Psychiatry Research 220 (2014) 11131117

Contents lists available at ScienceDirect

Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Spanish version of the Substance Use Risk Prole Scale: Factor

structure, reliability, and validity in Mexican adolescents
Rebeca Robles-Garca a, Ana Fresn a,n, Natalie Castellanos-Ryan b, Patricia Conrod b,c,
Diego Gmez d, Mara Emilia G. de Quevedo y Domnguez e, Claudia Rafful f, Tania Real a,
Luca Vsquez a, Mara Elena Medina-Mora a
a
Instituto Nacional de Psiquiatra Ramn de la Fuente Muz, Calz. Mxico-Xochimilco 101, Mexico City 14370, Mexico
b
Universit de Montral, CHU-Hpital, Canada
c
King's College London, UK
d
Instituto Mexicano de Psicoterapia Cognitivo Conductual, Mexico
e
Instituto Tecnolgico y de Estudios Superiores de Monterrey, Campus Len, Mexico
f
University of California, San Diego, USA

art ic l e i nf o a b s t r a c t

Article history: To validate the Substance Use Risk Prole Scale (SURPS) in a sample of Mexican adolescents, this brief
Received 15 April 2014 23-item self-report questionnaire has been developed to screen four high-risk personality traits for
Received in revised form substance misuse, to guide targeted approaches to prevention of addictions in adolescents. The scale has
19 August 2014
been previously validated in United Kingdom, Canada, Sri Lanka and China. A sample of 671 adolescents
Accepted 26 August 2014
Available online 6 September 2014
aged 1117 completed a Spanish translation of the SURPS as well as other measures of personality and
substance use. The Spanish translation of the SURPS has moderate internal consistency, and demon-
Keywords: strated a four-factor structure very similar to the original scale. The four subscales show good concurrent
Adolescents validity and three of the subscales were found to correlate with measures of substance use. The Spanish
Alcohol
translation of the SURPS seems to be a valid and sensitive scale that can be used in a Mexican adolescent
Drugs
population.
Personality
Prevention & 2014 Elsevier Ireland Ltd. All rights reserved.

1. Introduction broad public health initiatives through school-based programs,

There are several reasons for implementing measures aimed at
drug prevention in childhood and adolescence. First, many beha-
vioral risk factors are formed during this period of life. For
example, most smokers indicate taking up smoking in their youth,
with the highest rates of smoking reported amongst youth aged
1624 (Department of Health Report, 2000). In Mexico, almost
5.8% of adolescents aged between 12 and 14 years and 26.4% of
those aged 1517 are current smokers (Bustos et al., 2013). Second,
there is recent evidence that adolescents may be more sensitive to
the physiologic and neurotoxic effects of alcohol and drugs, and
that adolescent onset substance use is associated with a more
severe course of illness and higher risk of mortality than adult
onset (National Institute on Alcohol Abuse and Alcoholism, 2005).
For the specic case of Mexico, 22.5% of adolescents aged 1217
reported alcohol abuse with an early age of alcohol consumption
(approximately at age of 12) (Fregoso et al., 2013). Third, young
people are more accessible than adults and are easier to target in
n
Corresponding author. Tel.: 52 55 41605069; fax: 52 55 55133722.
E-mail address: fresan@imp.edu.mx (A. Fresn).
which present fewer barriers to treatment for underprivileged and
minority groups. Finally, there are several commonalties across
risk factors for adolescent onset substance use and behavior
problems, suggesting that each intervention could potentially
impact a variety of problems. Despite clinical demand for pre-
ventive interventions to address alcohol use problems among
teenagers, of those programs that have been evaluated, few have
been shown to be truly preventive.
Brief, school-based coping skills interventions targeting per-
sonality risk factors for adolescent substance misuse have been
shown to delay onset of early substance use (Conrod et al., 2006,
2008, 2010; OLeary-Barrett et al., 2010), effects which have been
shown to last for up to 2 years in two separate randomized trials
(Conrod et al., 2010). This intervention approach has also been
shown to be effective in reducing other emotional and behavioral
problems in youth (Castellanos and Conrod, 2006), problems that
often co-occur with substance use problems.
Unlike universal programs that tend to universally promote
generic coping skills and balance normative attitudes around
substance use, this selected personality-targeted approach is
based on an etiologic model of addiction outlined and validated
by Conrod et al. (2000) and Woicik et al. (2009), and targets four

