The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries

Chih-Ting Lee; Chung-Ying Lin; Mónika Koós; Léna Nagy; Shane W Kraus; Zsolt Demetrovics; Marc N Potenza; Rafael Ballester-Arnal; Dominik Batthyány; Sophie Bergeron; Joël Billieux; Julius Burkauskas; Georgina Cárdenas-López; Joana Carvalho; Jesús Castro-Calvo; Lijun Chen; Giacomo Ciocca; Ornella Corazza; Rita I Csako; David P Fernandez; Elaine F Fernandez; Hironobu Fujiwara; Johannes Fuss; Roman Gabrhelík; Ateret Gewirtz-Meydan; Biljana Gjoneska; Mateusz Gola; Joshua B Grubbs; Hashim T Hashim; Md Saiful Islam; Mustafa Ismail; Martha Jiménez-Martínez; Tanja Jurin; Ondrej Kalina; Verena Klein; András Költő; Sang-Kyu Lee; Karol Lewczuk; Christine Lochner; Silvia López-Alvarado; Kateřina Lukavská; Percy Mayta-Tristán; Ionut Milea; Dan J Miller; Oľga Orosová; Gábor Orosz; Sungkyunkwan University's Research Team(,); Fernando P Ponce; Gonzalo R Quintana; Gabriel C Quintero Garzola; Jano Ramos-Diaz; Kévin Rigaud; Ann Rousseau; Marco De Tubino Scanavino; Marion K Schulmeyer; Pratap Sharan; Mami Shibata; Sheikh Shoib; Vera Sigre-Leirós; Luke Sniewski; Ognen Spasovski; Vesta Steibliene; Dan J Stein; Julian Strizek; Berk C Ünsal; Marie-Pier Vaillancourt-Morel; Marie Claire Van Hout; Beáta Bőthe

doi:10.1016/j.jpsychires.2023.06.033

The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries

J Psychiatr Res. 2023 Sep:165:16-27. doi: 10.1016/j.jpsychires.2023.06.033. Epub 2023 Jul 6.

Authors

Chih-Ting Lee¹, Chung-Ying Lin², Mónika Koós³, Léna Nagy³, Shane W Kraus⁴, Zsolt Demetrovics⁵, Marc N Potenza⁶, Rafael Ballester-Arnal⁷, Dominik Batthyány⁸, Sophie Bergeron⁹, Joël Billieux¹⁰, Julius Burkauskas¹¹, Georgina Cárdenas-López¹², Joana Carvalho¹³, Jesús Castro-Calvo¹⁴, Lijun Chen¹⁵, Giacomo Ciocca¹⁶, Ornella Corazza¹⁷, Rita I Csako¹⁸, David P Fernandez¹⁹, Elaine F Fernandez²⁰, Hironobu Fujiwara²¹, Johannes Fuss²², Roman Gabrhelík²³, Ateret Gewirtz-Meydan²⁴, Biljana Gjoneska²⁵, Mateusz Gola²⁶, Joshua B Grubbs²⁷, Hashim T Hashim²⁸, Md Saiful Islam²⁹, Mustafa Ismail²⁸, Martha Jiménez-Martínez³⁰, Tanja Jurin³¹, Ondrej Kalina³², Verena Klein³³, András Költő³⁴, Sang-Kyu Lee³⁵, Karol Lewczuk³⁶, Christine Lochner³⁷, Silvia López-Alvarado³⁸, Kateřina Lukavská³⁹, Percy Mayta-Tristán⁴⁰, Ionut Milea⁴¹, Dan J Miller⁴², Oľga Orosová⁴³, Gábor Orosz⁴⁴; Sungkyunkwan University's Research Team(,)⁴⁵; Fernando P Ponce⁴⁶, Gonzalo R Quintana⁴⁷, Gabriel C Quintero Garzola⁴⁸, Jano Ramos-Diaz⁴⁹, Kévin Rigaud⁴⁴, Ann Rousseau⁵⁰, Marco De Tubino Scanavino⁵¹, Marion K Schulmeyer⁵², Pratap Sharan⁵³, Mami Shibata⁵⁴, Sheikh Shoib⁵⁵, Vera Sigre-Leirós⁵⁶, Luke Sniewski⁵⁷, Ognen Spasovski⁵⁸, Vesta Steibliene¹¹, Dan J Stein⁵⁹, Julian Strizek⁶⁰, Berk C Ünsal³, Marie-Pier Vaillancourt-Morel⁶¹, Marie Claire Van Hout⁶², Beáta Bőthe⁹

