- Email: [email protected]
Prevalence of problematic tobacco and alcohol use among general hospital outpatients in Thailand
Accepted Manuscript Title: Prevalence of problematic tobacco and alcohol use among general hospital outpatients in Thailand Author: Yanin Suksangkharn Piangmas Tasneeyapant Patcharida Mahatchariyapong Thanyathad Suwanaro Kunravitch Soraprajum Naratip Sanguanpanich Lakkhana Thongchot Nattawut Apiwannarat Wichian Boonyaprapa Woraphat Ratta-apha Nantawat Sitdhiraksa PII: DOI: Reference:
S1876-2018(17)30153-3 http://dx.doi.org/doi:10.1016/j.ajp.2017.05.009 AJP 1161
To appear in: Received date: Revised date: Accepted date:
5-3-2017 4-5-2017 6-5-2017
Please cite this article as: Suksangkharn, Y., Tasneeyapant, P., Mahatchariyapong, P., Suwanaro, T., Soraprajum, K., Sanguanpanich, N., Thongchot, L., Apiwannarat, N., Boonyaprapa, W., Ratta-apha, W., Sitdhiraksa, N.,Prevalence of problematic tobacco and alcohol use among general hospital outpatients in Thailand, Asian Journal of Psychiatry (2017), http://dx.doi.org/10.1016/j.ajp.2017.05.009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Prevalence of problematic tobacco and alcohol use among general hospital outpatients in Thailand
ip t
Yanin Suksangkharn*, Piangmas Tasneeyapant*,
cr
Patcharida Mahatchariyapong*,
us
Thanyathad Suwanaro*, Kunravitch Soraprajum*,
an
Naratip Sanguanpanich BSc**, Lakkhana Thongchot, BS**,
M
Nattawut Apiwannarat MD**,
Woraphat Ratta-apha MD, PhD**
Ac ce p
te
Nantawat Sitdhiraksa MD, PhD**
d
Wichian Boonyaprapa MSc***,
* Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*** Siriraj Information Technology Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Correspondence to: Woraphat Ratta-apha Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University,
Page 1 of 8
2
2 Prannok Road, Siriraj, Bangkoknoi, Bangkok 10700, Thailand. Phone: 0-2419-4293-8, Fax: 0-2419-4298
ip t
E-mail: [email protected]
cr
Tel: +66-2-419-4295-8, Fax +66-2-419-4298
us
Highlights:
an
- Prevalence of problematic tobacco and alcohol uses in general hospital was examined
M
- 2.2% of outpatients were moderate-to-high dependence to smoking - 10.8% of outpatients were the hazardous drinkers to alcohol dependence
d
- Problematic tobacco and alcohol use were prevalent in the mean age of 5th decade
te
Abstract
Ac ce p
The present study aimed to determine the prevalence of problematic tobacco and alcohol use in the outpatients. Data was collected from the screening tools (Fagerstrom, AUDIT, and CAGE questionnaires) of 1,700 recruited outpatients. The results showed 2.2% of outpatients were moderate-to-high dependence to smoking, 10.8% and 14.7% of outpatients were the hazardous drinkers to alcohol dependence and alcohol use problem respectively. The outpatients with problematic tobacco and alcohol use were in the mean age of 5th decade and had a bigger proportion of male. In conclusion, the prevalence of problematic tobacco and alcohol use was substantial and need to detection.
Page 2 of 8
3
Keywords: alcohol use, tobacco use, Fagerstrom, AUDIT, CAGE, Dear Editor,
ip t
Problematic tobacco and alcohol uses are important public health problems in Thailand, which associated with many physical and psychiatric disorders (Bundhamcharoen et al., 2011).
cr
We aimed to study the prevalence of patients with problematic tobacco and alcohol uses among
us
the outpatients through the screening instruments, to determine the scale and the characteristics of patients who were at risk in a General Hospital.
