Concurrent validity of an Estimator of Weekly Alcohol Consumption (EWAC) based on the Extended AUDIT
Concurrent validity of an Estimator of Weekly Alcohol Consumption (EWAC) based on the Extended AUDIT
Background and Aims: The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0–12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. Design: Cross-sectional diagnostic study based on a nationally-representative survey. Settings: Community dwelling households in England. Participants: A total of 22 404 household residents aged ≥16 years reporting drinking alcohol at least occasionally. Measurements: Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the ‘Extended AUDIT’) and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. Findings: EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was ±11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and ±2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). Conclusions: A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.
alcohol consumption, alcohol use disorder, diagnostic, preventative health services, screening programs, self report
Dutey-Magni, Peter
f2713e93-3179-4f7d-82cd-dcd415f1d06c
Brown, Jamie
64c8be68-e3cb-49ff-b5b0-525db5f4bcd0
Holmes, John
d1b329d3-fb42-42c2-b100-316be7ed0b73
Sinclair, Julia
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
14 October 2021
Dutey-Magni, Peter
f2713e93-3179-4f7d-82cd-dcd415f1d06c
Brown, Jamie
64c8be68-e3cb-49ff-b5b0-525db5f4bcd0
Holmes, John
d1b329d3-fb42-42c2-b100-316be7ed0b73
Sinclair, Julia
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Dutey-Magni, Peter, Brown, Jamie, Holmes, John and Sinclair, Julia
(2021)
Concurrent validity of an Estimator of Weekly Alcohol Consumption (EWAC) based on the Extended AUDIT.
Addiction.
(doi:10.1111/add.15662).
Abstract
Background and Aims: The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0–12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. Design: Cross-sectional diagnostic study based on a nationally-representative survey. Settings: Community dwelling households in England. Participants: A total of 22 404 household residents aged ≥16 years reporting drinking alcohol at least occasionally. Measurements: Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the ‘Extended AUDIT’) and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. Findings: EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was ±11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and ±2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). Conclusions: A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.
Text
EWAC manuscript_2021-07-25_v3
- Accepted Manuscript
More information
Accepted/In Press date: 28 July 2021
e-pub ahead of print date: 9 August 2021
Published date: 14 October 2021
Additional Information:
ACKNOWLEDGEMENTS
This research was supported by the Medical Research Council (grant reference MR/P016960/1). The Alcohol Toolkit Study data collection was funded primarily by the National Institute for Health Research (NIHR) School for Public Health Research (grant reference SPHR-SWP-ALC-WP5) and Public Health Research Programme (grant reference 15/63/01). The EWAC online calculator development was funded by the Wessex Academic Health Science Network. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Keywords:
alcohol consumption, alcohol use disorder, diagnostic, preventative health services, screening programs, self report
Identifiers
Local EPrints ID: 450697
URI: http://eprints.soton.ac.uk/id/eprint/450697
ISSN: 0965-2140
PURE UUID: d25755d9-12f7-4005-b8c9-a3b4daa9c396
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Date deposited: 06 Aug 2021 16:31
Last modified: 17 Mar 2024 06:44
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Author:
Peter Dutey-Magni
Author:
Jamie Brown
Author:
John Holmes
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