NR 503 Week 2: Epidemiological Methods

NR503 Epidemiological Methods- Alcohol Misuse screening tool

• Describe the diagnostic or screening tool selected, its purpose, and what age group it targets.

Alcohol abuse or misuse is common amongst college students and can be detrimental to their health, education, and relationships. This is an age group that is often overlooked. The age group being considered in this post is young adults and college students. There are several diagnostic/screening tools selected including: the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-Consumption (AUDIT-C), and single-question screening (Miller et. al., 2018). These screening tools have superior sensitivity to identify alcohol misuse. In this post I will focus on the AUDIT-C screening tool because it is a more simplified version of the AUDIT screening. Questions include: “How often do you have a drink with alcohol?’” “How often do you drink six or more drinks on one occasion?” It presents a multiple-choice questionnaire where each option comes with a set number of points. For example, option A=0 pts, B=1 pt, C=2 pts, D=3 pts, and E=4 pts. The total is then added up and a cutoff score is recommended by the tool based on gender (4 or more out of 12 pts for male) or (female 3 or more out 12 pts) (Miller et. al., 2018). The purpose of screening for alcohol misuse is to identify alcoholism to treat the patient. Screening for alcohol misuse leads to higher treatment, referral, and follow-up (Miller et. al., 2018).

• Has it been specifically tested in this age group?

According to Miller et. al. (2018) created a quality improvement project using a mixed-methods design for pre/post intervention using students who arrived at the clinic for any reason and were asked to participate in the alcohol misuse screening. All participants were students at the university who were above the age of 18. A maximum of 60 participants were used to test out the alcohol screening tool (AUDIT-C). With previous alcohol screening tools only 6 out 60 patients had been screened for alcohol misuse. With the AUDIT-C screening tool introduced 60 out of 60 patients reported occurrences with alcohol usage (Miller et. al., 2018). Following the introduction of the AUDIT-C screening tool identification of 23 out of 60 students showed high-risk alcohol drinking behaviors, with males identified as higher risk than the female students (Miller et. al., 2019).

• Next, discuss the predictive ability of the test. For instance, how do you know the test is reliable and valid? What are the reliability and validity values? What are the predictive values? Is it sensitive to measure what it has been developed to measure, for instance, HIV, or depression in older adults, or Lyme disease? Would you integrate this tool into your advanced practice based on the information you have read about the test, why or why not?

I know that the test is reliable because it measures what it claims to measure consistently. The AUDIT-C screening tool claims to measure alcohol misuse and according to the Miller et. al. (2018) improvement project, alcohol misuse was identified for the college age group. Campbell et. al. (2018) claims that the AUDIT-C screening tool was implemented by the Veterans Health Administration as a brief screen for problematic alcohol usage amongst veterans presenting to primary care. The validity was primarily researched among the veterans and validated among large samples of non-veteran adults (Campbell et. al., 2018). Additionally, through a meta-analysis the 3 item AUDIT-C is as effective as the original 10-item AUDIT screening for at-risk drinking and alcohol use disorder (Campbell et.al., 2018).

When the AUDIT was originally developed it was a WHO collaboration project for screening hazardous and harmful alcohol use and problems in adults. The issue with this screening tool was that it included a full 10-item questionnaire that was too long to use in a clinical setting (Liskola et.al., 2018).

The predictive capacity of the AUDIT-C screening tool was tested using a model which included a depression screening and full AUDIT questionnaire with use of a diagnostic interview.

 In regard to the predictive ability of the AUDIT-C screening tool, outcomes remained positive even after the baseline alcohol problem was included in the model. Odd ratio (OR) was 6.59 in prediction of any alcohol problem use at one year. When age, sex, and depressive symptoms were included in the model, the OR was 7.54 (Liskola et. al., 2021).

I feel that using the AUDIT-C screening tool is successful in detecting alcohol misuse and is sensitive enough to detect misuse amongst college students and young adults. It is not as lengthy as the original AUDIT screening tool and can be done briefly in a clinical setting without using too much time. As an NP I would utilize this in my primary care clinic to identify alcohol misuse in my patients. Since this was originally used on older adults and veterans, it makes it versatile in usage and can be applied to all age groups for screening purposes. The research that I have found supports the notion that this screening tool will work in a primary care setting and is reliable enough to do what the test was designed to do.

Reference:

Campbell CE, Maisto SA. Validity of the AUDIT-C screen for at-risk drinking among students utilizing university primary care. J Am Coll Health. 2018 Nov-Dec;66(8):774-782. doi: 10.1080/07448481.2018.1453514. Epub 2018 May 22. PMID: 29565778; PMCID: PMC6151161.

Liskola J, Haravuori H, Lindberg N, Kiviruusu O, Niemelä S, Karlsson L, Marttunen M. The predictive capacity of AUDIT and AUDIT-C among adolescents in a one-year follow-up study. Drug Alcohol Depend. 2021 Jan 1;218:108424. doi: 10.1016/j.drugalcdep.2020.108424. Epub 2020 Nov 22. PMID: 33257195.

