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Yang YC, Al-Garadi MA, Love JS, Cooper HLF, Perrone J, Sarker A. Can accurate demographic information about people who use prescription medications nonmedically be derived from Twitter? Proc Natl Acad Sci U S A 2023; 120:e2207391120. [PMID: 36787355 DOI: 10.1073/pnas.2207391120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Traditional substance use (SU) surveillance methods, such as surveys, incur substantial lags. Due to the continuously evolving trends in SU, insights obtained via such methods are often outdated. Social media-based sources have been proposed for obtaining timely insights, but methods leveraging such data cannot typically provide fine-grained statistics about subpopulations, unlike traditional approaches. We address this gap by developing methods for automatically characterizing a large Twitter nonmedical prescription medication use (NPMU) cohort (n = 288,562) in terms of age-group, race, and gender. Our natural language processing and machine learning methods for automated cohort characterization achieved 0.88 precision (95% CI:0.84 to 0.92) for age-group, 0.90 (95% CI: 0.85 to 0.95) for race, and 94% accuracy (95% CI: 92 to 97) for gender, when evaluated against manually annotated gold-standard data. We compared automatically derived statistics for NPMU of tranquilizers, stimulants, and opioids from Twitter with statistics reported in the National Survey on Drug Use and Health (NSDUH) and the National Emergency Department Sample (NEDS). Distributions automatically estimated from Twitter were mostly consistent with the NSDUH [Spearman r: race: 0.98 (P < 0.005); age-group: 0.67 (P < 0.005); gender: 0.66 (P = 0.27)] and NEDS, with 34/65 (52.3%) of the Twitter-based estimates lying within 95% CIs of estimates from the traditional sources. Explainable differences (e.g., overrepresentation of younger people) were found for age-group-related statistics. Our study demonstrates that accurate subpopulation-specific estimates about SU, particularly NPMU, may be automatically derived from Twitter to obtain earlier insights about targeted subpopulations compared to traditional surveillance approaches.
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Shenoi RP, Linakis JG, Bromberg JR, Casper TC, Richards R, Chun TH, Gonzalez VM, Mello MJ, Spirito A. Association of Physical Activity, Sports, and Screen Time With Adolescent Behaviors in Youth Who Visit the Pediatric Emergency Department. Clin Pediatr (Phila) 2022; 61:335-346. [PMID: 35152770 DOI: 10.1177/00099228221075094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Moderate to vigorous physical activity (MVPA), sports, and reduced screen time are associated with favorable youth risk profiles. We evaluated the association of MVPA, sports, and screen time with adolescent behaviors among pediatric emergency department youth. Adolescents were assessed for alcohol/drug use, risky behavior, conduct disorder, and depressive mood. MVPA was activity for ≥5 days/week and ≥60 minutes/day. Increased screen time was ≥3 hours/day computer/TV use for non-schoolwork. Multivariable regression studied association between MVPA, sports, and increased screen time and outcomes adjusting for demographics and academic achievement. Older age and lower academic achievement were significantly associated with risky behaviors, conduct disorder, and depression. Youth who endorsed MVPA and sports participation had less depression (odds ratio [OR] = 0.76; confidence interval [CI] = 0.66-0.87). Increased screen time was associated with conduct disorder (OR = 1.6; CI = 1.3-2.1), depression (OR = 1.2; CI = 1.0-1.4), and drug use (OR = 1.8; CI = 1.1-2.8). In pediatric emergency department youth, MVPA and sports participation is associated with less depression. Increased screen time is associated with conduct disorders, depression, and drug use.
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Affiliation(s)
- Rohit P Shenoi
- Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - James G Linakis
- Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - Julie R Bromberg
- Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | | | | | - Thomas H Chun
- Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - Victor M Gonzalez
- Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Michael J Mello
- Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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Linakis JG, Thomas SA, Bromberg JR, Casper TC, Chun TH, Mello MJ, Richards R, Ahmad F, Bajaj L, Brown KM, Chernick LS, Cohen DM, Dean JM, Fein J, Horeczko T, Levas MN, McAninch B, Monuteaux MC, Mull CC, Grupp-Phelan J, Powell EC, Rogers A, Shenoi RP, Suffoletto B, Vance C, Spirito A. Adolescent alcohol use predicts cannabis use over a three year follow-up period. Subst Abus 2022; 43:514-519. [PMID: 34236277 PMCID: PMC8759759 DOI: 10.1080/08897077.2021.1949665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Alcohol and cannabis use frequently co-occur, which can result in problems from social and academic impairment to dependence (i.e., alcohol use disorder [AUD] and/or cannabis use disorder [CUD]). The Emergency Department (ED) is an excellent site to identify adolescents with alcohol misuse, conduct a brief intervention, and refer to treatment; however, given time constraints, alcohol use may be the only substance assessed due to its common role in unintentional injury. The current study, a secondary data analysis, assessed the relationship between adolescent alcohol and cannabis use by examining the National Institute of Alcohol Abuse and Alcoholism (NIAAA) two question screen's (2QS) ability to predict future CUD at one, two, and three years post-ED visit. Methods: At baseline, data was collected via tablet self-report surveys from medically and behaviorally stable adolescents 12-17 years old (n = 1,689) treated in 16 pediatric EDs for non-life-threatening injury, illness, or mental health condition. Follow-up surveys were completed via telephone or web-based survey. Logistic regression compared CUD diagnosis odds at one, two, or three-year follow-up between levels constituting a single-level change in baseline risk categorization on the NIAAA 2QS (nondrinker versus low-risk, low- versus moderate-risk, moderate- versus high-risk). Receiver operating characteristic curve methods examined the predictive ability of the baseline NIAAA 2QS cut points for CUD at one, two, or three-year follow-up. Results: Adolescents with low alcohol risk had significantly higher rates of CUD versus nondrinkers (OR range: 1.94-2.76, p < .0001). For low and moderate alcohol risk, there was no difference in CUD rates (OR range: 1.00-1.08). CUD rates were higher in adolescents with high alcohol risk versus moderate risk (OR range: 2.39-4.81, p < .05). Conclusions: Even low levels of baseline alcohol use are associated with risk for a later CUD. The NIAAA 2QS is an appropriate assessment measure to gauge risk for future cannabis use.
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Affiliation(s)
| | | | - Julie R. Bromberg
- The Warren Alpert Medical School of Brown University;,Rhode Island Hospital
| | | | - Thomas H. Chun
- The Warren Alpert Medical School of Brown University;,Rhode Island Hospital
| | - Michael J. Mello
- The Warren Alpert Medical School of Brown University;,Rhode Island Hospital
| | | | - Fahd Ahmad
- St. Louis Children’s Hospital/ Washington University
| | | | | | | | | | | | - Joel Fein
- The Children’s Hospital of Philadelphia
| | - Timothy Horeczko
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
| | | | - B McAninch
- University of Pittsburgh/ Children’s Hospital of Pittsburgh of UPMC
| | | | - Colette C. Mull
- Sidney Kimmel Medical College at Jefferson University/ Nemours Alfred I. duPont Hospital for Children
| | | | | | | | | | - Brian Suffoletto
- University of Pittsburgh/ Children’s Hospital of Pittsburgh of UPMC
| | | | - Anthony Spirito
- The Warren Alpert Medical School of Brown University;,Address correspondence to: Anthony Spirito, PhD, Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Box G-BH, Providence, RI 02912, United States,
