The frequency of smoking and problem drinking among general hospital inpatients in Brazil - using the AUDIT and Fagerström questionnaires
Keywords:
AUDIT, Fagerström, Screening, Liaison psychiatry, InpatientsAbstract
CONTEXT: Although the CAGE questionnaire is one of the most widely used alcohol screening instruments, it has been criticized for not identifying people who are drinking heavily or who have alcohol related problems but do not as yet show symptoms of alcohol dependence. The AUDIT (Alcohol Use Disorder Identification Test) questionnaire was developed by WHO as a screening instrument specifically designed to identify problem drinkers, as well as those who were already dependent on alcohol. OBJECTIVE: The aim of this study was to use the AUDIT and Fagerström questionnaires in a general hospital inpatient population to measure the frequency of problem drinking and nicotine dependence, and to see if levels varied between medical speciality. DESIGN: Retrospective cross-sectional study. SETTING: Federally funded public teaching hospital. SAMPLE: 275 inpatients from both genders. MAIN MEASUREMENTS: Socio-demographic data, AUDIT (Alcohol Use Disorders Identification Test) and Fagerström Test for Nicotine Dependence. RESULTS: We interviewed 275 inpatients, 49% of whom were men and 51% women. Thirty-four patients were identified as "cases" by the Audit questionnaire; 22% of the male patients and 3% of the females. Just over 21% of inpatients were current smokers. The gastroenterology (26%) and general medicine (16%) inpatient units had the largest number of individual cases. CONCLUSIONS: Only by knowing the prevalence of alcohol abuse/dependence and nicotine dependence in a general hospital can we evaluate the need for a specialized liaison service to identify and treat these patients.
Downloads
References
Shapiro S, Skinner EA, Kessler LG, et al. Utilization of health and mental health services: three epidemiological catchment area sites. Arch Gen Psychiatry 1984;41(10):971-8.
Rice DP, Kelman S, Miller LS. Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988. Public Health Rep 1991;106(3):280-92.
Masur J, Tufik S, Ribeiro AB, et al. Consumo de álcool em pacientes de hospital geral: um problema negligenciado? Rev Assoc Med Bras 1979;25(9):302-6.
Silva VA, Laranjeira RR, Dolnikoff M, et al. Alcohol consumption during pregnancy and newborn outcome: a study in Brazil. Neurobehav Toxicol Teratol 1981;3:169-72.
Masur J, Jorge MR. Dados relacionados a bebidas alcoólicas e alcoolismo no Brasil: uma revisăo. Rev ABP-APAL 1986;8(4):157-65.
Iacoponi E, Laranjeira R, Jorge MR. At-risk drinking in primary care: report from a survey in Săo Paulo, Brazil. Brit J Addict 1989;84:653-8.
Noto AR, Carlini EAA. Internaçőes hospitalares provocadas por drogas: análise de sete anos consecutivos (1987-1993). Rev ABP-APAL 1995;17(3):107-14.
Almeida Filho N, Mari JJ, Coutinho E, et al. Estudo multicęntrico de morbidade psiquiátrica em áreas urbanas (Brasília, Săo Paulo, Porto Alegre). Rev ABP-APAL 1992;14:93-104.
Ryder D, Lenton S, Harrison S, Dorricott J. Alcohol-related problems in a general hospital and a general active: screening and the preventive paradox. Med J Austral 1988;149(3):355-60.
Moore RD, Bone LR, Geller G, Mamon JA, Stokes EJ, Levine DM. Prevalence, detection and treatment of alcoholism in hospitalized patients. JAMA 1989;261(3):403-7.
Chick J. Alcohol problems in the general hospital. Brit Med Bull 1994;50(1):200-10.
Babor TF, Grant M. From clinical research to secondary prevention: international collaboration in the development of the alcohol use disorders identification test (AUDIT). Alcohol Health Resear World 1989;13(4):371- 4.
Babor TF, La Fuente JR, Saunders J, Grant M. AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care. WHO (World Health Organization)/PSA/1992;4:1-29.
Saunders JB, Aasland OG, Babor TF, et al. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Part II. Addiction 1993;88:791-804.
Skipsey K, Burleson JA, Kranzler HR. Utility of the AUDIT for Identification of hazardous or harmful drinking in drug dependent patients. Drug and Alcoh Depend 1997;45:157-63.
Conigrave KM, Saunders JB, Reznic RB. Predictive capacity of the AUDIT questionnaire for alcohol related harm. Addiction 1995;90:1479-85.
Schmidt A, Barry KL, Fleming, MF. Detection of problems drinkers: The Alcohol use Disorders Identification Test (AUDIT). Southern Med J 1995;88(1):52-9.
Bohn MJ, Barbor TF, Kranzler HR. The alcohol use disorders identification test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcoh 1995;56(4):423-31.
U.S. Department of Health and Human Services. Smoking cessation. Clinical Practice Guideline; 1996.
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270(18):2007-12.
Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behaviors 1978;3:235-41.
Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for nicotine dependence: a revision of the Fagerström tolerance questionnaire. Br J Addict 1991;86:1119-27.
Heatherton TF, Kozlowski LT, Frecker RC, et al. Measuring the heaviness of smoking using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict 1989;84:791-800.
Saxon JA, McGuffin R, Walker RD. An open trial transdermal nicotine replacement therapy for smoking cessation among alcohol and drug dependent inpatients. J Subst Abuse Treat 1997;14(4):333-7.
Fleming MF, Barry KL, McDonald R. The Alcohol Use Disorders Identification Test (AUDIT) in a college sample. Int J Addict 1991;26:1173-85.
Cherpitel CJ. Analysis of cut points for screening instruments for alcohol problems in the emergency room. J Stud Alcohol 1995;56:695-700.
Seppa K, Makela R, Sillanaukee P. Effectiveness of the Alcohol Use Disorders Identification Test in occupational health screenings. Alcohol Clin Exp Res 1995;19(4):999-1003.
Kozlowski LT, Porter CQ, Orleans CT, et al. Predicting smoking cessation with FTND and HSI. Drug Alcohol Depend 1994;34:211-6.
Demers RY, Neale AV, Adams R, Trembath C, Herman SC. The impact of physicians brief smoking cessation counseling: a MIRNET study. J Fam Pract 1990;31:625-9.
Law M, Tang JL. An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Intern Med 1995;155:1933-41.
Hurt RD, Rochester M. Smoking cessation in primary care. Ind Med 1996;Mar/Apr:165-8.
Nascimento JD, Siqueira MM, Sutmoller F, et al. Longitudinal study of acute respiratory diseases in Rio de Janeiro: occurrence of respiratory viruses during four consecutive years. Rev Inst Med Trop Săo Paulo 1991;33(4):287-96.
Sutmoller F, Ferro ZP, Asensi MD, et al. Etiology of acute respiratory tract infections among children in a combined community and hospital study in Rio de Janeiro. Clin Infect Dis 1995;20(4):854-60.
Pereira HG, Linhares AC, Candeias JA, Glass RI. National Laboratory surveillance of viral agents of gastroenteritis in Brazil. Bull Pan Am Health Organ 1993;27(3):224-233.
