Validation of a self-administered questionnaire to screen for prenatal alcohol use in Northern Plains Indian women.

OBJECTIVE: This study among American Indian prenatal patients was conducted to validate a self-administered questionnaire (SAQ) designed to (1) identify women who had consumed alcohol during pregnancy, (2) identify women who may be at risk of drinking during pregnancy, and (3) determine the quantity and frequency of alcohol and other substance use just before and during pregnancy. METHODS: The validation involved three components: (1) review of the SAQ responses by a public health nurse; (2) structured patient interview with the research nurse; and (3) medical record abstraction postpartum. RESULTS: Compared to extensive interview and medical record data, the SAQ is sensitive (76.6%) and specific (92.8%) in detecting pregnant women who had consumed alcohol during pregnancy. CONCLUSION: The SAQ is a useful screening tool for alcohol use in this population.

Implementation of substance use screening in prenatal clinics.

BACKGROUND AND OBJECTIVES: To reduce women's consumption of alcohol and other drugs during pregnancy, the Department of Epidemiology for the Aberdeen Area Indian Health Service (AAIHS) promoted a maternal substance use screening program for prenatal clinics in 1992. This report describes the adherence to the screening protocol at AAIHS facilities and barriers to such screening. METHODS: Prenatal clinic staff members at 20 AAIHS health care facilities were surveyed to determine the extent of prenatal substance use screening and the barriers to its implementation. The medical records of a random sample of 235 women who sought prenatal care at five hospitals were reviewed to determine whether prenatal clinic staff adhered to the screening protocol. RESULTS: Of the 20 health care facilities, 13 (65%) had implemented the screening. The major barriers to implementing screening were lack of training in prenatal substance use screening and lack of clinic staff designated to administer the screening protocol. Though not statistically significant, our data suggest that women not administered the screening questionnaire were more likely to be multiparous (prevalence ratio = 2.1; 95% confidence interval = 0.9, 4.5). CONCLUSIONS: To improve screening of pregnant women for substance use, prenatal clinic staff members should address administrative barriers and assess adherence of health care providers and patients to the screening protocol. Training of prenatal clinic personnel is essential to implement optimal maternal substance use screening in prenatal clinics.

Relationship of prenatal alcohol use with maternal and prenatal factors in American Indian women.

Demographic factors and patterns of substance use among women who did not consume alcohol during pregnancy were compared to women who did consume alcohol during pregnancy. One-hundred seventy-seven Northern Plains Indian women who received prenatal care at an urban clinic in a rural state were screened for substance use as part of the validation study with a self-administered questionnaire. Women who drank during pregnancy were more likely to be single and have less education than women who did not drink. While most of the women in the study had available transportation resources, the women who drank during pregnancy were less likely to have transportation than the women who did not drink. Women who drank during pregnancy consumed more alcohol more frequently before pregnancy than did women who drank before but not during pregnancy. Compared to women who did not drink during pregnancy, women who drank during pregnancy were more likely to smoke cigarettes and use illicit drugs, to have parents who drank, to feel they drank the same or more than other pregnant women, or to have experienced more relationship breakups and physical and emotional abuse. Prenatal patients who drink alcohol during pregnancy need more intensive counseling regarding their multiple risk behaviors.