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Ahmad FA, Payne PRO, Lackey I, Komeshak R, Kenney K, Magnusen B, Metts C, Bailey T. Using REDCap and Apple ResearchKit to integrate patient questionnaires and clinical decision support into the electronic health record to improve sexually transmitted infection testing in the emergency department. J Am Med Inform Assoc 2021; 27:265-273. [PMID: 31722414 DOI: 10.1093/jamia/ocz182] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/16/2019] [Accepted: 09/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Audio-enhanced computer-assisted self-interviews (ACASIs) are useful adjuncts for clinical care but are rarely integrated into the electronic health record (EHR). We created a flexible framework for integrating an ACASIs with clinical decision support (CDS) into the EHR. We used this program to identify adolescents at risk for sexually transmitted infections (STIs) in the emergency department (ED). We provide an overview of the software platform and qualitative user acceptance. MATERIALS AND METHODS We created an ACASI with a CDS algorithm to identify adolescents in need of STI testing. We offered it to 15- to 21-year-old patients in our ED, regardless of ED complaint. We collected user feedback via the ACASI. These were programmed into REDCap (Research Electronic Data Capture), and an iOS application utilizing Apple ResearchKit generated a tablet compatible representation of the ACASI for patients. A custom software program created an HL7 (Health Level Seven) message containing a summary of responses, CDS recommendations, and STI test orders, which were transmitted to the EHR. RESULTS In the first year, 1788 of 6227 (28.7%) eligible adolescents completed the survey. Technical issues led to decreased use for several months. Patients rated the system favorably, with 1583 of 1787 (88.9%) indicating that they were "somewhat" or "very comfortable" answering questions electronically and 1291 of 1787 (72.2%) preferring this format over face-to-face interviews or paper questionnaires. CONCLUSIONS We present a novel use for REDCap to combine patient-answered questionnaires and CDS to improve care for adolescents at risk for STIs. Our program was well received and the platform can be used across disparate patients, topics, and information technology infrastructures.
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Affiliation(s)
- Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.,Department of Medicine, Washington School of Medicine University in St. Louis, St. Louis, Missouri, USA
| | - Ian Lackey
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Rachel Komeshak
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kenneth Kenney
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Brianna Magnusen
- Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christopher Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas Bailey
- Department of Medicine, Washington School of Medicine University in St. Louis, St. Louis, Missouri, USA
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Chernick LS, Chun TH, Richards R, Bromberg JR, Ahmad FA, McAninch B, Mull C, Shenoi R, Suffoletto B, Casper C, Linakis J, Spirito A. Sex Without Contraceptives in a Multicenter Study of Adolescent Emergency Department Patients. Acad Emerg Med 2020; 27:283-290. [PMID: 31596987 DOI: 10.1111/acem.13867] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/15/2019] [Accepted: 10/06/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In the United States, rates of teenage pregnancy and sexually transmitted infections (STIs) remain exceptionally high, and racial and ethnic disparities persist. Emergency departments (EDs) care for over 19 million adolescents each year, the majority being minority and low socioeconomic status. Single-center studies demonstrate infrequent use of contraceptives among adolescent ED patients and an association between risky sex and behaviors such as alcohol and drug use; however, no multicenter ED data exist. The objectives of this study were to 1) determine the prevalence of sex without contraceptives in a large multicenter adolescent ED study and 2) assess patient demographic and risky behaviors associated with sex without contraceptives. METHODS Participants aged 14 to 17 years (n = 3,247) in 16 pediatric EDs across the United States completed an electronic survey. Questions focused on validated measures of risky sex; use of alcohol, tobacco, marijuana, and other drugs; and depression and violence. In this secondary analysis, we constructed univariable and multivariable models to identify demographic and behavioral factors associated with sex without contraceptives (our primary outcome), separately for adolescent males and females. RESULTS In the prior year, 17.4% (236/1,356) of males and 15.8% (299/1,891) of females had sex without contraceptives. In the multivariable model, sex without contraceptives for both genders was more likely among teens who were black, with conduct problems and participated in casual sex, binge drinking, or cannabis use. Sex without contraceptives was also more likely among Hispanic and cigarette-smoking males, as well as depressed females. CONCLUSIONS Adolescent ED patients across the United States are participating in risky sexual behaviors that increase their likelihood of pregnancy and STI acquisition. These adolescents report a number of problem behaviors, including substance use, which are strongly correlated with unprotected sex. The ED visit may be an opportunity to identify at-risk adolescent patients, address risky behaviors, and intervene to improve adolescent health.
