This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (9)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Substance Abuse/ Alcoholism  • Tobacco  • Alert me on articles by topic  Social Bookmarking   What's this?

Sherry A. McKee, PhD; Tracy Falba, PhD; Stephanie S. O’Malley, PhD; Jody Sindelar, PhD; Patrick G. O’Connor, MD, MPH

Arch Intern Med. 2007;167(7):716-721.

Background  Screening for alcohol use in primary care settings is recommended by clinical care guidelines but is not adhered to as strongly as screening for smoking. It has been proposed that smoking status could be used to enhance the identification of alcohol misuse in primary care and other medical settings, but national data are lacking. Our objective was to investigate smoking status as a clinical indicator for alcohol misuse in a national sample of US adults, following clinical care guidelines for the assessment of these behaviors.

Methods  Analyses are based on a sample of 42 374 US adults from the National Epidemiological Survey on Alcohol and Related Conditions (Wave I, 2001-2002). Odds ratios (ORs), 95% confidence intervals (CIs), and test characteristics (sensitivity, specificity, positive and negative predictive values, and positive likelihood ratio of smoking behavior [daily, occasional, or former]) were determined for the detection of hazardous drinking behavior and alcohol-related diagnoses, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV.

Results  Daily, occasional, and ex-smokers were more likely than never smokers to be hazardous drinkers (OR, 3.23 [95% CI, 3.02-3.46]; OR, 5.33 [95% CI, 4.70-6.04]; OR, 1.19 [95% CI, 1.10-1.28], respectively). Daily and occasional smokers were more likely to meet criteria for alcohol diagnoses (OR, 3.52 [95% CI, 3.19-3.90] and OR, 5.39 [95% CI, 4.60-6.31], respectively). For the detection of hazardous drinking by current smoking (occasional smokers + daily smokers), sensitivity was 42.5%; specificity, 81.9%; positive predictive value, 45.3% (vs population rate of 26.1%); and positive likelihood ratio, 2.34. For the detection of alcohol diagnoses by current smoking, sensitivity was 51.4%; specificity, 78.0%; positive predictive value, 17.8% (vs population rate of 8.5%); and positive likelihood ratio, 2.33.

Conclusions  Occasional and daily smokers were at heightened risk for hazardous drinking and alcohol use diagnoses. Smoking status can be used as a clinical indicator for alcohol misuse and as a reminder for alcohol screening in general.

Author Affiliations: Departments of Psychiatry (Drs McKee and O’Malley), Epidemiology and Public Health (Drs Falba and Sindelar), and Internal Medicine (Dr O’Connor), Yale University School of Medicine, New Haven, Conn. Dr Falba is now with the Department of Economics, Duke University, Durham, NC.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Transdisciplinary Tobacco Use Research Centers: Research achievements and future implications
Baker et al.
Nicotine Tob Res 2009;11:1231-1244.
FULL TEXT  

Longitudinal evaluation of smoke-free Scotland on pub and home drinking behavior: Findings from the International Tobacco Control Policy Evaluation Project
McKee et al.
Nicotine Tob Res 2009;11:619-626.
ABSTRACT | FULL TEXT