Cost-utility analysis of an alcohol policy in Thailand: a case study of a random breath testing intervention.

BACKGROUND: Road traffic injuries are a major concern worldwide, with Thailand facing high accident mortality rates. Drunk driving is a key factor that requires countermeasures. Random breath testing (RBT) and mass media campaigns recommended by the World Health Organisation intend to deter such behaviour. This study aimed to evaluate the cost-effectiveness of implementing RBT in combination with mass media campaigns in Thailand. METHODS: A Markov simulation model estimated the lifetime cost and health benefits of RBT with mass media campaigns compared to mass media campaigns only. Direct medical and non-medical care costs were evaluated from a societal perspective. The health outcomes were quality-adjusted life years (QALY). Costs and outcomes were discounted by 3% per year. Subgroup analyses were conducted for both sexes, different age groups, and different drinking levels. Probabilistic sensitivity analyses were conducted over 5,000 independent iterations using a predetermined distribution for each parameter. RESULTS: This study suggested that RBT with mass media campaigns compared with mass media campaigns increases the lifetime cost by 24,486 THB per male binge drinker and 10,475 THB per female binge drinker (1 USD = 35 THB) and results in a QALY gain of 0.43 years per male binge drinker and 0.10 years per female binge drinker. The intervention yielded incremental cost-effectiveness ratios (ICERs) of 57,391 and 103,850 THB per QALY for male and female drinkers, respectively. Moreover, the intervention was cost-effective for all age groups and drinking levels. The intervention yielded the lowest ICER among male-dependent drinkers. Sensitivity analyses showed that at a willingness-to-pay (WTP) threshold of 160,000 per QALY gained, the RBT combined with mass media campaigns had a 99% probability of being optimal for male drinkers, whereas the probability for females was 91%. CONCLUSIONS: RBT and mass media campaigns in Thailand are cost-effective for all ages and drinking levels in both sexes. The intervention yielded the lowest ICER among male-dependent drinkers. Given the current Thai WTP threshold, sensitivity analyses showed that the intervention was more cost-effective for males than females.

The Health Impact of Long-Term Kratom (Mitragyna Speciosa) Use in Southern Thailand.

BACKGROUND: Mitragyna speciosa or Kratom has been used in Thailand traditionally for its medicinal value. Despite case reports of kratom consumption causing adverse effects, research on its long-term health impact is limited. This study examines the long-term health impact of kratom use among people in Southern Thailand. METHODS: Three community-based surveys were conducted from 2011 to 2015. In the first and second surveys (2011 and 2012) a total of 1,118 male respondents comprising 355 regular kratom users, 171 occasional kratom users, 66 ex-users, and 592 non-users aged 25 or above, were recruited from 40 villages. All respondents were followed up in this study. However, not all respondents were successfully followed up throughout the entire set of studies. RESULTS: Common health complaints were no more common among kratom users than ex- and non-users, but more regular than occasional users claimed kratom to be addictive. Those with high kratom dependence scores were more likely to experience intense withdrawal symptoms, which developed 1-12 h after the last kratom intake. Over half (57.9%) of regular users had experienced intoxication effects compared to only 29.3% of occasional users. Kratom users were less likely to have a history of chronic diseases such as diabetes, hypertension, dyslipidemia than ex- and non-users. CONCLUSION: Regular long-term chewing of fresh kratom leaves was not related to an increase in common health complaints, but may pose a drug dependence risk. Severe kratom dependents were more likely to suffer from intense withdrawal symptoms. Medical records revealed no death due to traditional kratom use, but the high prevalence of tobacco or/and hand rolled cigarette smoking among kratom users should be of concern.

Inter-ethnic differences in self-reported alcohol-related harm to children in Han vs. Yi ethnic minority households in Yunnan Province, China.

