title: Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice.
abstract: To examine the National Institute on Alcohol Abuse and Alcoholism Youth Guide alcohol frequency screening thresholds when applied to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria, and to describe alcohol use patterns and alcohol use disorder (AUD) characteristics in rural youth from primary care settings.
  
  
  
  Adolescents (n = 1193; ages 12 through 20 years) visiting their primary care practitioner for outpatient visits in six rural primary care clinics were assessed prior to their practitioner visit. A tablet computer collected youth self-report of past-year frequency and quantity of alcohol use and DSM-5 AUD symptoms. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined.
  
  
  
  For early adolescents (ages 12 through 14 years), 1.9% met DSM-5 criteria for past-year AUD and ≥3 days with alcohol use in the past year yielded a screen for DSM-5 with optimal psychometric properties (sensitivity: 89%; specificity: 95%; PPV: 37%; NPV: 100%). For middle adolescents (ages 15 through 17 years), 9.5% met DSM-5 AUD criteria, and ≥3 past year drinking days showed optimal screening results (sensitivity: 91%; specificity: 89%; PPV: 50%; NPV: 99%). For late adolescents (ages 18 through 20 years), 10.0% met DSM-5 AUD criteria, and ≥12 past year drinking days showed optimal screening results (sensitivity: 92%; specificity: 75%; PPV: 31%; NPV: 99%). The age stratified National Institute on Alcohol Abuse and Alcoholism frequency thresholds also produced effective results.
  
  
  
  In rural primary care clinics, 10% of youth over age 14 years had a past-year DSM-5 AUD. These at-risk adolescents can be identified with a single question on alcohol use frequency.
authors.affiliation: Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: clarkdb@upmc.edu.
authors.forename: Duncan B
authors.initials: DB
authors.lastname: Clark
authors.affiliation: Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Martin
authors.affiliation: Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Tammy
authors.initials: T
authors.lastname: Chung
authors.affiliation: Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: Center for Rural Health Practice, University of Pittsburgh, Bradford, PA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fiorentino
authors.affiliation: Warren Medical Group Family Practice, Warren, PA.
authors.forename: Mason
authors.initials: M
authors.lastname: Tootell
authors.affiliation: Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Rubio
mesh_terms: D000293:Adolescent; D019973:Alcohol-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011594:Psychometrics; D012424:Rural Population; D012680:Sensitivity and Specificity; D000066608:Underage Drinking / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: adolescents; alcohol; screening