an
We conducted a cross-sectional study to investigate the problematic tobacco and alcohol
M
uses in a setting of the general hospital. The number of participants was 1,700 recruited from 9 departments stratified by the number of outpatients in 2012. The participants met the criteria of
d
age ≥ 18 years which excluded communication deficit and mental retardation. The participants
te
were asked for filled the history of alcohol and tobacco use and status, Fagerstrom (Heatherton et al., 1991), AUDIT (Saunders et al., 1993) and CAGE (Ewing, 1984) questionnaires. The
Ac ce p
collecting data (characteristics, scores of the screening tools) was analyzed with SPSS software v16.0 (SPSS Inc, Chicago, Illinois, US). The problematic tobacco and alcohol use was defined by categories of moderate-to-high in Fagerstrom test, hazardous drinker to alcohol dependence in AUDIT, and alcohol use problem in CAGE. The total number of 1,700 was 710 (41.8%) males and 987(58.2%) females. The average age was 50.7 ± 17.6 years. The 96 (5.7%) participants were current smokers. The severity of Fagerstrom test was classified into 3 categories: low dependence, moderate dependence, and high dependence which contributed 3.18, 1.9, and 0.3 % among all participants and 58.1, 1.9, and 0.3 % among current smokers. Thus, the number of patients with problematic tobacco use
Page 3 of 8
4
was 2.2 %. The average ages of low dependence, moderate dependence, and high dependence were 44.1, 44.1 and 42.8, while male-to-female ratios were 12.5:1, 32.0:1 and 4.0:1. The result from AUDIT showed 19.3%, 8.4%, 1.1% and 1.3% were low-risk drinker,
ip t
hazardous drinker, harmful use, and alcohol dependence respectively. The number of patients with problematic alcohol use was 10.8 %. The average ages of low-risk drinker, hazardous
cr
drinker, harmful use, and alcohol dependence were 42.1, 49.3, 49.3, and 44.0, while the male-to-
us
female ratios were 1.3:1, 7.9:1, 19.0:0, and 21.0:1. The result from CAGE showed 14.7 % had alcohol use problem which could be implied as problematic alcohol use. This group’s age was
an
45.0 years in average with the male-to-female ratio of 3.1:1. Among current drinkers, 47.7 % of patients had alcohol use problem and considered having problematic alcohol use. The group’s
M
age was 47.7 year in average with male-to-female ratio of 3.2:1. We also analyzed the correlation
te
0.7).
d
between AUDIT and CAGE and found the strong correlation by the Pearson’s correlation (r =
The results from the present study showed the magnitude of problematic tobacco and
Ac ce p
alcohol uses among the outpatients with physical problems that might contribute to their physical diseases. The prevalence of problematic tobacco use ranged from 2.7 % in normal Thai population to 47.7 % (Maneeganol et al., 2014; Sooksompong et al., 2016), while the result of the present study was 2.2 %. The prevalence of problematic alcohol use ranged from 5.0 to 57.7 % (Assanangkornchai et al., 2010; Chaithawanwong et al., 2013; Junsirimongkol et al., 2011; Maneeganol et al., 2014; Sooksompong et al., 2016), while the results of the present study were 14.7 % with CAGE and 10.8 % with AUDIT. The difference among the size of prevalence of problematic alcohol and tobacco use depend on various factors, including, the screening and diagnostic tools, the surveyed setting, and the selected population.
Page 4 of 8
5
Next, it is worth noticing that all categories that defined problematic tobacco and alcohol use in patients with physical problems were in the age of 5th decade and had a greater proportion of male than female. These characteristics helped recognize the patients that were most at risk
ip t
and needed keen attention. We suggest the implementation of screening tests in outpatient departments, for example, the written version and the oral interview of CAGE questionnaire
cr
(Ratta-Apha et al., 2014).
us
The present study had several limitations. First, the result might not represent all of the outpatients such as patients with severe physical conditions, teenagers, and patients with
an
cognitive decline. Second, patients with problematic tobacco and alcohol consumption may be denial or exhibit recall bias. Collecting data from other sources, such as family’s members
M
should be helpful in the practice. The results of the present study could not be generalized to the
d
other general hospitals which needed to investigate the size of problems. In conclusion, we
te
suggested that problematic tobacco and alcohol use should be on spot. Screening instruments are
Ac ce p
helpful in detecting patients with patients at risk in clinical practice.
