Pediatricians may be able to provide an additional service to the children they treat, by screening their parents for alcohol use. According to a study conducted by the Center for Adolescent Substance Abuse Research (CeASAR) at Children's Hospital Boston, parents are open to alcohol screening during their child's pediatric visit and to discussing drinking habits with a pediatrician. When a potential drinking problem arises, the pediatrician could provide educational materials about alcoholism, and refer the parents for evaluation or treatment. The findings are published in the November issue of Pediatrics.

"Pediatricians, with their commitment to child health, frequent interactions with parents, and close relationships with both children and families, have a unique opportunity to screen parents for alcohol use and refer them for further assessment and treatment," says Celeste Wilson, MD, researcher and pediatrician in the CeASAR program at Children's and lead author of the study.

In the multi-center study, 879 parents from three pediatric primary care clinic sites---rural, urban and suburban---were surveyed using anonymous questionnaires. The questionnaire included two brief alcohol screening tests and questions designed to assess parents' preferences for who should perform the alcohol screening, acceptance of the screening, and preferred interventions if the screening was positive.

Nearly 90% of all parents responding to this anonymous survey reported being open to being asked about their alcohol use at their child's pediatric appointment. Surprisingly, over 75% of parents with a positive alcohol screen also indicated acceptance of being screened for alcohol problems during the pediatric office visit. The top three preferred screening methods for parents, including those found to have alcohol problems, were direct conversation with the pediatrician, computer-based questionnaire, and paper-pencil questionnaire. The researchers believe that the endorsement of the pediatrician over screening conducted by other medical staff (e.g., nurse, medical assistant) results from an intangible, yet distinct, quality of the parent-pediatrician relationship.

While the parents' openness to alcohol screening at pediatric appointments was encouraging, the researchers are quick to point out some of the findings are cause for concern. Of the 879 parent participants, one out of every nine (11.5%) were found to have a positive alcohol screen; an alarmingly high number when considering recruitment for study participation was on a volunteer-only basis.

"It is possible that those parents who declined participation in the study were the ones with the most severe alcohol problems," says Wilson who is also an Instructor in Pediatrics at Harvard Medical School. "However, if this is true, our results represent an underestimate of the actual problem."

According to research, children of alcoholics are at increased risk for behavioral, cognitive and mental health problems. They are more likely to witness domestic violence, and have a greater chance of becoming victims of all forms of child maltreatment including neglect, physical abuse, and sexual abuse. Furthermore, children of alcoholics are 3 to 4 times more likely to have their own alcohol problems later in life.

"Given the negative consequences of growing up with an alcoholic parent, it is critical, for the future health and well being of the child, to identify and provide a pathway to assessment and treatment for the parent with an unhealthy pattern of alcohol consumption," adds Wilson.

Dr. Wilson and her colleagues suggest that to optimally treat patients, pediatricians must acknowledge the potential adverse effects of parental alcohol use on the child and embrace the concept that alcohol use should be addressed with parents during the clinic visit. When considering possible implementation strategies, they believe that an alcohol screening tool could be incorporated into a preexisting health survey and completed by the parent prior to their child's clinic appointment.

The study was supported by a grant from the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program. Dr. Wilson was supported by a faculty fellowship grant from The Center of Excellence in Minority Health and Health Disparities at Harvard Medical School.