The Reliability and Validity of the Self-Reported Drinking Measures in the Army???s Health Risk Appraisal Survey

Social Sectors Development Strategies Inc., Eight Nonesuch Drive, Natick, MA 01769-1041, USA.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 06/2003; 27(5):826-34. DOI: 10.1097/01.ALC.0000067978.27660.73
Source: PubMed


The reliability and validity of self-reported drinking behaviors from the Army Health Risk Appraisal (HRA) survey are unknown.
We compared demographics and health experiences of those who completed the HRA with those who did not (1991-1998). We also evaluated the reliability and validity of eight HRA alcohol-related items, including the CAGE, weekly drinking quantity, and drinking and driving measures. We used Cohen's kappa and Pearson's r to assess reliability and convergent validity. To assess criterion (predictive) validity, we used proportional hazards and logistical regression models predicting alcohol-related hospitalizations and alcohol-related separations from the Army, respectively.
A total of 404,966 soldiers completed an HRA. No particular demographic group seems to be over- or underrepresented. Although few respondents skipped alcohol items, those who did tended to be older and of minority race. The alcohol items demonstrate a reasonable degree of reliability, with Cronbach's alpha = 0.69 and test-retest reliability associations in the 0.75-0.80 range for most items over 2- to 30-day interims between surveys. The alcohol measures showed good criterion-related validity: those consuming more than 21 drinks per week were at 6 times the risk for subsequent alcohol-related hospitalization versus those who abstained from drinking (hazard ratio, 6.36; 95% confidence interval=5.79, 6.99). Those who said their friends worried about their drinking were almost 5 times more likely to be discharged due to alcoholism (risk ratio, 4.9; 95% confidence interval=4.00, 6.04) and 6 times more likely to experience an alcohol-related hospitalization (hazard ratio, 6.24; 95% confidence interval=5.74, 6.77).
The Army's HRA alcohol items seem to elicit reliable and valid responses. Because HRAs contain identifiers, alcohol use can be linked with subsequent health and occupational outcomes, making the HRA a useful epidemiological research tool. Associations between perceived peer opinions of drinking and subsequent problems deserve further exploration.

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Available from: Nicole S Bell, Oct 07, 2015
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    • "This could result in underreporting of symptoms, given stigma surrounding mental health issues in the military (Hoge et al., 2004). However, participants in the study were assured that their responses were completely confidential and anonymous in an effort to reduce this problem, and other studies have found that self-reported alcohol use has demonstrated good validity in Army samples, even when anonymity was not assured (Bell et al., 2003). "
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    • "The main limitation is the assessment of test-retest characteristics over a range of time (approximately 2 weeks; see Methods), rather than using a fixed, a priori test-retest interval. Interval range approaches have however been used in a number of published test-retest studies of other measures of risk-taking and potentially injurious behavior (e.g., interval of 2 to 30 days for alcohol-related behavior, Bell et al., 2003; interval of 7 to 150 days for self-harm behavior, Fliege et al., 2006; interval of 6 to 11 days for HIV, HBV, and HCV risk behavior, Fry & Lintzeris, 2003; interval of 10 to 14 days for substance use, violent behavior, suicidality, and sexuality, Flisher et al., 2004). Future studies using fixed test-retest intervals, such as fixed 2-week, 3-week, 2-month, and 3-month retest intervals, would be valuable to assess the long-term stability of the behavior. "
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    • "" Responses were grouped into 4 categories based upon published guidelines for safe and unsafe drinking as follows: none ( " abstainers " ), 1 to 7 drinks, 8 to 14 drinks, and 15 or more drinks per week ( " heavy drinkers " ) (Campbell et al., 1999; Gordis, 1992; Sanchez- Craig et al., 1995). Although these self-reported items, as well as the weekly alcohol consumption measures, are susceptible to reporting bias, prior work has shown that they display good internal and external validity and are strong predictors of alcohol-related hospitalizations and early separation from service due to alcoholism (Bell et al., 2003). "
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