China is a multi-ethnic country, but inter-ethnic disparities in alcohol-related harm to children have not been described. In this study, we assessed differences in prevalence of self-reported alcohol-related harm to children in Yi and Han households in Chuxiong Yi Prefecture, Yunnan Province, China. We conducted a cross-sectional study among caregivers in households with a child age less than 18 years using structured questionnaire interview. Participants included 241 Yi caregivers and 610 Han caregivers (overall refusal rate = 1.1%). Heavy drinking was more common in Yi households than Han households (41.9% vs. 30.8%, respectively), but there was no difference in alcohol-related harm to children (21.2% vs. 17.9%; Adjusted OR = 0.98; 95% CI = 0.65, 1.46). Caveats such as social desirability in reporting sensitive issues and the cross-sectional study design should be considered in the interpretation of the study findings.

Expected Years Of Life Lost Due To Alcohol Consumption In Thai Adults: A 16-Year Follow-Up Cohort Of National Health Examination Survey 2004-2019.

AIMS: Evidence of premature death attributable to alcohol, a modifiable risk factor, is crucial for guiding public health policy for alcohol control. The aim of this study was to estimate alcohol-related mortality and potential years of life lost (PYLL) in Thailand in 2004-2019. METHODS: We analysed data of the third National Health Examination Survey in 2004 linked to National Death Registry data of 2004-2019. Causes of death were based on International Classification of Diseases version 10. PYLL was calculated by cause of death, age group and sex. All analyses were weighted to take into account the probabilities for the multi-stage sampling of the 2004 Thai population aged ≥15 years. RESULTS: There were 10,704 deaths with a follow-up time of 507,771.7 person-years. The crude mortality rate of the initial sample was 868.6 per 100,000 population. The mortality rate attributable to alcohol was 18.6 per 100,000 population (30.7 per 100,000 population in males and 6.8 per 100,000 population in females). The top leading cause of alcohol-attributable deaths was unspecified liver diseases in both males and females (6.1 and 3.1 per 100,000 population, respectively). The total years of life lost (YLL) at baseline were 9.4 million years or 49.5 years per person on average, with significantly more years in males. Mortality rate and expected YLL were highest in ages of 30-44 years, followed by 15-29 years. CONCLUSION: Males were 4-fold more likely to die from all alcohol-attributable causes compared with females. Young adults had a greater loss of life years than older adults.

Measuring the uptake of continuous care among people living with HIV receiving antiretroviral therapy and social determinants of the uptake of continuous care in the southwest of China: a cross-sectional study.

BACKGROUND: Continuous care is essential for people living with HIV. This study aimed to measure continuous care uptake and investigate the association between higher uptake of continuous care and behavioral and social factors, including HIV-acquisition risk and socioeconomic characteristics. METHODS: A hospital-based cross-sectional study was conducted from April to November 2019 in an HIV treatment center of a specialized hospital in Kunming city, China. Fourteen service indicators were used to calculate composite care scores, which were classified into three levels (low, middle, and high), using principal component analysis. The Behavioral Model for Vulnerable Populations was employed to examine predisposing, enabling, and need factors associated with composite care scores among people living with HIV. RESULTS: A total of 702 participants living with HIV aged ≥ 18 years (median age: 41.0 years, 69.4% male) who had been on ART for 1-5 years were recruited. Based on ordinal logistic regression modeling, predisposing factors: being employed (adjusted odds ratio (AOR): 1.54, 95% confidence interval (CI): 1.13-2.11), heterosexuals (AOR: 1.58, 95% CI: 1.11-2.25) and men who have sex with men (AOR: 2.05, 95% CI: 1.39-3.02) and enabling factors: Urban Employee Basic Medical Insurance (AOR: 1.90, 95% CI: 1.03-3.54), middle socioeconomic status (SES) (AOR: 1.42, 95% CI: 1.01-2.01), were positively associated with the higher level of continuous care uptake, compared to the unemployed, people who inject drugs, those with no medical insurance and low SES, respectively. CONCLUSION: There were large differences in continuous care uptake among people living with HIV. HIV-acquisition risk categories and socioeconomic factors were significant determinants of uptake of continuous care. Our findings could inform the development of evidence-based strategies that promote equitable healthcare for all people living with HIV.

Does husband's alcohol consumption increase the risk of domestic violence during the pregnancy and postpartum periods in Nepalese women?

