1. PROMIS ® Alcohol Use Item Banks: Construction and Calibration *Presenter, 1 University of Pittsburgh Medical Center, 2 Department of Psychiatry, University of Pittsburgh, 3 School of Public Health, University of North Carolina at Chapel Hill Colditz JB 1 *, Yu L 2, Johnston KL 1, Dodds NE 1, Stover AM 3, Maihoefer C 1, & Pilkonis PA 2 Background Many alcohol use measures tend to focus on severe symptoms associated with heavy use, and may not provide adequate information at lower thresholds of alcohol use. A National Institutes of Health Roadmap initiative, the Patient-Reported Outcomes Measurement Information System (PROMIS ® ) develops self-report measures of physical and mental health status that are generalizable across diverse populations. The present project developed and calibrated item banks for alcohol use, utilizing Item Response Theory (IRT), to study clinical treatment and social drinker populations. Construction Consistent with previous PROMIS projects at the University of Pittsburgh, comprehensive categorization and revision processes guided item pool development: Literature Review Faculty librarians utilized more than 400 terms in searching PsychINFO ® and MEDLINE ® databases for project-related literature. Content experts coded 785 relevant abstracts for presence of instruments and relevance of content. Item Pool Generation 272 primary citations yielded about 200 unique instruments, resulting in a pool of > 2,400 relevant items. Focus Groups Groups of Substance Use Disorder (SUD) patients and social drinkers helped to identify content gaps and themes for “low-threshold” items. Expert Item Review Content experts organized items into a conceptual hierarchy, resulting in 105 “bins” across 8 primary sub-domains. 147 exemplar items were chosen to undergo revision for consistency and quality. Literacy Demand Analysis Preliminary Lexile ® scores for literacy demand demonstrated an average reading level of 4 th grade (SD = 1 grade) for revised items. Cognitive Interviews Items were presented to a diverse sample of SUD and social drinker participants to further refine item understandability. Three rounds of interviews were completed as iterative changes were made to items. Intellectual Property Review Final items were compared to extant instrument items for content similarities. Author permissions were obtained to retain similar items. A final pool of 141 items went on to calibration testing… IRT Calibration Patients in treatment for substance use disorders (n=407) and social drinkers recruited from the YouGov ® Polimetrix internet panel (n=1,000) responded to the new items, extant measures of alcohol use, and PROMIS health status profiles. Exploratory and confirmatory factor analyses yielded five factors, and a unidimensional Graded Response Model was used to calibrate each of the resulting factors: References and Support 1.Babor, T. F., de la Fuente, J. R., Saunders, J., & Grant, M. (1992). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care. Geneva, Switzerland: World Health Organization. Research supported through supplemental funding to U01_AR052155 (PI: Paul A. Pilkonis, PhD) For more information on various PROMIS network projects, please visit: www.nihpromis.org For more information on PROMIS at the University of Pittsburgh, please visit: www.wpic.pitt.edu/research/promis Future Directions The PROMIS Alcohol Use Item Banks may be validated in samples of individuals starting treatment for alcohol use disorders as well as social drinkers. By implementing health status profiles in conjunction with the calibrated alcohol banks, it is possible to investigate alcohol use across the lifespan and in conjunction with chronic health conditions. Utilizing these banks within an IRT framework, it becomes possible to use Computerized Adaptive Testing or pen-and-paper short forms to assess constructs in as few as 4-5 items per bank, reducing participant burden while providing versatile measures of alcohol-related constructs that may be used in epidemiological studies, clinical trials, and as potential screening tools in clinical applications. Factor Sample Items # of Items Timeframe and Responses Consumption I drank too much. I had trouble controlling my drinking. I drank because I was irritable. 46 “In the past 30 days…” Never; Rarely; Sometimes; Often; Always Negative Consequences Drinking created problems between me and others. I took risks when I drank. I was criticized about my drinking. 31 Positive Consequences I felt outgoing when I drank. I felt at ease when I drank. I had more fun when I drank. 21 Negative Expectancies People are careless when they drink. People make bad decisions when they drink. People are rude when they drink. 13 (no timeframe) Not at all; A little bit; Somewhat; Quite a bit; Very much Positive Expectancies Alcohol makes it easier to talk to people. People forget their problems when they drink. People have more fun at social occasions when they drink. 13 Total124 Results and Significance 124 items performed well in calibration and contributed useful information to the five item banks, providing coverage along broad ranges of the alcohol use constructs. Wide bandwidths of information illustrated potentials for the measurement of constructs with greater inclusiveness than possible using many contemporary instruments. Both Expectancies banks demonstrated a broad range of information +/- 2-3 SD from the mean. Consumption and Negative Consequences banks showed a positive correlation with total scores on the Alcohol Use Disorders Identification Test (AUDIT 1 ), r = 0.89 and 0.78, respectively. Notable differences were found among Consumption items, with “activated drinking” items being more correlated with Negative Consequences. These banks show promise in measuring clinically significant alcohol use patterns. Test Information Curves Consumption Negative Consequences Positive Expectancies Sample Characteristics n = 1,407 Age Mean = 43 (SD = 15) Range = 18-86 Gender Ethnicity 56% Male 9% Hispanic Race 84% Caucasian 14% African American 5% Native American 2% Asian 1% Hawaiian or Pacific Islander Education Level 38% High school or less 51% Some college or 4-year graduate 11% Advanced degree Annual Household Income 28% Less than $20,000 27% $20,000 - $49,999 30% $50,000 - $99,999 15% More than $100,000