A number of screening instruments for alcohol dependence (AD) or problem drinking are currently in use in primary care settings. This study tests for differential item functioning by gender and ethnicity of the CAGE, TWEAK, brief MAST (BMAST), and AUDIT in 492 emergency room patients with lifetime drinking experience. As the referent standard, the Composite International Diagnostic Interview (CIDI) was used to establish whether the participant was either alcohol dependent or a harmful drinker according to ICD-10 criteria. Differential item functioning (DIF) analyses suggested that 38% of the items on the four screening instruments showed either gender or ethnic DIF.
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