Validity
The 4P’s Plus© has been validated across a variety of populations. The first validity data were collected in a population of 1,884 pregnant women enrolled in community health centers and maternal and child health programs in Alameda County, California. The instrument demonstrated moderately high sensitivity (83%) and specificity (80%). In addition, the goal of the 4P’s Plus© is to identify women with risky drinking patterns prior to learning of pregnancy, not just those women drinking once they learned of pregnancy. This was accomplished, as demonstrated by excellent levels of positive and negative predictive validity (50% and 95%, respectively). These levels of predictive validity demonstrate that we are able to identify not only those pregnant women who are drinking heavily or whose alcohol use is at a high enough level to impair daily functioning, but also identifies those women whose pregnancies are at risk from relatively small amounts of alcohol use. Importantly, by identifying women with a positive screen for alcohol use but whose assessment is negative (meaning the woman stopped drinking once she found out she was pregnant), the pregnant woman can receive prevention materials and education regarding the impact of even low levels of alcohol use during pregnancy and be given a strong prevention message.
The 4P’s Plus© Versus Urine Toxicology
In 2004, the effectiveness of the 4P’s Plus© in identifying pregnant women at risk for alcohol or illicit drug use was compared to universal urine toxicology testing. In this study of close to 1,500 pregnant women enrolled in a managed care system in Southern Illinois, urine toxicologies were positive in 2% of the women; however, the 4P’s Plus© identified 20% of the population as using alcohol or illicit drugs during pregnancy.3 In a similar study in Baton Rouge, Louisiana, the 4P’s Plus ©was compared to the T-ACE. Among 1,133 pregnant women, 42% of the women with a positive 4P’s Plus© were negative on the T-ACE. The 4P’s Plus© was able to identify women who were drinking 2 to 3 days per week and less, while the T-ACE identified only the heavier drinkers.
Published Research
In 2007 the team at NTI Upstream published a validity study in the Journal of Perinatology which confirmed previous findings.4 This was followed by the completion of a four-year study funded by NIAAA that validated the 4Ps Plus© in a population of women enrolled in Kaiser Permanente’s managed care plan. The excellent results achieved through this study were recently presented at the national meeting of the American Public Health Association.5