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Affiliation(s)
- Lauren S. Chernick
- Division of Pediatric Emergency Medicine Department of Emergency Medicine Columbia University Medical Center New York NY
| | - Thomas H. Chun
- Department of Pediatrics and Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Rachel Richards
- Division of Pediatric Critical Care Department of Pediatrics University of Utah Health Sciences Center Salt Lake City UT
| | - Julie R. Bromberg
- Department of Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Fahd A. Ahmad
- Department of Pediatrics Washington University School of Medicine St. Louis MO
| | - Brett McAninch
- Division of Pediatric Emergency Medicine Department of Pediatrics University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh PittsburghPA
| | - Colette Mull
- Division of Pediatric Emergency Medicine Department of Pediatrics Nemours/Alfred I. duPont Hospital for Children Wilmington DE
| | - Rohit Shenoi
- Section of Emergency Medicine Department of Pediatrics Baylor College of Medicine Houston TX
| | - Brian Suffoletto
- Department of Emergency Medicine University of Pittsburgh Pittsburgh PA
| | - Charlie Casper
- Division of Pediatric Critical Care Department of Pediatrics University of Utah Health Sciences Center Salt Lake City UT
| | - James Linakis
- Department of Pediatrics and Emergency Medicine The Warren Alpert Medical School of Brown UniversityRhode Island Hospital ProvidenceRI
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior Alpert Medical School of Brown University Providence RI
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6
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Shenoi RP, Linakis JG, Bromberg JR, Casper TC, Richards R, Mello MJ, Chun TH, Spirito A. Predictive Validity of the CRAFFT for Substance Use Disorder. Pediatrics 2019; 144:e20183415. [PMID: 31341007 PMCID: PMC6855834 DOI: 10.1542/peds.2018-3415] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The utility of CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) in identifying current and future problematic substance use and substance use disorders (SUDs) in pediatric emergency department (PED) patients is unknown. We conducted a secondary analysis of a study in 16 PEDs to determine the concurrent and predictive validity of CRAFFT with respect to SUD. METHODS At baseline, 4753 participants aged 12 to 17 years completed an assessment battery (CRAFFT and other measures of alcohol, drug use, and risk behaviors). A subsample was readministered the battery at 1-, 2-, and 3-year follow-up to investigate future SUDs. RESULTS Of 2175 participants assigned to follow-up, 1493 (68.6%) completed 1-year, 1451 (66.7%) completed 2-year, and 1265 (58.1%) completed the 3-year follow-up. A baseline CRAFFT value of ≥2 was significantly associated with problematic substance use or mild or moderate to severe SUD diagnosis on the Diagnostic Interview Schedule for Children at baseline (P < .001). The results persisted after 1, 2, and 3 years (P < .001). The best combined sensitivity and specificity was achieved with a baseline CRAFFT value of ≥1 as a cutoff for predicting problematic substance use and a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of mild SUD at 1, 2, and 3 years. The baseline CRAFFT score that best predicted a moderate to severe SUD at 1 year was ≥2; but at 2 and 3 years, the cutoff score was ≥1. CONCLUSIONS CRAFFT has good concurrent validity for problematic substance use and SUD in PED patients and is useful in predicting SUDs at up to 3 years follow-up but with limited sensitivity.
