Detection Of Alcohol Use Research Articles

Are we doing enough to detect alcohol use disorder? The case for accessible AST testing in Canada

Are we doing enough to detect alcohol use disorder? The case for accessible AST testing in Canada

Non-Invasive Alcohol Concentration Measurement Using a Spectroscopic Module: Outlook for the Development of a Drunk Driving Prevention System.

Alcohol acts as a central nervous system depressant and falls under the category of psychoactive drugs. It has the potential to impair vital bodily functions, including cognitive alertness, muscle coordination, and induce fatigue. Taking the wheel after consuming alcohol can lead to delayed responses in emergency situations and increases the likelihood of collisions with obstacles or suddenly appearing objects. Statistically, drivers under the influence of alcohol are seven times more likely to cause accidents compared to sober individuals. Various techniques and methods for alcohol measurement have been developed. The widely used breathalyzer, which requires direct contact with the mouth, raises concerns about hygiene. Methods like chromatography require skilled examiners, while semiconductor sensors exhibit instability in sensitivity over measurement time and has a short lifespan, posing structural challenges. Non-dispersive infrared analyzers face structural limitations, and in-vehicle air detection methods are susceptible to external influences, necessitating periodic calibration. Despite existing research and technologies, there remain several limitations, including sensitivity to external factors such as temperature, humidity, hygiene consideration, and the requirement for periodic calibration. Hence, there is a demand for a novel technology that can address these shortcomings. This study delved into the near-infrared wavelength range to investigate optimal wavelengths for non-invasively measuring blood alcohol concentration. Furthermore, we conducted an analysis of the optical characteristics of biological substances, integrated these data into a mathematical model, and demonstrated that alcohol concentration can be accurately sensed using the first-order modeling equation at the optimal wavelength. The goal is to minimize user infection and hygiene issues through a non-destructive and non-invasive method, while applying a compact spectrometer sensor suitable for button-type ignition devices in vehicles. Anticipated applications of this study encompass diverse industrial sectors, including the development of non-invasive ignition button-based alcohol prevention systems, surgeon's alcohol consumption status in the operating room, screening heavy equipment operators for alcohol use, and detecting alcohol use in close proximity to hazardous machinery within factories.

The role of general practitioners in Reunion in detecting alcohol use in pregnant women and identifying fetal alcohol spectrum disorder: a qualitative study

BackgroundFetal Alcohol Spectrum Disorder (FASD) is the leading cause of non-genetic intellectual disability and social maladjustment in children. International guidelines recommend abstinence from alcohol during pregnancy. Réunion is the most affected of all French regions with an estimated Fetal Alcohol Spectrum (FAS) prevalence of 1.2‰ births. General practitioners (GPs) are at the forefront of identifying patients with FASD. Objective: To understand how GPs identify FASD.MethodsQualitative study using a grounded theory approach, through semi-structured face-to-face interviews with GPs. Interviews were conducted with the aim of reaching theoretical saturation. These were transcribed verbatim and then analyzed by four researchers to ensure triangulation of the data.ResultsGPs reported barriers to the identification of FASD: challenges in overcoming social taboos and paradoxical injunctions, the influence of limited knowledge and experience, non-specific and highly variable symptoms, ambiguous classification and method of diagnosis involving the mobilization of a multidisciplinary team and lengthy consultations. Conversely, they felt competent to identify neurodevelopmental disorders of any cause, but were concerned about the long waiting time to access specialized care. From the perspective of GPs, it is crucial to prioritize promotion and training aimed at improving the identification and coordination of care pathways for children diagnosed with neurodevelopmental disorders, such as FASD.

