Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

GEN 97-022 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

GEN 97-022
Veterans Women's Alcohol Problems: Prevalence, Screening and Self-Help
Katharine A. Bradley MD MPH
VA Puget Sound Health Care System Seattle Division, Seattle, WA
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, Maynard C, Kivlahan DR, Johnson KM, Simpson T, David AC, Bradley K. Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women. Journal of general internal medicine. 2006 Mar 1; 21 Suppl 3:S58-64.
  2. Johnson KM, Bradley KA, Bush K, Gardella C, Dobie DJ, Laya MB. Frequency of mastalgia among women veterans. Association with psychiatric conditions and unexplained pain syndromes. Journal of general internal medicine. 2006 Mar 1; 21 Suppl 3:S70-5.
  3. Johnson KM, Nelson KM, Bradley KA. Television viewing practices and obesity among women veterans. Journal of general internal medicine. 2006 Mar 1; 21 Suppl 3:S76-81.
  4. 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 Feb 23; 164(4):394-400.
  5. 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 Dec 1; 27(12):1971-8.
  6. 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 Apr 14; 163(7):821-9.
  7. 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 (Washington, D.C.). 2003 Feb 1; 54(2):214-8.
  8. 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 Nov 1; 24(6):367-74.
  9. 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 : journal of the Society of Psychologists in Addictive Behaviors. 2001 Dec 1; 15(4):297-305.
  10. 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 Sep 14; 158(16):1789-95.
  11. 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 Jul 8; 280(2):166-71.
Conference Presentations

  1. Bradley K, Epler A, Bush K, Sporleder J, Dunn C, Cochran N, Braddock C, Kivlahan D, McDonell M, Fihn S. Primary Care Alcohol-Related Discussions with At-Risk Drinkers. Paper presented at: Society of General Internal Medicine Annual Meeting; 2001 May 2; San Diego, CA.
  2. Bush K, Epler A, Kivlahan D, Maynard C, Bradley K. Food insufficiency among female VA patients. Paper presented at: VA HSR&D National Meeting; 2001 Feb 1; Washington, DC.
  3. Dobie D, Kivlahan D, Maynard C, Bush K, Epler A, Bradley K. Validation of the PTSD Checklist in women VA outpatients. Paper presented at: VA HSR&D National Meeting; 2001 Feb 1; Washington, DC.
  4. Dobie D, Kivlahan D, McFall M, Maynard C, Bush K, Epler A, Bradley K. Screening for Post Traumatic Stress Disorder in female VA patients: validation of the PTSD Checklist. Poster session presented at: VA HSR&D National Meeting; 2001 Feb 1; Washington, DC.
  5. Bradley KA, Bush KR, Davis T, Dobie DJ, Rutter C, Kivlahan DR. Binge drinking and its association with health outcomes among female veterans. Paper presented at: VA HSR&D National Meeting; 2000 Feb 15; Washington, DC.
  6. Davis T, Bush KR, Kivlahan DR, Bradley KA. Screening for problem drinking among female VA patients using the TWEAK. Paper presented at: VA HSR&D National Meeting; 2000 Feb 15; Washington, DC.
  7. Dobie D, Kivlahan D, Maynard C, Bush K, Davis T, Bradley K. PTSD symptoms and physical health problems in female VA patients. Poster session presented at: International Society for Traumatic Stress Studies Annual Symposium; 2000 Jan 1; San Antonio, TX.


DRA: Substance Abuse and Addiction
DRE: Epidemiology, Prevention, Technology Development and Assessment
Keywords: Screening, Women - or gender differences
MeSH Terms: Mass Screening, Women

Questions about the HSR&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.