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Affiliation(s)
- Rohit P Shenoi
- Department of Pediatrics, Baylor College of Medicine and Department of Emergency Medicine, Texas Children's Hospital, Houston, Texas;
| | - James G Linakis
- Emergency Medicine and
- Pediatrics, The Warren Alpert Medical School, Brown University, Providence, Rhode Island; Departments of
- Emergency Medicine and
| | | | | | | | | | - Thomas H Chun
- Emergency Medicine and
- Pediatrics, The Warren Alpert Medical School, Brown University, Providence, Rhode Island; Departments of
- Pediatric Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and
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Linakis JG, Bromberg JR, Casper TC, Chun T, Mello MJ, Ingebretsen H, Spirito A. Reliability and Validity of the Newton Screen for Alcohol and Cannabis Misuse in a Pediatric Emergency Department Sample. J Pediatr 2019; 210:154-160.e1. [PMID: 30967250 PMCID: PMC6592736 DOI: 10.1016/j.jpeds.2019.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine the test-retest reliability, concurrent, convergent, and discriminant validity of a recently devised screen (the Newton screen) for alcohol and cannabis use/misuse, and its predictive validity at follow-up. STUDY DESIGN Adolescents, 12-17 years old (n = 4898), treated in 1 of 16 participating pediatric emergency departments across the US were enrolled in a study as part of a larger study within the Pediatric Emergency Care Applied Research Network. Concurrent and predictive validity (at 1, 2, and 3 years of follow-up) were assessed in a random subsample with a structured Diagnostic and Statistical Manual of Mental Disorders-based interview. Convergent validity was assessed with the Alcohol Use Disorders Identification, a widely used alcohol screening measure. RESULTS The sensitivity of the Newton screen for alcohol use disorder at baseline was 78.3% with a specificity of 93.0%. The cannabis use question had a baseline sensitivity of 93.1% and specificity of 93.5% for cannabis use disorder. Predictive validity analyses at 1, 2, and 3 years revealed high specificity but low sensitivity for alcohol and high specificity and moderate sensitivity for cannabis. CONCLUSIONS The Newton screening instrument may be an appropriate brief screening tool for use in the busy clinical environment. Specificity was high for both alcohol and cannabis, but sensitivity was higher for cannabis than alcohol. Like other brief screens, more detailed follow-up questions may be necessary to definitively assess substance misuse risk and the need for referral to treatment.
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Affiliation(s)
- James G. Linakis
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | - Julie R. Bromberg
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | | | - Thomas Chun
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | - Michael J. Mello
- The Warren Alpert Medical School of Brown University, Providence, RI,Rhode Island Hospital, Providence, RI
| | | | - Anthony Spirito
- The Warren Alpert Medical School of Brown University, Providence, RI
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Linakis JG, Bromberg JR, Casper TC, Chun TH, Mello MJ, Richards R, Mull CC, Shenoi RP, Vance C, Ahmad F, Bajaj L, Brown KM, Chernick LS, Cohen DM, Fein J, Horeczko T, Levas MN, McAninch B, Monuteaux MC, Grupp-Phelan J, Powell EC, Rogers A, Suffoletto B, Dean JM, Spirito A. Predictive Validity of a 2-Question Alcohol Screen at 1-, 2-, and 3-Year Follow-up. Pediatrics 2019; 143:e20182001. [PMID: 30783022 PMCID: PMC6398369 DOI: 10.1542/peds.2018-2001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2-question screen is a valid adolescent alcohol screening tool. No studies have examined if this tool predicts future alcohol problems. We conducted a study at 16 pediatric emergency departments to determine the tool's predictive validity for alcohol misuse and alcohol use disorders (AUDs). METHODS Participants (N = 4834) completed a baseline assessment battery. A subsample of participants completed the battery at 1, 2, and 3 years follow up. RESULTS Of the 2209 participants assigned to follow-up, 1611 (73%) completed a 1-year follow-up, 1591 (72%) completed a 2-year follow-up, and 1377 (62%) completed a 3-year follow-up. The differences in AUDs between baseline NIAAA screen nondrinkers and lower-risk drinkers were statistically significant at 1 year (P = .0002), 2 years (P <.0001), and 3 years (P = .0005), as were the differences between moderate- and highest-risk drinkers at 1 and 2 years (P < .0001 and P = .0088, respectively) but not at 3 years (P = .0758). The best combined score for sensitivity (86.2% at 1 year, 75.6% at 2 years, and 60.0% at 3 years) and specificity (78.1% at 1 year, 79.2% at 2 years, and 80.0% at 3 years) was achieved by using "lower risk" and higher as a cutoff for the prediction of a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis. CONCLUSIONS The NIAAA 2-question screen can accurately characterize adolescent risk for future AUDs. Future studies are needed to determine optimaluse of the screen.
