Multi-level Analyses of the NESARC to Explain Treatment Gaps

NESARC 的多层次分析解释治疗差距

• 批准号: 7046278
• 负责人: Mary Jo Larson
• 金额: $ 21.19万
• 依托单位: NEW ENGLAND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7046278
• 关键词: alcoholism /alcohol abuse therapy; clinical research; drug abuse therapy; gender difference; geographic difference; health care cost /financing; health care policy; health care service organization; health care service utilization; health services research tag; human data; longitudinal human study; racial /ethnic difference; socioeconomics; statistics /biometry

DESCRIPTION (provided by applicant): The objective of this grant application is to investigate the factors that explain the heterogeneity in alcohol and drug disorders, treatment seeking, and recovery across geographic areas, racial/ethnic groups and gender groups. This project conducts secondary analyses of the NESARC and NLAES to study the dynamic interaction of factors at both the individual level and societal/health system level, specifically: state policies, public financing, health system organization, and state/area socio-economic characteristics. To understand the influence of these contextual level factors, the study will employ hierarchical multi-level analytical techniques, modeling the behavior of individuals as nested within social and geographic environments. The analytic approach is informed by theories of treatment seeking, the social determinants of health, and research on recovery in treated and untreated populations. The Specific Aims are to: AIM 1: describe the variation in treatment need, treatment utilization (formal and informal services), and treatment gap across the 50 states, and identify the contextual factors (policy, financing, health system organization, and socio-economic) that explain the observed variation, controlling for demographic and other differences across states. This aim will involve cross-sectional and trends analyses of 1990-91 NLAES and 2001-02 NESARC. AIM 2: analyze how characteristics of individuals (particularly race/ethnicity and gender) interact with state and area contextual factors (policy, financing, health system organization, and socio-economic) to determine the probability that individuals with alcohol and drug use problems will recognize the need for care, seek care, and receive care. This aim will be addressed with cross-sectional analyses of NLAES and the 2001-02 NESARC. AIM 3: assess the impact of the state-level treatment gap and other area contextual factors on the probability of individual remission from alcohol and drug disorders and problems, all other things equal. This aim will involve longitudinal analysis of prospective data gathered on the 2004-2005 NESARC controlling for cohort information from the 2001-2002 NESARC. The treatment gap is a pressing problem in substance abuse health services research today, and yet there are significant limitations in our understanding of the problem. The NLAES and NESARC surveys offer an unprecedented opportunity to understand these dynamics since the surveys are based on representative samples of the community-at-large rather than a treated population and the NESARC collects longitudinal data on its community sample.

描述（由申请人提供）： 本拨款申请的目的是调查解释酒精和药物障碍、治疗寻求和跨地理区域、种族/族裔群体和性别群体的康复的异质性的因素。该项目对 NESARC 和 NLAES 进行二次分析，以研究个人层面和社会/卫生系统层面因素的动态相互作用，特别是：国家政策、公共融资、卫生系统组织和国家/地区社会经济特征。为了了解这些背景因素的影响，该研究将采用分层多层次分析技术，对嵌套在社会和地理环境中的个人行为进行建模。分析方法以寻求治疗的理论、健康的社会决定因素以及治疗和未治疗人群的康复研究为基础。 具体目标是： AIM 1：描述 50 个州的治疗需求、治疗利用（正式和非正式服务）和治疗差距的变化，并确定背景因素（政策、融资、卫生系统组织和社会经济）解释了观察到的变化，控制了各州之间的人口和其他差异。这一目标将涉及 1990-91 NLAES 和 2001-02 NESARC 的横断面和趋势分析。目标 2：分析个人特征（特别是种族/族裔和性别）如何与州和地区背景因素（政策、融资、卫生系统组织和社会经济）相互作用，以确定有酗酒和吸毒问题的个人出现酗酒和吸毒问题的可能性认识到护理的需要、寻求护理和接受护理。这一目标将通过 NLAES 和 2001-02 NESARC 的横断面分析来实现。目标 3：在其他条件相同的情况下，评估州级治疗差距和其他地区背景因素对个人从酒精和药物障碍和问题中缓解的可能性的影响。这一目标将涉及对 2004-2005 年 NESARC 收集的前瞻性数据进行纵向分析，并控制 2001-2002 年 NESARC 的队列信息。 治疗差距是当今药物滥用卫生服务研究中的一个紧迫问题，但我们对该问题的理解存在重大局限性。 NLAES 和 NESARC 调查为了解这些动态提供了前所未有的机会，因为这些调查是基于整个社区的代表性样本而不是接受治疗的人群，并且 NESARC 收集其社区样本的纵向数据。