BACKGROUND: Domestic violence against women during pregnancy and the postpartum period not only violates the human rights of women but also harms on the health of both mother and child. Domestic violence is entrenching in social norms, customs and structural factors against women in Nepal. The use of alcohol also exacerbates domestic violence. The objective of this study was to determine the association between domestic violence against women and husband's drinking behavior across the periods of pregnancy and postpartum. METHODS: This study was a cross-sectional study conducted in the antenatal care and postnatal care clinics of a government hospital in Kathmandu district. Among 660 women (aged 15-49), 165 women were consecutively recruited from each trimester of pregnancy and the postpartum period. Adjusted odds ratios (AOR) were computed from a multivariate logistic regression model to determine the association between domestic violence against women and the husband's drinking behavior. RESULTS: Women whose husbands drank alcohol were twice as likely to suffer from domestic violence, compared to those women whose husbands did not drink (AOR = 2.12; 95% CI: 1.4-3.2), independently of their socio-demographic status. Women suffered from domestic violence in each period of pregnancy and postpartum due to their husband's drinking habits, but the most affected period was the second trimester of pregnancy. Among women who suffered from physical, psychological and sexual violence during the pregnancy and postpartum periods, 70.2, 67.9, and 64.2% respectively experienced violence due to their husband's drinking habit. Other associated factors for domestic violence included the ethnic culture of Janjati ethnicity, illiteracy of the women, duration of marriage 2-5 years (compared to one year or less) and a husband who behaved in a controlling manner. CONCLUSIONS: Having a husband who has alcohol drinking behavior is an important risk factor for domestic violence against women in the pregnancy and postpartum periods. Screening of alcohol use in husbands will not prevent domestic violence but could lead to a referral to integrated treatment for alcohol and domestic violence treatment.

Metabolic syndrome in Thai adolescents and associated factors: the Thai National Health Examination Survey V (NHES V).

BACKGROUND: Presence of metabolic syndrome (MetS) in early life may influence cardiovascular outcome later in adulthood. There is limited data regarding MetS among Thai adolescents. This study aimed to estimate the prevalence of MetS and related factors in Thai adolescents. METHODS: Data on MetS components of 1934 Thai adolescents aged 10-16 years were obtained from the 5th National Health Examination Survey. Age at first screen time exposure, duration of screen time, frequency of food intake and physical activities were collected from interviews. MetS was defined according to 3 definitions: International Diabetes Federation (IDF), Cook's, and de Ferranti's. RESULTS: The prevalence of MetS was 4.1% by IDF, 8.0% by Cook's, and 16.8% by de Ferranti's definition. The overall prevalence was higher in male (19.0%) than female adolescents (15.3%). The most common MetS components composition among Thai adolescents was high waist circumference with high serum triglyceride and low HDL-cholesterol (40.0% for IDF, 22.6% for Cook's and 43.5% for de Ferranti's definition). Exposure to screen media during the first 2 years of life had a 1.3- fold increased odds of MetS by 1 out of 3 definitions (OR 1.30, 95% CI. 1.01-1.68). Duration of physical activity associated with decreased odds of MetS by Cook's definition (OR 0.96, 95% CI. 0.92-0.99). CONCLUSIONS: The prevalence of MetS among Thai adolescents was higher than previously reported by other studies. Screen media exposure during the first 2 years of life should be discouraged and measures to promote physical activity among children and adolescents should be strengthen.

A Context-Specific Instrument to Record Drinking Behaviour: A Pilot Study on Implications of Identifying the Context of Risky Drinking.

A context-specific quantity-frequency (CSQF) questionnaire has been developed to accurately measure alcohol consumption using probing questions on drinking context. The study aimed to describe the drinking context associated with different drinking intensities in a community of southern Thailand using the CSQF. A cross-sectional survey was conducted among adults aged > 15 years in Songkhla Province, Thailand. Among 804 participants, there were 183 current drinkers with 412 drinking events (215 low-, 79 medium-, and 118 high-intensity). More than half of these events occurred in special situations (i.e., holiday, party, and cultural drinking). About half of the drinking events occurred outside the drinker's house and most drinking events occurred among friends. Higher drinking intensity was associated with higher level of education [adjusted odds ratio (aOR) 4.74 for medium- and aOR 5.23 for high-intensity] and with a special drinking situation (aOR 2.46 for medium- and aOR 2.78 for high-intensity).

