Comparing Two Alcohol Screening Measures on Rates of Risky Alcohol Use in a University Health Clinic

  • Brian E. McCabeEmail author
  • Gisel Stark
  • Valerie Halstead
  • Derby Munoz-Rojas
  • Lillian Gelberg
  • Hilda Pantin
  • Guillermo Prado
Original Article


College drinking is a serious health concern. Few studies have examined screening measures and methods of administration. This study compares two alcohol screens (NIAAA 5/4 binge drinking question or Alcohol Use Disorders Identification Test (AUDIT)) in a college student health clinic waiting room and two modes of administration (self-administered either on a computer kiosk or on a tablet computer). Participants were 259 undergraduates from the University of Miami. Most (78–98%) students completed screening. More students were identified with risky alcohol use with the 5/4 (49%) than AUDIT (14%). On the 5/4, administration method was not linked to completion, 93% kiosk vs. 95% tablet, p = .554, but was related to identification as a risky alcohol user, 42% kiosk vs. 56% tablet, p = .033. On the AUDIT, administration method was significantly related to completion, 73% kiosk vs. 98% tablet, p < .001, and identification, 8% kiosk vs. 23% tablet, p = .003. Method of administration of the single item 5/4 binge drinking question was related to the a higher proportion of students identified with risky alcohol use when screened by a computer tablet, but not completion rates; the AUDIT method of administration was related to both completion and identification rates (higher rates with the tablet in both cases). Education of student health providers who make decisions about what screening tools to use in their centers and who interpret the results of alcohol screening in college health centers should consider the potential influence of administration method. Future research should examine the reasons that method of administration might influence screening results.


Screening Alcohol College Early adulthood Prevention 



This research was funded by the Center for Prevention and Implementation Methodology for Drug Abuse and Sexual Risk Behavior (Ce-PIM) grant P30DA027828 (C. Hendricks Brown, Principal Investigator). Support for this research was also received from the Center of Excellence for Health Disparities Research: El Centro, National Institute of Minority Health and Health Disparities grant P60MD002266 (Victoria Mitrani, Principal Investigator) and The University of Miami School of Nursing and Health Studies.

Compliance with Ethical Standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.


