The CRAFFT Screening Interview. Begin: “I’m going to ask you a few questions that I ask all my patients. Please be honest. I will keep your answers confidential.” . that you sniff or “huff”)? Put “0” if none. The CRAFFT Questionnaire (version ). Please answer all questions honestly; your answers will be kept confidential. The CRAFFT is a (updated version of a) behavioral health screening tool for use with children ages and is recommended by the American Academy of .
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Participants completed a self-administered survey. Among frequent substance users, those older in age, behaviorally infected, with questionnaire of incarceration or unstably housed were more likely to screen positive on the CRAFFT.
Los participantes completaron una encuesta autoadministrada. The use and misuse of alcohol, tobacco, marijuana and other illicit drugs is highly prevalent among adolescents and young adults 2. One of the primary reasons for concern regarding substance use among youth living with HIV YLWH is questonnaire potential for contributing to disease progression, morbidity, and transmission. Research has also shown an association between active substance use alcohol and illicit drug use and high-risk HIV transmission behaviors, such as engaging in condomless anal and vaginal sex with HIV-negative partners 4.
This association may be particularly strong for adolescents and young adults whose cognitive control system is still developing 5. Specifically, neural mechanisms in the developing brain lead to heightened responsiveness to both reward and emotional cues, while adolescents’ behavior and emotion regulation capacities are still relatively underdeveloped 6.
In addition, tobacco use is highly prevalent among people living with HIV 7and has the potential to contribute to non-AIDS defining quesitonnaire and mortality in this population 8.
Importantly, early substance use is associated with increased risk of questiinnaire dependence, psychiatric and medical disorders, and mortality 9. In light of the risks associated with substance use, screening YPLH for substance use is critical. Screening for substance use and identifying those with risky alcohol and drug use behaviors in primary care settings allows for integrated approaches to provide adequate preventative care and treatment.
Alcohol and drug use screening is particularly important in HIV care settings where substance use is highly prevalent among patients The Patient Protection and Affordable Care Act, approved insupports the integration of substance abuse interventions and treatments into mainstream healthcare systems, and the U.
Public Health Service has endorsed routine and universal alcohol and tobacco screening in primary care However, not all HIV primary care clinics routinely screen patients for alcohol and other substances 13 and the screening guidelines do not recommend a specific screening tool Although multiple substance use screening tools have been validated for use with adults, recent meta-analytic work identifies only a few screening processes that have substantial empirical qeustionnaire for use with adolescents In contrast, the CRAFFT addresses both alcohol and other substance use in six items and has a relatively simple scoring system.
A CRAFFT score of 2 or higher has been shown to have good sensitivity and specificity in identifying substance-related problems and disorders in a general population of adolescent medical clinic patients To date, the CRAFFT has been utilized in samples of youth living with HIV as an indicator of problematic substance use 18 — 21 ; however, to our knowledge, research has yet to validate its use by examining how it is associated with self-report substance use behaviors.
Given the importance of brief screening tools for clinicians working with YLWH in HIV care settings, the purpose of this study is two-fold: A better auestionnaire of whether the CRAFFT is associated with substance use behaviors, and is able to identify problematic substance use regardless of sociodemographic factors, will provide important information on whether the CRAFFT can be used in HIV care settings.
Details of the study methods have been described previously 20 From December through Januaryyouth living with HIV were recruited at 20 geographically diverse clinics to participate in a cross-sectional survey. To be eligible, youth had to be: The study was approved by the Institutional Review Boards IRB at each participating site as well as those of members of craffh protocol team.
Research staff approached all youth meeting eligibility criteria during one of their regularly scheduled clinic visits to describe the study. Youth were told that the purpose of the survey was to help design programs for youth and young adults living with HIV to help them lead healthier and happier lives. Youth were informed that the survey would ask questions about their health, sexual behaviors and substance use behaviors.
After a thorough explanation of craftt study and its procedures, staff obtained signed informed consent or youth assent from all youth who agreed to participate. Eighteen of the 22 sites obtained waivers of parental consent; however, written parental permission was obtained when required for youth under the age of The assessment took 45—90 minutes to complete.
Participants were compensated for their time and transportation in accordance with site IRB guidelines. A score craft two or greater indicates that individual may be at risk for substance-related problems and disorders We used five indicators of substance use in our analysis i.
While the CRAFFT is not designed to assess tobacco-related problems, tobacco use frequently co-occurs with alcohol and other drugs 2. Therefore, we included tobacco use as a substance use variable to determine whether the CRAFFT would be helpful tool for identify tobacco users.
For tobacco, alcohol and marijuana use, we categorized use into none, at least once a month, and weekly or more. Given the small number of participants who endorsed weekly or greater non-marijuana illicit drug use, we create a dichotomous variable of any past three month non-marijuana illicit drug use self-reported use of crack, cocaine, amphetamine, inhalants, opioids, sedatives, hallucinogens.
Finally, we created a dichotomous variable ATOD indicating whether a participant reported weekly or greater use of alcohol, tobacco, or marijuana, or any past three month other illicit drug use. Participants self-reported their age, sex assigned at birth, gender identity, race and ethnicity, sexual orientation, route of infection with HIV, past history of incarceration, unstable housing e.