Clinical Utility and Impact of Phosphatidylethanol Testing in Liver Transplantation Evaluations

BackgroundPhosphatidylethanol (PEth) is a serum biomarker that can detect alcohol use within the last 28 days with excellent sensitivity and specificity. Urinary ethyl glucuronide (uEtG) is commonly used in transplant settings to screen for alcohol use; however, it has several limitations relevant to liver transplantation. Transplant centers are beginning to regularly utilize PEth as part of the screening process for high-risk liver transplantation candidates, though the clinical utility of uniform pre-transplant PEth testing is unclear. MethodsThis was a retrospective chart review of all patients evaluated for liver transplantation from December 1, 2019, through May 31, 2022 at a large academic tertiary referral center utilizing uniform serum PEth and uEtG screening. Information regarding the patients’ transplantation status, age, sex, race, MELD Score, and PEth levels were obtained. In those with a positive PEth, we examined if the result would have been detected with uEtG, identified a discrepancy from the documented patient report of last use, led to a change in Psychosocial Assessment of Candidate for Transplantation (PACT) score, or influenced the transplant selection committee’s decision. ResultsOur sample included 865 individuals (mean age=55.20, 61.27% male and 82.54% white) with calculated MELDNa scores ranged from 6.43-50.65 (Mean 18.09; Median: 16.46). Forty-eight patients were found to have a positive PEth (PEth range 20-1833); 75% of the sample had Alcohol-associated Liver Disease (ALD). In 23/48 (47.91%) of cases, the positive PEth identified alcohol use missed by a concomitant uEtG screen. A positive PEth test identified a discrepancy from patients’ self-report in 29 (60.42%) cases and influenced the selection committee’s decision in 28 cases (58.33%). ConclusionUniform pre-transplant PEth screening of liver transplant candidates at the time of initial evaluation identified alcohol use that would have been missed by uEtG testing, identified discrepancies from the patient’s self-report, and influenced clinical decision making in a significant number of cases. These findings support the use of uniform PEth screening in Liver Transplantation Evaluations.

Management of alcohol use disorder in patients with chronic liver disease.

Alcohol use disorder (AUD) rates have risen dramatically in the United States, resulting in increasing rates of alcohol-associated liver disease (ALD), but many patients struggle to access alcohol use treatment. AUD treatment improves outcomes, including mortality, and represents the most urgent means by which care can be improved for those with liver disease (including ALD and others) and AUD. AUD care for those with liver disease involves 3 steps: detecting alcohol use, diagnosing AUD, and directing patients to alcohol treatment. Detecting alcohol use can involve questioning during the clinical interview, the use of standardized alcohol use surveys, and alcohol biomarkers. Identifying and diagnosing AUD are interview-based processes that should ideally be performed by a trained addiction professional, but nonaddiction clinicians can use surveys to determine the severity of hazardous drinking. Referral to formal AUD treatment should be made, especially where more severe AUD is suspected or identified. Therapeutic modalities are numerous and include different forms of one-on-one psychotherapy, such as motivational enhancement therapy or cognitive behavior therapy, group therapy, community mutual aid societies (such as Alcoholics Anonymous), inpatient addiction treatment, and relapse prevention medications. Finally, integrated care approaches that build strong relationships between addiction professionals and hepatologists or medical providers caring for those with liver disease are crucial to improving care for this population.

Detection of alcohol use: Guidance of direct biomarker phosphatidylethanol

Acknowledging the fact that alcohol is an important source of fatalities in traffic, the amount of alcohol consumed and the exact time of the consumption could enlighten forensic cases and guide the justice system correctly. However, determining the alcohol use is a difficult problem due to alcohol metabolism in individuals and parameters such as sex, age, amount of alcohol in the drink, satiety, should be taken into account which can be challenging for amount of alcohol interpretation. Considering that blood alcohol concentration (BAC) may not be reliable, alternative metabolic products of alcohol has arisen after alcohol consumption. One of the most interesting alcohol biomarker phosphatidylethanol (PEth) has caught attention due to its long half-life and not being affected from sex, liver diseases or age in addition to that it is only synthesized under the presence of ethanol. PEth is synthesized in cell-membranes and not being a single molecule, its homologues should be considered when determining the amount of alcohol intake. Although the homologues of PEth could be isolated from whole blood, less invasive dried blood spots (DBS) also provides reliable information. The analysis of PEth is performed in LC-MS/MS which is highly sensitive and specific. For forensic applications, direct alcohol biomarker PEth may be useful for distinguishing the alcohol use and helpful for justice system. This review focuses on studies about PEth biomarker, its applications and limitations conducted from 2010 to 2019.

Development and Validation of Seven Phosphatidylethanol Homologues in Dried Blood Spots Including Preliminary Results after Excessive Use of an Ethanol-Based Hand Sanitizer.

