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

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: cylin36933@gmail.com.
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

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

Chih-Ting Lee et al. J Psychiatr Res. 2023 Sep.

. 2023 Sep:165:16-27.

doi: 10.1016/j.jpsychires.2023.06.033. Epub 2023 Jul 6.

Authors

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: cylin36933@gmail.com.
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.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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MeSH terms

LinkOut - more resources

Full Text Sources

Medical