Alcohol and Alcoholism Advance Access originally published online on April 24, 2008
Alcohol and Alcoholism 2008 43(4):442-445; doi:10.1093/alcalc/agn028
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Audit Questionnaire as Part of Community Action Against Heavy Drinking
1 Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University Hospital, Finland,
2 Department of Mental Health and Alcohol Research, National Public Health Institute, Finland,
3 Department of Plastic Surgery, Tampere University Hospital, Finland,
4 Department of Psychiatry, Tampere University Hospital, Finland,
5 Medical School, University of Tampere, Finland
* Corresponding author: Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University Hospital, PO Box 2000, FIN-33 521, Tampere, Finland. Tel: +358-3-3116-6068; Fax: +358-3-3116-4366; E-mail: janne.kaariainen{at}pshp.fi
Received 27 November 2007; first review notified 12 February 2008; in revised form 19 March 2008; accepted 22 March 2008
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ABSTRACT |
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Aims: The purpose of the present study was to find out how well the alcohol questionnaire, AUDIT, as part of a wide community action was noticed, and if it had any effects especially among heavy drinkers. Methods: As part of local community action campaign (‘Booze Weeks’), the AUDIT pamphlet was delivered to all households (90,000) in Tampere, Finland, and 500 randomly selected inhabitants were interviewed on telephone. Results: More than three quarters of those consuming alcohol had noticed the ‘Booze Weeks’ campaign and considered it necessary. Inhabitants who drank most frequently were also the most likely to have noticed the campaign and the AUDIT pamphlet. Conclusions: As part of a wide community action, home-delivered self-help material is often noticed especially by heavy drinkers. They might come to realize their own heavy drinking and seek professional treatment.
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Introduction |
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A crucially important group for prevention is heavy drinkers. Majority of them never access any treatment services (Sobell et al., 1996
) or seek professional help (Sobell et al., 2000; Klingemann et al., 2001). In community-based prevention campaigns, tailored campaigns as well as collaboration in several fields of community are essential (Anderson et al., 2003; Anderson et al., 2004). This kind of multi-faceted campaigns could target and give advice to people who do not actively contact health care. These campaigns could also attract people, if they feel the need, to contact primary health care before alcohol problems are advanced.
As part of a brief intervention implementation project to health care professionals (Kääriäinen et al., 2001), we aimed at facilitating inhabitants to contact health care in case they considered themselves as heavy drinkers. By doing this we also indirectly aimed at encouraging health care professionals to bring up alcohol for discussion at consultations. The Alcohol Use Disorders Identification Test (AUDIT) is a good even if somewhat heterogeneous tool for detecting heavy drinkers (Saunders et al., 1993; Berner et al., 2007). Hitherto, there is only little evidence of its effectiveness as part of community action (Karlsson et al., 2005). The purpose of the present study was to find out how well the AUDIT questionnaire targeted to the whole population as part of a wide community action was noticed and whether it had any effects especially among heavy drinkers.
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Material and Methods |
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Description of community action
A local community action campaign (‘Booze Week’) took place during 13–26 January 1997 in Tampere, Finland. Tampere is a city in Southern Finland with a population of 200,000 and
90,000 households. The purpose of the campaign was to promote a change in the culture of alcohol consumption and to increase open discussion on alcohol. There were several different activities during the campaign. Lectures on alcohol were given in various venues. Inhabitants’ liver tests were measured almost for free, and there were information stands in the Main City Library and in the local outpatient A-clinic including information about alcohol. A course on alcohol aimed mainly at the general public was arranged lasting for four evenings. Thematic evenings for alcohol were arranged in the youth club.
As part of this community action and brief intervention implementation (Kääriäinen et al., 2001), a visually attractive AUDIT pamphlet, specially designed for this campaign, was delivered enclosed with a local biweekly newspaper to all households (90,000) in Tampere in the middle of a week in January. In addition to the AUDIT the pamphlet also included a chart to help readers calculate the number of drinks usually consumed per week, and information to contact health care if self-help was felt insufficient.