Phosphatidylethanol (PEth) has become a widespread marker offering an up to 4-week retrospective window to detect alcohol use. Due to the pandemic of coronavirus disease 2019, ethanol-based hand sanitizers are frequently used. The aim of this study was to develop and validate a method for the determination of up to seven different homologues of PEth from dried blood spots (DBSs) after use of an ethanol-based hand sanitizer. The objectives of its preliminary application were to prove whether a threshold of 20 ng/mL for PEth 16:0/18:1 is reached and whether other homologues are formed as well as if positive findings of urinary ethyl glucuronide (UEtG) can be observed with respect to assess monitoring of abstinence control programs. Ten volunteers (8 occasional and 2 regular drinkers) were recruited to excessively use an ethanol-based hand sanitizer on 5 successive days. DBSs and urine samples were collected daily. PEth and UEtG were determined by liquid chromatography--tandem mass spectrometry. In total, two volunteers with initial PEth 16:0/18:1 concentrations of 19.3 and 14.6 ng/mL exceeded the threshold of 20 ng/mL six times. Subjects drinking daily or almost daily had starting PEth 16:0/18:1 concentrations of 242 and 354 ng/mL, showing a decline of PEth concentrations in six out of the seven homologues over 5 days. In teetotalers, formation of PEth species could not be observed. Thus, not satisfying requirements in an alcohol monitoring program with initial PEth-negative blood cannot be explained by a frequent use of ethanol-based hand sanitizer only. In cases of regular alcohol consumption, PEth homologues are not likely to be further influenced. However, results indicated that individuals with a PEth concentration close to 20 ng/mL are at risk of exceeding the threshold by using ethanol-based hand sanitizer.

Availability of PEth testing is associated with reduced eligibility for liver transplant among patients with alcohol‐related liver disease

Serum phosphatidylethanol (PEth) is a highly sensitive test to detect alcohol use. We evaluated whether the availability of PEth testing impacted rates of liver transplant evaluation terminations and delistings. Medical record data were collected for patients who initiated transplant evaluation due to alcohol-related liver disease in the pre-PEth (2017) or PEth (2019) eras. Inverse probability weighting (IPW) was used to balance baseline patient characteristics. Outcomes included termination of evaluation or delisting due to alcohol use; patients were censored at receipt of transplant; death was considered a competing risk. The Fine-Gray method was performed to determine whether PEth testing affected risk of evaluation termination/ delisting due to alcohol use. Three hundred and seventy-five patients with alcohol-related indications for transplant (157 in 2017; 210 in 2019) were included. The final IPW-adjusted model for the composite outcome of terminations/delisting due to alcohol use retained two significant variables (P<.05): PEth era and BMI category. Patients evaluated during the PEth era were almost three times more likely to experience an alcohol-related termination/delisting than those in the pre-PEth era (sHR=2.86; 95%CI 1.67-4.97) CONCLUSION: We found that availability of PEth testing at our institution was associated with a higher rate of exclusion of patients from eligibility for liver transplant. Use of PEth testing has significant potential to inform decisions regarding transplant candidacy for patients with alcohol-related liver disease.

Psychometric properties of Alcohol Use Disorder Identification Test screening tool among medical outpatients in Dilla University Referral Hospital, southern Ethiopia, 2020.

Objective:A quick, efficient, and flexible screening tool is essential for identifying alcohol use disorder in a busy clinical context. The Alcohol Use Disorders Identification Test is the most widely used and validated screening tool in the outpatient context. The psychometric features of the Alcohol Use Disorders Identification Test have yet to be confirmed for Ethiopians. As a result, the purpose of this study was to evaluate the Alcohol Use Disorders Identification Test screening tool’s reliability and validity among medically ill patients in Ethiopia.Method:A total of 325 patients who visited the internal medicine outpatient department were included in this study. To diagnose alcohol use disorder based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), the psychometric features of the Alcohol Use Disorders Identification Test were compared to the gold standard of Mini International Neuropsychiatry Interview. The reliability was determined by examining internal consistency. The receiver operating characteristic curve was established to calculate sensitivity and specificity of the screening tool. Construct validity was determined using confirmatory factor analysis.Result:The translated version of Alcohol Use Disorders Identification Test showed language clarity. Internal consistency was excellent (Cronbach’s α = 0.9). The Alcohol Use Disorders Identification Test provides an excellent receiver operating curve with cut-off point ⩾8 for females (sensitivity = 0.92, specificity = 0.87, positive predictive value = 70.2, negative predictive value = 96.9, likelihood ratio+ = 7.16, and likelihood ratio− = 0.1) and ⩾10 for males (sensitivity = 0.91, specificity = 0.84, positive predictive value = 72.6%, negative predictive value = 95.3%, likelihood ratio+ = 5.57, and likelihood ratio− = 0.10). Confirmatory factor analysis yielded good model fit indices for the two- and three-factor models, with the two-factor model outperforming the others.Conclusion:The Alcohol Use Disorders Identification Test has been proven to be a reliable tool for detecting alcohol use in gedofa-speaking medical outpatients.

