title: Screening for high- and moderate-risk drinking during pregnancy: a comparison of several TWEAK-based screeners.
abstract: OBJECTIVE
  This study investigated the use of the TWEAK and nine alternative screeners for predicting high-risk and moderate-risk drinking during pregnancy.
  
  
  METHODS
  The analysis was based on self-reports from 404 lifetime drinkers who presented for an initial visit at nine prenatal clinics in Washington, DC. Data were collected anonymously by having women directly enter their responses onto an audio, computer-assisted interview that was programmed onto a laptop computer. Pregnancy risk drinking status was based on both average daily volume of intake and frequency of drinking 3+ drinks in a day. Each of the alternative screeners was constructed by adding one additional risk indicator to the TWEAK, and three different scoring options were explored.
  
  
  RESULTS
  Using thresholds of 2 points for high-risk drinking and 1 point for moderate-risk drinking, the TWEAK demonstrated a sensitivity and specificity of 70.6% and 73.2% for high-risk drinking and a sensitivity and specificity of 65.6% and 63.7% for any (high- or moderate-) risk drinking during pregnancy. None of the alternative screeners resulted in significant improvement, but the addition of current smoking status showed enough promise to warrant further testing in larger samples.
  
  
  CONCLUSIONS
  Despite some loss in sensitivity and specificity, the TWEAK, in its original or a modified form, can be extended to measures of high-risk drinking that incorporate infrequent heavy intake and can be used to test for moderate- as well as high-risk drinking. Because identification of moderate-risk drinkers substantially increases the pool of women targeted for intervention, cost implications must be considered in designing appropriate interventions.
authors.affiliation: NIAAA, NIH, Bethesda, Maryland 20892-7003, USA. ddawson@willco.niaaa.nih.gov
authors.forename: D A
authors.initials: DA
authors.lastname: Dawson
authors.forename: A
authors.initials: A
authors.lastname: Das
authors.forename: V B
authors.initials: VB
authors.lastname: Faden
authors.forename: B
authors.initials: B
authors.lastname: Bhaskar
authors.forename: C J
authors.initials: CJ
authors.lastname: Krulewitch
authors.forename: B
authors.initials: B
authors.lastname: Wesley
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology; D000647:Amnesia; D001007:Anxiety; D004361:Drug Tolerance; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011247:Pregnancy; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D012907:Smoking
chemical_list: D000431:Ethanol