Does Drinking Initiation of Young Thai Drinkers Vary Over Time and Generation? Results of the National Surveys on Tobacco and Alcohol Consumption of the Thai Populations 2007 to 2017.

BACKGROUND: Early age at drinking initiation may be one factor responsible for underage drinking in Thailand and this may be affected by cultural and generational changes over certain periods of time. This study aimed to explore the effects of time period and generation on drinking onset of young Thai drinkers in the past decade. METHODS: We analyzed data from a total of 60,018 Thais aged 15 to 24 years from 4 national surveys conducted in 2007, 2011, 2014, and 2017. We used multilevel and event history analysis to examine the effects of period (survey year) and cohort (birth year of participants), adjusted for sex, age, area of residence, and region on drinking onset. RESULTS: The overall prevalence of past-year drinking was 23.6 % (95% confidence interval [CI]: 23.2, 23.9) among participants of all surveys. Cox proportional hazards model revealed significantly different probabilities to have initiated drinking between participants of different surveys and birth years, indicating significant period and cohort effects. After adjusting for sex, age, cohort, living region, and area of residence, participants in the 2014 survey had the highest likelihood to have started drinking (hazard ratio [HR]: 1.25 CI: 1.15 to 1.36), compared to the participants of the same age in the 2007 survey while those in the 2011 (HR: 0.89, CI: 0.85, 0.93) and 2017 (HR: 0.63, CI: 0.58, 0.68) surveys had less likelihood. Participants born in 1993 to 2002 (later cohort) had higher probability to have started drinking than those born in 1983 to 1992 (HR: 1.80, CI: 1.69, 1.92). CONCLUSION: Thai youths of the recent generations living in recent years tend to have a higher probability of initiating drinking than those in the past. Interventions to prevent underage drinking should begin earlier for the young generation.

Health status and associated factors of HIV-infected patients in Kunming, China.

OBJECTIVE: To assess health status of HIV-positive patients and to examine its predictors in Kunming, China. METHODS: HIV-positive patients were recruited from a general hospital and an infection hospital in 2015. Health status of the patients was evaluated using standardized questions on eight health domains (mobility, self-care, pain and discomfort, cognition, interpersonal activities, vision, sleep and energy, and emotional distress) of the WHO World Health Survey. A multivariate linear regression model was employed to explore the predictors of health status. RESULTS: A total of 1,363 HIV patients were recruited. The mean (SD) health status score was 73.4 (18.2), with the prevalence of reporting problems ranging from 17.6% (self-care problems) to 86.3% (vision problems). CD4 count, occupation, household income, accessibility to healthcare services, and healthcare expenditures were found to be significant predictors of health status. CONCLUSIONS: Healthcare services for HIV patients may assist improvement of interpersonal activities and relieve emotional distress, and efforts are needed to continually increase accessibility to the services. Special attention should be given to those at low socioeconomic level and those suffering from low CD4 count.

Socio-economic inequalities in the association between alcohol use disorder and depressive disorder among Thai adults: a population-based study.

BACKGROUND: Previous evidence indicates significant associations between depressive disorders and alcohol use disorder (AUD) and their strong links with social conditions. This study aims to investigate the association between major depressive episode (MDE) and AUD across various socio-economic groups. METHODS: We analysed data from the 2014 Thai National Health Examination Survey containing a random sample of 13,177 adults aged > 20 years from the general population. The Alcohol Use Disorder Identification Test was used to classify respondents into non-problem drinking (score 0-7), hazardous drinking (score 8-15), and harmful-dependent drinking (score 16-40). MDE was identified using questions based on the DSM-IV. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated using multinomial logistic regression to determine the strength of associations between MDE as a predictor and AUD as an outcome variable across different socio-economic levels. RESULTS: The prevalence of MDE, hazardous, and harmful-dependent drinking was 2.5, 10.3, and 1.9%, respectively. The association between MDE and AUD was modified by wealth index, education level and area of residence. AORs for the association between MDE and harmful-dependent drinking were high among those in the highest (AOR = 8.68, 95% CI: 5.34, 14.11) and lowest (AOR = 7.14, 95% CI: 3.71, 13.73) levels of wealth index but not significant among those in the middle level (AOR = 1.78, 95% CI: 0.74, 4.25). Education had the strongest effect on the relationship between MDE and harmful-dependent drinking (AOR = 16.0, 95% CI: 10.30, 24.90 among those completing secondary school or higher and AOR = 1.44, 95% CI: 0.63, 3.33 among those completing primary school only). The association between MDE and harmful-dependent drinking was higher among people who lived in urban areas (AOR = 8.50, 95% CI: 5.50, 13.13) compared to those living in rural areas (AOR = 4.73, 95% CI: 3.31, 6.77). CONCLUSION: Socio-economic factors modify the association between alcohol use disorder and major depressive disorder among Thai people.

