Validity Of Self-reported Alcohol And Other Drug Use Among Pregnant Women Attending Midwife Obstetric Units In The Cape Metropole, South Africa

Abstract

Background: This paper examines the validity of self-report of alcohol and other drug use in a South African cohort of pregnant women by comparing simple questioning about alcohol and other drug use (yes/no), a standardized screening tool (Alcohol, Smoking and Substance Involvement Screening Test; ASSIST, and urine analysis. Method: An observational study among women in eleven public prenatal clinics was conducted. Dichotomous verbal screening is a standard of care, and pregnant patients reporting alcohol and substance use in dichotomous verbal screenings were asked to engage in screening using the ASSIST and urinalysis. Results: Significant agreements between dichotomous and ASSIST scores were observed (K = 0.73-0.76). A higher rate of self-reported (36.9%) alcohol use was detected, relative to urine screening (19.6%) with a predictive value of 34.9; while underreporting of illicit substance use was observed (3.6% self-report vs 8.8% urine screening) with an overall predictive value of 50.0. Conclusion: Dichotomous verbal screening was considered valid after comparison with the ASSIST; however, combined use with urine screenings can be recommended especially for identifying illicit substance use in order to accurately detect alcohol and other drug use in pregnancy so that women can be identified and referred for appropriate interventions where needed.

Scoping review of assessment tools for, magnitudes of and factors associated with problem drinking in population-based studies

“…These self-report measures can be supplemented with objective measures of alcohol use (alcohol biomarkers) such as phosphatidylethanol (PEth) 133–138. There is emerging evidence of the benefits of incorporating self-report alcohol use measures with alcohol biomarkers like PEth for valid assessment of problem drinking 136–149…”

“…[133][134][135][136][137][138] There is emerging evidence of the benefits of incorporating self-report alcohol use measures with alcohol biomarkers like PEth for valid assessment of problem drinking. [136][137][138][139][140][141][142][143][144][145][146][147][148][149] Problem drinking is affected by numerous factors at population and individual levels, and identifying these factors is important for informing the design of harm minimisation interventions. 28 The factors associated with problem drinking from our review summarised as sociodemographic and economic characteristics (age, sex, relationship status, education, employment, income level, religion, race, location and alcohol outlet density), clinical factors (medical problems, mental disorders and substance use) and quality of life fit into the biopsychosocial model used in medicine, psychiatry and psychology to understand health and illness.…”