Blood Biomarkers of Alcohol Use: A Scoping Review.

Understanding whether a person has consumed alcohol or not, as well as quantitative assessment of alcohol use, are often based on self-reported measures, which may be subject to recall bias, among other challenges. Although not without limitations, blood biomarkers may complement self-reported assessments to provide a more accurate determination of the presence and quantity of alcohol use. The aim of this review is to provide a critical overview of the current knowledge and research on biomarkers of alcohol use, with a particular focus on blood tests. This scoping review summarizes the published work on blood tests currently used in clinical practice, including phosphatidyl ethanol (PEth), fatty acid ethyl ester (FAEE), carbohydrate-deficient transferrin (CDT), total serum sialic acid (TSA), mean corpuscular volume (MCV), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), and cholesteryl ester transfer protein (CETP). Emerging blood biomarkers with a potential use to assess alcohol drinking are also briefly reviewed, including N-Acetyl-β-Hexosaminidase (Beta-Hex), macrophage migration inhibitory factor (MIF), and D-dopachrome tautomerase (DDT). We discuss the aforementioned biomarkers in the context of their clinical implications, characteristics, strengths, and limitations. The available blood biomarkers considerably vary in the time period in which they detect alcohol use and the amount of alcohol they are sensitive to. While currently available biomarkers provide useful information, especially in combination with self-reported measures, future work is needed to identify more sensitive and specific blood biomarkers for different levels and patterns of alcohol use. Integration of such biomarkers into clinical practice and research will increase the accuracy and richness of the data and may guide more effective and targeted strategies for prevention, diagnosis, and treatment of excessive alcohol use.

Alcohol Consumption as a Causator and/or an Accelerator of Neuropathy in People With Diabetes Is Regularly Overlooked.

Patients with diabetes and distal symmetrical polyneuropathy (DSP) are routinely evaluated for etiologies other than diabetes, including vitamin B12 deficiency, paraproteinemia, hypothyroidism and drug or autoimmune-induced neuropathy. However, the most common cause of DSP, next to that of diabetes, is alcohol intake, which is almost never evaluated. In addition to assessment of alcohol intake based on patient history, which often leads to an underestimation of alchohol intake, markers of a high alcohol intake (elevated liver enzymes, uric acid, triglycerides, low magnesium or low folic acid levels) should be obtained. However, the test that is most likely to detect surreptitious alcohol intake is urinary ethyl glucuronide (EtG), which will detect the intake of alcohol within the previous 90 h. Detection of alcohol use is important since if alcohol consumption is not discontinued, DSP, whatever the etiology, will not improve. In addition, the use of drugs to improve symptoms of DSP (tricyclics, anti-epileptics, serotonin, norepinephrine reuptake inhibitors and analgesics) may in combination with alcohol excessively suppress respiration and cognitive function such that these drugs should not be prescribed or utilized if use of alcohol continues. In the future, all patients with DSP, and especially those with symptomatic DSP, should be biochemically screened for excessive alcohol intake and appropriate action taken.

Phosphatidylethanol as Blood Biomarker of Alcohol Consumption in Early Pregnancy: An Observational Study in 4,067 Pregnant Women.