http://dx.doi.org/10.1016/j.psychres.2014.08.057
0165-1781/& 2014 Elsevier Ireland Ltd. All rights reserved.
1114 R. Robles-Garca et al. / Psychiatry Research 220 (2014) 11131117
personality-specic motivational pathways to substance misuse:
Hopelessness (H), Anxiety Sensitivity (AS), Impulsivity (IMP) and
Sensation Seeking (SS), each associated with different motivations
for substance use (Woicik et al., 2009), drug use proles (Conrod
et al., 2000; Woicik et al., 2009) and patterns of non-addictive
psychopathology (Castellanos-Ryan and Conrod, 2011).
The Substance Use Risk Prole Scale (SURPS) was developed to
evaluate these four personality traits among adolescents and
adults (Woicik et al., 2009). The SURPS is a self-administered
questionnaire of 23 items rated on a Likert scale (1 strongly
disagree to 4 strongly agree). It has shown good internal con-
sistency, test re-test reliability, as well as concurrent and predic-
tive validity when used in both in adult and adolescent samples
with respect to identifying future substance misuse (Castellanos-
Ryan et al., 2013; Woicik et al., 2009).
The SURPS has been validated in the United Kingdom
(Castellanos-Ryan et al., 2013), Canada (both English and French
versions) (Castonguay-Jolin et al., 2013; Krank et al., 2011), Sri
Lanka (Chandrika et al., 2009) and China (Siu, 2011). As substance
and alcohol use among Mexican adolescents is a focus of interest
in the eld of public health, the need of a validated instrument for
Mexican adolescents useful to determine personality traits as risk
factors that predict future substance abuse is needed. Therefore,
the aim of the present study was to evaluate the psychometric
properties of the SURPS-Spanish version in Mexican adolescents.
2. Method
2.1. Participants
Six hundred and seventy one adolescents were recruited, using a convenience
sampling approach from public schools located in Mexico City and Jalisco, Mexico.
The sample is made up of 314 (46.8%) boys and 357 girls (53.2%) attending high-
school, aged between 11 and 17 years (mean age 14.09, S.D. 1.2 years) whom
agreed to participate voluntarily and anonymously previous school authorities'
approval of the study. The Ethics Review Board of the INPRFM approved the study.
The study was conducted according to the Good Clinical Practices.
2.2. Measures and procedures
The translation of the SURPS was based on recommendations of the American
research teams (U.S. Census Bureau, 2010). First, the instrument was translated
from English into Spanish by two independent translators and back-translation was
performed. The translations were reviewed by one of the authors and by two
independent mental health professionals and consensus was reached for language
adaptation for each item. The recruitment for the study began after the translation
procedure of the SURPS was completed.
After students completed the SURPS, ve additional self-administered instru-
ments were provided, all of which have been previously validated for a Spanish-
speaking population. The rst three instruments were used to determine con-
vergent validity of the SURPS subscales: the Beck Hopelessness Scale (BHS) which
comprises 20 items of truefalse response (Beck et al., 1974) and has shown
adequate internal consistency in Mexican population ( 0.78) (Crdova and
Rosales, 2011); the Beck Anxiety Inventory (BAI) composed of 21 items rated on
a Likert scale (03 points) (Beck et al., 1988; Osman et al., 2002) with an internal
consistency of 0.84 in Mexican students (Robles et al., 2001) and the Impulsiveness,
Venturesomeness and Empathy-Junior version (IVE-J) which has 77 items each one
rated as true or false (Eysenck et al., 1984) with alpha values 40.70 in Mexican
population (Martorell and Silva, 1993).
The last two instruments were used to assess drug use and to determine
predictive validity of the SUPRS. As a screening test, the Drug Abuse Screening Test
(DAS-T), a 20-item instrument rated on a yes or no response, was used (Gavin et
al., 1989; Yudko et al., 2007). The DAS-T has been previously tested in Mexican
population with high values of internal consistency (Kuder Richardson 0.96) (De las
Fuentes and Villalpando, 2001). Students who answered yes to any question of the
DAS-T also completed the Alcohol, Smoking and Substance Involvement Screening