Acknowledgements
The present study was supported by the Siriraj Institutional Review Board (SIRB), Faculty of Medicine, Siriraj Hospital, Mahidol University. (CoA Si 392/2557). We would like to thank Miss Aree Singlampong for her coordination in this project and the staff of outpatient units, Siriraj Hospital for their cooperation.
Conflicts of interest None.
Page 5 of 8
6
Reference: Assanangkornchai, S., Sam-Angsri, N., Rerngpongpan, S., Lertnakorn, A., 2010. Patterns of alcohol consumption in the Thai population: results of the National Household Survey of
ip t
2007. Alcohol Alcohol 45 (3) 278-285.
cr
Bundhamcharoen, K., Odton, P., Phulkerd, S., Tangcharoensathien, V., 2011. Burden of disease in Thailand: changes in health gap between 1999 and 2004. BMC Public Health 11, 53.
us
Chaithawanwong, T., Kalayasiri, R., 2013. Alcohol Drinking of Construction Workers in
an
Bangkok Metropolis. J Psychiatr Assoc Thailand 58 (4) 345-358.
M
Ewing, J.A., 1984. Detecting alcoholism. The CAGE questionnaire. JAMA. 252 (14) 1905-1907. Heatherton, T.F., Kozlowski, L.T., Frecker, R. C., Fagerstrom, K.O., 1991. The Fagerstrom Test
te
Addict. 86 (9) 1119-1127.
d
for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J
Ac ce p
Junsirimongkol, B., Kittirattanapaiboon, P., Khamwongpin, M., Chutha, W., Kongsuk, T., Leejongpermpoon. J., 2011. The prevalence of alcohol use disorders and psychiatric comorbidity in Thailand: national epidemiological survey 2008. Journal of Mental Health of Thailand 19 (2) 88-102.
Maneeganol, S., Arunponpaisal, S., Pimpanit, V., Jarassaeng, N., Boontoch, K., 2014. Prevalence of Substance Use in Psychiatric Outpatient Clinic at Srinagarind Hospital. J Psychiatr Assoc Thailand 59 (4) 371-380. Ratta-apha, W., Sitdhiraksa, N., Pariwatcharakul, P., Saisavoey, N., Limsricharoen, K.,
Page 6 of 8
7
Thongchot, L., Kumkan, P., Sanguanpanich, N., Ketumarn, P., 2014. Under-recognized alcohol-related disorders in psychiatric outpatient unit. J Med Assoc Thai. 97 (4) 439446.
ip t
Saunders, J.B., Aasland, O.G., Babor, T.F., De la Fuente, J.R., Grant, M. 1993 Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on
cr
Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 88, 791-
us
804.
an
Sooksompong, S., Kwansanit, P., Supanya, S., Chuta, W., Kittirattanapaiboon, P., Udomittipong, D., Piboonarluk, W., Saensawang, S., 2016. The Thai National Mental Health Survey
M
2013: Prevalence of Mental Disorders in Megacities: Bangkok. J Psychiatr Assoc
Ac ce p
te
d
Thailand 61 (1) 75-88.
