Psychometric properties of the Spanish version of the Cannabis Use Problems Identification Test among Chilean university students: A validation study

Highlights

• The Spanish version of CUPIT is a valuable screening tool for use among young people.

• The Spanish CUPIT has been demonstrated to be a reliable and valid screening tool.

• It can classify cannabis users with a current and emergent cannabis use disorder.

• Spanish CUPIT will allow health professional taking preventive and intervention action.

Abstract

Background

In Chile, concerns mount about escalating cannabis use. Thus, it is important to have tools for early identification of at-risk users. The Cannabis Use Problems Identification Test (CUPIT) is a useful screening tool, and the aim of this study was to examine the psychometric properties of its Spanish version among Chilean university students.

Methods

The CUPIT was translated into Spanish, pre-tested in a focus group (n = 8), and then tested through an online survey (n = 3798, 28% response rate). Of the 1061 respondents, 578 reported 12-month cannabis use. Internal reliability, internal structure, and concurrent validity (using the Cannabis Abuse Screening Test [CAST]) were obtained. Test–retest reliability was calculated (n = 150) at 3–4 weeks (30% of attrition rate). Discriminative validity was evaluated comparing CUPIT subscales and four DSM-IV diagnostic groups. Receiving operator characteristic (ROC) curve analysis assessed sensitivity and specificity.

Results

Test–retest Pearson correlation between total CUPIT scores of 0.90 (p < 0.001), and highly significant Kendall Tau-b coefficients for individual items (p < 0.001) indicated excellent reliability. Concordance between the CUPIT and CAST (Pearson correlation 0.73, p < 0.001) indicated good concurrent validity. ANOVA revealed significant differences in CUPIT scores between the four DSM-IV diagnostic groups (p < 0.001), indicative of good discriminative validity. ROC analysis (gold standard: DSM-IV abuse/dependence) yielded an AUC value of 0.72, indicating acceptable discriminative capability.

Conclusions

The Spanish CUPIT is reliable, valid, and accepted by the university population studied, and, thus, a potentially useful tool for identifying both problematic and at-risk users.

Introduction

In Europe last year, 16.6 million (13.3%) young adults aged 15–34 years reported cannabis use (EMCDDA, 2016). Recent Chilean surveys show consistently dramatic increases in 12-month cannabis use from 19.5% in 2011 to 30.6% in 2013 by secondary students (SENDA, 2013). Last year, cannabis use also increased in the general population, from 5.3% in 2010 to 13.5% in 2014 among 12–18-year-olds, and from 12.3% in 2010 to 24% in 2014 for 19–25-year-olds (SENDA, 2015).

Surveys among students of Pontificia Universidad Católica de Chile (UC) showed that past-year cannabis use increased from 28% in 2011 to 46% in 2013. Perception of risks involved simultaneously decreased from 53.5% to 39.5% during that period (DAE, 2011, DAE, 2013)

There is much scientific evidence of the negative effects of cannabis use (Meier et al., 2012, Volkow et al., 2014, Volkow et al., 2016, Hall, 2015, Hall and Lynskey, 2016, Arria et al., 2016, Auer et al., 2016), especially in young people, who presented low risk perception (SENDA, 2013, DAE, 2013) and a low rate of seeking help (Caldeira et al., 2009). However, if not all users run the same risk, a screening instrument can facilitate timely targeted interventions to arrest progression to more serious physical and mental harm.

A small assortment of cannabis-specific screening instruments has been developed worldwide. These include the Cannabis Use Disorders Identification Test (CUDIT; Annaheim et al., 2008, Piontek et al., 2008) and its revised version, CUDIT-R (Adamson et al., 2010); the Cannabis Screening Inventory (MSI-X; Alexander and Leung, 2004) in the United States; the Problematic Cannabis Use Test (PUM; Piontek et al., 2008) in Poland; and the Adolescent Cannabis Problems Questionnaire (CPQ-A; Martin et al., 2006) and its version validated in Spain (Fernández-Artamendi et al., 2012). In Chile, the CAST (Legleye et al., 2015) has been used successfully to screen secondary students with past-year cannabis use for the risk of meeting criteria for cannabis use disorder (SENDA, 2013).

The CUPIT is a screening tool empirically developed by researchers from New Zealand (Bashford et al., 2010) for testing among users aged from 13 years. It identifies the frequency and intensity of cannabis use in the past year and in the past 3 months, cannabis-induced problems, the current risk of harm within the next 12 months, and a current disorder (Bashford et al., 2010). What distinguishes this instrument from other cannabis screening tests is its capability to classify both currently diagnosable and potentially problematic cannabis use (Bashford et al., 2010).

This instrument can be used as part of prevalence studies of drug use in university populations, where the identification of level of risk would enable preventive institutional interventions (Yap et al., 2012), such as: social norms campaigns (Dejong et al., 2006), aiming to reduce misperceptions about cannabis use and its associated risks (Turner et al., 2008), for targeted preventive interventions, using the instrument via online websites along with the delivery of personalized feedback (Larimer and Cronce, 2007, Palfai et al., 2014, Cronce and Larimer, 2011), and for the screening of non-consultant students, using brief motivational interventions (McCambridge et al., 2011) by trained professionals (Larimer and Cronce, 2007, Cronce and Larimer, 2011).

The validated CUPIT can make a valuable contribution because, besides CAST, no other cannabis screening instruments are validated nor available for use in Chile.

To have a Spanish version of this rapid and reliable tool for the identification of problematic and risky cannabis use, a validation project for the CUPIT was developed in 2013 at UC.