Validating a Hazardous Drinking Index in a Sample of Sexual Minority Women: Reliability, Validity, and Predictive Accuracy.

BACKGROUND: Although sexual minority women (SMW) are at increased risk of hazardous drinking (HD), efforts to validate HD measures have yet to focus on this population. OBJECTIVES: Validation of a 13-item Hazardous Drinking Index (HDI) in a large sample of SMW. METHODS: Data were from 700 adult SMW (age 18-82) enrolled in the Chicago Health and Life Experiences of Women study. Criterion measures included counts of depressive symptoms and post-traumatic stress disorder (PTSD) symptoms, average daily and 30-day ethanol consumption, risky sexual behavior, and Diagnostic and Statistical Manual (DSM-IV) measures of alcohol abuse/dependence. Analyses included assessment of internal consistency, construction of receiver operating characteristic (ROC) curves to predict alcohol abuse/dependence, and correlations between HDI and criterion measures. We compared the psychometric properties (diagnostic accuracy and correlates of hazardous drinking) of the HDI to the commonly used CAGE instrument. RESULTS: KR-20 reliability for the HDI was 0.80, compared to 0.74 for the CAGE. Predictive accuracy, as measured by the area under the receiver operating characteristic curve for alcohol abuse/dependence, was HDI: 0.89; CAGE: 0.84. The HDI evidenced the best predictive efficacy and tradeoff between sensitivity and specificity. Results supported the concurrent validity of the HDI measure. CONCLUSIONS: The Hazardous Drinking Index is a reliable and valid measure of hazardous drinking for sexual minority women.

Spiritually Sensitive Social Work with Victims of Natural Disasters and Terrorism.

As a primary intervention, raising the topics of faith and religion with individuals traumatised by terrorism and/or natural disasters can be daunting for social workers, because victims often enter the helping relationship with feelings of helplessness, loss of personal control and of doubt about their relationships, environment, and their cultural and belief systems. Just as clients benefit from knowledge and awareness in the aftermath of a traumatic event, insights gleaned from traumatic experiences and from research can be useful for social workers grappling with the challenges associated with designing and deploying appropriate helping strategies with victims of disaster and terrorism. This article draws on extant literature and survey research, to explore how social workers might ethically assess clients' spiritual perspectives and incorporate helping activities that support clients' recovery, in the context of a spiritually sensitive helping relationship with victims of disaster and terrorism.

Gender differences in the factor structure of the Alcohol Use Disorders Identification Test in multinational general population surveys.

BACKGROUND: Most gender-specific studies of the Alcohol Use Disorders Identification Test (AUDIT) have focused on gender differences in thresholds for hazardous drinking. This study examines gender differences in the factor structure of the AUDIT in general-population surveys. METHODS: General-population surveys from 15 countries provided 27,478 current drinkers' responses to the AUDIT and related measures. We used single-group confirmatory factor analysis (CFA) to evaluate goodness-of-fit of three hypothesized models for responses to the AUDIT by men and women in each country. Bayesian Information Criteria (BIC) using a maximum likelihood robust (MLR) estimator was evaluated to identify the best fitted model. We then assessed factorial invariance within country surveys where fit indices were acceptable for both genders. Gender-specific internal consistency and concurrent validity were also evaluated in all 15 countries. RESULTS: CFA revealed that the fit indices of 2-factor or 3-factor models were consistently better than fit indices for a 1-factor model in 14 of 15 countries. Comparisons of BIC values indicated that the 2-factor solution was the best fitted model. Factorial invariance tests in data from 3 countries indicated that the factor loadings and thresholds of the AUDIT were invariant across gender. The internal reliability and concurrent validity of AUDIT and its subscales were acceptable in both genders. CONCLUSIONS: A two-factor model best describes AUDIT responses across general-population surveys in 12 of 15 countries, with acceptable internal reliability and concurrent validity, and supports a gender-invariant structure in at least three of those countries.

Drinking and drinking-related problems among heterosexual and sexual minority women.

OBJECTIVE: Studies of alcohol use among lesbians have typically used convenience samples with uncertain generalizability or general population samples with small numbers of lesbians. Here we compare rates of high-risk and problem drinking in a large sample of Chicago-area lesbians and a national sample of age- and education-matched urban heterosexual women. METHOD: Data came from comparable face-to-face interviews with 405 self-identified Chicago-area lesbians and with 548 urban women from a U.S. national sample. Rates of hazardous drinking (heavy episodic drinking, intoxication, drinking-related problems, alcohol-dependence symptoms) were compared for exclusively heterosexual, mostly heterosexual, bisexual, mostly lesbian, and exclusively lesbian subgroups. RESULTS: Exclusively heterosexual women had lower rates than did all other women on all measures of hazardous drinking. Exclusively heterosexual women also reported less childhood sexual abuse, early alcohol use, and depression. Bisexual women reported more hazardous drinking indicators and depression than did exclusively or mostly lesbian women. CONCLUSIONS: These results indicate that sexual minority women are likely to have elevated risks of hazardous drinking. The differences between lesbian and bisexual women suggest that more attention is needed to subgroup differences among sexual minority women. Health care providers need to know the sexual identity of their patients and how their sexual identity may affect their risks for hazardous drinking. Higher rates of childhood sexual abuse, early drinking, and depression among sexual minority women suggest that these experiences may be important in assessing and treating problems related to their drinking, and in developing prevention and early intervention strategies.

Age and racial/ethnic differences in drinking and drinking-related problems in a community sample of lesbians.

OBJECTIVE: Although research on alcohol use among women has increased dramatically during the past several decades, relatively few studies have focused on lesbians, and almost none have included sufficient numbers of older lesbians or lesbians of color to permit comparative analyses. Using data from the Chicago Health and Life Experiences of Women Study (CHLEW), we examined drinking patterns and problems in a large and diverse sample of lesbians. METHOD: Structured interviews were conducted with 447 community-residing adult women (ages 18-83) who self-identified as lesbians (48% non-Hispanic white, 28% non-Hispanic black, and 20% Hispanic/Latina; the remainder were in the "other" category). We used multivariate logistic regressions to examine and compare the prevalence of lifetime and 12-month problem-drinking indicators across four age and three racial/ethnic groups. RESULTS: Unlike findings from general population surveys, in which women's rates of drinking tend to decrease with age, we found relatively few differences across the four age groups of CHLEW respondents. We also found no significant differences between Hispanic and white lesbians on any of the lifetime or 12-month problem-drinking indicators and only a few significant differences between white and black lesbians. CONCLUSIONS: As with heterosexual women, patterns of drinking and drinking-related problems among lesbians vary by age and race/ ethnicity. However, given our findings of substantially smaller variations among lesbians than among women in the general population, research is needed that examines in greater depth the intersections between age, race/ethnicity, sexual orientation, and drinking. Understanding how these sociocultural factors interact with each other and with other known risk factors is important for identifying population groups at greatest risk for developing alcohol-related problems.