Test (ASSIST) (Humeniuk et al., 2008; WHO ASSIST Working Group, 2002), which
was used for the present study to obtain information about lifetime use and use of
substances in the past 3 months. Also, the ASSIST has already been used with young
population in Mexico with adequate psychometric properties (Rivadeneyra and
Gmez-Maqueo, 2011)
2.3. Statistical analyses
The analyses were carried out with version 20.0 of the SPSS statistical software.
First, skewness and kurtosis were used in order to test normal distribution of the
SURPS items. Second, a principal-component analysis with varimax rotation was
performed to obtain construct validity of the proposed subscales of the SURPS. The
criterion of threshold for factor extraction was eigen values greater-than-one. Items
whose communality was greater than 0.40 were retained and allocated to factors
while those with communality less than 0.40 were excluded. Third, internal
consistency of the SUPRS subscales was determined by Cronbach's alpha. Fourth,
convergent validity of the SURPS subscales was obtained by determining their
association with the total scores of the BHS (for the H subscale), BAI (for the AS
subscale), IVE-J Impulsiveness (for IMP subscale) and IVE-J Venturesomeness (for
the SS subscale) with Pearson correlation coefcients.
For the present study a cut-off point of six (intermediate to severe risk for
substance abuse) in the total score of the DAS-T was used as the gold standard to
determine the predictive validity of the SURPS subscales used (Gavin et al., 1989).
For this, a Receiver Operating Characteristic (ROC) curve for each SURPS subscale
was plotted and the area under each ROC curve (AUC) was estimated. The optimal
cut-off point for each subscale, according to sensitivity and specicity values, was
obtained. With the use of these cut-off values, a logistic regression analysis was
performed to determine the odds ratios (OR) conferred by the SURPS subscales for
an increased risk for substance abuse according to the DAS-T (score Z6). Finally,
chi square tests (2) and independent samples T tests were used to compare the
ASSIST parameters (lifetime use and use of substances in the past 3 months) and
the SURPS subscales scores between subjects with an increased risk for substance
abuse (DAS-T score Z 6) and those with a low risk (DAS-T between 1 and 5 points).
3. Results
All items of the SURPS showed acceptable values of skewness
(range:  0.65 to 1.38) and kurtosis (range  1.17 to 1.63), where
none of the values were excessively out of range.
3.1. Factor structure and reliability of the SURPS
Four factors were identied for the SURPS accounting for
44.57% of the variance (Table 1), and corresponding to the original
dened dimensions. Mean scores of the dimensions were as
follows: Introversion/Hopelessness scale 10.8, S.D. 3.4 points;
Anxiety Sensitivity scale 11.9, S.D. 2.8 points; Impulsivity scale
11.5, S.D. 2.7 points; and Sensation Seeking scale 15.8, S.D. 3.5
points. All items loaded on one factor only, with the exception of
item 22 which showed communality less than 0.40 on all factors
and was excluded from analysis. All subscales showed nearly not
adequate internal consistency values (alpha values from 0.61 to
0.66) with the exception of the Introversion/Hopelessness scale
which exhibited strong Cronbach's alpha value (4 0.80). No
improvement was observed in the internal consistency of the
scales by removing any of the items that compose them.
3.2. Concurrent validity
Signicant correlations of the SURPS subscales were observed
with the instruments selected to obtain concurrent validity. The
association of the BHS with the Hopelessness/Introversion sub-
scale was 0.59 (po 0.001); for the IVEJ-Impulsiveness with the
Impulsivity subscale of 0.60 (p o0.001) and for the IVE-J Venture-
someness with the Sensation Seeking subscale of 0.60 (po 0.001).
The lowest correlation value was found with the BAI and the
Anxiety Sensitivity subscale (r 0.26, p o0.001).
3.3. Cut-off points and conferred risk for substance abuse of the
SURPS subscales
According to the DAS-T, 35 (5.2%) students met criteria for
being at intermediate/severe risk for substance abuse. The overall
discriminability of each SURPS subscale against the criterion of the
DAS-T was determined by ROC curves and the area under the
 R. Robles-Garca et al. / Psychiatry Research 220 (2014) 11131117 1115

