Asian Journal of Psychiatry 28 (2017) 167–169
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Letter to the Editor MARK
Prevalence of problematic tobacco and alcohol use among general hospital outpatients in Thailand
Dear Editor, Problematic tobacco and alcohol uses are important public health problems in Thailand, which associated with many physical and psychiatric disorders (Bundhamcharoen et al., 2011). We aimed to study the prevalence of patients with problematic tobacco and alcohol uses among the outpatients through the screening instruments, to determine the scale and the characteristics of patients who were at risk in a general hospital. We conducted a cross-sectional study to investigate the problematic tobacco and alcohol uses in a setting of the general hospital. The number of participants was 1700 recruited from 9 departments stratified by the number of outpatients in 2012. The participants met the criteria of age ≥18 years which excluded communication deficit and mental retardation. The participants were asked for filled the history of alcohol and tobacco use and status, Fagerstrom (Heatherton et al., 1991), AUDIT (Saunders et al., 1993) and CAGE (Ewing, 1984) questionnaires. The collecting data (characteristics, scores of the screening tools) was analyzed with SPSS software v16.0 (SPSS Inc, Chicago, Illinois, US). The problematic tobacco and alcohol use was defined by categories of moderate-to-high in Fagerstrom test, hazardous drinker to alcohol dependence in AUDIT, and alcohol use problem in CAGE. The total number of 1700 was 710 (41.8%) males and 987 (58.2%) females. The average age was 50.7 ± 17.6 years. The 96 (5.7%) participants were current smokers. The severity of Fagerstrom test was classified into 3 categories: low dependence, moderate dependence, and high dependence which contributed 3.18%, 1.9%, and 0.3% among all participants and 58.1%, 1.9%, and 0.3% among current smokers. Thus, the number of patients with problematic tobacco use was 2.2%. The average ages of low dependence, moderate dependence, and high dependence were 44.1, 44.1 and 42.8, while male-to-female ratios were 12.5:1, 32.0:1 and 4.0:1. The result from AUDIT showed 19.3%, 8.4%, 1.1% and 1.3% were low-risk drinker, hazardous drinker, harmful use, and alcohol dependence respectively. The number of patients with problematic alcohol use was 10.8%. The average ages of low-risk drinker, hazardous drinker, harmful use, and alcohol dependence were 42.1, 49.3, 49.3, and 44.0, while the male-to-female ratios were 1.3:1, 7.9:1, 19.0:0, and 21.0:1. The result from CAGE showed 14.7% had alcohol use problem which could be implied as problematic alcohol use. This group's age was 45.0 years in average with the maleto-female ratio of 3.1:1. Among current drinkers, 47.7% of patients had alcohol use problem and considered having problematic alcohol use. The group's age was 47.7 year in average with male-to-female ratio of 3.2:1. We also analyzed the correlation between AUDIT and CAGE and found the strong correlation by the Pearson's correlation (r = 0.7). The results from the present study showed the magnitude of problematic tobacco and alcohol uses among the outpatients with physical problems that might contribute to their physical diseases. The prevalence of problematic tobacco use ranged from 2.7% in normal Thai population to 47.7% (Maneeganol et al., 2014; Sooksompong et al., 2016), while the result of the present study was 2.2%. The prevalence of problematic alcohol use ranged from 5.0% to 57.7% (Assanangkornchai et al., 2010; Chaithawanwong and Kalayasiri, 2013; Junsirimongkol et al., 2011; Maneeganol et al., 2014; Sooksompong et al., 2016), while the results of the present study were 14.7% with CAGE and 10.8% with AUDIT. The difference among the size of prevalence of problematic alcohol and tobacco use depend on various factors, including, the screening and diagnostic tools, the surveyed setting, and the selected population. Next, it is worth noticing that all categories that defined problematic tobacco and alcohol use in patients with physical problems were in the age of 5th decade and had a greater proportion of male than female. These characteristics helped recognize the patients that were most at risk and needed keen attention. We suggest the implementation of screening tests in outpatient departments, for example, the written version and the oral interview of CAGE questionnaire (Ratta-apha et al., 2014). The present study had several limitations. First, the result might not represent all of the outpatients such as patients with severe physical conditions, teenagers, and patients with cognitive decline. Second, patients with problematic tobacco and alcohol consumption may be denial or exhibit recall bias. Collecting data from other sources, such as family's members should be helpful in the practice. The results of the present study could not be generalized to the other general hospitals which needed to investigate the size of problems. In conclusion, we suggested that problematic tobacco and alcohol use should be on spot. Screening instruments are helpful in detecting patients with patients at risk in clinical practice. Prevalence of problematic tobacco and alcohol use in number, average age, and male-to-female ratio:
Questionnaires and results
Score
Fagerstrom Smoking status History of smoking Current smoking http://dx.doi.org/10.1016/j.ajp.2017.05.009 Received 5 March 2017 1876-2018/ © 2017 Elsevier B.V. All rights reserved.
