1. Parental Alcoholism: Parents’ Perspectives About Being Screened in the Pediatric Office Setting Celeste R. Wilson, MD Sion Kim Harris, PhD Lon R. Sherritt, MPH Nohelani Lawrence, BA John R. Knight, MD Harvard Medical School Children’s Hospital Boston

2. Acknowledgements David Armsby, MD Wendy S. Davis, MD Deborah Glotzer, MDEmily 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

3. 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.

4. 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

5. 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

6. Current Study DesignProspective, observational study comprised of a cross sectional questionnaire ParticipantsConsecutive sample of parents/caregivers bringing their children for pediatric care SettingThree ambulatory pediatric clinic sites (urban, suburban, rural)

7. Definition of Positive Alcohol Screen FEMALEMALE TWEAK Positive ≥2≥3 AUDIT Positive ≥6≥8

8. Definition of Positive Alcohol Screen FEMALEMALE TWEAK Positive ≥2≥3 AUDIT Positive ≥6≥8

9. Results

10. Relationship to child (N=879)

11. Parents’ Race/Ethnicity (N=827)

12. Education (N=844)

13. Marital status (N=841)

14. 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

15. Alcohol Screen Acceptance by Screen Status (N=765) % Welcome/ Not Mind p <.001

16. Comfort with Screening Methods by Alcohol Screen Status * p <.001

17. Acceptance of Interventions by Alcohol Screen Positive

18. Acceptance of Interventions for Alcohol Screen Positive by Gender p ≤.05

19. 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.

20. 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.

21. 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

22. 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