The aims of this continuation proposal are to: 1) test standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, History of Trauma Scale), and develop new measures which would be sensitive, specific and efficient for identifying harmful drinking and alcohol dependence (based of ICD-10 criteria from the CIDI) among injured and non-injured patients in an emergency room (ER) with a large Hispanic population; 2) compare the sensitivity, specificity and efficiency of the standard screening instruments and new measures, separately for African Americans and Whites, in this ER sample with that from the University of Mississippi ER sample; 3) compare an abbreviated set of consequences of drinking and of dependence experiences which have been used in previous ER studies (and in the general population) with screening measures and with a standard diagnostic instrument for harmful drinking and for alcohol dependence; 4) determine the comparability of associations of demographic and drinking characteristics with the abbreviated set of consequences of drinking and dependence experiences from this ER study to similar data from the University of Mississippi ER study, from ER studies already carried out in the California Bay Area, and from the general population of the region where the new data will be collected. Replicating the Mississippi ER study is important in order to: 1) test findings from this study in a separate and different geographic region of the country; 2) compare findings within ethnic groups (African American and Whites) across sites and; 3) test findings from the Mississippi study in a Hispanic ER population. A probability sample of all patients over the age of 18 seeking care in the ER at Santa Clara Valley Medical Center during a 15-week period, and a second probability sample of African American patients for an additional 15-week period will be selected to be interviewed and breathalyzed as an estimate of blood alcohol level at the time of admission to the ER. This will yield a total sample of 1500 completed interviews (assuming a 75% completion rate as obtained in our prior ER studies). The performance of each of the screening instruments as well as breathalyzer reading, drinking prior to the event, quantity and frequency of usual drinking, and an abbreviated set of consequences of drinking and alcohol dependence experiences will be evaluated, separately by ethnic group, for identifying harmful drinking and alcohol dependence. Data from this ER study will be compared to those from the Mississippi study, from a number of ERs in the California Bay Area and to the general population of the region to determine, in part, the generalizability of findings from this study. Given a high rate of frequent heavy drinking and alcohol-related problems among both injured and non-injured in the ER, the development of a simple screening instrument specifically designed for use in this setting to identify those who would likely benefit from a brief intervention or from a referral for treatment is especially important.
