Alcohol treatment & health disparity in American Indians

酒精治疗

• 批准号: 7127499
• 负责人: R. Dale WALKER
• 金额: $ 14.42万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-01 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7127499
• 关键词: Native Americans; alcoholic beverage consumption; alcoholism /alcohol abuse; alcoholism /alcohol abuse therapy; clinical research; culture; gender difference; health care quality; health care service utilization; health disparity; health services research tag; human subject; interview; longitudinal human study; medically underserved population; substance abuse related behavior

DESCRIPTION (provided by applicant): This proposal is the third submission of application number R01 AA013806-01 which was originally submitted in response to Request for Application Number AA02.002 ("Research on Alcohol Health Disparities") and most recently reviewed February 13, 2003 by the National Institute on Alcohol Abuse and Alcoholism Health Services Research Review sub-committee (AA-2). The application has again been extensively revised in response to reviewer comments. Nonetheless, this health services research study continues to be motivated by health disparities such as the high rates of morbidity and mortality related to alcohol use among American Indians. Given these health disparities, it is worrisome that there have been few studies examining relationships between treatments and outcomes for natives with alcohol problems. In particular, there is little or no research on services for urban Native Americans with alcohol abuse or dependence. This lack of information is unfortunate since most American Indians now live in cities. The proposed project will examine processes of treatment and outcomes among clients of programs focusing on American Indians in Seattle, Washington and Portland, Oregon. The Seattle Indian Health Board and the Native American Rehabilitation Association in Portland, Oregon primarily serve urban American Indians, are closely connected with general medical services, offer ancillary care such as family therapy, provide numerous treatment modalities for individuals with alcohol problems, and support ongoing research projects. Both agencies serve members of several tribes and both have clients who spend part of the year in the city and part on reservations. Both agencies have adapted for Native people and incorporated into their treatment programs standardized therapies including Motivational Enhancement and Cognitive-Behavioral Treatment. The project will use an inception cohort design. Clients presenting for treatment of alcohol problems at the study programs will be informed about the project. After informed consent is obtained, subjects will be interviewed using instruments such as the Addiction Severity Index and the Project Match Form 90. Subjects will be interviewed again six months, 12, and 18 months after baseline. Outcomes of interest will include abstinence, number of drinking days, alcohol-related problems, psychiatric problems, general medical problems, and satisfaction with services. Interviews with clients and providers, observations of treatment sessions, and reviews of taped treatment encounters will be employed to elicit details of treatment services received. Hierarchical linear models and structural equations models will be used to relate treatments to outcomes. Predictors will include variables describing culturally specific treatments provided to the Native clients as well as measures of clinician cultural competence. Administrative data will be used to compare outcomes for American Indians versus general population clients. Information generated from the project will be useful in devising optimal treatment for indigenous people living in urban areas and in planning randomized clinical trials. The research team (headed by a Cherokee psychiatrist and including members of several tribes) will disseminate results in collaboration with the newly funded American Indian and Alaska Native National Resource Center on Substance Abuse Prevention and Treatment.

描述（申请人提供）：该提案是申请编号R01 AA013806-01的第三次提交，该提议最初是为了响应要求申请号AA02.002（“酒精健康差异研究”）而提交的，并且最近在2003年2月13日审查了2003年，由美国国家研究所在酒精滥用和酒精健康服务研究审查审查审查审查审查审查审查审查审查审查审查（AA）。该应用程序再次经过广泛的修订，以响应审阅者的评论。 尽管如此，这项卫生服务研究仍由健康差异（例如，与美国印第安人在酒精饮酒有关的高发病率和死亡率率）所激发的。 鉴于这些健康差异，令人担忧的是，很少有研究研究饮酒问题的当地人的治疗与结果之间的关系。特别是，对于滥用酒精或依赖的城市原住民的服务几乎没有或没有研究。由于大多数美国印第安人现在都住在城市，因此缺乏信息是不幸的。 拟议的项目将研究关注西雅图，华盛顿和俄勒冈州波特兰的美国印第安人计划的客户的治疗过程和结果。俄勒冈州波特兰的西雅图印度卫生委员会和美国原住民康复协会主要为城市印第安人服务，与一般医疗服务密切相关，提供辅助护理，例如家庭疗法，为酒精疾病的人提供多种治疗方式，并支持正在进行的研究项目。这两个机构都为几个部落的成员提供服务，并且都有在一年中在城市中度过一部分并进行预订的客户。这两个机构都适用于土著人，并将其纳入其治疗计划中，包括动机增强和认知行为治疗。 该项目将使用Inception队列设计。在研究计划中出示治疗酒精问题的客户将获悉该项目。获得知情同意后，将使用诸如成瘾严重程度指数和项目匹配表格90的工具进行采访。将在基线后六个月，12个月和18个月再次采访主题。感兴趣的结果将包括禁欲，饮酒天数，与酒精有关的问题，精神病问题，一般医疗问题以及对服务的满意度。将采用与客户和提供者的访谈，治疗课程的观察以及对录音治疗相遇的审查，以引起收到的治疗服务的详细信息。 分层线性模型和结构方程模型将用于将治疗与结果相关联。预测因素将包括描述提供给本地客户的文化治疗的变量，以及临床文化能力的度量。行政数据将用于比较美国印第安人与普通人群客户的结果。该项目产生的信息将有助于为居住在城市地区和计划随机临床试验的土著人民设计最佳治疗。研究团队（由切诺基精神科医生和包括几个部落的成员在内的领导）将与新资助的美洲印第安人和阿拉斯加国家原住民国家资源中心合作传播结果。