Alcohol Use Questions:
The Alcohol Use Disorders Identification Test (AUDIT): Self-Report Version, a World Health Organization (WHO)-approved instrument.
Because alcohol use can affect your health and can interfere with certain medications and treatments, it is important that we ask some questions about your use of alcohol. Select one box that best describes your answer to each question.
The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening tool developed by the World Health Organization (WHO) to assess alcohol consumption, drinking behaviors, and alcohol-related problems.
A score of 8 or more is considered to indicate hazardous or harmful alcohol use. The AUDIT has been validated across genders and in a wide range of racial/ethnic groups and is well suited for use in primary care settings. Detailed guidelines about use of the AUDIT have been published by the WHO and are available online:http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf
As for copyright, the AUDIT is a WHO-approved instrument and is in the public domain for use. The key research paper to cite for the AUDIT is: Saunders J.B., Aasland O.G., Babor T.F., de la Fuente J.R. and Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption II. Addiction 1993; 88:791-804.
Tobacco and Smoking Status Questions
The following questions ask about your current and past tobacco smoking status.
Daily means smoking at least one tobacco product every day or nearly every day over a period of a month or more.
Rare instances of smoking or experimental smoking (tried once or twice in your lifetime) should be counted in the NOT AT ALL category.
Thank you for taking the time to provide this information!
By submitting this form, you are attesting that all information you provided is true and accurate to the best of your knowledge.