research Assistant (RA) RAs blinded to screening results
13 Alcohol use: past-12-month Timeline Follow- Back (TLFB) calendar interview administered by trained research assistant in private room DSM-5 Alcohol Use Disorder: computer selfadministered Diagnostic Interview Schedule for Children (DISC) Alcohol Use module
14 Test-retest agreement examined for: Any past-12-month use (yes/no) Number of past-12-month drinking days NIAAA risk level: (1) No use, (2) Lower risk, (3) Moderate risk, (4) Highest risk Statistics: Cohen s kappa coefficient Intra-class correlation coefficients (ICC)
15 Sensitivity (SN), specificity (SP), positive/negative predictive values (PPV/NPV) compared to criterion Receiver-operating characteristic curve (ROC) analysis to identify optimal cutpoint in number of drinking days for detecting problematic use (DSM-5 AUD)
16 Total sample (N=1276) % Girls 50.2 Grade (age) group Elementary (9-11 yrs) 20.2 Middle (11-14 yrs) 36.3 High (14-18 yrs) 43.5 Race/ethnicity White non-hispanic 41.8 Black/Hispanic 41.7 Asian/Other/Multi 16.5 College-graduate parent(s) 72.4
17 Total sample (N=1276) % Test-retest sample (n=353) % Girls Grade (age) group Elementary (9-11 yrs) Middle (11-14 yrs) High (14-18 yrs) Race/ethnicity White non-hispanic Black/Hispanic Asian/Other/Multi College-graduate parent(s)
18 Elementary (n=258) Middle (n=463) High School (n=555) Used in lifetime 2.7% * Drink at binge levels
19 Elementary (n=258) Middle (n=463) High School (n=555) Used in lifetime 2.7% Used past 12 mo % 33.9% * Drink at binge levels
20 Elementary (n=258) Middle (n=463) High School (n=555) Used in lifetime 2.7% Used past 12 mo % 33.9% Friends drink 2.3% 6.5% 58.2/39.0* * Drink at binge levels
21 Elementary (n=258) Middle (n=463) High School (n=555) Used in lifetime 2.7% Used past 12 mo % 33.9% Friends drink 2.3% 6.5% 58.2/39.0* NIAAA risk level No use/lower 97.3% 98.1% 84.9% Moderate 0 1.7% 12.3% Highest 2.7% 0.2% 2.9% * Drink at binge levels
22 Elementary (n=258) Middle (n=463) High School (n=555) Used in lifetime 2.7% Used past 12 mo % 33.9% Friends drink 2.3% 6.5% 58.2/39.0* NIAAA risk level No use/lower 97.3% 98.1% 84.9% Moderate 0 1.7% 12.3% Highest 2.7% 0.2% 2.9% DSM-5 AUD >1 sx 0 0.6% 14.8% DSM-5 AUD >2 sx % DSM-5 AUD >4 sx % * Drink at binge levels
23 Baseline Retest Any past year use 36.9% 37.3% Friends drink 48.9% 50.5% # of drinking days (mean + SD) NIAAA risk level * No elementary schoolers Kappa/ ICC (95%CI).81 ( ).83 ( ).84 ( ) No use/lower 82.1% 80.3% Moderate 15.4% 16.7% Highest 2.6% 2.9%.75 ( )
24 * No elementary schoolers Sensitivity Specificity PPV NPV Middle school Any past-yr use >Moderate risk Highest risk High school Any past-yr use >Moderate risk Highest risk
25 * No elementary schoolers Sensitivity Specificity PPV NPV Middle school Any past-yr use >Moderate risk Highest risk High school Any past-yr use >Moderate risk Highest risk
26 * High schoolers only Screen result: Moderate or Highest Risk Level DSM-5 AUD Sensitivity Specificity PPV NPV Any symptom Disorder Mod/severe dis Screen result: Highest Risk Level DSM-5 AUD Sensitivity Specificity PPV NPV Disorder Mod/severe dis
27 * High schoolers only Screen result: Moderate or Highest Risk Level DSM-5 AUD Sensitivity Specificity PPV NPV Any symptom Disorder Mod/severe dis Screen result: Highest Risk Level DSM-5 AUD Sensitivity Specificity PPV NPV Disorder Mod/severe dis
28 Area Under Curve (AUC) Optimal cutpoint (number of days) Age Group < ( ).82 ( ).84 ( ) >1 day >1 day >6 days Sensitivity 88% 91% 85% Specificity 83% 66% 82%
29 Area Under Curve (AUC) Optimal cutpoint (number of days) Age Group < ( ).82 ( ).84 ( ) >1 day >1 day >6 days Sensitivity 88% 91% 85% Specificity 83% 66% 82% NIAAA cutpoints >1 day >6 days >12 days
30 NIAAA YSG responses showed reliability among adolescents screened in pediatricians offices (all kappas >.70) Middle schoolers tended to under-report use on screener (low sensitivity) High schoolers report of any use had good validity, but screen sensitivity declined at higher risk levels (i.e., more frequent drinking)
31 NIAAA risk-level cutpoints had low sensitivity for detecting DSM-5 AUD in this sample should be lowered for youth age <18 Findings similar to previous studies that show optimal cutpoints should be lower than NIAAA cutpoints (Kelly et al., 2014; Spirito et al., 2016; Clark et al., 2016; D Amico et al., 2016)
32 Conducted in Boston-area pediatric practices; findings may not be generalizable to other settings, adolescent populations Criterion measures based on self-report Unable to examine screen performance for detecting AUD in younger adolescents in this sample; no AUD
33 NIAAA youth screening tool has evidence for reliability and validity among high school-aged youth; middle schoolers may under-report For identifying AUD among high schoolers age <18, NIAAA cutpoints too high Any days of use in past 12 months best cutpoint for AUD in youth age <18 and should be followed by a brief problem screen such as the CRAFFT
34 Do you have any friends who drank beer, wine, or any drink containing alcohol in the past 12 months? During the past 12 months, on how many days did you drink more than a few sips of beer, wine, or any drink containing alcohol? 34
35 During the past 12 months, on how many days did you drink more than a few sips of beer, wine, or any drink containing alcohol? If your friends drink, how many drinks do they usually drink on an occasion? 35
Sion K. Harris, PhD, Lon Sherritt, MPH, Erin B. Gibson MPH, Laura Grubb, MD MPH, Ronald Samuels, MD, Thomas Silva, MD, Louis Vernacchio, MD MSc,
Sion K. Harris, PhD, Lon Sherritt, MPH, Erin B. Gibson MPH, Laura Grubb, MD MPH, Ronald Samuels, MD, Thomas Silva, MD, Louis Vernacchio, MD MSc, Wendy Wornham, MD, Jesse Boggis, BA, John R. Knight, MD
Acknowledgements: USA
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