ASSIST V1-V4🔗

Name

Alcohol, Smoking and Substance Involvement Screening Test V1-V4 (ASSIST V1-V4)

Table Namepex_bm_assist{v1|v2|v3|v4}
Construct
  • V1 : Substance use pre-pregnancy and during pregnancy
  • V2 : Substance use late pregnancy and early postnatal (0–4 weeks)
  • V3 : Substance use postpartum (3-month anchor)
  • V4 : Substance use postpartum (12-month anchor)
Study Visits

V01 - V04

TypeIn-person/Remote Questionnaire (Parent on Self; 3-5 min)
Quality Control

Response distributions are reviewed for outliers. For V1-V2, responses are cross-checked with TLFB for consistency in reported substance use.

Note: Participants in Alabama were trained to self-administer remotely; otherwise administration was in-person.

V1 & V2

Responsible use of prenatal drug exposure data requires thoughtful interpretation of exposure-related outcomes in the context of measured and unmeasured confounders. These confounders include, but are not limited to, phenotypic risks associated with persistent alcohol, tobacco, and other drug use during pregnancy by birthing parents (Massey et al., 2010), and confounding by familial risk from within-family studies (Estabrook et al., 2016).

Finally, unwarranted speculation about ‘neural bases of behavior’ form differences in neuroimaging between exposed and unexposed children in the absence of differences in behavioral performance can exacerbate stigma already faced by birthing parents with substance use disorders and their children (McAllister & Hart 2015).

It was difficult for some participants to self-report the typical size of a single drink (in oz) to capture ‘standard drinks’ of alcohol for ASSIST, leading to some reports falling outside the expected range. Similarly, reporting the frequency of use for substances like electronic cigarette devices proved difficult, resulting in outliers. While sites were queried on these outliers, participants could not always be re-contacted for clarification.

Instrument Details🔗

The HBCD ASSIST was adapted from the NIDA Quick Screen (Modified ASSIST) and incorporates selected questions from the Family History Assessment Module (FHAM) and the All of Us Personal and Family Health History to assess substance use pre-, during, and post-pregnancy. For each substance, participants first indicate whether they have ever used it, and if so, frequency of use (0 = Never, 1 = Once or Twice, 2 = Monthly, 3 = Weekly, and 4 = Daily or Almost Daily). For substances reported before pregnancy, during pregnancy, or at the end of pregnancy, participants are also asked about modes of use and typical quantities consumed for alcohol and opioids if applicable.

Compared with the original NIDA Quick Screen, the HBCD ASSIST expands both the range of substances assessed (see ASSIST Substance Type Options) and the time periods evaluated. Rather than asking only about use during the past year, the HBCD ASSIST collects information on lifetime use, problematic use, and use before pregnancy, during pregnancy, at the end of pregnancy, after pregnancy, and during the past three months. Detailed changes for each instrument are described under HBCD Modification Details.

Administration of the Timeline Follow-Back (TLFB) is triggered when substance use is reported before or during pregnancy (pre-use / during_use) on ASSIST V1, or at the end of pregnancy (end_use) on ASSIST V2. See the TLFB documentation for additional details.

Scoring Removed

Unlike the original NIDA Modified ASSIST, the HBCD adaptation is not scored. When describing these measures in publications, authors may note that the instrument was adapted from the NIDA Modified ASSIST.

Replacement Questions for NIDA Quick Screen

ASSIST V1

Lifetime (lt__use) substance use and disordered use, 3 months pre-pregnancy (pre_use), and during pregnancy (during_use)

  • [lt__use]IN YOUR LIFE, which of the following substances have you EVER used for any reason?
  • [lt__concern] Have you EVER been concerned about your use of this substance or worried it was problematic use?
  • [lt__concernoth] Has a friend, relative, or anyone else EVER expressed concern about your use of this substance?
  • [control] Have you EVER tried and failed to control, cut down, or stop using this substance?
  • [tx] Have you EVER sought or received treatment related to your use of this substance by a medical provider, spiritual leader, community mutual help group (like AA or SMART Recovery), counselors, or in other settings?
  • [diagn] Have you EVER been clinically diagnosed with abuse, dependence, or a substance use disorder related to your use of this substance?
  • [med] Have you EVER taken (prescribed or otherwise) medication(s) as treatment for a problem substance?
  • [pre_use] IN THE THREE MONTHS BEFORE YOU BECAME PREGNANT, which of the following substances have you ever used for any reason?
  • [during_use] DURING YOUR PREGNANCY, which of the following substances have you ever used for any reason?
  • [during_med] DURING YOUR PREGNANCY, did you take (prescribed or otherwise) medication(s) as treatment for a problem substance?
ASSIST V2

