KeywordsScreen Test Alcohol Drinking Behavioral Risk Excessive Alcohol Behavioral Risk Factor
Screening refers to the process of surveying a population or sample of a population, in the attempt to identify people at risk for or with a given health condition. Screening is a crucial part of epidemiology, as it informs about the prevalence and risk factors of various health conditions in a population. Furthermore, screening is crucial for preventive medicine, since it enables to identify people who may benefit from primary, secondary, or tertiary interventions. Screening for primary prevention reflects identifying people without a risk factor (e.g., hypertension, depression), to prevent the risk factor and subsequent illnesses. Screening for secondary prevention could be among people with a risk factor, to prevent an illness. And screening for tertiary prevention would be done to prevent relapse or mortality in people already ill (e.g., after a first myocardial infarction). Screening could be in relation to psychosocial factors such as hostility or anxiety, to behavioral risk factors of disease such as smoking or excessive alcohol drinking, and to genetic profiles. For implementing screening tests in clinical use to reliably predict disease risk or prognosis, it is crucial to know the relative risk for a disease in people high and low on a screening risk factor as well as the correct value of “false positives” (Wald and Morris 2011). It is of utmost importance to identify the criteria or cutoffs for screening in clear, precise, and operational manners (e.g., smoking more than ten cigarettes/day, depression score above 10 on the Center for Epidemiological Studies Depression Scale). Screening then enables either to study specific subpopulations at risk for health conditions or for treating them. One important criterion for screening tests is their accuracy. A test is thought to be 95 % accurate if in 95 % of the times it predicts correctly who has a disease (sensitivity) and if 95 % of the time it predicts correctly who does not have a disease (specificity). Screening also enables to increase one’s therapeutic and statistical effects, since by excluding people below a certain cutoff, researchers can prevent a “floor effect” of therapeutic effectiveness. Regretfully, such exclusion is often not practiced in psychological intervention trials. In clinical practice, the cutoffs used to screen are a function of previously defined cutoffs from research or clinical studies, a function of how severe a risk the researchers aim to identify, and the available therapeutic resources that can be allocated for treating the “screened in” subpopulation later. Furthermore, in randomized controlled trials (RCT), the more strict screening criteria are, the longer could be the trial’s duration as the sought patient profile becomes more scarce. Thus, the screening criteria are a function of the research question and available resources for such screening and subsequent treatment, and this is a vital part of clinical epidemiology and research and of therapeutic preventative interventions.