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Alcohol Screening in a Pediatric Setting Welcomed by Most Parents

  • Authors: News Author: Marlene Busko
    CME Author: Désirée Lie, MD, MSEd
  • CME / CE Released: 11/10/2008
  • Valid for credit through: 11/10/2009
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Target Audience and Goal Statement

This article is intended for primary care clinicians and specialists who care for children.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Describe the prevalence of alcoholism among parents of children seen in pediatric clinics.
  2. Describe preferred methods of alcohol screening and referral among parents of children seen in pediatric clinics.


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  • Marlene Busko

    Marlene Busko is a staff journalist for Medscape Psychiatry. She can be contacted at [email protected]


    Disclosure: Marlene Busko has disclosed no relevant financial relationships.


  • Brande Nicole Martin

    Brande Nicole Martin is the News CME editor for Medscape Medical News.


    Disclosure: Brande Nicole Martin has disclosed no relevant financial information.


  • Laurie E. Scudder, MS, NP-C

    Nurse Planner, Medscape; Adjunct Assistant Professor, School of Health Sciences, George Washington University, Washington, DC; Curriculum Coordinator, Nurse Practitioner Alternatives, Inc., Ellicott City; Nurse Practitioner, Baltimore City School-Based Health Centers, Baltimore, Maryland


    Disclosure: Laurie Scudder, MS, NP-C, has disclosed no relevant financial information.

CME Author(s)

  • Désirée Lie, MD, MSEd

    Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California


    Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

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Alcohol Screening in a Pediatric Setting Welcomed by Most Parents

Authors: News Author: Marlene Busko CME Author: Désirée Lie, MD, MSEdFaculty and Disclosures

CME / CE Released: 11/10/2008

Valid for credit through: 11/10/2009


November 10, 2008 — Most parents, even those with alcohol problems, are receptive to being screened for alcohol use by their child's pediatrician, results from a large multicenter study suggest.

"The fact that more than 75% of the parents who screened positive were receptive to alcohol screening should reassure pediatricians who fear a negative response to questioning," lead author Celeste R. Wilson, MD, from the Children's Hospital, in Boston, Massachusetts, told Medscape Psychiatry.

Children with a parent who abuses alcohol are at increased risk for neglect, physical and sexual abuse, and educational, cognitive, and mental health problems, and are 3 to 4 times more likely to later have alcohol problems themselves, she noted.

"It is important for clinicians to recognize that screening a parent for alcohol-use problems is a way to help minimize the large negative affect that alcoholism has on the well-being of the child," she said.

The study is published in the November issue of Pediatrics.

Ideal Opportunity

The American Academy of Pediatrics recognizes that a child's healthcare visit is an ideal opportunity to address attitudes about alcohol use with parents and to discuss the importance of being a good role model for their children.

Previous studies have shown that parents are receptive to being screened for alcohol use in a pediatrician's office, but little was known about the subgroup of parents who screen positive for problem alcohol use.

To shed light on parents' attitudes and preferences about screening for alcohol use during a visit to a pediatric clinic with a child, the researchers surveyed 879 parents who brought their child to 1 of 3 urban, rural, and suburban pediatric clinics in 2 states between 2004 and 2006.

Willing to Take That First Step

The parents completed a questionnaire that included 2 brief tests to detect alcohol problems and to assess willingness to be screened in a pediatrician's office, preferred screening methods, and preferred interventions should they screen positive.

About 1 in 9 parents screened positive for an alcohol problem.

A total of 91% of parents who screened positive and 77% of parents who screened negative for alcohol problems indicated that they would welcome or at least not mind being asked about their drinking during a pediatric office visit.

The parents indicated they would be most comfortable and honest if they were replying to questions posed by their child's pediatrician, as opposed to another staff member, or if they were filling in a questionnaire.

More than 70% of parents who screened positive reported that they would be receptive if their child's pediatrician discussed the implications of their drinking habits, gave them telephone numbers for centers where they could get additional help, or provided them with educational material.

"This study suggests that if pediatricians can implement a screening and intervention model, then there is already a population of parents who would surely benefit and may, indeed, be willing to take that first step," the researchers conclude.

