Parents comfortable with alcohol screening in pediatricians' offices

Nov 4 2008

Parents are surprisingly receptive to being screened for alcohol problems during a visit to their child's pediatrician, including those who have alcohol problems.

And if they need help, many parents would look to their pediatrician for a referral, according to a new study in the November issue of the journal Pediatrics.

"This is a surprising and important finding," said lead author and pediatrician Celeste Wilson, MD, of Children's Hospital Boston and Harvard Medical School. "It appears that in the context of their children receiving care by a trusted health care provider, parents are receptive to interventions that can ultimately keep their children safe." The study was funded by the Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation.

The American Academy of Pediatrics has recognized the child health care visit as an ideal venue to address the family history and attitudes around alcohol use, as well as the opportunity to discuss with parents the influence of role modeling on their children. But until now, there was little information about how parents would react if asked about their use of alcohol. Wilson said the results of the study should reassure pediatricians who were concerned that parents would resist inquiries regarding their alcohol use.

Researchers surveyed three different pediatric primary care clinic sites, (two in Massachusetts and one in Vermont) in urban, suburban, and rural areas, to create a diverse socio-economic and racially mixed group of over one thousand study participants.

The parents or caregivers were given questionnaires (filled out anonymously) that screened for alcohol problems. The questionnaires also assessed their preferences for who should perform the alcohol screening, their acceptance of screening through the pediatrician's office, and preferred interventions if the screening indicated problems.

The majority of participants - 73 percent - who did not have alcohol problems based on the screening indicated that they would be completely comfortable being screened by their child's pediatrician, and were similarly receptive to being screened through a computer survey or by a paper and pencil survey.

Surprisingly, many parents who were found to have alcohol problems based on being screened said they would also be completely comfortable with these methods (and 77 percent reported that they would welcome or not mind alcohol screening in general). Fifty-two percent of this group (parents with alcohol issues) indicated they'd feel completely comfortable being screened by a pediatrician; 54 percent were comfortable with a computer survey, and 48 percent were comfortable with a paper survey.

This study provides insight into the preferences and attitudes of the subgroup of parents with a positive alcohol screen, the authors write.

Compared to other screening options, such as a nurse or another health professional, parents expressed a greater likelihood of being honest when screened by the pediatrician, a computer-based questionnaire or a paper-pencil questionnaire.

The compelling endorsement of the pediatrician over other medical staff may suggest that there is a component to the parent-pediatrician dyad that makes this relationship unique and sets the pediatrician apart from other office staff.

Based on this research, pediatric training should include educational components addressing parental alcohol screening and office-based intervention, Wilson said. In terms of interventions, the parents who screened positive for alcohol problems said they preferred for the pediatrician to initiate further discussion about drinking and its effect on their child, to give educational materials about alcoholism, and to offer referrals for evaluation and treatment.

These findings also found that the likelihood of getting a positive screen from a parent at a pediatrician's visit is one in nine or 11 percent. In general, 12 percent of the adult population screens positive for alcohol-related problems at their primary care providers.

"To the extent that a parent's ability to parent is influenced by his or her use of substances, I would strongly argue that parental alcohol use is a pediatric issue. If a parent is an alcoholic or has problem alcohol use, then they are not the parent they would like to be to their child," Wilson explained.