Validity of the CAGE questionnaire for men who have sex with men (MSM) in China

• We examine the validity of the CAGE as a screening tool for alcohol use problems among a sample of Chinese MSM.
• The CAGE had inadequate sensitivity, specificity, and positive predictive values using past week drinking as the criterion.
• The CAGE was limited in the ability to discriminate between heavy and non-drinkers.
• Findings showed the inadequate validity of CAGE as a screening instrument for current heavy drinking in Chinese MSM population. Further research using a combination of validity criteria and culturally-informed research is needed to determine the applicability of CAGE for this population.

BackgroundDetection of heavy drinking among men who have sex with men (MSM) is crucial for both intervention and treatment. The CAGE questionnaire is a popular screening instrument for alcohol use problems. However, the validity of CAGE for Chinese MSM is unknown.MethodData were from three waves of cross-sectional assessments among general MSM (n = 523) and men who sell sex to other men (“money boys” or MBs, n = 486) in Shanghai, China. Specifically, participants were recruited using respondent-driven, community popular opinion leader, and venue-based sampling methods. The validity of the CAGE was examined for different cutoff scores and individual CAGE items using self-reported heavy drinking (≥14 drinks in the past week) as a criterion.ResultsIn the full sample, 75 (7.4%) of participants were classified as heavy drinkers. 32 (6.1%) of general MSM and 43 (8.9%) of MBs were heavy drinkers. The area under curve statistics for overall sample was 0.7 (95% CI: 0.36–0.77). Overall, the sensitivities (ranging from 18.7 to 66.7%), specificities (ranging from 67.5 to 95.8%), and positive predictive values (ranging from 14.1 to 26.4%) for different cutoff scores were inadequate using past week heavy drinking as the criterion. The ability of CAGE to discriminate heavy drinkers from non-heavy drinkers was limited.ConclusionsOur findings showed the inadequate validity of CAGE as a screening instrument for current heavy drinking in Chinese MSM. Further research using a combination of validity criteria is needed to determine the applicability of CAGE for this population.