Miller, Brennan-Cook, J., Turner, B., Husband-Ardoin, M., & Hayes, C. S. (2018). Utilizing an Evidence-Based Alcohol Screening Tool for Identification of Alcohol Misuse. Journal of Addictions Nursing, 29(2), 90–95. https://doi.org/10.1097/JAN.0000000000000217

Purpose

This discussion board content is intended to facilitate learning for students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice.

The use of discussions provides students with opportunities to contribute graduate level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship.

Participation in the discussion generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. Discussions foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines

Course Outcomes

This assignment enables the student to meet the following course outcomes:

CO 4: Discriminate among various screening tools that may be used in the provision of care as an Advanced Practice Nurse.

Due Date

• Initial prompt due by Wednesday, 11:59 PM MT of week 2
• One peer and one faculty or two peer posts due by Sunday 11:59 PM MT of week 2

A 10% late penalty will be imposed for initial discussions posted after the weekly deadline regardless of the number of days late. No postings will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT.

Total Points Possible: 60 points

Preparing the Assignment

Assignment Requirements

1. Your course faculty will provide you with topics for the Week 2 Discussion Board. You will need to check the NR503 course Announcements for the topics for the Week 2 Discussion Board regarding screening. The week’s topics were choosen from the following website:  Agency for Healthcare Research and QualityLinks to an external site.
2. Reply to the following prompt:

• Describe the diagnostic or screening tool selected, its purpose, and what age group it targets.
• Has it been specifically tested in this age group?
• Next, discuss the predictive ability of the test. For instance, how do you know the test is reliable and valid? What are the reliability and validity values? What are the predictive values? Is it sensitive to measure what it has been developed to measure, for instance, HIV, or depression in older adults, or Lyme disease? Would you integrate this tool into your advanced practice based on the information you have read about the test, why or why not?

3. You should include a minimum of two (2) scholarly articles from the last five (5) years (3 is recommended).
4. Respond to a minimum of two (2) individuals, peer and/or faculty, with a scholarly and reflective post of a minimum of two (2) paragraphs of 4-5 sentences. A minimum of one (1) scholarly article should be utilized to support the post in addition to your textbook.
5. Your work should have in-text citations integrating at a minimum one scholarly article and the course textbook. APA format should be utilized to include a reference list. Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first – person use.

Need assistance? Click here for the Week 2 FAQ documentLinks to an external site.  that discusses these terms.

Posting Directions

1. Posts should be made on a minimum of 3 separate days/dates.
2. All faculty replies to students must be responded to directly in the discussion board.
3. Minimum posting is:

• Initial discussion board post to the weekly prompt, two peer posts (if there are no faculty postings), or one peer post and a faculty post.

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.

I found the Audit-C screening tool to be extremely helpful in ruling out alcohol misuse in primary care. College students are often overlooked when it comes to alcohol misuse because drinking is ignored as some sort of right of passage in college. What is not recognized is the link between alcohol use and stress amongst this age group. Savage et. al. (2022) conducted a research study of college students from diverse backgrounds to investigate predictors of four drinking motives (enhancement, social, coping, and conformity). Results showed that motives for drinking alcohol included genetic predisposition, stressful life events, and peer group alcohol uses. Savage et. al. (2022) attributed enhancement motives such as hanging out with drinking buddies or peer group drinking will become a norm in which early drinking motives develop. The use of 9889 students from 4 cohorts were enrolled in the study. Demographic characteristics of the sample included 61.5% female, 0.5% American Indian, 16.3% Asian, 18.9% African American, 49.4% Caucasian, 6.0% Hispanic/Latino, 6.2% multi-racial, 0.7% Native Hawaiian/Pacific Islander, and 1.9 % unknown (Savage et. al., 2022). The drinking motives questionnaire contained four subscales to create scores involving coping, enhancement, social, and conformity. Using the genome-wide association study (GWAS) Savage et. al. (2022) determined enhancement motives included 2 SNPS (single nucleotide polymorphism or DNA building block) found only in the EUR ancestry group, located on chromosome 3 in the fibulin 2 gene, which codes for an extracellular matrix protein involved in organ development and differentiation. After the completion of the study, it was found that besides genetic predisposition to drinking, people are motivated by drinking activities with friends, coping with stress, and some low associations with lifetime trauma. The findings by Savage et. al. (2022) granted some insight into drinking motives with alcohol misuse, identifying potential reasons for why college students engage in alcohol use. Limitations to the study included cost and time. I think the study is interesting because it helps to explain why college students engage in alcohol misuse.

