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Psychometric Properties of the CAGE Questionnaire Amongst Middle-Aged and Older Adults in Khuzistan Province of Iran

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Abstract

The CAGE questionnaire is an instrument, proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The questionnaire has been more pervasive simple tool than AUDIT and LAST scales to screen in busy medical settings where limited time is considered for adult patient interviews. The present study aimed to determine the reliability and validity of the CAGE questionnaire in Khuzistan province, Iran and evaluate its role in detecting alcohol-related problems. For this purpose, 382 men with mean age of 65 ± 5 were sampled by cluster-random sampling method in convenience model from the medical centers in eight counties of Khuzistan province during 2019 and they responded to the CAGE questionnaire. The coefficients of Cronbach’s alpha (α = 0.82), convergent validity (0.73), divergent validity (-0.06), and criterion validity (0.87) were estimated (ρ < 0.01). The exploratory factor analysis demonstrated that the four –items related to the CAGE for the aged samples are organized into one factor, which clarifies 94% of the variance. Based on the results of the second-order confirmatory factor analysis, all factors were matched up well into a principal factor. Finally, the one -factor model was appropriate for the data by using the fit index techniques for adjusting the scale (AGFI = 0.81, TLI = 0.91, GFI = 0.93, RMSEA = 0.006, IFI = 0.94, NFI = 0.91, CFI = 0.97).The results could prove the well-adjusted reliability and validity of the CAGE and its usefulness for the relevant studies.

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Acknowledgements

We wish to thank colleagues and the anonymous referees for their valuable comments.

Author information

Authors and Affiliations

  1. Department of Gerontology, School of Health, Shiraz University of Medical Science, 3rd Floor, Razi Ave, Shiraz, 43400, Iran

    Abdolrahim Asadollahi, Mohammad Hossein Kaveh & Masud Karimi

  2. Australian Centre for Quality of Life, Deakin University, Melbourne, Australia

    Abdolrahim Asadollahi

  3. Department of Community Health Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Mazandaran Province, Iran

    Laleh Fani Saberi

  4. Department of Community Development, Faculty of Human Ecology, UPM, Serdang, Malaysia

    Nobaya Ahmad

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  1. Abdolrahim Asadollahi
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  2. Mohammad Hossein Kaveh
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  4. Masud Karimi
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Contributions

NA & LFS contributed to the design, performed the interviews, and interpreted the interviews. MK has contributed to the design, interpretation, and discussion. AA & MHK analyzed the data, wrote the draft and has revised the content, and scientific writing. All authors have approved the final manuscript.

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Correspondence to Abdolrahim Asadollahi.

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MeSH Terms

Aged, Alcoholism/complications, Alcoholism/diagnosis, Alcoholism/psychology, Analysis of Variance, Cognition Disorders/etiology, Cognition Disorders/psychology, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales/standards, Reproducibility of Results.

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Research Report, N.I.H., Extramural, Validation Studies.

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The authors declare that they have no competing interests.

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ANNEX: Three of Most Used Alcoholism/Alcohol Misuse Inventories

ANNEX: Three of Most Used Alcoholism/Alcohol Misuse Inventories

CAGE Questionnaire *

  1. 1.

    Have you ever felt you ought to cut down on your drinking?

  2. 2.

    Have people annoyed you by criticizing your drinking?

  3. 3.

    Have you ever felt, bad, or guilty about your drinking?

  4. 4.

    Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

* 2 Yes or more: Indicates need for further clinical investigation and/or referral as indicated by clinician’s expertise.

AUDIT Questionnaire

  1. 1.

    How often did you have a drink containing alcohol in the past year?

    (0) Never (1) Monthly or less (3) 2–4 times/month (4) 2–3 times/week (5) ≥ 4 times/week

  2. 2.

    How many drinks containing alcohol did you have on a typical day when you were drinking in the past year?

    (1) 1 or 2 (2) 3 or 4 (3) 5 or 6 (4) 7 to 9 (5) 10 or more

LAST Questionnaire**

  1. 1.

    Are you able to stop drinking when you want to?

  2. 2.

    CAGE Questions (1) and (2)

  3. 3.

    Does any near relative or close friend worry or complain about your drinking?

  4. 4.

    Have you ever gotten into trouble at work because of your drinking?

  5. 5.

    Have you ever been told you have liver trouble such as cirrhosis?

  6. 6.

    Have you ever been hospitalized because of your drinking?

** All yes or no questions; Question 1 scoring: no; Questions 2–6: scoring: yes. Two or more points indicative of alcohol dependence or abuse.

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Asadollahi, A., Kaveh, M.H., Saberi, L.F. et al. Psychometric Properties of the CAGE Questionnaire Amongst Middle-Aged and Older Adults in Khuzistan Province of Iran. J Cross Cult Gerontol 38, 97–109 (2023). https://doi.org/10.1007/s10823-023-09470-w

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