Identifying Aboriginal-specific AUDIT-C and AUDIT-3 cutoff scores for at-risk, high-risk, and likely dependent drinkers using measures of agreement with the 10-item Alcohol Use Disorders Identification Test

Abstract

BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) is a 10-item alcohol screener that has been recommended for use in Aboriginal primary health care settings. The time it takes respondents to complete AUDIT, however, has proven to be a barrier to its routine delivery. Two shorter versions, AUDIT-C and AUDIT-3, have been used as screening instruments in primary health care. This paper aims to identify the AUDIT-C and AUDIT-3 cutoff scores that most closely identify individuals classified as being at-risk drinkers, high-risk drinkers, or likely alcohol dependent by the 10-item AUDIT.MethodsTwo cross-sectional surveys were conducted from June 2009 to May 2010 and from July 2010 to June 2011. Aboriginal Australian participants (N = 156) were recruited through an Aboriginal Community Controlled Health Service, and a community-based drug and alcohol treatment agency in rural New South Wales (NSW), and through community-based Aboriginal groups in Sydney NSW. Sensitivity, specificity, and positive and negative predictive values of each score on the AUDIT-C and AUDIT-3 were calculated, relative to cutoff scores on the 10-item AUDIT for at-risk, high-risk, and likely dependent drinkers. Receiver operating characteristic (ROC) curve analyses were conducted to measure the detection characteristics of AUDIT-C and AUDIT-3 for the three categories of risk.ResultsThe areas under the receiver operating characteristic (AUROC) curves were high for drinkers classified as being at-risk, high-risk, and likely dependent.ConclusionsRecommended cutoff scores for Aboriginal Australians are as follows: at-risk drinkers AUDIT-C ≥ 5, AUDIT-3 ≥ 1; high-risk drinkers AUDIT-C ≥ 6, AUDIT-3 ≥ 2; and likely dependent drinkers AUDIT-C ≥ 9, AUDIT-3 ≥ 3. Adequate sensitivity and specificity were achieved for recommended cutoff scores. AUROC curves were above 0.90.

The quality of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review

“…• SEWB (nine studies) 19,20,[25][26][27][28][29][30][31][32][33][34] • Alcohol misuse (five studies) 21,22,[35][36][37][38] • Smoking cessation (four studies) 23,24,[39][40][41] • Dual diagnosis -SEWB and drug or alcohol misuse (three studies) 17,18,42,43 • Depression 44,45 , depression or anxiety 46 , or a mental health worker program (four studies). 15,16 Nineteen studies were conducted in AMSs , six of which used mixed methods [17][18][19][20]30,31,37 and one of which was a quasiexperimental design.…”

“…34 Quantitative methods on their own were used in five studies. 21,22,27,28,33,36,45 One case study was included. 40 Participatory action research principles were used in combination with yarning techniques 41 , a social-ecological perspective 23,24 or as part of a mixed- Research teams: including primary health care staff, community members and researchers located outside the community methods study.…”

“…Multiple articles that reported findings relating to the same study (such as one evaluation 15,16 , one project [17][18][19][20] , one survey 21,22 , one interview/focus group session [23][24][25][26] , or one questionnaire 27,28 ) were considered as a single study, and all references were included. The included studies focused on:…”

“…In 12 studies, the risk of bias was judged to be high 19,20,27,28,30,[33][34][35]37,46 or unclear 21,22,36,40,45 , four were at moderate risk of bias 19,20,25,26,41,42,44 and five were at a low risk of bias. 23,24,29,31,39,43 AIMhi 1 was assessed using the qualitative 19 and randomised controlled trial 20 risk-of-bias tools, because these methods were reported separately.…”

“…25,31 Two primary outcomes were identified and met in three studies. [21][22][23][24][25][26] For example, one study assessed the acceptability of an alcohol-related intervention 21 and identified cut-off scores of an alcohol dependence screening tool for Indigenous clients. 22 Two of these articles reported on data that appear to have been collected at one time point.…”