Veterans Women's Alcohol Problems: Prevalence, Screening and Self-Help
Katharine A. Bradley MD MPH
VA Puget Sound Health Care System, Seattle
Seattle, WA
Funding Period: October 1997 - September 2001

BACKGROUND/RATIONALE:
Standardized reviews have demonstrated that the AUDIT and TWEAK questionnaires are the optimal alcohol screening questionnaires for clinical populations of women, although screening test performance has varied in different populations. No study has evaluated the performance of these screening tests in veteran women.

OBJECTIVE(S):
The primary objectives of the Veteran Women’s Alcohol Problem (VWAP) Study are to validate alcohol-screening questionnaires in female VA patients, by comparing them to interview gold standards. Specifically, we are evaluating the TWEAK, AUDIT, AUDIT-C and the third question of the AUDIT (standard and gender-specific versions). The VWAP study is also developing a summary of each patient’s preventive health information obtained from Women’s Health Surveys and placing these computer generated Women’s Health Research Preventive Care Notes in each patient’s VA Computerized Patient Record System (CPRS). These notes will be used in a randomized controlled trial of alcohol screening and provider prompting. Secondary objectives: A small grant from VA PSHCS Epidemiology Research Information Center (ERIC) was obtained to identify laboratory markers potentially related to alcohol use in women who reported drinking alcohol in the past month. A supplemental grant was also obtained from ERIC to evaluate the performance of a screening test for Post-Traumatic Stress Disorder (PTSD) in conjunction with the validation study.

METHODS:
All women who received care at VA Puget Sound Health Care System are eligible for this study, which includes annual Women’s Health Surveys and an interview validation study. The annual Women’s Health Survey (Year 2) was conducted August 1999 to January 2000, later than originally anticipated due to supplemental funding that was not approved until late in Year 2. Supplemental funding permitted use of the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS) for validation studies, but human subjects approval required three months therefore interviewing was initiated in January 2000. All eligible women were mailed invitations for in-person interviews. At the time of scheduling of interviews, patients were mailed a pre-interview packet that included all screening instruments. The annual Women’s Health Survey (year 3) was mailed in June 2000 and data collection for that survey continues as of October 2000. The screening test, the PTSD Checklist, was compared to the Clinician Administered PTSD Schedule (CAPS) interviews.

FINDINGS/RESULTS:
Of 3,308 female veterans determined eligible for the Year 3 annual mailed survey, 1,807 (55%) returned completed Year 3 surveys. Analyses on 393 women who completed the AUDADIS in-person interview and pre-interview questionnaire in 2000, indicate that the AUDIT-C is the optimal screening questionnaire for female VA patients when a cut-point of > 2 is used. Analyses are underway to evaluate the natural history of alcohol problems in female VA patients.

IMPACT:
Analyses will permit us to identify the optimal alcohol-screening questionnaire for female VA patients. Results of this study will permit clinicians to use the most sensitive yet specific screening questionnaire for identification of at-risk drinking in this high-risk population. Future research will then be able to focus on evaluation of interventions with female VA patients who report at-risk drinking, with the aim of preventing alcohol-related morbidity and mortality.

PUBLICATIONS:

Journal Articles

1. Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Archives of Internal Medicine. 2004; 164(4): 394-400.
2. Bush KR, Kivlahan DR, Davis TM, Dobie DJ, Sporleder JL, Epler AJ, Bradley KA. The TWEAK is weak for alcohol screening among female Veterans Affairs outpatients. Alcoholism, Clinical and Experimental Research. 2003; 27(12): 1971-8.
3. Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, Maynard C, Burman ML, Kivlahan DR. Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Archives of Internal Medicine. 2003; 163(7): 821-9.
4. Davis TM, Bush KR, Kivlahan DR, Dobie DJ, Bradley KA. Screening for substance abuse and psychiatric disorders among women patients in a VA Health Care System. Psychiatric Services. 2003; 54(2): 214-8.
5. Dobie DJ, Kivlahan DR, Maynard C, Bush KR, McFall M, Epler AJ, Bradley KA. Screening for post-traumatic stress disorder in female Veteran's Affairs patients: validation of the PTSD checklist. General Hospital Psychiatry. 2002; 24(6): 367-74.
6. Bradley KA, Bush KR, Davis TM, Dobie DJ, Burman ML, Rutter CM, Kivlahan DR. Binge drinking among female Veterans Affairs patients: prevalence and associated risks. Psychology of Addictive Behaviors. 2001; 15(4): 297-305.
7. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Archives of Internal Medicine. 1998; 158(16): 1789-95.
8. Bradley KA, Boyd-Wickizer J, Powell SH, Burman ML. Alcohol screening questionnaires in women: a critical review. JAMA : The Journal of The American Medical Association. 1998; 280(2): 166-71.

DRA: Special (Underserved, High Risk) Populations, Substance Abuse, Addictive Disorders
DRE: Communication and Decision Making, Epidemiology, Prevention, Technology Development and Assessment
Keywords: Screening, Women - or gender differences
MeSH Terms: Mass Screening, Women