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Affiliation(s)
- James G. Linakis
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Julie R. Bromberg
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | | | - Thomas H. Chun
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Michael J. Mello
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | | | - Colette C. Mull
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rohit P. Shenoi
- Texas Children’s Hospital and College of Medicine, Baylor University, Houston, Texas
| | - Cheryl Vance
- University of California, Davis, Davis, California
| | - Fahd Ahmad
- St Louis Children’s Hospital and School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Lalit Bajaj
- Children’s Hospital Colorado, Aurora, Colorado
| | - Kathleen M. Brown
- Children’s National Medical Center, Washington, District of Columbia
| | | | | | - Joel Fein
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Brett McAninch
- University of Pittsburg Medical Center Children’s Hospital of Pittsburgh and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Elizabeth C. Powell
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | | | - Brian Suffoletto
- University of Pittsburg Medical Center Children’s Hospital of Pittsburgh and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Anthony Spirito
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - for the Pediatric Emergency Care Applied Research Network
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
- University of Utah, Salt Lake City, Utah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Texas Children’s Hospital and College of Medicine, Baylor University, Houston, Texas
- University of California, Davis, Davis, California
- St Louis Children’s Hospital and School of Medicine, Washington University in St Louis, St Louis, Missouri
- Children’s Hospital Colorado, Aurora, Colorado
- Children’s National Medical Center, Washington, District of Columbia
- Columbia University Irving Medical Center, New York City, New York
- Nationwide Children’s Hospital, Columbus, Ohio
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Los Angeles Biomedical Research Institute, Torrance, California
- Medical College of Wisconsin, Milwaukee, Wisconsin
- University of Pittsburg Medical Center Children’s Hospital of Pittsburgh and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Boston Children’s Hospital, Boston, Massachusetts
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
- University of Michigan, Ann Arbor, Michigan
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9
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Spirito A, Bromberg JR, Casper TC, Chun T, Mello MJ, Mull CC, Shenoi RP, Vance C, Ahmad F, Bajaj L, Brown KM, Chernick LS, Cohen DM, Fein J, Horeczko T, Levas MN, McAninch B, Monuteaux MC, Grupp-Phelan J, Powell EC, Rogers A, Suffoletto B, Linakis JG. Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis, Tobacco, and Other Drug Use? Subst Use Misuse 2019; 54:1007-1016. [PMID: 30727811 PMCID: PMC6476662 DOI: 10.1080/10826084.2018.1558251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. OBJECTIVE A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs. METHODS Participants included 12-17-year olds (n = 4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer. RESULTS A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.
