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