Selection of screening items for alcohol abuse and alcohol dependence among Mexicans and Mexican Americans in the emergency department

Objective: This article reports on the selection of screening items to dete ct Mexican or Mexican-American patients in the emergency department (ED) wh o have alcohol problems and could benefit from an intervention or a referra l for treatment. Items are tested against the Rapid Alcohol Problems Screen (RAPS), which has been optimized from standard screening instruments and h as outperformed these instruments. Method: The performance of individual it ems from standard screening instruments (CAGE, TWEAK, AUDIT, TRAUMA and BMA ST) against International Classification of Diseases, Tenth Revision and Di agnostic and Statistical Manual, Fourth Revision criteria for alcohol abuse and dependence was evaluated in a merged probability sample (N = 869; 72% men) of 537 ED patients from three hospitals in Pachuca, Mexico, and 332 Me xican-American ED patients in Santa Clara County, CA. Logistic regression a nd tree-classification models were used for item selection. Results: We fou nd a prevalence of 15% for alcohol dependence and a prevalence of 28% for a lcohol abuse or dependence in the merged sample. The RAPS items did not per form as well in terms of sensitivity (93%) as the optimal five items identi fied in these analyses (sensitivity = 98%) for alcohol dependence, but did demonstrate better specificity (79%) than the optimal five items (65%), whi ch is an important consideration in a time of cost containment. Both sets o f items showed better sensitivity and positive predictive value but similar Receiver Operating Characteristic values for respondents in the high accul turation group compared to those at other levels of acculturation. Differen ces in positive predictive value across all subgroups tended to increase at increased cutpoints, especially for the RAPS. Conclusions: These analyses suggest that the RAPS performs favorably compared to those items optimized, in this sample of Hispanic ED patients. Based on comparative item performa nce in these analyses, the RAPS may hold promise as a useful tool for scree ning for alcohol dependence, but requires further evaluation as a stand-alo ne instrument in comparison with other standard screening instruments.