Mental health problems from direct vs indirect exposure to violent events among children born and growing up in a conflict zone of southern Thailand.

PURPOSE: This study aims to examine and compare the effects of direct and indirect exposure to armed conflicts on the mental health of primary school students in the three southernmost provinces of Thailand. METHODS: A school-based survey was conducted. Detailed exposure of traumatic events both directly and indirectly were measured by a self-completed questionnaire. Behavioral-emotional problems were measured by the Strength and Difficulty Questionnaire and screening for post-traumatic stress disorder (PTSD) was done using the Children's Revised Impact of Events Scale (CRIES). Multivariate analysis adjusted for gender and other covariates was used to determine the effect of direct and indirect exposure of armed conflict on mental health problems. RESULTS: Out of 941 students included in the study, almost half had direct exposure to an armed conflict event. Overall, 42.1% of students had at least one behavioral-emotional problem (47.6% and 38.5% in the direct- and indirect-exposed groups, respectively) and 30.5% was found to have PTSD (37.3% and 25.9% in the direct- and indirect-exposed groups, respectively). Students who had direct exposure to an armed conflict event had a two times higher odds of mental health problems than their peers. Other modifiable factors of mental health problems were receiving news from two sources including other adults and media, and exposure to other non-conflict-related traumatic life events. CONCLUSIONS: Children living in armed conflict areas of southern Thailand, although without any direct exposure to traumatic events, also suffered from mental health problems. Research on appropriate interventions for these children should be further conducted.

Comparison of drinking prevalence among Thai youth before and after implementation of the Alcoholic Beverage Control Act.

BACKGROUND: Underage drinking contributes to numerous health and social problems among adolescents. The Alcoholic Beverage Control Act, issued in Thailand in 2008, contains several clauses aiming at preventing underage and novice drinking, such as raising the minimum legal purchasing age from 18 to 20, banning alcohol sale and consumption in places frequented by youth, and banning alcohol advertisements. OBJECTIVES: To estimate the changes in the prevalence of alcohol consumption and perceptions of drinking norms among high-school students 8 years after the Act was implemented. METHODS: Data from the Thai national high-school surveys in 2007 (N = 50,033; 49.9% female) and 2016 (N = 38,535; 49.8% female), using similar questionnaires, were analyzed. Prevalence rates and group norms toward drinking were compared between the two surveys, using weighted Poisson regression and prevalence ratios. RESULTS: Drinking prevalence significantly increased in females, with prevalence ratios ranging from 1.2 for 30-day intoxication to 2.1 for 30-day binging. In males, the 12-month drinking prevalence increased in 2016, but a non-significant change for binge drinking and a 40% decrease for intoxication was seen. Higher proportions of students in 2016 perceived that most of their friends also drank alcohol compared to students in 2007 (16.8% vs. 11.2%; 49.8% increase). A significant effect of the year of survey on drinking patterns was seen across all school levels. CONCLUSION: Drinking rates decreased among males, but increased in females. These changes may be somewhat due to the Act, or to changes in the social environment in Thailand over this 8-year period.

Clusters of alcohol and drug use and other health-risk behaviors among Thai secondary school students: a latent class analysis.