The authors are solely responsible for this article’s content and do not necessarily represent the official views of the National Institutes of Health.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. American College Health Association. (2011). American College Health Association-National College Health Assessment II: University of California Merced Executive Summary Spring 2011. Linthicum, MD: American College Health Association.Google Scholar
  2. Angelini, K., Sutherland, M. A., & Fantasia, H. C. (2017). Reported alcohol and tobacco use and screening among college women. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46, e75–e82.CrossRefGoogle Scholar
  3. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Montiero, M. G. (2001). The alcohol use disorders identification test: guidelines for use in primary care (2nd ed.). Geneva: World Health Organization.Google Scholar
  4. Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, Brief Intervention, and Referral to Treatment (SBIRT). Substance Abuse, 28, 7–30. Scholar
  5. Bertholet, N., Daeppen, J. B., Wietlisbach, V., Fleming, M., & Burnand, B. (2005). Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Archives of Internal Medicine, 165, 986–995.CrossRefGoogle Scholar
  6. Bonevski, B., Campbell, E., & Sanson-Fisher, R. W. (2010). The validity and reliability of an interactive computer tobacco and alcohol use survey in general practice. Addictive Behaviors, 35(5), 492–498.CrossRefGoogle Scholar
  7. Borsari, B., Hustad, J. T. P., Mastrelo, N. R., Tevyaw, T. O., Barnett, N. P., Kahler, et al. (2012). Addressing alcohol use and problems in mandated college students: a randomized clinical trial using stepped care. Journal of Consulting and Clinical Psychology, 80, 1062–1074. Scholar
  8. Bowling, A. (2005). Mode of questionnaire administration can have serious effects on data quality. Journal of Public Health, 27(3), 281–291.CrossRefGoogle Scholar
  9. Centers for Disease Control and Prevention [CDC]. (2014). Planning and implementing screening and brief intervention for risky alcohol use: a step-by-step guide for primary care practices. Atlanta, GA: CDC.Google Scholar
  10. Cunningham, R. M., Bernstein, S. L., Walton, M., Broderick, K., Vaca, F. E., Woolard, R., et al. (2009). Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 16, 1078–1088.CrossRefGoogle Scholar
  11. Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., et al. (2018). Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA, 320, 1899–1909.CrossRefGoogle Scholar
  12. DeMartini, K. S., & Carey, K. B. (2012). Optimizing the use of the AUDIT for alcohol screening in college students. Psychological Assessment, 24, 954–963.CrossRefGoogle Scholar
  13. Ewing, J. A. (1984). Detecting alcoholism: the CAGE questionnaire. JAMA, 252, 1905–1907.CrossRefGoogle Scholar
  14. Fleming, M. (2002). Clinical protocols to reduce high risk drinking in college students: the college drinking prevention curriculum for health care providers. Washington, DC: NIAAA.Google Scholar
  15. Grossberg, P. M., Brown, D. D., & Fleming, M. F. (2004). Brief physician advice for high-risk drinking among young adults. The Annals of Family Medicine, 2, 474–480.CrossRefGoogle Scholar
  16. Kaner, E. F., Beyer, F. R., Muirhead, C., Campbell, F., Pienaar, E. D., Bertholet, N., et al. (2018). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews, 2, 1–90.Google Scholar
  17. Kokotailo, P. K., Egan, J., Gangnon, R., Brown, D., Mundt, M., & Fleming, M. (2004). Validity of the alcohol use disorders identification test in college students. Alcoholism: Clinical and Experimental Research, 28, 914–920.CrossRefGoogle Scholar
  18. Lenk, K. M., Erickson, D. J., Winters, K. C., Nelson, T. F., & Toomey, T. L. (2012). Screening services for alcohol misuse and abuse at four-year colleges in the US. Journal of Substance Abuse Treatment, 43, 352–358.CrossRefGoogle Scholar
  19. Lenk, K. M., Nelson, T. F., Erickson, D. J., & Toomey, T. L. (2015). How are 2-year US colleges addressing student alcohol use and related problems? Journal of College Student Development, 56, 380–385.CrossRefGoogle Scholar
  20. Maddock, J. E., Laforge, R. G., Rossi, J. S., & O’Hare, T. (2001). The college alcohol problems scale. Addictive Behaviors, 26, 385–398.CrossRefGoogle Scholar
  21. McBride, D. R., Orman, S. V., Wera, C., & Leino, V. (2010). ACHA benchmarking committee report: 2010 survey on the utilization of student health services. Retrieved January 19, 2016, from chmarkingReport_2010_Utilization_Survey.pdf.
  22. McPherson, T. L., & Fischer, L. (2013). Guide to Screening, Brief Intervention and Referral Treatment (SBIRT): an introduction to screening. Presented by the National SBIRT ATTC and B IG Initiative. eningPpts.pdf.
  23. Miller, W. R., Baca, C., Compton, W. M., Ernst, D., Manuel, J. K., Pringle, B., Schermer, C. R., Weiss, R. D., Willenbring, M. L., & Zweben, A. (2006). Addressing substance abuse in health care settings. Alcoholism: Clinical and Experimental Research, 30, 292–302.CrossRefGoogle Scholar
  24. National Institute on Alcohol Abuse and Alcoholism [NIAAA]. (2005). Helping patients who drink too much: a clinician’s guide. U.S. Department of Health and Human Services (NIH publication no. 07–3769). Retrieved January 19, 2016, from
  25. Reinert, D. F., & Allen, J. P. (2007). The alcohol use disorders identification test: an update of research findings. Alcoholism: Clinical and Experimental Research, 31, 185–199.CrossRefGoogle Scholar
  26. Saitz, R., Horton, N. J., Sullivan, L. M., Moskowitz, M. A., & Samet, J. H. (2003). Addressing alcohol problems in primary care: a cluster randomized, controlled trial of a systems intervention: the screening and intervention in primary care (SIP) study. Annals of Internal Medicine, 138, 372–382.CrossRefGoogle Scholar
  27. Schaus, J. F., Sole, M. L., McCoy, T. P., Mullett, N., & O’Brien, M. C. (2009). Alcohol screening and brief intervention in a college student health center: a randomized controlled trial. Journal of Studies on Alcohol and Drugs. Supplement, 16, 131–141.CrossRefGoogle Scholar
  28. Seigers, D. K., & Carey, K. B. (2010). Alcohol use, psychopathology, and treatment utilization in a university mental health clinic. Journal of College Student Psychotherapy, 24, 328–337.CrossRefGoogle Scholar
  29. Solberg, L. I., Maciosek, M. V., & Edwards, N. M. (2008). Primary care intervention to reduce alcohol misuse: ranking its health impact and cost effectiveness. American Journal of Preventive Medicine, 34, 143–152.CrossRefGoogle Scholar
  30. Substance Abuse and Mental Health Services Administration [SAMHSA]. (2013). Results from the 2013 national survey on drug use and health: national findings (NSDUH series H-32 DHHS publication no. SMA 07-4293). Rockville, MD: Office of Applied Studies.
  31. Substance Abuse and Mental Health Services Administration [SAMHSA] (2010). Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, Public-Use Data.Google Scholar
  32. Wechsler, H., & Nelson, T. F. (2006). Relationship between level of consumption and harms in assessing drink cut-points for alcohol research: commentary on “Many college freshmen drink at levels far beyond the binge threshold” by White et al. Alcoholism: Clinical and Experimental Research, 30, 922–927.CrossRefGoogle Scholar
  33. Wechsler, H., Davenport, A., Dowdall, G., Moeykens, B., & Castillo, S. (1994). Health and behavioral consequences of binge drinking in college: a national survey of students at 140 campuses. JAMA: Journal of the American Medical Association, 272, 1672–1677.CrossRefGoogle Scholar
  34. Winters, K. C., Toomey, T., Nelson, T. F., Erickson, D., Lenk, K., & Miazga, M. (2011). Screening for alcohol problems among 4-year colleges and universities. Journal of American College Health, 59, 350–357.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Nursing and Health StudiesUniversity of MiamiCoral GablesUSA
  2. 2.Student Health ServiceUniversity of MiamiCoral GablesUSA
  3. 3.School of NursingUniversity of Costa RicaSan JoseCosta Rica
  4. 4.David Geffen School of MedicineUCLALos AngelesUSA
  5. 5.Department of Public Health Sciences, Miller School of MedicineUniversity of MiamiMiamiUSA

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