Assessment of the validity of the AUDIT factor structure in parents involved with child protective services

ABSTRACT

Background: Identification of hazardous alcohol use is a critical step in connecting individuals to treatment and child protective services (CPS) is a treatment entry-point for parents if hazardous use is identified. The Alcohol Use Disorders Identification Test (AUDIT) is a common screening tool in this setting. However, prior research identifies one to three factors in the AUDIT, revealing uncertainty in the perception and/or impact of alcohol use. Determining the factor structure of the AUDIT for CPS-involved parents is important for its relevance and use in CPS.

Objectives: This analysis examines the type and number of factors present in a sample of parents involved with CPS.

Methods: Using confirmatory factor analysis (CFA), this study compares the one-, two-, and three-factor structures of the AUDIT in a large sample of CPS-involved parents (N = 4009, 90.8% female, 9.2% male) and a sub-sample who endorsed alcohol use (N = 1950). This analysis used data from Waves I and II of the National Survey of Child and Adolescent Well-Being II.

Results: In the main sample, the two-factor (RMSEA = .044, 90% CI: 0.039–0.048; CFI = 0.967; TLI = 0.956) and three-factor (RMSEA = .045, 90% CI: 0.041–0.050; CFI = 0.966; TLI = 0.952) fit better than the single factor model (RMSEA = .072, 90% CI: 0.067–0.076; CFI = 0.908; TLI = 0.881). In the three-factor model two of the factors had a correlation of 0.99; parsimonious models are usually preferable. Sub-sample results were similar.

Conclusions: The two-factor AUDIT is appropriate for screening CPS-involved parents. Screening with the AUDIT should improve early identification and referral to treatment for CPS-involved parents with hazardous alcohol use.

KEYWORDS:

• Substance use disorders
• child protective services
• child welfare
• confirmatory factor analysis
• AUDIT

Disclosure of Interest

The authors report no conflict of interest.

Additional information

Funding

This research was supported by the National Institute on Drug Abuse under Award Numbers [F31DA034442 (K. Seay, PI) and 5T32DA015035 (K. Seay)], The Doris Duke Fellowship (K. Seay, PI; M. Feely, PI), and the Washington University Institute of Clinical and Translational Sciences [grant UL1 TR000448] from the National Center for Advancing Translational Sciences (M. Feely). The study design, execution, and content of this manuscript are solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the other funders.