Page 7 of 8
Table 1 Prevalence of problematic tobacco and alcohol use in number, average age, and male8
to-female ratio Number of Percentag Average age Male: Questionnaires and results score
participants/ e
(Year)
Female
Fagerstrom Smoking status 449/1,700
Current smoking
96/1,700
26.4 5.7
8.2:1
44.2
12.7:1
3.2
44.1
12.5:1
1.9
44.1
32.0:1
0.3
42.8
4.0:1
324/1,682
19.3
42.1
1.3:1
142/1,682
8.4
49.3
7.9:1
0-3
54/92 (58.7)
Moderate dependence
4-6
33/92 (35.9)
High dependence
7-10
5/92 (5.4)
d
M
Low dependence
an
Dependency among current smokers
te
AUDIT 1–7
Ac ce p
Low risk drinker
54.6
us
History of smoking
cr
ip t
total responses
Hazardous drinker
8 – 15
Harmful use
16 – 19 19/1,682
1.1
49.2
19.0:0
Alcohol dependence
20-40
22/1,682
1.3
44.0
21.0:1
No problem
0-1
1,445/1,692
85.4
51.7
0.6:1
Alcohol use problem
2-4
248/1,692
14.7
45.0
3.1:1
No problem
0-1
270/516
52.3
43.8
1.6:1
Alcohol use problem
2-4
246/516
47.7
45.0
3.2:1
CAGE
Among all participants
Among Current drinkers*
Page 8 of 8
*Patient who consumed alcohol due to response in AUDIT test
S1876-2018(17)30153-3 http://dx.doi.org/doi:10.1016/j.ajp.2017.05.009 AJP 1161
To appear in: Received date: Revised date: Accepted date:
5-3-2017 4-5-2017 6-5-2017
Please cite this article as: Suksangkharn, Y., Tasneeyapant, P., Mahatchariyapong, P., Suwanaro, T., Soraprajum, K., Sanguanpanich, N., Thongchot, L., Apiwannarat, N., Boonyaprapa, W., Ratta-apha, W., Sitdhiraksa, N.,Prevalence of problematic tobacco and alcohol use among general hospital outpatients in Thailand, Asian Journal of Psychiatry (2017), http://dx.doi.org/10.1016/j.ajp.2017.05.009 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1
Prevalence of problematic tobacco and alcohol use among general hospital outpatients in Thailand
ip t
Yanin Suksangkharn*, Piangmas Tasneeyapant*,
cr
Patcharida Mahatchariyapong*,
us
Thanyathad Suwanaro*, Kunravitch Soraprajum*,
an
Naratip Sanguanpanich BSc**, Lakkhana Thongchot, BS**,
M
Nattawut Apiwannarat MD**,
Woraphat Ratta-apha MD, PhD**
Ac ce p
te
Nantawat Sitdhiraksa MD, PhD**
d
Wichian Boonyaprapa MSc***,
* Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*** Siriraj Information Technology Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Correspondence to: Woraphat Ratta-apha Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University,
Page 1 of 8
2
2 Prannok Road, Siriraj, Bangkoknoi, Bangkok 10700, Thailand. Phone: 0-2419-4293-8, Fax: 0-2419-4298
ip t
E-mail: [email protected]
cr
Tel: +66-2-419-4295-8, Fax +66-2-419-4298
us
Highlights:
an
- Prevalence of problematic tobacco and alcohol uses in general hospital was examined
M
- 2.2% of outpatients were moderate-to-high dependence to smoking - 10.8% of outpatients were the hazardous drinkers to alcohol dependence
d
- Problematic tobacco and alcohol use were prevalent in the mean age of 5th decade
te
Abstract
Ac ce p
The present study aimed to determine the prevalence of problematic tobacco and alcohol use in the outpatients. Data was collected from the screening tools (Fagerstrom, AUDIT, and CAGE questionnaires) of 1,700 recruited outpatients. The results showed 2.2% of outpatients were moderate-to-high dependence to smoking, 10.8% and 14.7% of outpatients were the hazardous drinkers to alcohol dependence and alcohol use problem respectively. The outpatients with problematic tobacco and alcohol use were in the mean age of 5th decade and had a bigger proportion of male. In conclusion, the prevalence of problematic tobacco and alcohol use was substantial and need to detection.
Page 2 of 8
3
Keywords: alcohol use, tobacco use, Fagerstrom, AUDIT, CAGE, Dear Editor,
ip t
Problematic tobacco and alcohol uses are important public health problems in Thailand, which associated with many physical and psychiatric disorders (Bundhamcharoen et al., 2011).
cr
We aimed to study the prevalence of patients with problematic tobacco and alcohol uses among
us
the outpatients through the screening instruments, to determine the scale and the characteristics of patients who were at risk in a General Hospital.