Data collection
A telephone survey was conducted during the following Saturday and Tuesday after the mailing by the leading telephone interview company in Finland (The Finnish Gallup Group) (www.tns-gallup.fi). The Computer-Aided Telephone Interview system was applied. Data were collected from 500 randomly selected Tampere inhabitants aged 18 and above (legal drinking age 
18 in Finland) on a quota basis stratified by age and gender. Trained interviewers interviewed one person per household. The mean length of one telephone interview was 5.3 min.
The interview included background information (Table 1) regarding age, gender, occupation, basic education, professional education, living stage and working status. Other questions concerned frequency of alcohol consumption and whether the respondent had calculated his/her AUDIT score and/or discussed the issue with other people. There were also questions on the necessity of community action campaigns on alcohol. Only those respondents reporting ever using alcohol were asked the CAGE (Mayfield et al., 1974): (1) Have you ever felt you should cut down on your drinking? (2) Have people annoyed you by criticizing your drinking? (3) Have you ever felt bad or guilty about your drinking? and (4) Have you ever taken a drink as the first thing in the morning (eye opener)? Specific questions concerning the "Booze Week" and the pamphlet were only asked from those who, respectively, remembered hearing of or seeing anything related to the campaign. Thus the number of responses in individual questions varied between 160 and 500 (Tables 2 and 3).
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Data analysis
Based on drinking frequency respondents were divided as (1) abstainers, (2) respondents who drink once a month to once a year, (3) two to four times a month and (4) two to seven times a week. Respondents were also grouped using their CAGE score to categorize the level of problems: those having CAGE score 0–1 and those with score 2 or more. The groups were compared by using
2 tests. |
Results |
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Table 1 displays the demographic characteristics of the sample. Total abstinence was reported by 12% (60/500) and 88.0% (440/500) reported consuming alcohol. Of the drinkers, 28.0% (123/440) reported consuming alcohol once a month or less frequently, 43.6% (192/440) 2–4 times a month and 28.4% (125/440) reported consuming alcohol 2–7 times a week. The corresponding figures among women were 40.5% (89/220), 41.8% (92/220) and 17.7% (39/220) and among men 15.4% (34/220), 45.5% (100/220) and 39.1% (86/220). There was a statistical significant difference between women and men (P < 0.000). Based on the CAGE questions there were 79.3% (349/440) with CAGE scores of 0–1, and 20.7% (91/440) with CAGE scores of
2. The corresponding figures among women were 90.0% (198/220) and 10.0% (22/220). Among men figures were 68.6% (151/220) and 31.4% (69/220). There was a statistical difference between women and men (P < 0.000). Table 2 shows the study questions and comparisons between groups based on drinking frequency. The Booze Week campaign was noticed by most respondents, with those consuming alcohol noticing the campaign more frequently than those who abstained from alcohol consumption, 75.9% (334/440) and 60.0% (36/60) (P = 0.035). The pamphlet including the AUDIT was noticed by 15.0–40.8% of all the respondents and was also noticed significantly more often by those drinking frequently compared to those who abstained, 68.9% (51/74) and 15.0% (9/60) (P = 0.004). At least 66.7% of respondents considered community action campaign like the Booze Week necessary; no statistical differences were found between the groups based on drinking frequency (P > 0.05). Almost half of respondents who consumed alcohol reported that they had calculated their AUDIT scores; there was no statistical difference between the groups (P > 0.05). Similarly, almost half of the respondents in all groups had discussed the pamphlet with other people (no significance across the different drinker groups, P > 0.05). Respondents who drank more frequently reported thinking more often of their own alcohol consumption 54.9% (28/51), and in trying to reduce one's alcohol consumption 24.8% (31/125) as compared to respondents who were less frequent drinkers (abstainers were not asked these questions), the corresponding figures were 23.3% (17/73) and 15.1% (29/192), (P < 0.000 and P < 0.000).