The teratogenic effects of alcohol are well documented, but there is a lack of screening methods to detect alcohol use during pregnancy. Phosphatidylethanol 16:0/18:1 (PEth) is a specific and sensitive biomarker reflecting alcohol intake up to several weeks after consumption. The aim of this study was to investigate the prevalence of positive PEth values as an indicator of early prenatal alcohol exposure in a general population of pregnant women. Rhesus typing is routinely performed in Norway in all pregnancies around gestational week 12. Rhesus-negative women have an additional test taken around week 24. Blood samples submitted to St. Olav University Hospital in Trøndelag, Norway, for Rhesus typing during the period September 2017 to October 2018 were collected. A total of 4,533 whole blood samples from 4,067 women were analyzed for PEth (limit of quantification of 0.003µM). Fifty-eight women had a positive PEth sample. Of these, 50 women were positive around gestational week 12, 3 women were positive around week 24, and in 5 cases, the timing was unknown. There were no significant differences in proportions of women with positive PEth values related to age, or rural versus urban residency. In an unselected pregnant population in Norway, 1.4% had a positive PEth sample around gestational week 12, whereas 0.4% had a positive sample around week 24. The use of PEth as an alcohol biomarker should be further investigated as a diagnostic tool in the antenatal setting.

Mixed-methods trial of a phosphatidylethanol-based contingency management intervention to initiate and maintain alcohol abstinence in formerly homeless adults with alcohol use disorders

BackgroundContingency management (CM) is an intervention where incentives are provided in exchange for biochemically confirmed alcohol abstinence. CM is effective at initiating alcohol abstinence, but it is less effective at maintaining long-term abstinence. Phosphatidylethanol (PEth), collected via a finger-stick, can detect alcohol use for 14–28 days. PEth allows for the development of a CM model that includes increasingly less frequent monitoring of abstinence to assist high risk groups, such as formerly homeless individuals, maintain long-term abstinence. AimsInvestigate whether PEth-based CM intervention targeting alcohol abstinence in formerly homeless, currently housed individuals with alcohol use disorders is: (1) acceptable and feasible for housing program tenants and personnel; and is associated with increased (2) alcohol abstinence and (3) housing tenure. MethodsAcceptability and feasibility will be assessed using a QUAL+quant mixed-methods design using qualitative interviews and quantitative measures of satisfaction and attrition. Effectiveness will be evaluated through a randomized pilot trial of 50 study participants who will receive 6 months of either treatment as usual (TAU) including incentives (e.g., gift cards) for providing blood samples (Control Condition) or TAU and incentives for negative PEth results (PEth-CM Condition). Outcomes will be assessed during the intervention and at a three-month follow-up visit. The trial will be conducted via telehealth as a result of COVID-19. DiscussionThis protocol seeks to utilize a novel alcohol biomarker to evaluate the acceptability, feasibility, and initial effectiveness of a CM model that encourages long-term abstinence in a high-risk group.

Clinical usefulness of a urine dipstick to detect ethyl glucuronide (EtG): A quantitative clinical study in healthy young female volunteers.

The metabolite of ethanol, ethyl glucuronide (EtG), reflects alcohol intake longer than ethanol and is used as a biomarker in clinical settings to detect alcohol use. We aimed to assess the clinical usefulness in a low-to-moderate alcohol intake setting and validate a new urine EtG dipstick. A three-way, open, cross-over trial was conducted. Data were collected from January to June 2019. Among 12 healthy female volunteers, we quantified urine EtG and used a dipstick following intake of either one, two or four units of alcohol. Main outcomes were concentrations of EtG in urine and serum, and creatinine and ethanol in serum. EtG in urine was determined dichotomously by dipsticks at two different thresholds and by mass spectrometry used as gold standard. EtG in urine was quantifiable up to 24hours after alcohol intake. In some individual cases, EtG was quantifiable up to 72hours at low concentrations. The dipstick detected EtG in urine up to 24hours. At thresholds of 1000 and 1500ng/mL, the dipsticks had a specificity of 100% (both), while sensitivity was 84% and 69%, respectively. The sensitivity of the dipsticks was insufficient to support a screening purpose in this setting of low-to-moderate alcohol intake.