BACKGROUND: Alcohol and drug use and other health-risk behaviors tend to cluster together among adolescents and contribute a large amount of harm to both themselves and to others. This paper aims to characterize secondary school students based on their clusters of health-risk behaviors and identify factors determining class membership to these behavior-clusters. METHODS: Data from a national school survey was used to identify clusters of alcohol and drug use and other health-risk behaviors among secondary school students aged 12-15 years using a latent class regression model. A multinomial logistic regression model was used to identify predictors of the cluster membership. RESULTS: A total of 25,566 students were included in the analysis, of which 88% were classified as having low-risk behaviors reporting only moderate alcohol use; 11% as having moderate-risk behaviors, such as driving under the influence of alcohol, fighting, carrying a weapon, and alcohol and tobacco use; and 0.6% as having high-risk behaviors, such as use of illicit drugs, particularly kratom and cannabis. Males, older students, those with a poor school performance, not living with parents, drug use by family members and peers, and having a low level of perceived disdain from their friends if they used drugs were significant risk factors for being in the moderate- and high-risk behavior classes. CONCLUSIONS: Alcohol, tobacco and drug use, as well as other health-risk behaviors such as fighting, are clustered in Thai secondary school students. This result highlights the importance of comprehensive prevention and education strategies, particularly for moderate to high-risk groups.

Can socio-economic differences explain low expectation of health services among HIV patients compared to non-HIV counterparts?

BACKGROUND: The health service of China has encountered significant challenges due to inequalities in socio-economic determinants of health. HIV patients are known to suffer from social stigma, and may receive inadequate responsiveness from health providers. Before assessing the responsiveness they receive, it is important to know their expectations. We aimed to compare levels of expectation towards the healthcare service among HIV and non-HIV patients with adjustment for socio-economic factors. METHODS: A cross-sectional study was conducted during January and February, 2015 among two consecutive groups of HIV positive and non-HIV patients in two hospitals in Kunming, China. Patients' expectation towards eight domains of health system responsiveness was measured using 40 vignettes; five per domain. Each vignette was ranked from 1 "very good" to 5 "very bad", and the responses were summed to obtain a total score for each domain. Differences in total scores were compared between the two groups and adjusted for other factors using multiple linear regression. RESULTS: The three domains with the highest scores, reflecting high expectation, were prompt attention, basic amenities and choice. Adjusted for other factors, HIV patients had significantly lower levels of expectation in all domains compared to the non-HIV group. Age was associated with the basic amenities domain, with young adults having higher expectations than other age groups. Minority ethnic groups had lower expectation towards dignity, prompt attention and autonomy domains compared to Han ethnicity. Those who lived in a home with 2-4 family members had higher expectations towards confidentiality than those who lived alone. CONCLUSION: Patients with HIV have significantly lower levels of expectations even after adjusting for socio-economic factors. Assessment of health system responsiveness based on their judgments above may give biased results toward favorable service quality.

Factor Analytical Investigation of Krathom (Mitragyna speciosa Korth.) Withdrawal Syndrome in Thailand.

Krathom (Mitragyna speciosa Korth.) is an addictive and illicit substance used in Thailand and other Southeast Asian countries. It has become the most commonly used substance among villagers. The study aimed to explore the factor structure of the krathom withdrawal syndrome based on the findings of an earlier qualitative study. The current study was divided into two stages. Cross-sectional data collections were employed in both phases. The samples comprised, respectively, 196 and 330 krathom users aged over 25 years. The characteristics of krathom withdrawal symptoms and signs were identified and the factor structure examined using exploratory factor analysis (EFA). Confirmatory Factor Analysis (CFA) was used to examine the construct validity and multivariate linear regression was used to identify factors predicting the intensity of krathom withdrawal symptoms. The final scale comprised 20 items with four factors: craving-fatigue syndrome; musculoskeletal system and insomnia; mood symptoms; and autonomic nervous system/physical sickness. Symptoms and signs of krathom withdrawal similar to those of the withdrawal syndrome of opioid substances appear to be present in regular krathom users. The krathom withdrawal intensity is predicted by duration of krathom use, frequency, and daily amount of krathom use.

Patterns of Alcohol Consumption in Yunnan Province of China: Which Measure is Optimal?

