The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): cross-cultural psychometric evaluation across 42 countries

Lee, Chih-Ting, Lin, Chung-Ying, Koós, Mónika, Nagy, Léna, Kraus, Shane W., Demetrovics, Zsolt, Potenza, Marc N., Ballester-Arnal, Rafael, Batthyány, Dominik, Bergeron, Sophie, Billieux, Joël, Burkauskas, Julius, Cárdenas-López, Georgina, Carvalho, Joana, Castro-Calvo, Jesús, Chen, Lijun, Ciocca, Giacomo, Corazza, Ornella, Csako, Rita I., Fernandez, David P., Fernandez, Elaine F., Fujiwara, Hironobu, Fuss, Johannes, Gabrhelík, Roman, Gewirtz-Meydan, Ateret, Gjoneska, Biljana, Gola, Mateusz, Grubbs, Joshua B., Hashim, Hashim T., Jurin, Tanja, Kalina, Ondrej, Klein, Verena, Költő, András, Lee, Sang-Kyu, Lewczuk, Karol, Lochner, Christine, López-Alvarado, Silvia, Lukavská, Kateřina, Mayta-Tristán, Percy, Milea, Ionut, Miller, Dan J., Orosová, Olga, Orosz, Gábor, Ponce, Fernando P., Quintana, Gonzalo R., Quintero Garzola, Gabriel C., Ramos‐Diaz, Jano, Riggaud, Kévin, Rousseau, Ann, De Tubino Scanavino, Marco, Schulmeyer, Mario K., Sharan, Pratap, Shibata, Mami, Shoib, Sheikh, Sigre-Leirós, Vera, Sniewski, Luke, Spasovski, Ognen, Steibliene, Vesta, Stein, Dan J., Strizek, Julian, Ünsal, Berk C., Vaillancourt-Morel, Marie-Pier, Van Hout, Maire Claire and Bőthe, Beáta (2023) The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): cross-cultural psychometric evaluation across 42 countries. Journal of Psychiatric Research, 165, 16-27. (doi:10.1016/j.jpsychires.2023.06.033).

Abstract

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an instrument to screen substance-use-related health risks. However, little is known whether the ASSIST could be further shortened while remaining psychometrically sound across different countries, languages, gender identities, and sexual-orientation-based groups. The study aimed to validate a shortened 11-item ASSIST (ASSIST-11). Using the International Sex Survey data, 82,243 participants (M _age = 32.39 years) across 42 countries and 26 languages completed questions from the ASSIST-11 regarding gender identity, sexual orientation, and other information. Confirmatory factor analysis (CFA) and multigroup CFA (MGCFA) evaluated the ASSIST-11's structure and tested measurement invariance across groups. Cronbach's α and McDonald's ω were used to examine the internal consistency. Cohen's d and independent t-tests were used to examine known-group validity. The ASSIST-11 was unidimensional across countries, languages, age groups, gender identities (i.e., men, women, and gender-diverse individuals), and sexual orientations (i.e., heterosexual and sexual minority individuals). Cronbach's α was 0.63 and McDonald's ω was 0.68 for the ASSIST-11. Known-group validity was supported by Cohen's d (range between 0.23 and 0.40) with significant differences (p-values<0.001). The ASSIST-11 is a modified instrument with a unidimensional factor structure across different languages, age groups, countries, gender identities, and sexual orientations. The low internal consistency of the ASSIST-11 might be acceptable as it assesses a broad concept (i.e., use of several different substances). Healthcare providers and researchers may use the ASSIST-11 to quickly assess substance-use information from general populations and evaluate the need to follow up with more detailed questions about substance use.

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Contributors

Author: Verena Klein

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