Screening is the first step in identifying and treating alcohol-related problems among the senior population. This study was designed with two purposes. The first was to cross-validate the Senior Alcohol Misuse Indicator (SAMI) with two commonly used screening tools - the CAGE and the Shortened Michigan Alcoholism Screening Test – Geriatric version (SMAST-G). The second purpose was to examine the feasibility of using these tools within a front-line health care worker’s clinical protocol. The effectiveness of each screening tool was assessed by calculating the sensitivity, specificity, and the area under the receiver operating characteristic (AUROC) for each screening tool with a sample of seniors recruited from clinical and community sources (N=87). Participants were classified into different types of drinker with a structured clinical interview (i.e., the Structured Clinical Interview for the DSM-IV and a medical history, including medication list). Seven problem drinkers, 36 at-risk drinkers, 25 non-problem drinkers, and 19 non-drinkers were identified. Among the three screening tools, the SAMI had the highest sensitivity (83.72%) in identifying at-risk drinkers and problems drinkers and best overall performance with the greatest AUROC (0.710), whereas the SMAST-G had the highest specificity (95.45%) in ruling out an alcohol-related problem among participants classified as non-problem drinkers and non-drinkers. Six outreach mental health care workers tested each screening tool at least three times with their senior clientele and rated each tool on a number of characteristics. An ANOVA and post-hoc analyses using the Least Significant Difference (LSD) compared these ratings among the three screening tools. The SMAST-G and CAGE were cited as the easiest to score (p=0.002), while the SMAST-G was cited as the screening tool providing the most clinical information (p=0.047) and the most comprehensive (p=0.019) of the three tools. These results point to the overall effectiveness of the SAMI and the user-friendliness of the SMAST-G as appropriate screening tools for identifying alcohol-related problems among the senior population. Future studies may further examine these two screening tools among as-yet-untested clinical populations (i.e., geriatric mental health outreach patients, cognitively impaired, collateral informants) and how to improve screening tool usage among health care providers. / Thesis (Ph.D, Psychology) -- Queen's University, 2013-08-23 15:11:13.165

This study describes the reliability reporting practices in empirical studies using eight adolescent alcohol screening tools and characterizes and explores variability in internal consistency estimates across samples. Of 119 observed administrations of these instruments, 40 (34%) reported usable reliability information. The Personal Experience Screening QuestionnaireProblem Severity scale generated average reliability estimates exceeding 0.90 (95% CI=0.90-0.96) and the Adolescent Alcohol Involvement Scale generated average score reliability estimates below 0.80 (95% CI=0.67-0.85). Average reliability estimates of the remaining instruments were distributed between these extremes. Sample characteristics were identified as potentially important predictors of variability in the reliability estimates of all the instruments and all instruments under evaluation generated more reliable scores in clinical settings (M=0.89) as opposed to nonclinical settings (M=0.82; r effect size (38)=0.29, p.10). Clinicians facing instrument selection decisions can use these data to guide their choices and researchers evaluating the performance of these instruments can use these data to inform their future studies.

Meta-analytic methods provide a framework around which an inquiry into MAST and SMAST score reliability was completed. Of the 470 measurement opportunities observed between 1971 and 2005, 62 (13.2%) were coupled with accurate reliability information. Weighted reliability estimates centered on.80 suggesting that the MAST and SMAST generally produce scores of similar and adequate reliability for most research purposes. However, the variability of internal consistency estimates shows that at times these tools will not produce reliable scores, particularly among female and nonclinical respondents. Multiple regression equations provide practical guidelines to improve reliability estimates for the future use of these instruments.

Alcohol consumption during pregnancy remains a common occurrence and is associated with a multitude of adverse birth and long-term outcomes. Binge drinking in particular is shown to be particularly harmful to the developing fetus. Effects include full fetal alcohol syndrome, with characteristic facial dysmorphology, growth restriction, and developmental to delays. Exposed children may also have partial fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental disorders. These effects are preventable, and efforts must begin with accurate identification of women who consume alcohol during pregnancy. Several screening tools have been developed and validated for use in prenatal care settings, and the most recently proposed brief and easy to use T-ACER3 has demonstrated high sensitivity and specificity in both identifying risk drinking during pregnancy and predicting long-term neurobehavioral outcomes in exposed children. Once identified, effective interventions are available for use with pregnant women consuming alcohol. Brief interventions, which can be delivered by a health professional and involve motivational interviewing, have been demonstrated to significantly reduce alcohol consumption during pregnancy. These approaches, recommended by American College of Obstetricians and Gynecologist (ACOG), help move patients toward increased readiness to positively change their drinking behavior. Ultimately, all prenatal care providers should routinely screen all patients for alcohol use using validated tools, and where appropriate, should offer intervention.

