parental alcoholism: parents’ perspectives about being screened in the pediatric office setting...
TRANSCRIPT
Parental Alcoholism: Parents’ Perspectives About Being
Screened in the Pediatric Office Setting
Celeste R. Wilson, MDSion Kim Harris, PhDLon R. Sherritt, MPH
Nohelani Lawrence, BAJohn R. Knight, MD
Harvard Medical SchoolChildren’s Hospital Boston
Acknowledgements
David Armsby, MD Wendy S. Davis, MD
Deborah Glotzer, MD Emily Kallock, LICSW
Judith Shaw, RN, MPHLori V. Turner, MA
Supported by grant #051109 from
The Robert Wood Johnson Foundation - Substance Abuse Policy Research Program
and The Center of Excellence in Minority Health and Health Disparities, Harvard Medical School
Background
1 out of 4 children in the US lives with an adult who has an alcohol disorder.
Parental alcoholism affects a child’s medical well being and psychosocial development.
Pediatricians have a unique opportunity to screen their patients’ parents for alcohol use.
Background
According to prior studies, parents do not mind being asked about their use of alcohol.*
However, little is known about how the screening should be conducted and what interventions parents who screen positive would find acceptable.
*Kahn et. al, 1999; Wilson et. al., in press
Objectives
Estimate the proportion of problem drinkers among parents
Assess parents’ attitudes about being screened for alcohol problems by their child’s pediatrician, and assess differences between alcohol screen-positive and screen-negative parents.
Assess parents’ preferences for alcohol intervention methods
Current Study
Design Prospective, observational study comprised of a cross sectional questionnaire
Participants Consecutive sample of parents/caregivers bringing their children for pediatric care
Setting Three ambulatory pediatric clinic sites (urban, suburban, rural)
Definition of Positive Alcohol Screen
FEMALE MALE
TWEAK
Positive
≥2 ≥3
AUDIT
Positive
≥6 ≥8
Definition of Positive Alcohol Screen
FEMALE MALE
TWEAK
Positive
≥2 ≥3
AUDIT
Positive
≥6 ≥8
RURAL(N=296)
34%
URBAN(N=284)
32%
SUBURBAN (N=299)
34%
Results
Relationship to child (N=879)
Parents’ Race/Ethnicity (N=827)
Education (N=844)
Marital status (N=841)
Alcohol Screening (N=879)
7.2% screened positive on the TWEAK
6.2% screened positive on the AUDIT
11.5% screened positive on either the TWEAK or AUDIT
Alcohol Screen Acceptance by Screen Status (N=765)
% Welcome/ Not Mind
p < .001
Comfort with Screening Methods by Alcohol Screen Status
0 20 40 60 80 100
*Medical Asst
*Nurse
*NP
*Paper/pencil
*Computer
*Pediatrician
% Completely Comfortable
Negative Screen
Positive Screen
* p < .001
Acceptance of Interventions by Alcohol Screen Positive
0 20 40 60 80 100
Do Nothing
Refer to SW
Schedule MD Appt
Notify Family Member
Notify MD
Education Materials
Telephone #s
Pediatrician Talk to Me
% Welcome/Not Mind
Positive Screen
Acceptance of Interventions for Alcohol Screen Positive by Gender
0 20 40 60 80 100
*Do Nothing
Refer to SW
Schedule MD Appt
Notify Family Member
Notify MD
*Educational Materials
*Telephone #s
Pediatrician Talk to Me
% Welcome/Not Mind
Female Alc Pos
Male Alc Pos
p ≤ .05
Summary
The majority of parents agree to being screened for alcohol problems as part of the routine pediatric office visit.
Regardless of alcohol screen status, parents are comfortable being screened by either the pediatrician or computer-based questionnaire.
Summary
Parent with a positive alcohol screen preferred that the pediatrician initiate further discussion about their drinking, give them educational materials, and refer for evaluation and treatment.
Fathers with a positive alcohol screen, in contrast to alcohol positive mothers, were more accepting of no intervention.
Implications
Screening practices– Computer-based questionnaires are an
acceptable screening method.
Intervention– Pediatricians will need additional training and
support– More clinic visit time allotted– Reimbursement structure– Attendant to sit with child
Implications
Child protection:– Children of alcoholic parents at increased risk
of abuse/neglect– Screening parents in pediatric office setting
specifically identifies parents at risk for harmful or hazardous drinking
– Identification and referral would maximize likelihood of parent getting help
– Final outcome: Decrease in child’s risk of being abused/neglected