Affiliations

¹ Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: [email protected].
³ Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
⁴ Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA.
⁵ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.
⁶ Yale University School of Medicine, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA.
⁷ Departmento de Psicología Básica, Clínica y Psicobiología, University Jaume I of Castellón, Spain.
⁸ Institute for Behavioural Addictions, Sigmund Freud University Vienna, Austria.
⁹ Département de Psychologie, Université de Montréal, Montréal, Canada.
¹⁰ Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland.
¹¹ Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
¹² Virtual Teaching and Cyberpsychology Laboratory, School of Psychology, National Autonomous University of Mexico, Mexico.
¹³ William James Center for Research, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal; CPUP: Center for Psychology at Porto University.
¹⁴ Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain.
¹⁵ Department of Psychology, College of Humanity and Social Science, Fuzhou University, China.
¹⁶ Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
¹⁷ Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, United Kingdom; Department of Psychology and Cognitive Science, University of Trento, Italy.
¹⁸ Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand.
¹⁹ Nottingham Trent University, United Kingdom.
²⁰ HELP University, Malaysia.
²¹ Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Decentralized Big Data Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.
²² Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
²³ Charles University, Department of Addictology, Prague, Czech Republic; General University Hospital in Prague, Department of Addictology, Czech Republic.
²⁴ School of Social Work, University of Haifa, Israel.
²⁵ Macedonian Academy of Sciences and Arts, Macedonia.
²⁶ Institute of Psychology, Polish Academy of Sciences, Poland; Institute for Neural Computations, University of California San Diego, USA.
²⁷ Bowling Green State University, United States.
²⁸ University of Baghdad, College of Medicine, Iraq.
²⁹ Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, 1342, Bangladesh.
³⁰ Universidad Pedagógca y Tecnológica de Colombia, Colombia; Grupo de Investigación Biomédica y de Patología, Colombia.
³¹ Department of Psychology, Humanities and Social Sciences, University of Zagreb, Croatia.
³² Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia.
³³ School of Psychology, University of Southampton, United Kingdom.
³⁴ Health Promotion Research Centre, University of Galway, Ireland.
³⁵ Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, South Korea; Chuncheon Addiction Management Center, South Korea.
³⁶ Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
³⁷ SAMRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch University, South Africa.
³⁸ University of Cuenca, Ecuador.
³⁹ Charles University, Department of Addictology, Prague, Czech Republic; Charles University, Department of Psychology, Prague, Czech Republic.
⁴⁰ Universidad Científica Del Sur, Lima, Peru.
⁴¹ Babeș-Bolyai University, Romania.
⁴² James Cook University, Australia.
⁴³ Pavol Jozef Safarik University in Kosice, Department of Educational Psychology and Psychology of Health, Slovakia.
⁴⁴ Artois University, France.
⁴⁵ Department of Psychology, Sungkyunkwan University, South Korea.
⁴⁶ Facultad de Psicología, Universidad de Talca, Chile.
⁴⁷ Departamento de Psicología y Filosofía, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile.
⁴⁸ Florida State University, Panama; Sistema Nacional de Investigación (SNI), SENACYT, Panama.
⁴⁹ Universidad Privada Del Norte, Lima, Peru.
⁵⁰ Leuven School for Mass Communication, KU Leuven, Leuven, Belgium.
⁵¹ Department of Psychiatry, Universidade de São Paulo, Brazil; Experimental Pathophisiology Post Graduation Program, Universidade de São Paulo, Brazil.
⁵² Universidad Privada de Santa Cruz de la Sierra, Bolivia.
⁵³ Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India.
⁵⁴ Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁵⁵ Department of Psychology, Shardha University, India.
⁵⁶ Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Institute of Legal Psychiatry, Lausanne University Hospitals (CHUV), Lausanne, Switzerland.
⁵⁷ Auckland University of Technology, New Zealand.
⁵⁸ University of Ss. Cyril and Methodius in Trnava, Slovakia.
⁵⁹ SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa.
⁶⁰ Austrian Public Health Institute, Austria.
⁶¹ Département de Psychologie, Université Du Québec à Trois-Rivières, Trois-Rivières, Canada.
⁶² Public Health Institute, Liverpool John Moores University, United Kingdom.

PMID: 37453212
DOI: 10.1016/j.jpsychires.2023.06.033

Abstract

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an instrument to screen substance-use-related health risks. However, little is known whether the ASSIST could be further shortened while remaining psychometrically sound across different countries, languages, gender identities, and sexual-orientation-based groups. The study aimed to validate a shortened 11-item ASSIST (ASSIST-11). Using the International Sex Survey data, 82,243 participants (M _age = 32.39 years) across 42 countries and 26 languages completed questions from the ASSIST-11 regarding gender identity, sexual orientation, and other information. Confirmatory factor analysis (CFA) and multigroup CFA (MGCFA) evaluated the ASSIST-11's structure and tested measurement invariance across groups. Cronbach's α and McDonald's ω were used to examine the internal consistency. Cohen's d and independent t-tests were used to examine known-group validity. The ASSIST-11 was unidimensional across countries, languages, age groups, gender identities (i.e., men, women, and gender-diverse individuals), and sexual orientations (i.e., heterosexual and sexual minority individuals). Cronbach's α was 0.63 and McDonald's ω was 0.68 for the ASSIST-11. Known-group validity was supported by Cohen's d (range between 0.23 and 0.40) with significant differences (p-values<0.001). The ASSIST-11 is a modified instrument with a unidimensional factor structure across different languages, age groups, countries, gender identities, and sexual orientations. The low internal consistency of the ASSIST-11 might be acceptable as it assesses a broad concept (i.e., use of several different substances). Healthcare providers and researchers may use the ASSIST-11 to quickly assess substance-use information from general populations and evaluate the need to follow up with more detailed questions about substance use.

Keywords: Addictive behaviors; Cross-cultural study; Factor structure; Measurement invariance; Psychometrics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Cultural Comparison*
Female
Gender Identity
Humans
Male
Psychometrics
Reproducibility of Results
Smoking
Substance-Related Disorders* / diagnosis
Surveys and Questionnaires