References:

Savage, Peterson, R. E., Aliev, F., & Dick, D. M. (2022). Genetic and environmental etiology of drinking motives in college students. Alcoholism, Clinical and Experimental Research, 46(10), 1783–1796. https://doi.org/10.1111/acer.14930

The screening tool I chose to discuss is the alcohol misuse screening tool. According to the Substance Abuse and Mental Health Services Administration (SAMHSA, n.d.) the alcohol misuse screening tool was created by the World Health Organization that primary care providers, healthcare paraprofessionals, and individuals use to identify misuse and problematic use of alcohol. When misuse is indicated then providers are able to provide behavioral counseling interventions that promote health and healing from alcohol abuse. Excessive alcohol intake is a problem worldwide, but especially amongst the young adult population (Miller et al., 2018).  Characteristics of alcohol misuse are risky drinking behavior, or dangerous drinking habits. Binge drinking is prevalent among the college student and young adult age (Miller et al., 2018). This source also calculated that 1,825 deaths and 599,000 injuries have been caused by alcohol misuse among college students every year (Miller et al., 2018). 

There have been several screening tools that have been used to screen for alcohol misuse in this specific age range. The screening tools with finer details and more accuracy are the Alcohol Use Disorders Identification Tool (AUDIT), AUDIT Consumption (AUDIT-C) and the single-question screening tool (Miller et al., 2018). Many larger studies using AUDIT and AUDIT-C found accurate identification of alcohol misuse in primary care settings. Evidence-based screening and treatment for alcohol misuse in both primary care and student health clinics can be added to provider visits as a method to decrease the prevalence of misuse and current evidence shows that this leads to improved patient outcomes (Miller et al., 2018). 

Four studies were performed on the AUDIT-C screens. The studies explains how the process was managed, how the two screens differ from each other, and whether the screens were deemed well founded (Higgins-Biddle & Babor, 2018). It was reported that the AUDIT-C screen identified heavy drinkers more than the original AUDIT screen did. However, the full AUDIT screening tool more adequately identified patients with active alcohol abuse or reliance (Higgins-Biddle & Babor, 2018). I would integrate these tools into my practice. I would start with the Single Alcohol Screening Question (SASQ) as it can be eased into a conversation and based on how the question is answered, I could integrate the AUDIT or AUDIT-C to investigate further. The only limitations would be that these tools are only questionnaires and require 100% truthful answers. Some people may feel ashamed to answer truthfully, and as providers we have to trust our patients and believe them when they tell us they don’t partake in risky behaviors.

Higgins-Biddle, J. C., & Babor, T. F. (2018). A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: Past issues and future directions. The American journal of drug and alcohol abuse, 44(6), 578–586. https://doi.org/10.1080/00952990.2018.1456545Links to an external site. 

Miller, L.B., Brennan-Cook, J., Turner, B., Husband-Ardoin, M., & Hayes, C. S. (2018). Utilizing an Evidence-Based alcohol screening tool for identification of alcohol misuse. Journal of Addictions Nursing, 29(2), 90–95. https://doi.org/10.1097/JAN.0000000000000217Links to an external site. 

SAMHSA. (n.d.).  Use Disorders Identification Test (audit). https://www.samhsa.gov/resource/dbhis/alcohol-use-disorders-identification-test-audit#:~:text=Developed%20by%20the%20World%20Health,themselves%2C%20for%20problematic%20alcohol%20use

DISCUSSION CONTENT
Category	Points	%	Description
Scholarly	13	22%	The student actively stimulates and sustains inquiry by making reflective insightful comments, asking thoughtful questions and/or engaging in a scholarly discussion.The student expresses a clear idea of the topic under discussion and sustains inquiry in order to explore relevant issues.The student recognizes values or values conflict as things that form the assumption basis of arguments and recognizes when it is important to acknowledge these values.The student recognizes the accuracy, logic, relevance, or clarity of statements.The student asks clarifying questions and knows when clarifying questions need to be asked.The student distinguishes fact from opinion.
Application	20	33%	All components of discussion prompt addressed (met) in initial posting.The student’s writing conveys an understanding of significant ideas relevant to the issue under discussion. This is indicated by integration of course and weekly objectives, as well as readings from text and articles.All posts should make correct use of terminology, precise selection of the pieces of information required to make a point, correct and appropriate use of examples and counterexamples, demonstrations of which distinctions are important to make, and explanations that are concise and to the point.Information and knowledge are accurate.The student elaborates statements with accurate explanations, reasons, or evidence from the course and/or weekly objectives.All postings integrate scholarly sources to support points consistently.
Interactive Dialogue	10	16.6%	Responds to ideas in a way that advances discussion with engagement, depth, rigor, and application.Interacts with a professional tone and is able to express opinions with ownership and without judgement.Chooses to include professional experience to the discussion board mindful of appropriateness and boundaries. Experience is integrated as it supports the discussion board topic and utilizes scholarly references to support overall topic.
	43	72%	Total CONTENT Points = 43 pts
DISCUSSION FORMAT
Category	Points	%	Description
APA	12	20%	In text citations are formatted per APA 7th ed.Reference list is formatted per APA 7th ed.Spelling, grammar, and scholarly tone are per APA 7th ed.
Spelling / Grammar etc.	5	8%	Posts should utilize correct spelling and grammar (sentence structure and avoidance of slang or casual language).
	17	28%	Total FORMAT Points = 17 pts
	60	100%	DISCUSSION TOTAL = 60 points