title: Alcohol abuse and dependence in Latinos living in the United States: validation of the CAGE (4M) questions.
abstract: BACKGROUND
  Brief alcoholism screening questionnaires have not been adequately studied in the rapidly growing Latino population living in the United States.
  
  
  OBJECTIVE
  To assess (1) the prevalence of alcoholism and (2) the performance of 2 alcohol screening instruments in Latinos.
  
  
  METHODS
  We performed a cross-sectional interview study in an urban teaching hospital-based primary care practice. Consecutive self-identified Latino subjects provided informed consent. All subjects were interviewed in English or Spanish using 2 alcoholism screening tools, the CAGE (or the Spanish version, the 4M), and the Alcohol Use Disorders Identification Test, and a criterion standard for the diagnosis of alcohol abuse and dependence, the Composite International Diagnostic Interview.
  
  
  RESULTS
  Of 210 subjects interviewed, 36% had a lifetime diagnosis of alcohol abuse or dependence by the criterion standard. Thirty-one percent were currently drinking hazardous amounts of alcohol. A CAGE (4M) score of 1 or more was 92% sensitive and 74% specific, and a score of 2 or more was 80% sensitive and 93% specific for a lifetime diagnosis of alcohol abuse or dependency. CAGE (4M) scores of 0, 2, 3, and 4 were associated with likelihood ratios (0.1, 4.8, 18.5, and 36.8, respectively) that resulted in substantial changes from pretest (36%) to posttest probability (to 6%, 73%, 91%, and 95%, respectively) of a diagnosis of alcohol abuse or dependency. At the standard cutoff point, the Alcohol Use Disorders Identification Test detected only 51% of subjects with alcohol disorders.
  
  
  CONCLUSIONS
  In Latinos in primary care settings, alcohol abuse and dependence are common and the CAGE (4M) is a brief, valid, screening tool for detecting alcohol use disorders.
authors.affiliation: Department of Medicine, Boston University School of Medicine, Boston Medical Center, Mass 02118-2393. USA. rsaitz@bu.edu
authors.forename: R
authors.initials: R
authors.lastname: Saitz
authors.forename: M F
authors.initials: MF
authors.lastname: Lepore
authors.forename: L M
authors.initials: LM
authors.lastname: Sullivan
authors.forename: H
authors.initials: H
authors.lastname: Amaro
authors.forename: J H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis* / Q000208:ethnology*; D003937:Diagnosis, Differential; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology