The CAGE is a commonly used alcohol screening instrument. Although considerable work has been done on the validity of CAGE scores, relatively little information is available on their reliability. Reliability induction and generalization studies were performed for the CAGE. Of the 259 studies available for analysis, only 19 (7.3%) contained reliability information for the sample scores. Thirteen (5.0%) and 227 (87.6%) articles made what are designated as reliability induction by report and reliability induction by omission. The median internal consistency reliability across 22 samples was .74, with a range of .52 to .90. Sample age was the only identified sample characteristic that demonstrated a statistically significant relationship with CAGE score reliability.
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References
1.
Adams, W. L., Yuan, Z., Barboriak, J. J., & Rimm, A. A. (1993). Alcohol related hospitalizations of elderly people: Prevalence and geographic variation in the United States. Journal of the American Medical Association, 270, 1222-1225.
2.
Aertgeerts, B., Buntinx, F., Fevery, J., & Ansoms, S. (2000). Is there a difference between CAGE interviews and written CAGE questionnaires? Alcoholism: Clinical and Experimental Research, 24, 733-736.
3.
Allen, J. P., & Fertig, J. B. (1995). Assessment in alcoholism treatment: An overview. In J. P. Allen & M. Columbus (Eds.), Assessing alcohol problems: A guide for clinicians and researchers (NIH No. 95-3745). Bethesda, MD: National Institute of Health.
4.
Barry, K., & Fleming, M. (1990). Computerized administration of alcoholism screening tests in a primary care setting. Journal of the American Board of Family Practice, 3, 93-98.
5.
Bernadt, M. W., Daniels, O. J., Blizard, R. A., & Murray, R. M. (1989). Can a computer reliably elicit an alcohol history? British Journal of Addiction, 84, 405-411.
6.
Bradley, K. A., Boyd-Wickizer, J., Powell, S. H., & Burman, M. L. (1998). Alcohol screening questionnaires in women. Journal of the American Medical Association, 280, 166-171.
7.
Bradley, K. A., Kivlahan, D. R., Bush, K. R., McDonell, M. B., & Fihn, S. D. (2001). Variations on the CAGE alcohol screening questionnaire: Strengths and limitations in VA general medical patients. Alcoholism: Clinical and Experimental Research, 25, 1472-1478.
8.
Caruso, J. C., Witkiewitz, K., Belcourt-Dittloff, A., & Gottlieb, J. D. (2001). Reliability of scores from the Eysenck Personality Questionnaire: A reliability generalization study. Educational and Psychological Measurement, 61, 675-689.
9.
Cherpitel, C. J. (1998). Differences in performance of screening instruments for problem drinking among Blacks, Whites, and Hispanics in an emergency room population. Journal of Studies on Alcohol, 59, 420-426.
10.
Cherpitel, C. J., & Clark, W. B. (1995). Ethnic differences in performance of screening instruments for identifying harmful drinking and alcohol dependence in the emergency room. Alcoholism: Clinical and Experimental Research, 19, 628-634.
11.
Chung, T., Colby, S. M., Barnett, N. P., Rohsenow, D. J., Spirito, A., & Monti, P. M. (2000). Screening adolescents for problem drinking: Performance of brief screens against DSM-IV alcohol diagnoses. Journal of Studies on Alcohol, 61, 579-587.
12.
Clements, R. (1998). A critical evaluation of several alcohol screening instruments using the CIDI-SAM as a criterion measure. Alcoholism: Clinical and Experimental Research, 22, 985-993.
13.
Connors, G. J. (1995). Screening for alcohol problems. In J. P Allen & M. Columbus (Eds.), Assessing alcohol problems: A guide for clinicians and researchers (NIH No. 95-3745). Bethesda, MD: National Institute of Health.
14.
Cornel, M., Knibbe, R. A., van Zutphen, W. M., & Drop, M. J. (1994). Problem drinking in a general practice population: The construction of an interval scale for severity of problem drinking. Journal of Studies on Alcohol, 55, 466-470.
15.
Deditius-Island, H. K., & Caruso, J. C. (2002). An examination of the reliability of scores from Zuckerman’s sensation seeking scales, form V. Educational and Psychological Measurement, 64, 728-734.
16.
Dimitrov, D. M. (2002). Reliability: Arguments for multiple perspectives and potential problems with generalization across studies. Educational and Psychological Measurement, 62, 783-801.
17.
Dyson, V., Appleby, L., Altman, E., Doot, M., Luchins, D. J., & Delehant, M. (1998). Efficiency and validity of commonly used substance abuse screening instruments in public psychiatric patients. Journal of Addictive Diseases, 17, 57-77.
18.
Ewing, J. A. (1984). Detecting alcoholism: The CAGE questionnaire. Journal of the American Medical Association, 252, 1905-1907.
19.
Fleming, M., & Barry, K. (1991). A three-sample test of a masked alcohol screening questionnaire. Alcohol and Alcoholism, 26, 81-91.
20.
Frank, S. H., Graham, A. V., Zyzanski, S. J., & White, S. (1992). Use of the family CAGE in screening for alcohol problems in primary care. Archives of Family Medicine, 1, 209-216.
21.
Friedman, P. D., Saitz, R., Gogineni, A., Zhang, J. X., & Stein, M. D. (2001). Validation of the screening strategy in the NIAAA “physicians guide to helping patients with alcohol problems.” Journal of Studies on Alcohol, 62, 234-238.
22.
Galanter, M., Castaneda, R., & Ferman, J. (1988). Substance abuse among general psychiatric patients: Place of presentation, diagnosis, and treatment. American Journal of Drug and Alcohol Abuse, 14, 211-235.
23.
Hays, R. D., Hill, L., Gillogly, J. J., Lewis, M. W., Bell, R. M., & Nicholas, R. (1993). Response times for the CAGE, Short-MAST, AUDIT, and JELLINEK alcohol scales. Behavior Research Methods, Instruments & Computers, 25, 304-307.
24.
Hays, R. D., Merz, J. F., & Nicholas, R. (1995). Response burden, reliability, and validity of the CAGE, short MAST, and AUDIT alcohol screening measures. Behavior Research Methods, Instruments, & Computers, 27, 277-280.
25.
Heck, E. J., & Lichtenberg, J. W. (1990). Validity of the CAGE in screening for problem drinking in college students. Journal of College Student Development, 31, 359-364.
26.
Henson, R. K. (2001). Understanding internal consistency reliability estimates: A conceptual primer on coefficient alpha. Measurement and Evaluation in Counseling and Development, 34, 177-189.
27.
Henson, R. K., & Thompson, B. (2002). Characterizing measurement error in scores across studies: Some recommendations for conducting “reliability generalization” studies. Measurement & Evaluation in Counseling & Development, 35, 113-127.
28.
Hogan, T. P., Benjamin, A., & Brezinski, K. L. (2000). Reliability methods: A note on the frequency of use of various types. Educational and Psychological Measurement, 60, 523-531.
29.
Indran, S. K. (1995). Usefulness of the “CAGE” in Malaysia. Singapore Medical Journal, 36, 194-196.
30.
Jones, T., Lindsey, B., Young, P., Soltys, R., & Farani-Enayat, B. (1993). Alcoholism screening questionnaires: Are they valid in elderly medical outpatients. Journal of General Internal Medicine, 8, 359-369.
31.
Joseph, C. L., Rasmussen, J., Ganzini, L., & Atkinson, R. M. (1997). Outcome of nursing home care for residents with alcohol use disorders. International Journal of Geriatric Psychiatry, 12, 767-772.
32.
Kieffer, K. M., Reese, R. J., & Thompson, B. (2001). Statistical Techniques employed in AERJ and JCP articles from 1988 to 1997: A methodological review. Journal of Experimental Education, 69, 280-309.
33.
King, M. (1986). At risk drinking among general practice attenders: Validation of the CAGE questionnaire. Psychological Medicine, 16, 213-217.
34.
Knight, J. R., Goodman, E., Pulerwitz, T., & DuRant, R. H. (2000). Reliabilities of the short substance abuse screening tests among adolescent medical patients. Pediatrics, 105, 948-953.
35.
Li, H., Rosenthal, R., & Rubin, D. B. (1996). Reliability of measurement in psychology: From Spearman-Brown to maximal reliability. Psychological Methods, 1, 98-107.
36.
Lord, F. M., & Novick, M. R. (1968). Statistical theories of mental test scores. Reading, MA: Addison-Wesley.
37.
Maisto, S. A., Connors, G. J., & Allen, J. P. (1995). Contrasting self-report screens for alcohol problems: A review. Alcoholism: Clinical and Experimental Research, 24, 1510-1516.
38.
Mayfield, D., McLeod, G., & Hall, P. (1974). The CAGE questionnaire: Validation of a new alcoholism instrument. American Journal of Psychiatry, 131, 1121-1123.
39.
Meier, S. T., & Davis, S. R. (1990). Trends in reporting psychometric properties of scales used in counseling psychology research. Journal of Counseling Psychology, 37, 113-115.
40.
Midanik, L. T., Zahnd, E. G., & Klein, D. (1998). Alcohol and drugCAGE screeners for pregnant low-income women: The California perinatal needs assessment. Alcoholism: Clinical & Experimental Research, 22, 121-125.
41.
Mischke, H. D., & Venneri, R. L. (1987). Reliability and validity of the MAST, Mortimer-Filkins Questionnaire and CAGE in DWI assessment. Journal of Studies on Alcohol, 48, 492-501.
42.
Moore, R. D., Bone, L. R., Geller, G., Mamon, J. A., Stokes, E. J., & Levine, D. M. (1989). Prevalence, detection, and treatment of alcoholism in hospitalized patients. Journal of the American Medical Association, 261, 403-407.
43.
Murray, M., & McMillian, C. (1993). Problem drinking in Northern Ireland: Results of a community survey using the CAGE questionnaire. Alcohol & Alcoholism, 28, 477-483.
44.
Myerholtz, L. E., & Rosenberg, H. (1997). Screening DUI offenders for alcohol problems: Psychometric assessment of the Substance Abuse Subtle Screening Inventory. Psychology of Addictive Behaviors, 11, 155-165.
45.
Myerholtz, L. E., & Rosenberg, H. (1998). Screening college students for alcohol problems: Psychometric assessment of the SASSI-2. Journal of Studies on Alcohol, 59, 439-446.
46.
National Institute on Alcohol Abuse and Alcoholism. (1995a). Assessing alcohol problems: A guide for clinicians and researchers (NIH No. 95-3745). Bethesda, MD: National Institute of Health.
47.
National Institute on Alcohol Abuse and Alcoholism. (1995b). The physicians guide to helping patients with alcohol problems (Department of Health and Human Services No. 95-3769). Rockville, MD: National Institute of Health.
48.
Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.
49.
Nystrom, M., Perasalo, J., & Salaspuro, M. (1993). Screening for heavy drinking and alcohol-related problems in young university students: The CAGE, the Mm-MAST, and the trauma score questionnaires. Journal of Studies on Alcohol, 54, 528-533.
50.
O’Hare, T., & Tran, T. (1997). Predicting problem drinking in college students: Gender differences and the CAGE questionnaire. Addictive Behaviors, 22, 13-21.
51.
Ogborne, A. C., & DeWit, D. J. (1999). Lifetime use of professional and community services for help with drinking: Results from a Canadian population survey. Journal of Studies on Alcohol, 60, 867-872.
52.
Reinherz, H. Z., Giaconia, R. M., Lefkowitz, E. S., & Pakiz, B. (1993). Prevalence of psychiatric disorders in a community population of older adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 32, 369-377.
53.
Rosenthal, R. (1979). The “file drawer problem” and tolerance for null results. Psychological Bulletin, 86, 638-641.
54.
Rumpf, H. J., Hapke, U., & Hill, J. U. (1997). Development of a screening questionnaire for the general hospital and general practices. Alcoholism: Clinical & Experimental Research, 21, 894-898.
55.
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, 791-803.
56.
Sawilowsky, S. S. (2000). Psychometrics versus datametrics: Comment on Vacha-Haase’s “reliability generalization” method and some EPM editorial policies. Educational and Psychological Measurement, 60, 157-173.
57.
Shields, A. L., & Caruso, J. C. (2003). Reliability generalization of the Alcohol Use Disorders Identification Test. Educational and Psychological Measurement, 63, 404-413.
58.
Smith, D. S., Collins, M., Kreisberg, J. P., Volpicelli, J. R., & Alterman, A. (1987). Screening for problem drinking in college freshman. Journal of American College Health, 36, 89-94.
59.
Steinbauer, J. R., Cantor, S. B., Holzer, C. E., & Volk (1998). Ethnic and sex bias in primary care screening tests for alcohol use disorders. Annals of Internal Medicine, 129, 353-362.
60.
Teitelbaum, L. M., & Carey, K. B. (2000). Temporal stability of alcohol screening measures in a psychiatric setting. Psychology of Addictive Behaviors, 14, 401-404.
61.
Thom, B., Herring, R., & Judd, A. (1999). Identifying alcohol-related harm in young drinkers: The role of accident and emergency departments. Alcohol and Alcoholism, 34, 910-915.
62.
Thompson, B. (1994). Guidelines for authors. Educational and Psychological Measurement, 54, 837-847.
63.
Thompson, B. (2002). What future quantitative social science research could look like: Confidence intervals for effects sizes. Educational Researcher, 31, 24-31.
64.
Vacha-Haase, T. (1998). Reliability generalization: Exploring variance in measurement error affecting score reliability across studies. Educational and Psychological Measurement, 58, 6-20.
65.
Vacha-Haase, T., Henson, R., & Caruso, J. C. (2002). Reliability generalization: Moving toward improved understanding and use of score reliability. Educational and Psychological Measurement, 62, 562-569.
66.
Vacha-Haase, T., Kogan, L. R., & Thompson, B. (2000). Sample compositions and variabilities in published studies versus those in test manuals: Validity of score reliability inductions. Educational and Psychological Measurement, 60, 509-522.
67.
Whittington, D. (1998). How well do researchers report their measures? An evaluation of measurement in published educational research. Educational and Psychological Measurement, 58, 21-37.
68.
Wilkinson, L., & the American Psychological Association Task Force on Statistical Inference. (1999). Statistical methods in psychology journals. American Psychologist, 54, 594-604.
69.
Wolford, G. L., Rosenberg, S. D., Drake, R. E., Mueser, K. T., Oxman, T. E., Hoffman, D., et al. (1999). Evaluation of methods for detecting substance use disorder in persons with severe mental illness. Psychology of Addictive Behaviors, 13, 313-326.
70.
Wu, L.-T., Kouzis, A. C., & Leaf, P. J. (1999). Influence of comorbid alcohol and psychiatric disorders on utilization of mental health services in the national comorbidity survey. American Journal of Psychiatry, 156, 1230-1236.
71.
Yin, P., & Fan, X. (2000). Assessing the reliability of Beck depression inventory scores: Reliability generalization across studies. Educational and Psychological Measurement, 60, 201-223.
