1. Conclusions Background Objective Results Methods This study was supported by funding from the Scaife Family Foundation, the National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health Program (NIH/NICHD 5 K12 HD43441-04; PI—Roberts), the Association of Professors of Gynecology and Obstetrics/Abbott Medical Education Award, and the Agency for Healthcare Research and Quality (AHRQ 1 K08 HS13913-01A1; PI—Chang). This was also made possible by Grant Number UL1 RR024153 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Re- engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.http://www.ncrr.nih.gov/http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp 11.4% 13.6% Screening for past alcohol drinking behavior among pregnant women Kate Hughes, 1 Sara Schussler, 1 Diane Dado, LCSW, 2 Keri L. Rodriguez, PhD, 3,4,5 Robert Arnold, MD, 5 Susan Zickmund, PhD, 3,5 Kevin Kraemer, MD, 5 Doris Rubio, PhD 5,6, Judy C. Chang, MD, MPH 2,5,7 1 First Experiences in Research Program, University of Pittsburgh, 2 Magee-Women's Research Institute, Magee-Women's Hospital, 3 Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 4 Geriatric Research, Education, and Clinical Center, 5 Department of Internal Medicine, University of Pittsburgh School of Medicine, 6 Center for Research on Health Care, University of Pittsburgh, 7 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine Fetal alcohol syndrome is the leading preventable cause of mental retardation. ACOG recommends that providers screen patients using tools that include past and present history of alcohol use. Asking directly about alcohol use during pregnancy has a high false negative rate. Studies suggest that disclosure of PAST problem alcohol use (prior to pregnancy) is most predictive of continued use during pregnancy. Although most obstetric care providers report screening their pregnant patients for alcohol use, little is known about what questions providers use or whether they ask about past problem drinking. To examine provider-patient screening conversations about alcohol use during the first obstetric visits. We audio-taped and transcribed verbatim first obstetrics visits in an outpatient hospital clinic. Two coders independently qualitatively analyzed the transcripts for content and process of provider- patient communication. Alcohol screening discussions were identified and categorized as: Questions about past use prior to pregnancy Questions about current use during pregnancy Non-specific screening questions (not specifying past or current use). Early identification of pregnant women with problem alcohol use is crucial to providing needed interventions and supports to reduce harm associated with alcohol use during pregnancy. During first outpatient visits most obstetric care providers did not specifically assess past drinking behavior.  Patients with past alcohol use problems who are at risk for continued use during pregnancy are missed.  Patients at risk for continued alcohol used during pregnancy are thus also missed. Most alcohol screening questions asked by providers were vague, with no discernable difference between past or current use in the current pregnancy.  Obstetric care providers should ask pregnant patients directly about both past and present alcohol use. Examples of Past Use Screening Questions Examples of Non-specific Screening Questions Examples of Current Use Screening Questions Results Any alcohol or drug use this pregnancy? Have you used any alcohol since you became pregnant? What about any alcohol before you knew you were pregnant? Any history of drug or alcohol use? Any alcohol or drug use? Drink? No alcohol? Proportion of Visits with Types of Alcohol Screening Subject CharacteristicsMean (range/median) or number (%) Obstetric Care Providers (N=29) Provider type Obstetrics-gynecology resident physician Nurse midwife Nurse practitioner Provider gender Female Resident training year Post-graduate year 1 Post-graduate year 2 Post-graduate year 3 Post-graduate year 4 Nurse-midwife mean years of experience Nurse practitioner mean year if experience 21 (72) 5 (17) 3 (10) 29 (100) 4 (19) 3 (14) 9 (43) 5 (24) 9.2 (1-20; median 10) 10.3 (5-18; median 8) Pregnant Patients (N=51) Age (years) Race Caucasian African-American Asian Marital Status Single Married Divorced/separated Pregnancy history Nulliparous Prior births 24 (18-36) 30 (59) 20 (39) 1 (2) 43 (84) 6 (12) 2 (4) 20 (39) 31 (61)