Lane Wendy G, Dubowitz Howard, Feigelman Susan, Kim Jeongeun, Prescott Leslie, Meyer Walter, Tracy J Kathleen
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Ambul Pediatr. 2007 Nov-Dec;7(6):458-62. doi: 10.1016/j.ambp.2007.07.007.
Parental alcohol and drug abuse may have significant deleterious effects on children. Although screening in the pediatric office is recommended, few screening measures have been evaluated for use in this setting. We sought to validate a 2-question screening tool for parental substance abuse.
A total of 216 caregivers bringing children to a primary care clinic completed a brief screening for psychosocial problems that contained 2 substance abuse questions. To assess reliability and validity of the questionnaire, recruited caregivers returned within 2 months to complete a computerized study protocol that contained the brief screening questions and the substance abuse sections of the Composite International Diagnostic Inventory (CIDI).
Sixteen percent of caregivers acknowledged a problem with drugs or alcohol on the CIDI. A "yes" response to either screening question had a sensitivity of 29%, specificity of 95%, positive predictive value of 17%, and negative predictive value of 98% for drug abuse. Values were 13%, 96%, 33%, and 87%, respectively for predicting alcohol abuse.
Brief screening in pediatric primary care can identify many, but not all, parents who may need intervention for problems with drugs and/or alcohol. Children should benefit from such screening if it enables parents to acknowledge and receive treatment for substance abuse. Further research is needed to assess whether sensitivity of screening can be improved without sacrificing brevity.
父母滥用酒精和药物可能会对孩子产生重大的有害影响。尽管建议在儿科诊所进行筛查，但很少有筛查措施在这种环境下得到评估。我们试图验证一种用于筛查父母药物滥用情况的包含两个问题的筛查工具。
共有216名带孩子到初级保健诊所的照顾者完成了一项针对心理社会问题的简短筛查，其中包含两个关于药物滥用的问题。为了评估问卷的信度和效度，招募的照顾者在两个月内返回，完成一份计算机化的研究方案，其中包含简短筛查问题以及综合国际诊断问卷（CIDI）的药物滥用部分。
16%的照顾者在CIDI上承认存在药物或酒精问题。对于药物滥用，对任何一个筛查问题回答“是”的敏感度为29%，特异度为95%，阳性预测值为17%，阴性预测值为98%。对于酒精滥用的预测值分别为13%、96%、33%和87%。
在儿科初级保健中进行简短筛查可以识别出许多但并非所有可能需要针对药物和/或酒精问题进行干预的父母。如果这种筛查能使父母承认并接受药物滥用治疗，孩子们应该会从中受益。需要进一步研究以评估在不牺牲简短性的情况下，筛查的敏感度是否能够提高。