an
We conducted a cross-sectional study to investigate the problematic tobacco and alcohol
M
uses in a setting of the general hospital. The number of participants was 1,700 recruited from 9 departments stratified by the number of outpatients in 2012. The participants met the criteria of
d
age ≥ 18 years which excluded communication deficit and mental retardation. The participants
te
were asked for filled the history of alcohol and tobacco use and status, Fagerstrom (Heatherton et al., 1991), AUDIT (Saunders et al., 1993) and CAGE (Ewing, 1984) questionnaires. The
Ac ce p
collecting data (characteristics, scores of the screening tools) was analyzed with SPSS software v16.0 (SPSS Inc, Chicago, Illinois, US). The problematic tobacco and alcohol use was defined by categories of moderate-to-high in Fagerstrom test, hazardous drinker to alcohol dependence in AUDIT, and alcohol use problem in CAGE. The total number of 1,700 was 710 (41.8%) males and 987(58.2%) females. The average age was 50.7 ± 17.6 years. The 96 (5.7%) participants were current smokers. The severity of Fagerstrom test was classified into 3 categories: low dependence, moderate dependence, and high dependence which contributed 3.18, 1.9, and 0.3 % among all participants and 58.1, 1.9, and 0.3 % among current smokers. Thus, the number of patients with problematic tobacco use
Page 3 of 8
4
was 2.2 %. The average ages of low dependence, moderate dependence, and high dependence were 44.1, 44.1 and 42.8, while male-to-female ratios were 12.5:1, 32.0:1 and 4.0:1. The result from AUDIT showed 19.3%, 8.4%, 1.1% and 1.3% were low-risk drinker,
ip t
hazardous drinker, harmful use, and alcohol dependence respectively. The number of patients with problematic alcohol use was 10.8 %. The average ages of low-risk drinker, hazardous
cr
drinker, harmful use, and alcohol dependence were 42.1, 49.3, 49.3, and 44.0, while the male-to-
us
female ratios were 1.3:1, 7.9:1, 19.0:0, and 21.0:1. The result from CAGE showed 14.7 % had alcohol use problem which could be implied as problematic alcohol use. This group’s age was
an
45.0 years in average with the male-to-female ratio of 3.1:1. Among current drinkers, 47.7 % of patients had alcohol use problem and considered having problematic alcohol use. The group’s
M
age was 47.7 year in average with male-to-female ratio of 3.2:1. We also analyzed the correlation
te
0.7).
d
between AUDIT and CAGE and found the strong correlation by the Pearson’s correlation (r =
The results from the present study showed the magnitude of problematic tobacco and
Ac ce p
alcohol uses among the outpatients with physical problems that might contribute to their physical diseases. The prevalence of problematic tobacco use ranged from 2.7 % in normal Thai population to 47.7 % (Maneeganol et al., 2014; Sooksompong et al., 2016), while the result of the present study was 2.2 %. The prevalence of problematic alcohol use ranged from 5.0 to 57.7 % (Assanangkornchai et al., 2010; Chaithawanwong et al., 2013; Junsirimongkol et al., 2011; Maneeganol et al., 2014; Sooksompong et al., 2016), while the results of the present study were 14.7 % with CAGE and 10.8 % with AUDIT. The difference among the size of prevalence of problematic alcohol and tobacco use depend on various factors, including, the screening and diagnostic tools, the surveyed setting, and the selected population.
Page 4 of 8
5
Next, it is worth noticing that all categories that defined problematic tobacco and alcohol use in patients with physical problems were in the age of 5th decade and had a greater proportion of male than female. These characteristics helped recognize the patients that were most at risk
ip t
and needed keen attention. We suggest the implementation of screening tests in outpatient departments, for example, the written version and the oral interview of CAGE questionnaire
cr
(Ratta-Apha et al., 2014).
us
The present study had several limitations. First, the result might not represent all of the outpatients such as patients with severe physical conditions, teenagers, and patients with
an
cognitive decline. Second, patients with problematic tobacco and alcohol consumption may be denial or exhibit recall bias. Collecting data from other sources, such as family’s members
M
should be helpful in the practice. The results of the present study could not be generalized to the
d
other general hospitals which needed to investigate the size of problems. In conclusion, we
te
suggested that problematic tobacco and alcohol use should be on spot. Screening instruments are
Ac ce p
helpful in detecting patients with patients at risk in clinical practice.
Acknowledgements
The present study was supported by the Siriraj Institutional Review Board (SIRB), Faculty of Medicine, Siriraj Hospital, Mahidol University. (CoA Si 392/2557). We would like to thank Miss Aree Singlampong for her coordination in this project and the staff of outpatient units, Siriraj Hospital for their cooperation.
Conflicts of interest None.