AIMS: Although varied methods are used in estimating alcohol consumption, there has been no methodological comparison of these methods in China. The aim of this study is to compare different methods used for estimating drinking indices, such as annual per capita consumption, and proportions of risk drinking. METHODS: A cross-sectional household survey using a multistage systematic sampling technique was conducted in Yunnan Province of China. The beverage-specific quantity frequency (BSQF), tri-level, last 7-day (L7D) and beverage-specific yesterday (BSY) methods were used. RESULTS: A total of 977 subjects aged 12-35 years were surveyed. The BSQF yielded the highest annual per capita consumption (2094.2 g), followed by the tri-level (1430.8), L7D (983.0) and BSY (409.7 g) methods. The annual per drinker consumption quantities were 1762.1, 938.5, 865.7 and 493.3 g for tri-level, BSQF, L7D and BSY methods, while the proportions of high-risk drinking were 13.4, 9.4, 4.8 and 2.5%, respectively. CONCLUSION: The BSQF method is more suitable for measurement of annual per capita alcohol consumption in this population. The tri-level approach is a promising substitution of the graduated quantity frequency (GF) method if implemented with caution for both quantity and pattern of alcohol consumption.

Use of cataract surgery in urban Beijing: a post screening follow-up of the elderly with visual impairment due to age-related cataract.

OBJECTIVE: To understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing. METHODS: From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. RESULTS: At the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery. CONCLUSIONS: The data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.

Implementing the Alcohol, Smoking, Substance Involvement Screening Test and linked brief intervention service in primary care in Thailand.

BACKGROUND: This paper reports findings on the implementation, acceptability and uptake of the screening and brief intervention programme based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to help decrease substance misuse in primary care in Thailand. METHODS: Action research involving selection of suitable study areas; obtaining support for its introduction and corporation at national and local levels; training and monitoring of healthcare providers; delivery of the ASSIST-BI (brief intervention) procedure and assessments of acceptability and uptake of the procedure by patients and staff. RESULTS: Between October 2011 and October 2012, 5931 patients (2.5% of all patients attending primary care units) were screened with the ASSIST. Of these, 29.6 and 3.4% were in the moderate- and high-risk groups, respectively, and were offered BI or other treatment. The most popular substances used were tobacco and alcohol. Less than 1% screened positively for illicit substances. CONCLUSION: The ASSIST detected many substance users capable of benefiting from intervention. The programme was well received by patients and staff. The development of the project from conception to inclusion in Thailand's national public health strategy is described and suggested as a model for introducing similar procedures into developing countries.

Validation of Krathom (Mitragyna speciosa Korth.) Dependence Scale (KDS): a dependence screen for internationally emerging psychoactive substance.

BACKGROUND: Krathom (Mitragyna speciosa Korth.) is the most commonly used illicit substance in Thailand, and its use has become widespread internationally. Studies on krathom dependence and its health impact are scarce, as there has been no instrument to measure its dependence syndrome and classify krathom users. This study aimed to develop and explore the factor structure, reliability, and validity of a Krathom Dependence Scale (KDS). METHODS: This study comprised 2 phases. First, cross-sectional surveys were conducted with 523 (Phase I) and 595 (Phase II) male villagers aged >25 years who were regular, occasional, ex-, or nonusers of krathom. Scale construction was based on the qualitative results from users and previous literature. Exploratory factor analysis (EFA) using maximum likelihood extraction with oblimin rotation was conducted in Phase I and confirmatory factor analysis (CFA) in Phase II to confirm the construct of the scale. Internal consistency of the KDS was assessed using Cronbach's alpha coefficient. Discriminative validity was examined by checking its ability to differentiate between regular and occasional users and patterns of krathom use and its concurrent validity by comparing its levels of score with the Fagerstrom Test for Nicotine Dependence (FTND). The KDS contains 16 items on a 0-3 (never-always) rating scale, making a total score of 0-48. RESULTS: Phase I EFA revealed a single-factor solution for the scale, which was confirmed by the CFA in Phase II, with an alpha coefficient of .98. The KDS discriminates regular from occasional users reasonably well and is highly correlated with the FTND score. Two cutoffs were suggested: 34/35 for distinguishing moderate from high dependence and 13/14 for low from moderate. CONCLUSIONS: The KDS appears to capture key theoretical constructs and correlates with indices of drug dependence by standard criteria. It should be useful in early intervention for those with krathom use disorders in community and primary care settings.