Alcohol consumption during pregnancy remains a common occurrence and is associated with a multitude of adverse birth and long-term outcomes. Binge drinking in particular is shown to be particularly harmful to the developing fetus. Effects include full fetal alcohol syndrome, with characteristic facial dysmorphology, growth restriction, and developmental to delays. Exposed children may also have partial fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neurodevelopmental disorders. These effects are preventable, and efforts must begin with accurate identification of women who consume alcohol during pregnancy. Several screening tools have been developed and validated for use in prenatal care settings, and the most recently proposed brief and easy to use T-ACER3 has demonstrated high sensitivity and specificity in both identifying risk drinking during pregnancy and predicting long-term neurobehavioral outcomes in exposed children. Once identified, effective interventions are available for use with pregnant women consuming alcohol. Brief interventions, which can be delivered by a health professional and involve motivational interviewing, have been demonstrated to significantly reduce alcohol consumption during pregnancy. These approaches, recommended by American College of Obstetricians and Gynecologist (ACOG), help move patients toward increased readiness to positively change their drinking behavior. Ultimately, all prenatal care providers should routinely screen all patients for alcohol use using validated tools, and where appropriate, should offer intervention.

No description available.

Background: Prenatal alcohol consumption is one of the leading preventable causes of birth defects, including fetal alcohol syndrome and learning disabilities. Although there is strong evidence of the benefits of screening and alcohol brief interventions (ABIs) in reducing hazardous and harmful drinking among the primary care population, evidence of its effectiveness with the antenatal care population is limited. Nevertheless, the Scottish Government is incorporating an alcohol screening and ABI programme as part of the routine antenatal care provided to women in a bid to protect the health and safety of the unborn child and improve subsequent health and developmental outcomes. This research therefore seeks to increase understanding of the factors that are likely to influence the effectiveness of this recently implemented programme. It also aims to explore the extent to which contemporary issues such as change in guidelines regarding alcohol consumption during pregnancy influences perceptions and attitudes, and the possible implications of these on the screening and ABI delivery. Methods: The study described in this thesis employed a realistic evaluation methodology. Realistic evaluation is a theory-driven approach to investigating social programmes. It is concerned with hypothesising, testing and refining programme theories by exploring the interaction of contexts, mechanisms and outcomes. To identify the relevant screening and ABI programme theories, two separate systematic reviews, a critical review and four face-to-face interviews were undertaken with health policy implementers. The findings were used to construct context, mechanism and outcomes propositions. The propositions were then tested by conducting individual interviews with seventeen pregnant women and fifteen midwives, a further six midwifery team leaders were involved in a focus group discussion. A thematic approach using a hybrid of inductive and deductive coding and theme development informed the qualitative analysis. Results: In the context of uncertainties regarding the threshold of drinking that causes fetal harm, pregnant women reported that screening assessment helped them to reflect on their drinking behaviour and facilitate behaviour change. For women who drank at hazardous and harmful levels before attending the booking appointment, screening and ABI may be helpful in terms of eliciting behaviour change. However, they may not be very beneficial in terms of reducing harm to the fetus as it has been found that drinking during the first trimester poses the most risk to the fetus. Training and resources provided to midwives as part of the screening and ABI programme were found to be facilitating mechanisms that midwives indicated improved their skills and confidence. However, most of the midwives had not subsequently employed the motivational interviewing skills required for the ABI delivery, as many of the pregnant women reported that they reduced or abstained from alcohol consumption once pregnancy was confirmed. The outcome noted was that midwives confidence decreased leading to missed opportunities to appropriately deliver the ABI to eligible women. The small numbers of women being identified for ABI meant midwives rarely delivered the ABI. This negatively influenced midwives attitudes as they then accorded ABI low priority in their workload. Other disenabling mechanisms noted to be hampering the implementation of the screening and ABI initiative included midwives contending with competing priorities at the booking appointments, and the lack of adequate rapport between midwives and pregnant women at the booking appointment to discuss alcohol issues appropriately, leading to women providing socially desirable responses to screening questions. Conclusions: The findings of this study has generated greater explanations of the working of the screening and ABI programme in antenatal care setting and has provided transferable lessons that can be used by others intending to implement similar programmes in other settings.