Number of participants/total responses
Percentage
Average age (year)
Male:Female
449/1700 96/1700
26.4 5.7
54.6 44.2
8.2:1 12.7:1
Asian Journal of Psychiatry 28 (2017) 167–169
Letter to the Editor
Dependency among current smokers Low dependence 0–3 Moderate dependence 4–6 High dependence 7–10
54/92 (58.7) 33/92 (35.9) 5/92 (5.4)
3.2 1.9 0.3
44.1 44.1 42.8
12.5:1 32.0:1 4.0:1
AUDIT Low risk drinker Hazardous drinker Harmful use Alcohol dependence
1–7 8–15 16–19 20–40
324/1682 142/1682 19/1682 22/1682
19.3 8.4 1.1 1.3
42.1 49.3 49.2 44.0
1.3:1 7.9:1 19.0:0 21.0:1
CAGE Among all participants No problem Alcohol use problem
0–1 2–4
1445/1692 248/1692
85.4 14.7
51.7 45.0
0.6:1 3.1:1
Among current drinkersa No problem Alcohol use problem
0–1 2–4
270/516 246/516
52.3 47.7
43.8 45.0
1.6:1 3.2:1
Conflicts of interest None. Acknowledgements The present study was supported by the Siriraj Institutional Review Board (SIRB), Faculty of Medicine, Siriraj Hospital, Mahidol University (CoA Si 392/2557). We would like to thank Miss Aree Singlampong for her coordination in this project and the staff of outpatient units, Siriraj Hospital for their cooperation. References Assanangkornchai, S., Sam-Angsri, N., Rerngpongpan, S., Lertnakorn, A., 2010. Patterns of alcohol consumption in the Thai population: results of the National Household Survey of 2007. Alcohol Alcohol. 45 (3), 278–285. Bundhamcharoen, K., Odton, P., Phulkerd, S., Tangcharoensathien, V., 2011. Burden of disease in Thailand: changes in health gap between 1999 and 2004. BMC Public Health 11, 53. Chaithawanwong, T., Kalayasiri, R., 2013. Alcohol drinking of construction workers in Bangkok metropolis. J. Psychiatr. Assoc. Thail. 58 (4), 345–358. Ewing, J.A., 1984. Detecting alcoholism. The CAGE questionnaire. JAMA 252 (14), 1905–1907. Heatherton, T.F., Kozlowski, L.T., Frecker, R.C., Fagerstrom, K.O., 1991. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br. J. Addict. 86 (9), 1119–1127. Junsirimongkol, B., Kittirattanapaiboon, P., Khamwongpin, M., Chutha, W., Kongsuk, T., Leejongpermpoon, J., 2011. The prevalence of alcohol use disorders and psychiatric comorbidity in Thailand: national epidemiological survey 2008. J. Ment. Health of Thail. 19 (2), 88–102. Maneeganol, S., Arunponpaisal, S., Pimpanit, V., Jarassaeng, N., Boontoch, K., 2014. Prevalence of substance use in psychiatric outpatient clinic at Srinagarind hospital. J. Psychiatr. Assoc. Thail. 59 (4), 371–380. Ratta-apha, W., Sitdhiraksa, N., Pariwatcharakul, P., Saisavoey, N., Limsricharoen, K., Thongchot, L., Kumkan, P., Sanguanpanich, N., Ketumarn, P., 2014. Under-recognized alcoholrelated disorders in psychiatric outpatient unit. J. Med. Assoc. Thail. 97 (4), 439–446. Saunders, J.B., Aasland, O.G., Babor, T.F., De la Fuente, J.R., Grant, M., 1993. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption – II. Addiction 88, 791–804. Sooksompong, S., Kwansanit, P., Supanya, S., Chuta, W., Kittirattanapaiboon, P., Udomittipong, D., Piboonarluk, W., Saensawang, S., 2016. The Thai National Mental Health Survey 2013: prevalence of mental disorders in megacities: Bangkok. J. Psychiatr. Assoc. Thail. 61 (1), 75–88.
Yanin Suksangkharn Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Piangmas Tasneeyapant Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Patcharida Mahatchariyapong Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Thanyathad Suwanaro Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Kunravitch Soraprajum Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Naratip Sanguanpanich Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Lakkhana Thongchot Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand Nattawut Apiwannarat Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 168
Asian Journal of Psychiatry 28 (2017) 167–169
Letter to the Editor
Wichian Boonyaprapa Siriraj Information Technology Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ⁎
Woraphat Ratta-apha Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand E-mail address:
[email protected] Nantawat Sitdhiraksa Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
⁎
Corresponding author at: Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Siriraj, Bangkoknoi, Bangkok 10700, Thailand.
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