The Alcohol Use Disorders Identification Test (AUDIT) in Adolescents: Using a Model-Based Approach to Identify Patterns of Alcohol Misuse

Abstract

Objective

To explore the latent structure of the Alcohol Use Disorders Identification Test (AUDIT) among adolescents of different school grades (age strata). Methods: Data derived from two simultaneous run cohort studies from the “Adolescent Nutritional Assessment Longitudinal Study-ELANA” conducted in private and public schools of Rio de Janeiro/Brazil. Participants comprised 564 seventh-graders and 419 ninth-graders, respectively sampled in 2011 and 2013 from cohort 1, and 730 eleventh-graders sampled in 2011 from cohort 2. Latent class factor analytical (LCFA) models were applied to the AUDIT items to identify internally homogeneous latent groups of individuals representing distinct patterns of alcohol use, and optimal group-separating cutoffs. The classification agreement was also evaluated. Results: Three and two groups (classes) were found for the eleventh and the earlier grades, respectively. These best-fitting models held a very high degree of class separation (entropy >0.9). By contrasting the AUDIT’s raw scores (0–10) with the model-based latent classes, the cutoff separating the base (milder) category was found between scores 0 and 1 in all grades. The eleventh-graders differed from the others by showing a third and more intense category of alcohol use (cutoff between 4 and 5). The classification agreement was almost perfect in eleventh-graders (98.6%) and perfect in the earlier grades (100%). Conclusions: Findings show that the AUDIT may be adequately used in adolescents of different ages and school grades, although the number of homogeneous categories may differ accordingly. Besides, raw scores may be pragmatically used to identify groups with confidence by applying specific optimal cutoffs.

Keywords:

• Alcohol misuse
• binge drinking
• adolescent
• cohort study
• classification analysis
• factor mixture model

Acknowledgements

This work was supported by the National Council for Scientific and Technological Development (CNPq) [grant 47667/2011-9]; the Carlos Chagas Filho Research Support Foundation of the State of Rio de Janeiro [grants E26/110.847/2009, E26/110.626/2011, and E-26/110.774/2013]; and the Coordination for the Improvement of Higher Education Personnel (CAPES) [grant 23038.007702/2011-5]. M.E.R. was partially supported by CNPq, grant number 301381/2017-8. C.L.M was also partially supported by CNPq, grant number 302663/2015-0. The funders had no role in the design, analysis or writing of this article.

The author’s responsibilities were as follows: M.E.R. and C.L.M. planned, designed, and coordinated the study. G.S.I. and M.F.F. contributed to the conception and design of the study and undertook the literature review. G.S.I. performed the statistical analyses and wrote the first draft of the manuscript. C.L.M. and M.E.R. participated in the interpretation of results. G.S.I. and M.E.R. had primary responsibility for the final content. All authors critically reviewed and contributed to the manuscript. All authors read and approved the final content.

Declaration of interest

The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the article.