Increased Cut-Point of the TACER-3 Screen Reduces False Positives Without Losing Sensitivity in Predicting Risk Alcohol Drinking in Pregnancy
Article first published online: 21 MAR 2014
Copyright © 2014 by the Research Society on Alcoholism
Alcoholism: Clinical and Experimental Research
Volume 38, Issue 5, pages 1401–1408, May 2014
How to Cite
Chiodo, L. M., Delaney-Black, V., Sokol, R. J., Janisse, J., Pardo, Y. and Hannigan, J. H. (2014), Increased Cut-Point of the TACER-3 Screen Reduces False Positives Without Losing Sensitivity in Predicting Risk Alcohol Drinking in Pregnancy. Alcoholism: Clinical and Experimental Research, 38: 1401–1408. doi: 10.1111/acer.12368
- Issue published online: 22 APR 2014
- Article first published online: 21 MAR 2014
- Manuscript Accepted: 10 DEC 2013
- Manuscript Received: 9 JUN 2013
- National Institute of Drug Abuse. Grant Number: R01-DA08524
- Gerber Foundation
- Wayne State University
- Alcohol Use Screens;
- Fetal Alcohol Spectrum Disorders;
- Fetal Alcohol Syndrome;
Detection of in-pregnancy maternal risk alcohol drinking is an essential first step in preventing fetal alcohol spectrum disorders, and the widely used T-ACE screen was developed for that purpose. We recently reported that increasing the total T-ACE score cut-point from 2 to 3 doubled specificity of detecting risk drinking in pregnancy and identified 4-year-old children with neurobehavioral effects associated with prenatal alcohol exposure.
In this study, the TACER-3 was further validated in another prospectively identified high-risk urban cohort. Women were categorized as follows: (i) Not At-Risk Group (negative on T-ACE and TACER-3); (ii) At-Risk Group (positive on T-ACE and TACER-3); and (iii) Change Risk Group (positive on T-ACE but negative on TACER-3).
The TACER-3 total score cut-point of 3 yielded fewer “false positives” than the T-ACE cut-point of 2. Based on relative risk scores, women in the TACER-3-positive At-Risk Group were more likely to drink alcohol during pregnancy than women in the Change Risk Group. In contrast, women in the Not At-Risk Group were largely not different in their drinking from women in the Change Risk Group. The largest increases in relative risk of the At-Risk Group compared to the Change Risk Group were for the amount of drinking per day across pregnancy (RR = 11.4) and for the amount of drinking per drinking day at the first prenatal visit (RR = 12.7). For both of these measures, the relative risk of at-risk alcohol consumption in the At-Risk Group was over >10 times that of the Change Risk Group.
Thus, the TACER-3 was more effective at selectively identifying women drinking at fetal risk levels than the original T-ACE. The TACER-3 allows for more efficient use of healthcare provider time in directing targeted clinical interventions with pregnant women identified as drinking at fetal risk levels.