Table 1
Factor loadings of the SURPS itemsvarimax.

Item Factors

Introversion/Hopelessness Impulsivity Sensation Seeking Anxiety Sensitivity

1 I am content 0.767
4 I am happy 0.758
7 I have faith that my future holds great promise 0.613
13 I feel proud of my accomplishments 0.669
17 I feel that I'm a failure 0.629
20 I feel pleasant 0.745
23 I am very enthusiastic about my future 0.705
2 I often don't think things through before I speak 0.496
5 I often involve myself in situations that I later regret being involved in 0.606
11 I usually act without stopping to think 0.747
15 Generally, I am an impulsive person 0.712
3 I would like to skydive. 0.725
6 I enjoy new and exciting experiences even if they are unconventional 0.548
9 I like doing things that frighten me a little 0.576
12 I would like to learn how to drive a motorcycle 0.579
16 I am interested in experience for its own sake, even if it is illegal 0.514
19 I would enjoy hiking long distances in wild and uninhabited territory 0.681
8 It's frightening to feel dizzy or faint 0.578
10 It frightens me when I feel my heart beat change 0.621
14 I get scared when I'm too nervous 0.645
18 I get scared when I experience unusual body sensations 0.677
21 It scares me when I'm unable to focus on a task 0.535
Eigenvalue 4.26 2.57 2.09 1.31
Variance (%) 18.53 11.17 9.12 5.73
Cronbach's alpha 0.83 0.63 0.66 0.61

curve (AUC). With the exception of the AS subscale, all the SURPS
subscales showed signicant capacity for discrimination. Several
cut-off points for each subscale were tested to identify the most
appropriate threshold for substance abuse risk (Fig. 1).
The logistic regression analysis using the obtained cut-off
points showed that all subscales with the exception of AS
(B  0.25, OR 0.77, CI 95% 0.361.64, p 0.50) were signicant
predictors for substance abuse. The IMP subscale was the stronger
predictor (B 1.6, OR 5.20, CI 95%1.9413.93, p 0.001), fol-
lowed by the SS subscale (B 1.4, OR4.24, CI 95% 1.809.98,
p 0.001) and the H subscale (B 0.93, OR 2.54, CI 95% 1.14
5.65, p 0.02).

3.4. Risk for substance abuse and current consumption

Signicant differences emerged between students with an

increased risk for substance abuse (DAS-T score Z6; n 35) and
those with a low risk (DAS-T between 1 and 5 points; n 236) on
the ASSIST parameters of lifetime use and use of substances in the
past 3 months. A higher proportion of students with an increased
risk exhibited a weekly or daily pattern of substance consumption
(Table 2). For hallucinogens and opioid use less than 5 students in
each group reported lifetime use.
In addition, these students reported higher scores in the H
subscale (14.0, S.D. 4.4 vs. 11.4, S.D. 3.5, p o0.001), the IMP
subscale (14.1, S.D. 2.9 vs. 12.0, S.D. 2.6, p o0.001) and the SS
subscale (18.8, S.D. 2.5 vs. 16.3, S.D. 3.4, p o0.001) with no
differences in the AS subscale (12.3, S.D. 3.5 vs. 12.0, S.D. 2.9,
p 0.59) of the SURPS.
4. Discussion
The aim of the present study was to evaluate the factor
structure, validity and reliability of the SURPS-Spanish version, a
valuable tool for identifying adolescents at high-risk for substance
misuse (Conrod et al., 2006, 2010; Krank et al., 2011).
Fig. 1. Receiver Operating Characteristic (ROC curves) and area under the curve
(AUC) of the SURPS subscales.
According to our data, the factor structure of the Spanish
version of the SURPS corresponded to the original, including four
main dimensions: Hopelessness (H), Anxiety Sensitivity (AS),
Impulsivity (IMP), and Sensation Seeking (SS). However, the item
I feel I have to be manipulative to get what I want (an intended
IMP item; item 22) was problematic. This also happened with the
EnglishCanadian version (Krank et al., 2011); and it seems to be
an item more related to callous/unemotional traits than with
impulsivity.
Additionally, concurrent validity tests showed that all four brief
scales measure the desired personality dimension. In terms of
predictive validity, our results replicate previous results of the
1116 R. Robles-Garca et al. / Psychiatry Research 220 (2014) 11131117

