title: Validation of an audio computer-assisted self-interview (ACASI) version of the alcohol, smoking and substance involvement screening test (ASSIST) in primary care patients.
abstract: OBJECTIVE
  To address barriers to implementing the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in medical settings, we adapted the traditional interviewer-administered (IA) ASSIST to an audio-guided computer assisted self-interview (ACASI) format. This study sought to validate the ACASI ASSIST by estimating the concordance, correlation and agreement of scores generated using the ACASI versus the reference standard IA ASSIST. Secondary aims were to assess feasibility and compare ASSIST self-report to drug testing results.
  
  
  METHODS
  Participants completed the ACASI and IA ASSIST in a randomly assigned order, followed by drug testing.
  
  
  METHODS
  Urban safety-net primary care clinic in New York City, USA.
  
  
  METHODS
  A total of 393 adult patients.
  
  
  METHODS
  Scores generated by the ACASI and IA ASSIST; drug testing results from saliva and hair samples.
  
  
  RESULTS
  Concordance between the ACASI and IA ASSIST in identifying moderate-high-risk use was 92-99% for each substance class. Correlation was excellent for global scores [intraclass correlation (ICC) = 0.937, confidence interval (CI) = 0.924-0.948] and for substance-specific scores for tobacco (ICC = 0.927, CI = 0.912-0.940), alcohol (ICC = 0.912, CI = 0.893-0.927) and illicit drugs (ICC = 0.854, CI = 0.854-0.900) and good for prescription drugs (ICC = 0.676, CI = 0.613-0.729). Ninety-four per cent of differences in global scores fell within anticipated limits of agreement. Among participants with a positive saliva test, 74% self-reported use on the ACASI ASSIST. The ACASI ASSIST required a median time of 3.7 minutes (range 0.7-15.4), and 21 (5.3%) participants requested assistance.
  
  
  CONCLUSIONS
  The computer self-administered Alcohol, Smoking and Substance Involvement Screening Test appears to be a valid alternative to the interviewer-administered approach for identifying substance use in primary care patients.
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY, USA.|Department of Medicine, NYU School of Medicine, New York, NY, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNeely
authors.affiliation: NYU College of Nursing, New York, NY, USA.
authors.forename: Shiela M
authors.initials: SM
authors.lastname: Strauss
authors.affiliation: Department of Psychiatry, NYU School of Medicine, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rotrosen
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY, USA.
authors.forename: Arianne
authors.initials: A
authors.lastname: Ramautar
authors.affiliation: Department of Population Health, NYU School of Medicine, New York, NY, USA.|Department of Medicine, NYU School of Medicine, New York, NY, USA.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D003201:Computers; D003936:Diagnosis, Computer-Assisted / Q000592:standards; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000592:standards; D008297:Male; D008875:Middle Aged; D009519:New York City; D011320:Primary Health Care; D018570:Risk Assessment; D057566:Self Report / Q000592:standards*; D012907:Smoking; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires / Q000592:standards; D055815:Young Adult
keywords: ACASI; alcohol; drugs; screening; substance abuse; tobacco