Prenatal Substance Use and Perceptions of Parent and Partner Use Using the 4P’s Plus Screener
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Background Prenatal substance use screening is recommended. The 4 P’s Plus screener includes questions on perceived problematic substance use in parents and partner that are not considered in risk stratification. Objectives This research examined the: (1) prevalence of self-reported problematic parental and partner substance use and associations with biochemically-verified prenatal substance use; (2) utility of self-reported perceptions of parent/partner substance use as proxies for prenatal substance use; and (3) degree to which the sensitivity of the 4P’s Plus can be augmented with consideration of parent/partner questions in risk stratification. Methods A convenience sample of 500 pregnant women was recruited between January 2017 and January 2018. Participants completed the 4P’s Plus and provided urine for drug testing. Diagnostic utility of problematic parent/partner substance use questions was assessed, then compared to the 4P’s Plus used as designed, and to the 4P’s Plus used with these 2 questions included in risk stratification. Results Half (51%) of respondents reported either partner or parental problematic substance use. When partner or parent problematic substance use were considered as proxies for prenatal substance use, sensitivity was 65% and specificity was 55%. When used as intended, sensitivity was 94% and specificity was 29%. Including partner/parent questions increased sensitivity to 96% but lowered specificity (19%). Partner substance use and combined partner/parent use were associated with prenatal substance use [adjusted odds ratio (aOR): 2.0 (1.2, 2.4; p = 0.006); aOR = 1.6 (1.1, 2.5, p = 0.04)]. Conclusions for Practice Sensitivity of the 4P’s Plus may improve with inclusion of self-reported problematic partner/parent substance use items in risk stratification.
Keywords4P’s Plus Drug use Pregnancy Partner Parent Sensitivity Prenatal
We would like to recognize and appreciate the contributions of Sage Roth, Bartosz Koszowski, Geraldine Baltazar, Elaine Madison and Linda McLellan to the execution of this study.
EAO and VCC conceived the study. EAO, ENP, VCC, KT and KM conducted literature searches and provided summaries of previous research studies. EAO conducted the statistical analysis. EAO, ENP, KT, KM and VCC participated in the writing of the first draft of the manuscript and all authors contributed to and have approved the final manuscript.
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA041328. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with Ethical Standards
Conflict of interest
The authors declare no conflicts of interest.
- Ahrnsbrak, R., Bose, J., Hedden, S., Lipari, R., & Park-Lee, E. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA). NSDUH Data Review. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm.
- Anderson, K. N., Dutton, A. C., Broussard, C. S., Farr, S. L., Lind, J. N., Visser, S. N., et al. (2018). ADHD medication use during pregnancy and risk for selected birth defects: National Birth Defects Prevention Study, 1998–2011. Journal of Attention Disorders, 1087054718759753.Google Scholar
- Calvo, N., Cannon-DeKreek, S., Dahms, E., Kinkle, S. A., May, B., & Whalen, S. (2010). Two perspectives on use of 4P’s Plus© to screen pregnant women for alcohol and other drugs. THESOURCE, 2(2), 21.Google Scholar
- Coleman-Cowger, V. H., Oga, E. A., Peters, E. N., Trocin, K., Koszowski, B., & Mark, K. (2018b). Comparison and validation of screening tools for substance use in pregnancy: A cross-sectional study conducted in Maryland prenatal clinics. British Medical Journal Open, 8(2), e020248.Google Scholar
- Jones, H. E. (2005). The challenges of screening for substance use in pregnant women: commentary on the 4P’S plus tool. London: Nature Publishing Group.Google Scholar
- NIDA. (2017a). Health consequences of drug misuse. Retrieved December 22, 2017, from https://www.drugabuse.gov/related-topics/health-consequences-drug-misuse.
- NIDA. (2017b). Substance use in women. Retrieved December 22, 2017, from https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women.
- NTI Upstream. (2011). The 4P’s Plus© screen for substance use in pregnancy: Research background and clinical application. Retrieved from https://www.ntiupstream.com/4psabout/#.
- SAMHSA. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of national findings. In NSDUH Series H-46, HHS Publication No.(SMA) 13-4795. Rockville: Substance Abuse and Mental Health Services Administration (SAMHSA).Google Scholar
- SAMHSA. (2018). SAMHSA’s annual mental health, substance use data provide roadmap for future action. Rockville: Substance Abuse and Mental Health Services Administration (SAMHSA).Google Scholar