First, we calculated descriptive statistics to summarize substance use and other characteristics of the sample. Next, we examined bivariate differences using Fisher’s exact tests and logistic regression models to compare sociodemographic and substance use behaviors according to whether or not participants screened positive on the CRAFFT i. Finally, we used a series of chi-square analyses to examine whether there were differences in key sociodemographic characteristics i.
The majority of the sample was behaviorally infected with HIV questilnnaire More than half of the sample self-identified as a sexual minority The majority of sample self-reported a male gender identity Approximately half of the sample identified as students Approximately one in four participants reported any non-marijuana illicit drug use The majority of the sample reported ATOD qusstionnaire Young people of color were significantly less likely to screen positive on the CRAFFT compared to their white counterparts.
Table 2 presents bivariate comparisons of those who screened positive on the CRAFFT with those who did not on each of the substance use variables. There were no other significant sociodemographic differences by screening status on the CRAFFT among participants who reported substance use. Demographic differences by screening positive on the CRAFFT among participants who reported weekly or more tobacco and alcohol use in the past 3 months.
When compared to the U. The prevalence of substance use problems is known to increase with age in the general population and ethnic differences are documented in the literature Our findings are consistent with previous literature on sociodemographic and structural factors associated with substance use 3031which provides preliminary support for the utility of the CRAFFT as a brief screening tool for YLWH.
An additional aim of the study was to examine whether there were any sociodemographic differences among those questionnaiee reported frequent substance use among those who screened positive on the CRAFFT compared to frequent substance users who did not screen positive on the CRAFFT. Similar to the original validation study of the CRAFFT 14few sociodemographic differences arose xrafft the youth who reported frequent substance use in our sample.
Although this was the case, there were some differences that are worth noting. Specifically, for youth who reported weekly or more marijuana use and reported any other illicit drug, those who were older in age were more likely to screen positive on the CRAFFT compared to those younger in age.
Among non-marijuana illicit drug users, youth who questionnajre behaviorally infected with HIV were also more likely to screen questionnair on the CRAFFT compared to perinatally infected youth. It is plausible that behaviorally infected youth may use multiple substances as a means of coping with an HIV diagnosis and therefore, are more likely to experience greater consequences related to substance use.
Notably, youth who with a history of incarceration and unstable housing who used substances were more likely to screen positive on the CRAFFT. Specifically, the CRAFFT could be used to identify problematic substance use and then young people could receive brief interventions, and individuals with more severe substance use problems could be referred to specialized treatment. The current findings must be interpreted in light of several limitations.
First, the results are generalizable only to YLWH who have been diagnosed and linked to care in the cities which were represented with the ATN sample. Future work should extend these findings to other geographic regions that are heavily impacted by HIV in the United States. Second, the cross-sectional design of the study limits our ability to make causal inferences.
Although ACASI technology was used to mitigate social desirability bias, the self-reported data from this study may still be subject to social desirability and recall bias; thus, to the extent that some participants may have underreported and others over-reported is unknown.
However, self-report alcohol and other drugs has been shown to be generally reliable and comparable to other methods of substance use detection 2633 Thus, future research is warranted to use more advanced statistical modeling to better understand the predictive validity of the CRAFFT.
Fifth, the CRAFFT was not designed to screen for tobacco use; thus, although screening positive on the CRAFFT appears to be associated with tobacco use in this sample, without further information it is unclear whether this is because tobacco is commonly co-used with other substances or whether the CRAFFT can be used specifically to screen for tobacco use as well.
Finally, an item determining the presence of heavy episodic alcohol use was not available. Although we can report on weekly or more frequent alcohol use, we cannot report our samples response to heavy episodic alcohol use, which is an important indicator for further assessment. Given the high prevalence of substance use queationnaire YLWH and its potential impact on medication adherence and linkage to care, HIV clinical settings should systematically screen for and address substance use among youth in HIV care settings.
Youth living with HIV questjonnaire benefit from a holistic team-based approach to screening and brief intervention which is integrated into HIV care settings Demographic differences by screening positive on the CRAFFT among participants who reported weekly or more marijuana use and any non-marijuana illicit drug use in questionnair past 3 months.
CRAFFT Screening Test – Wikipedia
National Center for Biotechnology InformationU. Author manuscript; available in PMC Jul 1. Gamarel1, 2 Kimberly M.
Nelson1, 3 Larry Brown1, 2 M. Lauderdale, FL Find articles by M. Author information Copyright and License information Disclaimer. See other articles in PMC that cite the published article. Sampling and Recruitment Research crafrt approached all youth meeting eligibility criteria during one of their regularly scheduled clinic visits to describe the study.
CRAFFT Screening Test
Substance Use We used five indicators of substance use in our analysis i. Sociodemographic variables Participants self-reported their age, sex assigned at birth, gender identity, race and ethnicity, sexual orientation, route of infection with HIV, past history of incarceration, unstable housing e.
Statistical Analyses First, we calculated descriptive statistics to summarize substance use and other characteristics of the sample. Open in a separate window. Table 3 Demographic differences by screening positive on the CRAFFT among participants who reported weekly or more tobacco and alcohol use in the past 3 months. Study Limitations The current findings must be interpreted in light of several limitations. Monitoring the Future national results on adolescent drug use: Overview of key findings, Crafdt ND, Montaner J.
Journal of the American Medical Association. Prevalence and clinical implications of interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapies among people living with HIV.
A time of change: Examing health, substance use, and psychosocial correlates across the smoking spectrum.