INTERVENÇÕES BREVES JUNTO A UTENTES DA ATENÇÃO PRIMÁRIA EM USO DE RISCO E NOCIVO DE ÁLCOOL

Objetivo: avaliar o efeito das intervenções breves na redução do consumo de álcool em utentes de uma Unidade de Saúde Familiar.Método: estudo pré-experimental, avaliação antes e depois (quatro meses) de 205 utentes (grupo único). Utilizou-se o Alcohol Use Disorders Identification Test (AUDIT). A coleta ocorreu em Coimbra, Portugal, nos meses de maio/junho e setembro/outubro de 2019. Utilizou-se o teste Wilcoxon para avaliação dos efeitos das intervenções.Resultados: na primeira avaliação, 189 (92,2%) encontravam-se na zona I; 15 (7,3%) na zona II e 1 (0,5%) na zona IV. No seguimento, quatro meses após as intervenções com os 15 utentes que pontuaram zona 2, teve-se perda da amostra de 5, demonstrando que 6 (60%) pontuaram zona I, 3 (30%) zona II e 1 (10%) zona III.Conclusão: as intervenções breves são recursos efetivos na detecção precoce do consumo de álcool, sendo necessários à disseminação nos cuidados primários à saúde.

Factors Associated With Alcohol Use Among Medical Students at Ridgeway Campus, University of Zambia

Background: Alcohol use among students has been found to be significantly associated with suicide ideation, physical fighting, and poor academic performance. Consequently, the regular use of alcohol during the adolescence and early adulthood stage can be seen as a risk factor or an indicator of possible future health and social problems. The aim of this study was to determine the factors associated with alcohol use among medical students at Ridgeway campus.Methodology: The study enrolled259 medical students at Ridgeway campus who completed an anonymous, self-applied questionnaire. SPSS version 20 was used to verify the correlation between alcohol use and variables. The significance level was set at 95% (p&gt;0.05) interval.Results: Alcohol consumption was 60%. Year of the study was related to alcohol use. Additionally, other related factors were boredom (p&lt;0.001), forget problems (p=0.001) and improvement of academic performance (p=0.018). Conclusion:The results obtained are useful for developing strategies for alcohol prevention among this population. Training with tips on how to deal with stress, early detection of alcohol use, provision of scientific information, programs for professors/tutors and others and an increase in the time dedicated to disciplines that discuss alcohol use. Keywords:Alcohol use, Medical students, ridgeway campus, university of Zambia

Phosphatidylethanol Reliably and Objectively Quantifies Alcohol Consumption in Adolescents and Young Adults.

Alcohol contributes to numerous annual deaths and various societal problems not just in adult, but also in adolescent, populations. Therefore, it is vital to find methods for reliably detecting alcohol use for early preventative measures. Research has shown phosphatidylethanol (PEth) to be superior to self-report instruments and indirect biomarkers for alcohol consumption in adult populations. However, the transferability onto an adolescent population has not yet been investigated. N=106 adolescents and young adults aged between 13 and 21years were included. PEth analysis using high-pressure liquid chromatography-tandem mass spectrometry was performed on dried blood spot samples. Self-report questionnaires for alcohol consumption (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C, and Timeline Followback, TLFB) and drug and alcohol consumption (Detection of Alcohol and Drug Problems in Adolescents, DEP-ADO) were completed by each participant. AUDIT-C scores showed large correlations with PEth 16:0/18:1 (rs =0.732) and PEth 16:0/18:2 (rs =0.661) concentrations. AUDIT-C with a cutoff value ≥3 was largely correlated with PEth 16:0/18:1 (η=0.411) and showed a medium-sized correlation with PEth 16:0/18:2 (η=0.397) concentrations. Using an AUDIT-C cutoff value ≥5 showed large correlations with both PEth 16:0/18:1 (η=0.510) and PEth 16:0/18:2 (η=0.497) concentrations, respectively. ROC curves indicated higher PEth concentrations are a good model for detecting positive AUDIT-C cutoff values (AUROC range: 0.800 to 0.849). PEth concentrations showed medium to large correlations with DEP-ADO and TLFB subscales (range rs =0.469 to 0.746). The results suggest that PEth is a reliable and objective marker for quantifying alcohol consumption in adolescents and young adults. This could be of importance for early preventative measures against hazardous alcohol consumption, which is increasingly common at younger ages.

