PRENATAL SUBSTANCE USE SCREENING: VALIDATION AND COMPARISON OF PROMISING MEASURES

 描述（由申请人提供）：对孕妇进行的全国代表性调查显示，在过去一个月里，5.4%的孕妇报告使用非法药物，9.4%的孕妇报告使用酒精，15.4%的孕妇报告吸烟。此外，自2000年以来，孕妇在怀孕期间使用类阿片的人数增加了近五倍。这些统计数字可能被低估，因为它们是基于自我报告，而且由于耻辱和恐惧，许多妇女在怀孕期间少报了她们使用有害物质的情况。查明怀孕期间饮酒的筛查措施相对完善，但非法药物使用或处方药滥用的情况并非如此。在怀孕期间使用物质的良好筛查工具的可用性可以帮助临床医生确定可以从额外的援助和资源中受益的患者。本申请中提出的研究经过精心设计，旨在验证和比较母体物质使用的筛查工具。这项研究将由来自耶鲁大学医学院、韦恩州立大学和哈佛大学的一个研究小组领导。该团队在开发和评估与孕妇相关的物质使用筛查方面拥有丰富的经验。研究队列将由临床中心组成，这些临床中心在种族、民族、社会经济地位和药物使用方面总体上代表孕妇。我们将使用一种创新的两阶段方法，既可以匿名筛选女性，也可以解决参与者的反应集/期望。所有参与者都将被转介接受治疗。我们将使用来自参与者自我报告和尿液毒理学筛查的金标准。分析将描述所有筛选器的优点测量，比较其性能，并将使用可用数据生成与现有筛选器相比可能具有上级性能的新测量。该项目的工作将用于开发可用于促进将这些措施用于临床环境的材料。总的来说，该项目很有可能有益于妇女及其子女的健康，并对照顾孕妇的临床医生有价值。

 DESCRIPTION (provided by applicant): Nationally representative surveys of pregnant women show that, in the past month, 5.4% report use of illicit substances, 9.4% report use of alcohol, and 15.4% report smoking cigarettes. Further, since 2000 there has been nearly a five-fold increase in maternal use of opioids during pregnancy. These statistics are likely to be underestimates given that they are based upon self-report and because of stigma and fear, many women under-report their use of hazardous substances in pregnancy. Screening measures for identifying alcohol use in pregnancy are relatively well developed but this is not the case for illicit drug use or prescription drug misuse. The availability of well-performing screening tools for substance use in pregnancy can help clinicians identify patients who could benefit from additional assistance and resources. The study proposed in this application has been carefully designed to validate and compare screening tools for maternal substance use. The study would be led by a team of investigators from the Yale School of Medicine, Wayne State University and Harvard University. This team has extensive experience developing and evaluating substance use screeners that are relevant for pregnant women. The study cohort would be assembled from clinical centers that in their totality are representative of pregnant women in terms of race, ethnicity, socioeconomic status and substance use. We would use an innovative two-phase approach that would screen women anonymously but also address response set/expectations in participants. All participants would be offered referrals for treatment. We would use a gold standard that is derived from participant self-report and urine toxicology screens. Analyses would describe the measurements of merit for all screeners, compare their performance and would use available data to generate a new measure that may have superior performance compared to existing screeners. The work from this project would be used to develop materials that can be used to facilitate the use of these measures into clinical settings. Overall, this project has a high likelihood of benefitting the health of women and their children and of being of value to clinicians who care for pregnant women.