Page 5 of 8
6
Reference: Assanangkornchai, S., Sam-Angsri, N., Rerngpongpan, S., Lertnakorn, A., 2010. Patterns of alcohol consumption in the Thai population: results of the National Household Survey of
ip t
2007. Alcohol Alcohol 45 (3) 278-285.
cr
Bundhamcharoen, K., Odton, P., Phulkerd, S., Tangcharoensathien, V., 2011. Burden of disease in Thailand: changes in health gap between 1999 and 2004. BMC Public Health 11, 53.
us
Chaithawanwong, T., Kalayasiri, R., 2013. Alcohol Drinking of Construction Workers in
an
Bangkok Metropolis. J Psychiatr Assoc Thailand 58 (4) 345-358.
M
Ewing, J.A., 1984. Detecting alcoholism. The CAGE questionnaire. JAMA. 252 (14) 1905-1907. Heatherton, T.F., Kozlowski, L.T., Frecker, R. C., Fagerstrom, K.O., 1991. The Fagerstrom Test
te
Addict. 86 (9) 1119-1127.
d
for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J
Ac ce p
Junsirimongkol, B., Kittirattanapaiboon, P., Khamwongpin, M., Chutha, W., Kongsuk, T., Leejongpermpoon. J., 2011. The prevalence of alcohol use disorders and psychiatric comorbidity in Thailand: national epidemiological survey 2008. Journal of Mental Health of Thailand 19 (2) 88-102.
Maneeganol, S., Arunponpaisal, S., Pimpanit, V., Jarassaeng, N., Boontoch, K., 2014. Prevalence of Substance Use in Psychiatric Outpatient Clinic at Srinagarind Hospital. J Psychiatr Assoc Thailand 59 (4) 371-380. Ratta-apha, W., Sitdhiraksa, N., Pariwatcharakul, P., Saisavoey, N., Limsricharoen, K.,
Page 6 of 8
7
Thongchot, L., Kumkan, P., Sanguanpanich, N., Ketumarn, P., 2014. Under-recognized alcohol-related disorders in psychiatric outpatient unit. J Med Assoc Thai. 97 (4) 439446.
ip t
Saunders, J.B., Aasland, O.G., Babor, T.F., De la Fuente, J.R., Grant, M. 1993 Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on
cr
Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 88, 791-
us
804.
an
Sooksompong, S., Kwansanit, P., Supanya, S., Chuta, W., Kittirattanapaiboon, P., Udomittipong, D., Piboonarluk, W., Saensawang, S., 2016. The Thai National Mental Health Survey
M
2013: Prevalence of Mental Disorders in Megacities: Bangkok. J Psychiatr Assoc
Ac ce p
te
d
Thailand 61 (1) 75-88.
Page 7 of 8
Table 1 Prevalence of problematic tobacco and alcohol use in number, average age, and male8
to-female ratio Number of Percentag Average age Male: Questionnaires and results score
participants/ e
(Year)
Female
Fagerstrom Smoking status 449/1,700
Current smoking
96/1,700
26.4 5.7
8.2:1
44.2
12.7:1
3.2
44.1
12.5:1
1.9
44.1
32.0:1
0.3
42.8
4.0:1
324/1,682
19.3
42.1
1.3:1
142/1,682
8.4
49.3
7.9:1
0-3
54/92 (58.7)
Moderate dependence
4-6
33/92 (35.9)
High dependence
7-10
5/92 (5.4)
d
M
Low dependence
an
Dependency among current smokers
te
AUDIT 1–7
Ac ce p
Low risk drinker
54.6
us
History of smoking
cr
ip t
total responses
Hazardous drinker
8 – 15
Harmful use
16 – 19 19/1,682
1.1
49.2
19.0:0
Alcohol dependence
20-40
22/1,682
1.3
44.0
21.0:1
No problem
0-1
1,445/1,692
85.4
51.7
0.6:1
Alcohol use problem
2-4
248/1,692
14.7
45.0
3.1:1
No problem
0-1
270/516
52.3
43.8
1.6:1
Alcohol use problem
2-4
246/516
47.7
45.0
3.2:1
CAGE
Among all participants
Among Current drinkers*
Page 8 of 8
*Patient who consumed alcohol due to response in AUDIT test