Online Searching and Social Media to Detect Alcohol Use Risk at Population Scale

Harnessing engagement in online searching and social media may provide complementary information for monitoring alcohol use, informing prevention and policy evaluation, and extending knowledge available from national surveys. Relative search volumes for 7 alcohol-related keywords were estimated from Google Trends (data, 2014-2017), and the proportion of alcohol use-related Twitter posts (data, 2014-2015) was estimated using natural language processing. Searching/posting measures were created for all 50 U.S. states plus Washington, D.C. Survey reports of alcohol use and summaries of state alcohol policies were obtained from the Behavioral Risk Factor Surveillance System (data, 2014-2016) and the Alcohol Policy Scale. In 2018-2019, associations among searching/posting measures and same state/year Behavioral Risk Factor Surveillance System reports of recent (past-30-day) alcohol use and maximum number of drinks consumed on an occasion were estimated using logistic and linear regression, adjusting for sociodemographics and Internet use, with moderation tested in regressions that included interactions of select searching/posting measures and the Alcohol Policy Scale. Recent alcohol use was reported by 52.93% of 1,297,168 Behavioral Risk Factor Surveillance System respondents, which was associated with all state-level searching/posting measures in unadjusted and adjusted models (p<0.0001). Among drinkers, most searching/posting measures were associated with maximum number of drinks consumed (p<0.0001). Associations varied with exposure to high versus low levels of state policy controls on alcohol. Strong associations were found among individual alcohol use and state-level alcohol-related searching/posting measures, which were moderated by the strength of state alcohol policies. Findings support using novel personally generated data to monitor alcohol use and possibly evaluate effects of alcohol control policies.

An Integrative Screening Tool of Alcohol Exposure During Early Pregnancy: Combining of the CDT Biomarker with Green Page Questionnaire.

In current clinical practice, prenatal alcohol exposure is usually assessed by interviewing the pregnant woman by applying questionnaires. An alternative method for detecting alcohol use is to measure the biomarker carbohydrate-deficient transferrin (CDT). However, few studies measure CDT during pregnancy. This study examines the utility of CDT biomarker in the screening of alcohol exposure during early pregnancy. A cohort of 91, first-trimester pregnant women assigned to a public reference maternity hospital, was screened using the Green Page (GP) questionnaire, an environmental exposure tool. CDT levels and other biomarkers of alcohol use were measured and compared with questionnaire data. About 70% of the mothers in the study consumed alcohol during early pregnancy and 22% met high-risk criteria for prenatal exposure to alcohol. CDT measurement showed a statistically significant area under the receiver operating characteristic curve with a value of 0.70. For a value of 0.95% of CDT, a specificity of 93% was observed. The most significant predictors of CDT were the number of binge drinking episodes, women's body mass index and European white race. Pregnant women with a CDT value >0.95% would be good candidates for the performance of the GP questionnaire during early pregnancy in order to detect potential high-risk pregnancy due to alcohol exposure.

Evidence for essential unidimensionality of AUDIT and measurement invariance across gender, age and education. Results from the WIRUS study

IntroductionGlobally, alcohol use is among the most important risk factors related to burden of disease, and commonly emerges among the ten most important factors. Also, alcohol use disorders are major contributors to global burden of disease. Therefore, accurate measurement of alcohol use and alcohol-related problems is important in a public health perspective. The Alcohol Use Identification Test (AUDIT) is a widely used, brief ten-item screening instrument to detect alcohol use disorder. Despite this the factor structure and comparability across different (sub)-populations has yet to be determined. Our aim was to investigate the factor structure of the AUDIT-questionnaire and the viability of specific factors, as well as assessing measurement invariance across gender, age and educational level. MethodsWe employed data (N = 4,318) from the ongoing screening study in the Norwegian national WIRUS project. We used Confirmatory Factor Analysis (CFA) to establish the factor structure of the AUDIT. Next, we investigated the viability of specific factors in a bi-factor model, and assessed measurement invariance of the preferred factor structure. ResultsOur findings indicate the AUDIT is essentially unidimensional, and that comparisons can readily be done across gender, age and educational attainment. ConclusionWe found support for a one-factor structure of AUDIT. To the best of our knowledge, this is the first study to investigate the viability of specific factors in a bi-factor model as well as evaluating measurement invariance across gender, age and educational attainment for the AUDIT questionnaire. Therefore, further studies are needed to replicate our findings related to essential unidimensionality.