The study was supported by a grant from the Robert Wood Johnson Foundation-Substance Abuse Policy Research Program. Dr. Wilson was supported by a grant from the Center of Excellence in Minority Health and Health Disparities at Harvard Medical School. The study authors have disclosed no relevant financial relationships.

Pediatrics. 2008;122:e1022-e1029.

Clinical Context

In 2001, more than 6 million children in the United States were living with a parent with either alcohol or other substance abuse, and these children are more likely to witness domestic violence and be physically and sexually abused, neglected, or maltreated. Tools are needed to identify alcohol consumption habits among parents of children.

This is prospective descriptive study of parents of children presenting to 3 pediatric clinics to examine the prevalence of alcohol abuse and preferred methods of screening and referral for these problems.

Study Highlights

  • The study involved 3 clinics: 1 urban, 1 suburban, and 1 rural.
  • The urban site had 14,000 visits per year, the suburban site had more than 20,000 visits per year, and the rural site had 12,000 visits per year.
  • Participants were parents who were at least 18 years old who brought children for routine care.
  • 879 parents returned the questionnaires administered at the sites.
  • A combined convenience and consecutive sampling approach was used.
  • Patients' parents were recruited at each site consecutively, and questionnaires were completed and returned sealed in an envelope.
  • The screening questionnaire for alcohol abuse consisted of 2 tests: TWEAK and the Alcohol Use Disorders Identification Test (AUDIT).
  • TWEAK consisted of 5 items with use of 7-point scale responses.
  • The 5 items covered drinking tolerance (T), others' concerns about alcohol intake (W for "worried"), having an eye-opener (E), others being annoyed by one's drinking (A), and feeling a need to cut down on one's drinking (K).
  • The AUDIT is a 10-item scale with 3 subscales yielding a score from 0 to 40 and has difference sensitivity and specificity for men and women.
  • Different cutoff points were used for both screening tests for men and women.
  • A positive TWEAK screen was defined as a score of 2 or higher for women and 3 or higher for men.
  • A positive AUDIT screen was defined as a score of 6 or more for women and 8 or more for men.
  • Parents were asked which of the 3 screening methods they preferred: computer questionnaire; paper-and-pencil test; or being asked by the pediatrician, nurse practitioner, or nurse.
  • They were also questioned about their preference for being referred and treated once they were screened positive on the alcohol screening test.
  • Most participants were women (82.9%), the child's mother (81.2%), white (81.3%), college graduates (57%), and married (70.7%).
  • The urban site had more black participants (19.3%), and the suburban site had more college graduates (80.1%).
  • There was no difference in proportion of positive screens across the 3 sites.
  • Approximately 1 in 9 parents (n = 101; 11.5%) screened positive on either the TWEAK test or the AUDIT test.
  • The alcohol-positive and alcohol-negative screen groups did not differ with sex, age, race, clinic site, marital status, education, parity, or children's age.
  • The alcohol-positive group was more likely to have ever had counseling (12.2% vs 5.4%; P = .01).
  • 89% reported that they would not mind or would welcome being asked about their alcohol history during a pediatric visit.
  • Those who screened negative (91%) were more likely vs those who screened positive (77%) to report not minding screening.
  • Parents who screened negative for alcohol abuse were comfortable about being screened across all methods.
  • Both groups felt the most comfortable with computer-based questionnaire, pediatrician screening, or pencil-and-paper questionnaire.
  • Self-reported honesty about responses was highest for pediatrician screening, computer questionnaire, and the paper-and-pencil questionnaire.
  • 50% of mothers who screened positive for alcohol abuse vs 74.6% of mothers who screened negative reported being completely comfortable with screening by a pediatrician.
  • Regardless of sex, most participants reported that should they be found with an alcohol problem, they would welcome or not mind the pediatrician talking to them (82%), giving the telephone contacts for referral (74%), and providing educational materials about alcoholism.
  • The authors concluded that alcohol abuse prevalence was high in parents of children, and parents preferred pediatricians to do the screening or referral.

Pearls for Practice

  • One in 9 parents of children who present to pediatric clinics for care screens positive for alcohol abuse.
  • Parents of children report preference for screening by computer, paper-and-pencil questionnaire, or by the pediatrician, and further care and referral by the pediatrician were acceptable and preferred.

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