The alcohol, smoking and substance involvement screening test (the assist) version 3.0 in pregnancy

Abstract

Hypothesis: That the World Health Organization’s ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) Version 3.0 would have utility in pregnancy. Procedures: Face-to-face interviews with 104 pregnant women were conducted, administering the ASSIST Version 3.0 and other established tools, focused on tobacco, alcohol and cannabis, substances identifi ed as most used by public hospital antenatal patients in Adelaide, Australia. Results: Findings were analysed via a two-pronged harm categorisation: risk to the fetus and risk to the woman as an individual, the latter using cut-offs earlier established for the general population. The ASSIST Version 3.0 performed only moderately well versus the Revised Fagerstrom Tolerance Questionnaire (RTQ) for tobacco, the TACE for alcohol, and the Timeline FollowBack (TLFB) for cannabis. Most participants used tobacco (98 of 104), predominance of tobacco use likely linked to recognised diffi culties in cessation, despite stopping other substances. Kappa analyses of Specifi c Substance Involvement Scores (SSIS) on ASSIST Version 3.0 did not support changing cut-offs for the woman as an individual; however, ROC curves delineated an SSIS of 4 as indicative of fetal risk for both alcohol and cannabis. As all 98 tobacco users were ‘high risk’ users, a cut-off for fetal risk with tobacco could not be determined. Conclusions: Identifying tobacco use with an accepted tobaccospecifi c tool should be the initial screening. Screening for other substance use should be initiated if use is identifi ed; the ASSIST Version 3.0 could have a place. A cut-off for fetal risk with tobacco may emerge from research with fi rst trimester women, poorly represented in this study. Obstetric care providers should be willing and competent to address identifi ed use with equal zeal as for medical disorders, whilst avoiding unhelpful stereotyping. Substance use is often a marker for mental ill-health and environmental stressors such as poverty and domestic violence; these should not be ignored.