Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI)

Research output: Contribution to journalArticle

Abstract

Background Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). Methods Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13–17 living in low-income, high-density neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables. Results Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68–0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. Conclusions ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.

Original languageEnglish (US)
Pages (from-to)85-92
Number of pages8
JournalDrug and Alcohol Dependence
Volume166
DOIs
StatePublished - Sep 1 2016

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Zambia
Orphaned Children
Alcohols
Screening
Smoking
Africa South of the Sahara
Area Under Curve
Hazardous Substances
Aptitude
Tobacco
Vulnerable Populations
Risk-Taking
Hypnotics and Sedatives
Psychometrics
Reproducibility of Results
Self Report
HIV Infections
Primary Health Care
HIV
Sensitivity and Specificity

Keywords

  • Adolescent
  • ASSIST
  • HIV
  • Orphans and vulnerable children
  • Psychometrics
  • sub-Saharan Africa
  • Substance use
  • Youth Self Report

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

@article{37b00f5c42c94a688dfc29120b95a201,
title = "Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI)",
abstract = "Background Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). Methods Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13–17 living in low-income, high-density neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables. Results Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68–0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. Conclusions ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.",
keywords = "Adolescent, ASSIST, HIV, Orphans and vulnerable children, Psychometrics, sub-Saharan Africa, Substance use, Youth Self Report",
author = "Kane, {Jeremy C} and Laura Murray and Judith Bass and Johnson, {Renee M} and Bolton, {Paul A}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.drugalcdep.2016.06.026",
language = "English (US)",
volume = "166",
pages = "85--92",
journal = "Drug and Alcohol Dependence",
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TY - JOUR

T1 - Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI)

AU - Kane, Jeremy C

AU - Murray, Laura

AU - Bass, Judith

AU - Johnson, Renee M

AU - Bolton, Paul A

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). Methods Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13–17 living in low-income, high-density neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables. Results Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68–0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. Conclusions ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.

AB - Background Substance and alcohol misuse is a global problem that increases the risk of HIV infection. This is a concern among orphans and vulnerable children (OVC) in sub-Saharan Africa who may have elevated substance use rates. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is a reliable and valid instrument of substance use among adults in primary care high-income settings. This study examined psychometric properties of the ASSIST among OVC in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). Methods Baseline data from an ongoing randomized trial of interventions to reduce HIV risk behaviors were analyzed. The analysis included 502 OVC ages 13–17 living in low-income, high-density neighborhoods in Lusaka, Zambia. Internal consistency of the ASSIST was assessed and discriminant validity was measured using items from the Youth Self Report as criterion variables. Results Internal reliability was strong with a Cronbach's alpha of ≥0.80 for each of the specific substance scales and total substance involvement. For all substances except tobacco and sedatives, discriminant validity was demonstrated in distinguishing between low risk use and moderate use. Sensitivity and specificity analysis indicated adequate area under the curve across substance types (AUC range: 0.68–0.80). Discrimination between moderate and high risk was demonstrated for alcohol and total substance involvement. Conclusions ASSIST administered via ACASI is a reliable instrument and an appropriate tool for distinguishing between low and hazardous substance use among adolescent OVC populations in sub-Saharan Africa. Additional examination is warranted to determine its ability to measure gradations of severity within hazardous use.

KW - Adolescent

KW - ASSIST

KW - HIV

KW - Orphans and vulnerable children

KW - Psychometrics

KW - sub-Saharan Africa

KW - Substance use

KW - Youth Self Report

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U2 - 10.1016/j.drugalcdep.2016.06.026

DO - 10.1016/j.drugalcdep.2016.06.026

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EP - 92

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

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