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Affiliation(s)
- Anthony Spirito
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA
| | - Julie R Bromberg
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA.,b Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island, USA
| | - T Charles Casper
- c University of Utah, Department of Pediatrics, Salt Lake City, Utah, USA
| | - Thomas Chun
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA.,b Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island, USA
| | - Michael J Mello
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA.,b Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island, USA
| | - Colette C Mull
- d Nemours/Alfred I. duPont Hospital for Children, Department of Pediatrics, Wilmington, Delaware, USA
| | - Rohit P Shenoi
- e Baylor College of Medicine/Texas Children's Hospital, Departments of Emergency Medicine and Pediatrics, Houston, Texas, USA
| | - Cheryl Vance
- f University of California , Davis, Department of Pediatrics, Davis , California, USA
| | - Fahd Ahmad
- g St. Louis Children's Hospital/Washington University, Department of Emergency Medicine, St. Louis, Washington, USA
| | - Lalit Bajaj
- h Children's Hospital - Colorado, Departments of Pediatric Emergency Medicine and Pediatrics, Aurora, Colorado, USA
| | - Kathleen M Brown
- i Children's National Medical Center, Department of Emergency Medicine and Trauma Services, Washington, DC, USA
| | - Lauren S Chernick
- j Columbia University Medical Center, Department of Pediatric Emergency Medicine, New York, New York, USA
| | - Daniel M Cohen
- k Nationwide Children's Hospital, Departments of Pediatrics and Emergency Medicine, Columbus, Ohio, USA
| | - Joel Fein
- l The Children's Hospital of Philadelphia, Departments of Pediatrics and Emergency Medicine, Philadelphia, Pennsylvania, USA
| | - Timothy Horeczko
- m Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Department of Emergency and Pediatric Emergency Medicine, Los Angeles, California, USA
| | - Michael N Levas
- n Medical College of Wisconsin, Department of Pediatric Emergency Medicine, Milwaukee, Wisconsin, USA
| | - B McAninch
- o University of Pittsburgh/Children's Hospital of Pittsburgh of UPMC, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael C Monuteaux
- p Boston Children's Hospital, Department of Pediatrics, Boston, Massachusetts, USA
| | - Jackie Grupp-Phelan
- q University of California , San Francisco, Department of Pediatric Emergency Medicine, San Francisco , California, USA
| | - Elizabeth C Powell
- r Lurie Children's Hospital of Chicago, Department of Pediatric Emergency Medicine, Chicago, Illinois, USA
| | - Alexander Rogers
- s University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan, USA
| | - Brian Suffoletto
- o University of Pittsburgh/Children's Hospital of Pittsburgh of UPMC, Division of Pediatric Emergency Medicine, Pittsburgh, Pennsylvania, USA
| | - James G Linakis
- a The Warren Alpert Medical School of Brown University, Departments of Psychiatry and Human Behavior, Pediatrics, Emergency Medicine, Providence, Rhode Island, USA.,b Rhode Island Hospital, Department of Emergency Medicine, Providence, Rhode Island, USA
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Ranney ML, Bromberg J, Hozey A, Casper TC, Mello MJ, Spirito A, Chun TH, Linakis JG; Pediatric Emergency Care Applied Research Network. Problem Behaviors and Psychological Distress Among Teens Seen in a National Sample of Emergency Departments. Acad Pediatr 2018; 18:650-4. [PMID: 29505897 DOI: 10.1016/j.acap.2018.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/19/2018] [Accepted: 02/24/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Problem behaviors, such as substance use and peer aggression, frequently coexist and are common among youth seen in emergency departments (EDs). EDs are increasingly urged to screen for both psychological distress and problem behaviors. OBJECTIVE To inform screening and intervention efforts, we aimed to identify classes of problematic substance use and peer aggression in a sample of adolescents from 16 pediatric EDs, and to examine the relative prevalence of psychological distress in identified classes. METHODS We completed a cross-sectional survey of youth (n = 5001) presenting for any reason to 16 pediatric EDs across the United States, with the use of validated measures of demographics, alcohol and substance use, and peer aggression. We used standard latent class analysis techniques to create behavioral risk classes of adolescents based on violence and substance use variables; then we conducted logistic regression to examine the relationship between psychological distress and the latent classes. RESULTS Three classes of problem behaviors were identified: low-risk (few problem behaviors, 91.2% of sample), medium risk (high cigarette smoking; moderate violence, alcohol/substance use; 5.2%), and high risk (high levels of all problem behaviors, 3.5%). A significant directional association (P < .001) between worse psychological distress and higher-risk behavior classes was noted, even after adjusting for demographics. CONCLUSIONS Youth seen in the ED for any reason who report higher levels of past-year substance use and peer aggression are significantly more likely to report negative mood symptoms. Targeted screening and interventions for this population may be indicated.
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