Comparison of Short Questionnaires on Alcohol Drinking Behavior in a Nonclinical Population of 36-Year-Old Men and Women

Abstract

Little is known on the diagnostic characteristics of brief questionnaires on alcohol drinking behaviors. This report investigates the determinants of three short alcohol questionnaires and investigates their diagnostic utility as screening tools for alcohol-related problems in a general population from The Netherlands. This report uses cross-sectional data obtained in the year 2000 from 36-year-old healthy male (N = 166) and female (N = 165) volunteers who reported to drink alcohol at least occasionally. Since they were 13-years-old these volunteers have been members of the Amsterdam Growth And Health Longitudinal Study, which started as a school-based study in 1977. Among many other variables, quantity–frequency questions (QF), the CAGE questionnaire, and a question on the highest number of alcoholic units consumed on one occasion during the previous month (MAX) were asked. The sensitivity, specificity, Cohen's kappa, and diagnostic odds ratio of QF, CAGE, MAX, and combinations of these three brief questionnaires were calculated using a 7-item questionnaire on alcohol-related problems as reference. Both in women and men, the prevalence of most alcohol-related problems and of a high QF, CAGE, and MAX was low. QF, CAGE, and MAX, as well as all possible combinations of the three questionnaires, were poor in detecting last-year alcohol-related problems. The CAGE appeared to perform worse than the even shorter and easier-to-interpret QF and MAX. In this healthy population of 36-year-old men and women, using the QF, MAX, and especially the CAGE questionnaire as screening instruments for alcohol-related problems resulted in many false positive and false negative classifications.

• Problematic alcohol use
• CAGE
• MAX
• QF

Resumen

Poco se sabe sobre las características del diagnóstico procedente de encuestas sobre el comportamiento alcohólico. Este informe investiga los determinantes de una alta puntuación en 3 cuestionarios breves sobre alcohol y investiga su utilidad diagnóstica como instrumento de examinación para problemas relacionados con alcohol dentro en una población genérica de Los Países Bajos. Este informe utiliza datos transversales obtenidos en el año 2000 en un grupo de voluntarios sanos (166 hombres y 165 mujeres) de 36 años de edad, que indicaron beber alcohol por lo menos occasionalmente. Estos voluntarios son miembros desde que tenían 13 años del Amsterdam Growth And Health Longitudinal Study, que comenzó como un estudio de colegio en 1977. Entre otras muchas variables, se realizaron preguntas del tipo cantidad-frecuencia (QF), así como la encuesta CAGE y una pregunta sobre el mayor número de consumiciones alcohólicas en alguna ocasión durante el mes anterior (MAX). La sensibilidad, especificiadad, Cohen's kappa, y odds ratio diagnóstico de QF, CAGE, MAX, así como combinaciones de estas tres breves encuestas, fueron calculados utilizando como referencia una encuesta de 7 items sobre problemas relacionados con el alcohol. En ambos grupos, tanto hombres como mujeres coincidían en una baja incidencia de problemas relacionados con el alcohol y de un alto QF, CAGE y MAX. QF, CAGE y MAX y todas las combinaciones posibles entre las tres encuestas, resultaron escasas para detectar problemas relacionados con el alcohol durante el pasado año. Utilizar las encuestas QF, MAX y especialmente la encuesta CAGE en una población sana de hombres y mujeres de 36 años de edad, como instrumentos contra problemas relacionados con el alcohol, resultó en muchas clasificaciones falsamente positivas y falsamente negativas.

Résumé

Les caractéristiques diagnostiques des questionnaires courts sur le comportement alcoolique sont peu connues. Ce rapport examine les facteurs responsables de scores élévés pour trois questionnaires courts sur le comportement alcoolique et étudie l’effacité diagnostique de ces trois questionnaires dans une population en bonne santé d’origine hollandaise. Ce rapport est basé sur des données d’une coupe instantannée réalisée en 2000 incluant des volontaires en bonne santé âgés de 36 ans de sexe masculin (N = 166) et féminin (N = 165) rapportant une consommation occasionelle d’alcool. Ces volontaires participent depuis l’âge de 13 ans à l’Amsterdam Growth and Health Longitudinal Study, qui a débuté en 1977 par une étude à l’école. Les variables collectées incluent le questionnaire CAGE, des questions concernant la quantité/fréquence de consommation (QF), et le maximum d’unités d’alcool consommées en une occasion durant le mois précédent (MAX). La sensitivité, la spécificité, le Cohen's kappa, et les odds ratio diagnostiques de CAGE, QF, MAX, et des combinaisons de ces trois questionnaires courts sont calculés. La référence est un questionnaire sur les problèmes relatifs à l’alcool incluant 7 éléments. La prévalence de la plupart des problèmes relatifs à l’alcool, d’un QF, d’un CAGE et d’un MAX élevé est faible pour les deux sexes. QF, CAGE, et MAX ainsi que n’importe quelle combinaison des trois questionnaires prédisent pauvrement la prévalence de problèmes relatifs à l’alcool durant l’année passée. Le CAGE se révèle être plus insatisfaisant que QF et MAX, qui sont plus courts et plus faciles à interpréter. Dans cette population d’individus de sexe masculin et féminin en bonne santé âgée de 36 ans, l’utilisation de QF, MAX et plus spécifiquement de CAGE comme instrument de diagnose pour les problèmes relatifs à l’alcool conduit à de nombreuses erreurs de classements (faux-positifs et faux-négatifs).