Table 2 Second, current non-probabilistic sampling does not guarantee

ASSIST parameters between students with high and low risk for substance abuse. the generalization of results to all Mexicans. Moreover, adolescents
in the present study were from large urban areas. Thus, further
Low risk High risk Statistic
n 236 n 35 studies with a probabilistic sampling approach are still needed.
Third, the cross-sectional design of the study limits the inter-
n % n % pretation of our results as the directionality of the relationship
between the personality traits and drugs consumption cannot be
Tobacco Lifetime use 126 53.4 27 77.1 2 6.9, p 0.008
In the last 3 months 2 6.9, p 0.008
fully determined. A longitudinal research may provide data of
No 133 56.4 9 25.7 higher impact related to this topic.
12 times/each month 89 37.7 14 40.0 Fourth, the low reliability values of three of the SURPS
Weekly/daily 14 5.9 12 34.3 subscales highlight the need of conducting more studies aimed
Alcohol Lifetime use 223 94.5 34 97.1 2 0.43, p 0.50
at improving the internal consistency of the subscales. It is
In the last 3 months 2 34.1, p o 0.001
No 39 16.5 3 8.6 possible that language translation and cultural factors are inter-
12 times/each month 165 70.0 14 40.0 fering with the reliability of the scale; in this way, it is possible
Weekly/daily 32 13.5 18 51.4 that by replacing some items for other more adequate to the
Cannabis Lifetime use 24 10.2 16 45.7 2 30.6, p o 0.001 cultural background of the sample as well as proving different
In the last 3 months 2 49.0, p 0.008
No 217 91.9 19 54.3
choices in the translation of the items may improve reliability and
12 times/each month 18 7.7 11 31.4 validity of the SURPS and should be targeted in future studies.
Weekly/daily 1 0.5 5 14.3 Despite these caveats, the present study provides support for
Cocaine Lifetime use 3 13 8 22.9 2 36.4, p o 0.001 the structural validity, and good concurrent and predictive validity
In the last 3 months 2 36.7, po 0.001
of the SURPS in young adolescence. Clinical implications include
No 234 99.2 28 80.0
12 times/each month 2 0.8 6 17.1 making available a valid and reliable brief tool to identify young
Weekly/daily 0 1 2.9 people at risk for developing addictions in non-English speaking
Amphetamines Lifetime use 9 3.8 8 22.9 2 18.8, p o0.001 populations allowing international comparisons of the prevalence
In the last 3 months 2 28.9, p o 0.001 of youth at risk. Moreover, the SURPS may become an important
No 229 97.0 27 77.1
12 times/each month 6 2.6 7 20.0
tool for the daily clinical practice and for the clinical researcher, as
Weekly/daily 1 0.4 1 3.0 it has been repeatedly used to match adolescents at risk with
Inhalants Lifetime use 25 10.6 14 40.0 2 21.3, p o0.001 successful personality-targeted prevention/intervention programs.
In the last 3 months 2 33.9, p o 0.001
No 217 91.9 21 60.0
12 times/each month 18 7.6 13 37.1
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