Validation of the 4P's Plus© screen for substance use in pregnancy validation of the 4P's Plus

Chasnoff, Ira J.; Wells, Anne M.; McGourty, Richard F; Bailey, L K

doi:10.1038/sj.jp.7211823

Cited by 92 publications

(69 citation statements)

References 26 publications

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“…A research assistant or nurse would approach pregnant women, obtain consent to screen and ask them to complete a health questionnaire that included demographic information, plans for prenatal care, the Patient Health Questionnaire-2 (PHQ-2) (Kroenke, Spitzer, & Williams, 2003), the 4 P's (Chasnoff, McGourty, Bailey, Hutchins, Lightfoot, Pawson, Fahey, May, Brodie, McCulley, & Campbell, 2005; Chasnoff, Wells, McGourty, & Bailey, 2007), the modified TWEAK (Russell, 1996; Chang et al, 1999), and yes/no probes about individual substances of abuse (cigarettes, alcohol, marijuana, cocaine, opiates, and “other”) within the previous 28 days. The TWEAK is a five-item screener that was originally designed to screen pregnant women for hazardous alcohol use (Russell, 1996; Chang et al, 1999).…”

Section: Methodsmentioning

confidence: 99%

Self-report of illicit substance use versus urine toxicology results from at-risk pregnant women

Yonkers

Howell

Gotman

et al. 2010

Journal of Substance Use

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Introduction Many factors comprise a patient's decision to disclose use of drugs. Pregnant women may report drug use because they would like help with their addiction but the stigma associated with drug use may dampen their willingness to disclose. Knowledge about the accuracy of self-reported drug use as compared to urine toxicology screens can assist clinicians in the management of substance use in pregnancy. Method We compared the urine toxicology screens and self-reported use of marijuana or cocaine for 168 women enrolled in an integrated obstetrical/substance abuse treatment program. We stratified by various periods of self-reported use and race and utilized Cohen's kappa to measure overall agreement between self-report and toxicology tests. Results Most women with a positive toxicology screen reported use in the past 28 days (78% for marijuana, 86% for cocaine). However, many women reported their most recent use to be outside of the assays’ detection window (14% for marijuana, 57% for cocaine). We did not find differences in self-report for women with positive urine between Whites and non-Whites (p = 1.00). Agreement over the previous month was good (Kappa = 0.74 and 0.70 for marijuana and cocaine, respectively.) Summary A question about use of marijuana or cocaine during the preceding month rather than the prior few days may be a better indicator of use.

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Section: Methodsmentioning

confidence: 99%

Self-report of illicit substance use versus urine toxicology results from at-risk pregnant women

Yonkers

Howell

Gotman

et al. 2010

Journal of Substance Use

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“…During prenatal care, physicians have the opportunity to assess the risk of drug exposure by opening a discussion about past substance use habits or by using a questionnaire. There are a number of validated screening tools, including the Alcohol Use Disorders Identification Test (AUDIT-C), a three-question test for alcohol use (Bradley et al, 2003) and the 4 P’s test for substance use (Chasnoff et al, 2007). However, self-reported drug use is often unreliable, especially in a situation such as pregnancy where fear and stigma may result (Ostrea et al, 1992; Grekin et al, 2010), bringing into question the validity of these screening tools.…”

Section: Timing Of Screeningmentioning

confidence: 99%

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

2018

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North America is currently suffering from one of the worst epidemics of illicit drug use in recent history: the opioid crisis. Pregnant women are not immune to the ravages of substance misuse which affects themselves, their pregnancies, and the wider community. The prevalence of drug misuse in pregnancy is not well quantified due to the lack of good validated tests, cooperation between clinicians and scientists developing tests, and consensus as to who should be tested and how results should be used. A wide range of tissues can be tested for drug use, including maternal blood, urine, and hair; neonatal meconium, urine, and hair; and placenta and umbilical cord tissues. Testing methods range from simple spectrophotometry and clinical chemistry to sophisticated analytical HPLC or mass spectrometry techniques. The drive for ever greater accuracy and sensitivity must be balanced with the necessities of medical practice requiring minimally invasive sampling, rapid turnaround, and techniques that can be realistically utilized in a clinical laboratory. Better screening tests have great potential to improve neonatal and maternal medical outcomes by enhancing the speed and accuracy of diagnosis. They also have great promise for public health monitoring, policy development, and resource allocation. However, women can and have been arrested for positive drug screens with even preliminary results used to remove children from custody, before rigorous confirmatory testing is completed. Balancing the scientific, medical, public health, legal, and ethical aspects of screening tests for drugs in pregnancy is critical for helping to address this crisis at all levels.

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“…The T-ACE (Tolerance, Annoyance, Cut Down, Eye Opener) 7 and TWEAK (Tolerance, Worried, Eye-openers, Amnesia, K[C] Cut Down) 8 are two screening questionnaires that have performed acceptably in pregnant women 9 but are limited to risky alcohol use. The 4Ps 10 and 4Ps plus 11,12 screen for a range of substances and can detect pregnant women with lower levels of alcohol or drug use. However, they have low to moderate specificity; thus, many women will screen positive but not have problems with drugs or alcohol.…”

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confidence: 99%

Screening for Prenatal Substance Use

Yonkers

Gotman²,

Kershaw³

et al. 2010

Obstetrics &Amp; Gynecology

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OBJECTIVE To report on the development of a questionnaire to screen for hazardous substance use in pregnant women and to compare the performance of the questionnaire with other drug and alcohol measures. METHODS Pregnant women were administered a modified TWEAK (Tolerance, Worried, Eye-openers, Amnesia, K[C] Cut Down) questionnaire, the 4Ps Plus questionnaire, items from the Addiction Severity Index, and two questions about domestic violence (N=2,684). The sample was divided into “training” (n=1,610) and “validation” (n=1,074) subsamples. We applied recursive partitioning class analysis to the responses from individuals in the training subsample that resulted in a three-item Substance Use Risk Profile-Pregnancy scale. We examined sensitivity, specificity, and the fit of logistic regression models in the validation subsample to compare the performance of the Substance Use Risk Profile-Pregnancy scale with the modified TWEAK and various scoring algorithms of the 4Ps. RESULTS The Substance Use Risk Profile-Pregnancy scale is comprised of three informative questions that can be scored for high- or low-risk populations. The Substance Use Risk Profile-Pregnancy scale algorithm for low-risk populations was mostly highly predictive of substance use in the validation subsample (Akaike’s Information Criterion=579.75, Nagelkerke R2=0.27) with high sensitivity (91%) and adequate specificity (67%). The high-risk algorithm had lower sensitivity (57%) but higher specificity (88%). CONCLUSION The Substance Use Risk Profile-Pregnancy scale is simple and flexible with good sensitivity and specificity. The Substance Use Risk Profile-Pregnancy scale can potentially detect a range of substances that may be abused. Clinicians need to further assess women with a positive screen to identify those who require treatment for alcohol or illicit substance use in pregnancy.

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Validation of the 4P's Plus© screen for substance use in pregnancy validation of the 4P's Plus

Cited by 92 publications

References 26 publications

Self-report of illicit substance use versus urine toxicology results from at-risk pregnant women

Self-report of illicit substance use versus urine toxicology results from at-risk pregnant women

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

Screening for Prenatal Substance Use

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