Additional information

Notes on contributors

Lando L. J. Koppes

Lando L.J. Koppes is a post-doctoral researcher at the Institute for Research in Extramural Medicine (EMGO Institute), and Department of Social Medicine of the VU University Medical Center in Amsterdam, The Netherlands. He has a background in physical education, human movement and exercise sciences, and epidemiology. He has been secretary of the council and member of the board of the Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, and has been secretary of the Committee on the quality of research at the EMGO Institute. After receiving his Ph.D. in 2002, he continued to investigate the relationships between lifestyles and health within and outside the data of the Amsterdam Growth and Health Longitudinal Study. To date, most of his scientific publications concern the consumption of alcohol.

Jos W. R. Twisk

Jos W.R. Twisk started to work for the Amsterdam Growth and Longitudinal Study in 1990 and he received his Ph.D. in 1995. Since then he worked as a senior researcher at the Institute for Research in Extramural Medicine and in 2000 he moved to the Department of Clinical Epidemiology and Biostatistics. He is associate professor, teaching in a postdoctoral Epidemiology teaching program in which he teaches courses from basic statistics to more complicated data analyzing techniques such as multilevel analysis and longitudinal data analysis. The latter is also his main interest area, which resulted in the writing of a book entitled: Applied longitudinal data analysis for epidemiology. A practical guide. Cambridge University Press published this book in 2003.

Jan Snel

Jan Snel has been a lecturer and researcher at the Department of Psychology, University of Amsterdam, since he received his Ph.D. in psychology in 1979. He is associate professor lecturing physiological psychology to first year students and neurosciences to senior students. His research focuses on the role of psychoactive substances (caffeine and alcohol) on cognitive processes, such as attention, memory, health and functioning and on mood, positive and negative stress and pleasure. Since the start in 1976, Jan Snel is one of the researchers of the Amsterdam Growth and Health Longitudinal Study. He is member of the board of Foundation Mind at Work and of ARISE (Associates for Research into the Science of Enjoyment). Jan Snel is the author of several scientific and popular-scientific articles and books.

Willem Van Mechelen

Willem van Mechelen obtained his MD-degree in 1982 and his specialty registration in occupational medicine in 1988, followed by a Ph.D. in Human Movement Sciences in 1992, and a specialty registration in epidemiology in 1993. Since 1992 he works full-time in research. In 1999 Willem van Mechelen was appointed as a full professor of Social Medicine at the Institute for Research in Extramural Medicine and at the Department of Social Medicine of the VU University Medical Center in Amsterdam. He now leads a group of about 35 researchers who dedicate their research to health-related issues in the broad field of physical activity, sport, and work. Willem van Mechelen is a member of various national committees, he is a member of the editorial board of various international peer-reviewed journals and a senior associate editor of the Clinical Journal of Sports Medicine.

Han C. G. Kemper

Han C.G. Kemper is full professor in Health with respect to Human Movement at the EMGO Institute, VU University Medical Center in Amsterdam. He received his Ph.D. in 1968, and is the founder and principle investigator of the Amsterdam Growth And Health Longitudinal Study. In this study, about 600 13-year-old boys and girls have been followed for 23 years up to age 36 years with respect to their lifestyle, health, and psychological characteristics. With his research group he published three monographs and more than 300 articles in (inter)national journals. In 1998 he received an Honorary Degree from St. Mary's College of the University of Surrey, Guildford, UK, and in 2001 a second Doctor Honoris Causa from the Semmelweis University in Budapest, Hungary, and he received a third Honorary Degree from the Stradina University in Riga, Latvia in 2004. In 2002 he received the Citation Award from the American College of Sports Medicine.