Objective.-To describe the performance of alcohol screening questionnaires in female patients.Data Sources.-We searched MEDLINE from 1966 to July 1997 for alcoholism or alcohol-drinking and for CAGE, AUDIT, BMAST, TWEAK, T-ACE, MAST, SMAST, or SAAST; Citations Indexes for newer screening questionnaires and those without acronyms; and MEDLINE from 1996 to July 1997 for alcoholism or alcohol-drinking and screening.Study Selection and Data Extraction.-Reviewed studies presented data for women comparing brief alcohol screening questionnaires with valid criterion standards for heavy drinking (Ն2 drinks per day) or alcohol abuse or dependence in US general clinical populations. Sensitivities, specificities, and areas under receiver operating characteristic curves (AUROCs) were extracted.Data Synthesis.-Thirteen articles (9 studies) were reviewed. The CAGE questionnaire had AUROCs of 0.84 to 0.92 for alcohol abuse and dependence in predominantly black populations of women, but using the traditional cut point of 2 or more resulted in low sensitivities (38%-50%) in predominantly white female populations. The TWEAK and Alcohol Use Disorders Identification Test (AUDIT) questionnaires had high AUROCs (0.87-0.93) for past-year alcohol abuse or dependence in black or white women, but had sensitivities less than 80% at traditional cut points. For detecting heavy drinking, the AUDIT questionnaire had AUROCs of at least 0.87 in female primary care patients. The TWEAK and T-ACE questionnaires had higher AUROCs (0.84-0.87) than the CAGE questionnaire (0.76-0.78) for detecting heavy drinking before pregnancy was recognized in black obstetric patients.Conclusions.-The CAGE questionnaire was relatively insensitive in predominantly white female populations. The TWEAK and AUDIT questionnaires have performed adequately in black or white women, using lower cut points than usual.

OBJECTIVE:To summarize for clinicians recent epidemiologic evidence regarding medical risks of alcohol use for women.METHODS: MEDLINE and PsychINFO, 1990 through 1996, were searched using key words "women" or "woman," and "alcohol." MEDLINE was also searched for other specific topics and authors from 1980 through 1996. Data were extracted and reviewed regarding levels of alcohol consumption associated with mortality, cardiovascular disease, alcoholrelated liver disease, injury, osteoporosis, neurologic symptoms, psychiatric comorbidity, fetal alcohol syndrome, spontaneous abortion, infertility, menstrual symptoms, breast cancer, and gynecologic malignancies. Gender-specific data from cohort studies of general population or large clinical samples are primarily reviewed. MAIN RESULTS:Women develop many alcohol-related medical problems at lower levels of consumption than men, probably reflecting women's lower total body water, gender differences in alcohol metabolism, and effects of alcohol on postmenopausal estrogen levels. Mortality and breast cancer are increased in women who report drinking more than two drinks daily. Higher levels of alcohol consumption by women are associated with increased menstrual symptoms, hypertension, and stroke. Women who drink heavily also appear to have increased infertility and spontaneous abortion. Adverse fetal effects occur after variable amounts of alcohol consumption, making any alcohol use during pregnancy potentially harmful. CONCLUSIONS:In general, advising nonpregnant women who drink alcohol to have fewer than two drinks daily is strongly supported by the epidemiologic literature, although specific recommendations for a particular woman should depend on her medical history and risk factors. L ess than three quarters of women in the UnitedStates drink alcohol, and those who do drink consume fewer drinks and less absolute alcohol than men. 1 However, at similar levels of self-reported alcohol consumption, the risk of psychosocial problems or dependence is greater for women than men (for definitions, see Appendix A). [2][3][4][5][6] Women also appear to develop alcohol abuse and dependence after fewer years of drinking than men. 7 Although only 4% to 5% of women in the U.S. general population meet criteria for past-year alcohol abuse or dependence, 8,9 9% of female primary care patients in some studies have reported recent heavy drinking or alcohol-related problems. 10,11 Many heavy drinkers decrease consumption following brief interventions that include explicit advice about safe drinking limits. [12][13][14] In addition, offering feedback about specific risks or consequences of their drinking to patients who drink heavily can help motivate them to decrease alcohol consumption or seek treatment. 15,16 Physicians report they would be more likely to advise patients about safe drinking practices if they were more confident of their knowledge about safe levels of alcohol consumption. 17 Women who drink more than two drinks daily on average, or who frequently drink five or more d...

Managed care plans and health insurance companies have adopted aggressive cost-containment strategies in response to competitive pressures and to the demand by health care payers for improved cost control. Little is known about the effects of these strategies on the delivery of medical care among adult patients, and almost nothing is known about their effects among children and adolescents.Utilization management (UM) is one of the most widely used approaches to health care cost containment. Current sion. By analyzing a case series of patients whose care was subject to UM, we obtained information on denials and restrictions resulting from UM-mandated preadmission authorization and concurrent review and were able to examine the effects of these restrictions on readmission. Because we did not have population-based comparison data on groups subjected to UM review and those not so subjected, however, we were unable to examine the sentinel effect ofUM on admissions. Methods Utilization Management ProgramUtilization management was conducted as part of a managed fee-for-service health care plan offered by a large commercial insurance carrier from 1989 onward. More than 500 groups, located in 47 states, adopted the insurance carrier's program with UM to promote cost containment. Health care for dependent children covered under the groups' respective policies became subject to the review procedures of the UM program. The groups to which the UM program applied had Thomas M. Wickizer is with, and at the time of the study Jodie Boyd-Wickizer was with, the Department