Abstract
OBJECTIVES: This study investigated the efficacy of screening for risk drinking during pregnancy with two brief questionnaires, TWEAK and T-ACE. Both include an assessment of tolerance based on the number of drinks women report they can hold. METHODS: Subjects were disadvantaged African-American obstetric patients in Detroit, Mich. Traditional alcoholism screens (Michigan Alcohol Screening Test [MAST], CAGE) and the tolerance question were administered (n = 2717); TWEAK and T-ACE were constructed from tolerance and embedded MAST and CAGE items. In a separate sample (n = 1420), only the T-ACE was administered. Periconceptional risk drinking was the gold standard. Screen evaluations were based on receiver-operating characteristic analyses. RESULTS: At the cutpoint of 2, sensitivity/specificity for embedded screens were 91/77 for TWEAK and 88/79 for T-ACE; comparable values for T-ACE alone were 67/86. TWEAK and T-ACE screened more effectively than CAGE or MAST. CONCLUSIONS: Embedded versions of TWEAK and T-ACE were both highly sensitive to periconceptional risk drinking in this population. Administering T-ACE alone reduced its sensitivity; this suggests that MAST and CAGE administration improves its performance.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bowman R. S., Stein L. I., Newton J. R. Measurement and interpretation of drinking behavior. I. On measuring patterns of alcohol consumption. II. Relationships between drinking behavior and social adjustment in a sample of problem drinkers. J Stud Alcohol. 1975 Sep;36(9):1154–1172. doi: 10.15288/jsa.1975.36.1154. [DOI] [PubMed] [Google Scholar]
- Chan A. W., Pristach E. A., Welte J. W., Russell M. Use of the TWEAK test in screening for alcoholism/heavy drinking in three populations. Alcohol Clin Exp Res. 1993 Dec;17(6):1188–1192. doi: 10.1111/j.1530-0277.1993.tb05226.x. [DOI] [PubMed] [Google Scholar]
- Ernhart C. B., Sokol R. J., Ager J. W., Morrow-Tlucak M., Martier S. Alcohol-related birth defects: assessing the risk. Ann N Y Acad Sci. 1989;562:159–172. doi: 10.1111/j.1749-6632.1989.tb21014.x. [DOI] [PubMed] [Google Scholar]
- Ernhart C. B., Sokol R. J., Martier S., Moron P., Nadler D., Ager J. W., Wolf A. Alcohol teratogenicity in the human: a detailed assessment of specificity, critical period, and threshold. Am J Obstet Gynecol. 1987 Jan;156(1):33–39. doi: 10.1016/0002-9378(87)90199-2. [DOI] [PubMed] [Google Scholar]
- Ewing J. A. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905–1907. doi: 10.1001/jama.252.14.1905. [DOI] [PubMed] [Google Scholar]
- Friedenreich C. M. Improving long-term recall in epidemiologic studies. Epidemiology. 1994 Jan;5(1):1–4. [PubMed] [Google Scholar]
- Hanley J. A., McNeil B. J. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology. 1983 Sep;148(3):839–843. doi: 10.1148/radiology.148.3.6878708. [DOI] [PubMed] [Google Scholar]
- Hanley J. A., McNeil B. J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
- Lapham S. C., Kring M. K., Skipper B. Prenatal behavioral risk screening by computer in a health maintenance organization-based prenatal care clinic. Am J Obstet Gynecol. 1991 Sep;165(3):506–514. doi: 10.1016/0002-9378(91)90276-w. [DOI] [PubMed] [Google Scholar]
- Metz C. E. Basic principles of ROC analysis. Semin Nucl Med. 1978 Oct;8(4):283–298. doi: 10.1016/s0001-2998(78)80014-2. [DOI] [PubMed] [Google Scholar]
- Midanik L. T. Validity of self-reported alcohol use: a literature review and assessment. Br J Addict. 1988 Sep;83(9):1019–1030. doi: 10.1111/j.1360-0443.1988.tb00526.x. [DOI] [PubMed] [Google Scholar]
- Minor M. J., Van Dort B. Prevention research on the teratogenic effects of alcohol. Prev Med. 1982 May;11(3):346–359. doi: 10.1016/0091-7435(82)90058-5. [DOI] [PubMed] [Google Scholar]
- Rosett H. L., Weiner L., Edelin K. C. Treatment experience with pregnant problem drinkers. JAMA. 1983 Apr 15;249(15):2029–2033. [PubMed] [Google Scholar]
- Russell M., Bigler L. Screening for alcohol-related problems in an outpatient obstetric-gynecologic clinic. Am J Obstet Gynecol. 1979 May 1;134(1):4–12. doi: 10.1016/0002-9378(79)90787-7. [DOI] [PubMed] [Google Scholar]
- Russell M., Martier S. S., Sokol R. J., Mudar P., Bottoms S., Jacobson S., Jacobson J. Screening for pregnancy risk-drinking. Alcohol Clin Exp Res. 1994 Oct;18(5):1156–1161. doi: 10.1111/j.1530-0277.1994.tb00097.x. [DOI] [PubMed] [Google Scholar]
- Selzer M. L. The Michigan alcoholism screening test: the quest for a new diagnostic instrument. Am J Psychiatry. 1971 Jun;127(12):1653–1658. doi: 10.1176/ajp.127.12.1653. [DOI] [PubMed] [Google Scholar]
- Sokol R. J., Martier S. S., Ager J. W. The T-ACE questions: practical prenatal detection of risk-drinking. Am J Obstet Gynecol. 1989 Apr;160(4):863–870. doi: 10.1016/0002-9378(89)90302-5. [DOI] [PubMed] [Google Scholar]
- Steinweg D. L., Worth H. Alcoholism: the keys to the CAGE. Am J Med. 1993 May;94(5):520–523. doi: 10.1016/0002-9343(93)90088-7. [DOI] [PubMed] [Google Scholar]