Use after pregnancy

  • [end_use] SINCE WE LAST MET UNTIL THE END OF PREGNANCY, which of the following substances did you use for any reason?
  • [end_med]SINCE WE LAST MET UNTIL THE END OF PREGNANCY, did you take (prescribed or otherwise) medication(s) as treatment for a problem substance?
  • [post_use]FROM THE TIME THAT YOU DELIVERED your child until now, how often have you used any of the following substances for any reason?
ASSIST V3

Substance use in past 3 months and impact after pregnancy

  • [3m_use] IN THE PAST THREE MONTHS, how often have you used any of the following substances for any reason?
  • [problem] DURING THE PAST THREE MONTHS, has your use of this substance led to physical or mental health, social, or financial problems?
  • [perform] DURING THE PAST THREE MONTHS, have you ever failed to do what was normally expected of you (like work, go to school, be a parent, or household tasks) because of your use of this substance?
ASSIST V4

Substance use in past 12 months and impact after pregnancy

  • [12m_use] IN THE PAST TWELVE MONTHS, how often have you used any of the following substances for any reason?
  • [problem] DURING THE PAST TWELVE MONTHS, has your use of this substance led to physical or mental health, social, or financial problems?
  • [perform] DURING THE PAST TWELVE MONTHS, have you ever failed to do what was normally expected of you (like work, go to school, be a parent, or household tasks) because of your use of this substance?

Coles, C. D. (1993). Saying “goodbye” to the “crack baby.” Neurotoxicology and Teratology, 15(5), 290–292; discussion 311-2. https://doi.org/10.1016/0892-0362(93)90024-i

Estabrook, R., Massey, S. H., Clark, C. A. C., Burns, J. L., Mustanski, B. S., Cook, E. H., O’Brien, T. C., Makowski, B., Espy, K. A., & Wakschlag, L. S. (2016). Separating family-level and direct exposure effects of smoking during pregnancy on offspring externalizing symptoms: Bridging the behavior genetic and behavior teratologic divide. Behavior Genetics, 46(3), 389–402. https://doi.org/10.1007/s10519-015-9762-2

Gal, P., & Sharpless, M. K. (1984). Fetal drug exposure-behavioral teratogenesis. Drug Intelligence & Clinical Pharmacy, 18(3), 186–201. https://doi.org/10.1177/106002808401800304

Level, R. A., Zhang, Y., Tiemeier, H., Estabrook, R., Shaw, D. S., Leve, L. D., Wakschlag, L. S., Reiss, D., Neiderhiser, J. M., & Massey, S. H. (2024). Unique influences of pregnancy and anticipated parenting on cigarette smoking: results and implications of a within-person, between-pregnancy study. Archives of Women’s Mental Health, 27(2), 301–308. https://doi.org/10.1007/s00737-023-01396-z

Massey, S. H., Lieberman, D. Z., Reiss, D., Leve, L. D., Shaw, D. S., & Neiderhiser, J. M. (2010). Association of clinical characteristics and cessation of tobacco, alcohol, and illicit drug use during pregnancy. The American Journal on Addictions, no-no. https://doi.org/10.1111/j.1521-0391.2010.00110.x

McAllister, D., & Hart, C. L. (2015). Inappropriate interpretations of prenatal drug use data can be worse than the drugs themselves. Neurotoxicology and Teratology, 52, 57. https://doi.org/10.1016/j.ntt.2015.07.002

National Institute on Drug Abuse. (n.d.). NIDA Modified ASSIST.

Shah, S. K., Perez-Cardona, L., Helner, K., Massey, S. H., Premkumar, A., Edwards, R., Norton, E. S., Rogers, C. E., Miller, E. S., Smyser, C. D., Davis, M. M., & Wakschlag, L. S. (2023). How penalizing substance use in pregnancy affects treatment and research: a qualitative examination of researchers’ perspectives. Journal of Law and the Biosciences, 10(2), lsad019. https://doi.org/10.1093/jlb/lsad019

Wakeman, S. E., Bryant, A., & Harrison, N. (2022). Redefining child protection. Obstetrics and Gynecology, 140(2), 167–173. https://doi.org/10.1097/aog.0000000000004786