The groups based on the CAGE scores did not differ in relation to interest in the Booze Week campaign or in noticing the pamphlet (P > 0.05; see Table 3). Similar to the findings based on drinking frequency, no statistical differences were found between CAGE scores and considering Booze Week necessary (P > 0.05), but the approval percentage was high. The group of CAGE scores 2 has calculated their AUDIT scores or discussed the AUDIT pamphlet less often than those with CAGE scores of 0–1, but these differences did not reach statistical significance (P > 0.05). When the effect of the Booze Week campaign or the pamphlet to alcohol consumption was asked, those with CAGE scores 2 were more interested in thinking about their own alcohol consumption than those with CAGE scores of 0–1, but there was no statistical difference (P > 0.05).
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Discussion |
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TOPABSTRACTIntroductionMaterial and MethodsResultsDiscussionReferences |
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Traditional treatment programmes never reach all heavy drinkers. The aim of the present study was to find out how well a pamphlet including the AUDIT questionnaire as part of a wide community action campaign and delivered with a weekly newspaper was noticed by inhabitants. Further, we were interested in whether it had any effects especially among heavy drinkers. Inhabitants who drank most frequently were also the most likely to have noticed the campaign and the pamphlet with the AUDIT. More than three quarters of those consuming alcohol had noticed the campaign and considered it necessary. The AUDIT pamphlet was also well received with almost half of those who had noticed the pamphlet calculating their own scores and a similar group discussing the matter with other people.
A problem in our study was the small number of individuals in the CAGE-4 category. This may be the reason why statistical differences were not reached by using categorization based on the CAGE; only trends were detected.
The strength of our study was that the target population was big, 90,000 households, and that the respondents were representative of the general population. The city of Tampere is an average-size city in Finland and includes some rural areas. Thus, the results can be generalized to at least Finland. Alcohol consumption in Finland is of the median European level (Alcohol in Europe. A public health perspective. 2006. http://ec.europa.eu/health-eu/news_alcoholineurope_en.htm) and Finnish drinking is mainly of heavy episodic type (Drinking Habit Surveys, STAKES, 2004, www.stakes.info /files/pdf/taskumatti/quickfacts2004.pdf). This drinking pattern is becoming more common in many countries, which means that our results may be valid in several countries where population characteristics are close to those found in our study.
There are few studies which show that those who drink the most are also most worried about their drinking and are interested in receiving help to control their drinking (Werch, 1990; Cunningham et al., 1999). In Canada, Cunninghamet al. (2001) found that 30% of problem drinkers recall receiving the self-test pamphlet. In our study the result is similar; the pamphlet was noticed by 40% of those having a CAGE score of 4 and by 41% of those drinking 2–7 times per week. In our study heavy drinkers noticed the pamphlet with the AUDIT better than non-heavy drinkers. Karlsson et al. (2005) ended up with a same kind of result; those having higher AUDIT scores had thought more about their drinking and considered means of changing their drinking habits compared to those with low AUDIT scores.
Based on the present study AUDIT with scoring instructions delivered to the population may have important role in helping problem drinkers and could provide an initial motivation boost to seek treatment and discuss with their own physician about alcohol. This might promote the use of brief intervention by health care providers.
We conclude that as part of a wide community action, home-delivered self-help material is often noticed especially by heavy drinkers. In future, there is a need to study whether this kind of activity leads to a real change in alcohol consumption and possibly also activates the number of heavy drinkers contacting health care.
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ACKNOWLEDGEMENTS |
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We thank the Finnish Social Science Data Archives about data material. We also thank Ms Aulikki Kuusela from the Temperance Committee, City of Tampere. This study was support by a grant from the Medical Research Fund of Tampere University Hospital, Tampere, Finland.
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References |
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