Detecting risk drinking during pregnancy: a comparison of four screening questionnaires

Am J Public Health. 1996 Oct;86(10):1435-9. doi: 10.2105/ajph.86.10.1435.


Objectives: This study investigated the efficacy of screening for risk drinking during pregnancy with two brief questionnaires, TWEAK and T-ACE. Both include an assessment of tolerance based on the number of drinks women report they can hold.

Methods: Subjects were disadvantaged African-American obstetric patients in Detroit, Mich. Traditional alcoholism screens (Michigan Alcohol Screening Test [MAST], CAGE) and the tolerance question were administered (n = 2717); TWEAK and T-ACE were constructed from tolerance and embedded MAST and CAGE items. In a separate sample (n = 1420), only the T-ACE was administered. Periconceptional risk drinking was the gold standard. Screen evaluations were based on receiver-operating characteristic analyses.

Results: At the cutpoint of 2, sensitivity/specificity for embedded screens were 91/77 for TWEAK and 88/79 for T-ACE; comparable values for T-ACE alone were 67/86. TWEAK and T-ACE screened more effectively than CAGE or MAST.

Conclusions: Embedded versions of TWEAK and T-ACE were both highly sensitive to periconceptional risk drinking in this population. Administering T-ACE alone reduced its sensitivity; this suggests that MAST and CAGE administration improves its performance.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Alcohol Drinking / epidemiology*
  • Alcoholism / diagnosis*
  • Drug Tolerance
  • Female
  • Humans
  • Mass Screening / methods
  • Michigan / epidemiology
  • Parity
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Prospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Surveys and Questionnaires*