Assessing the Effects of State Alcohol Exclusion Laws on Alcohol-Related Behaviors and Outcomes

评估国家禁酒法对酒精相关行为和结果的影响

• 批准号: 9976404
• 负责人: Sunday Azagba
• 金额: $ 30.53万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9976404
• 关键词: Accident and Emergency department; Accidents; Address; Admission activity; Adult; Affect; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcoholism; Alcohols; American; American College of Surgeons; American Medical Association; American Public Health Association; Area; Awareness; Behavior; Behavior Therapy; Behavioral Risk Factor Surveillance System; Belief; Blood Tests; Blood alcohol level measurement; Code; Data; Data Set; Data Sources; Databases; Diagnosis; Discrimination; Disease; Disincentive; District of Columbia; Drug usage; Economic Burden; Effectiveness; Emergency Situation; Emergency response; Epidemiology; Exclusion; Experimental Designs; Failure; Family; Future; Health; Health Personnel; Health Professional; Healthcare; Healthcare Systems; Heavy Drinking; Impairment; Individual; Injury; Inpatients; Insurance; Insurance Carriers; Insurance Coverage; Knowledge; Laws; Legal; Methods; Morals; National Institute on Alcohol Abuse and Alcoholism; Natural experiment; Neurobiology; Outcome; Patients; Pattern; Pharmaceutical Preparations; Policies; Prevalence; Productivity; Public Health; Research; Science; Societies; Source; Surveys; Time; Treatment Effectiveness; United States; Variant; addiction; alcohol abuse therapy; alcohol behavior; alcohol policy information system; alcohol related problem; alcohol use disorder; barrier to care; base; behavioral outcome; behavioral response; brief intervention; cost; disability; evidence base; experience; experimental analysis; injured; innovation; patient screening; payment; prevent; response; social stigma; societal costs; substance abuse epidemiology; treatment services; trend

Project Summary/Abstract Alcohol use disorders (AUDs) are highly prevalent in the U.S., and impose a substantial burden on individuals, families and society. Public understanding of AUD and the disease of addiction has evolved as a result of advances in science demonstrating the neurobiological basis of addiction and the fact that it is a treatable condition. Nonetheless, individual and institutional discrimination against people with AUD persists. For example, in contrast to shifts in public awareness, many states still have Alcohol Exclusion Laws (AELs). These laws (which are part of the Uniform Accident and Sickness Policy Provision Law) allow insurance companies of various types (accident, auto, disability, health) to deny coverage for injuries sustained by those impaired by alcohol. There are concerns that such laws prevent or create disincentives to healthcare providers testing blood alcohol levels of injured patients, screening and identifying those with alcohol-related problems, and making referrals for treatment. As a result, over the past 20 years, 16 states and the District of Columbia have repealed AELs. However, the impact of repeal has not been assessed scientifically. In response to NIAAA PA-17-135, the proposed study will address this critical knowledge gap by conducting the first rigorous analyses of how the repealing of AELs has affected alcohol treatment-seeking behavior, practice patterns of healthcare providers, and how behavioral responses to these laws might be influenced by payment source. Additionally, we will examine an important potential unintended consequence of repealing these laws--whether doing so increases problem drinking. We propose a quasi-experimental design, exploiting variation across state laws over time as a natural experiment. We will use data from five large national surveys and administrative sources: the Treatment Episode Data Set, State Inpatient Databases, State Emergency Response databases, the National Survey on Drug Use and Health, and the Behavioral Risk Factor Surveillance System. We will also use NIAAA's Alcohol Policy Information System supplemented by original legal research and other policy data sources. This project addresses a highly understudied area of high public health significance: the potential of a state healthcare system-level factor--insurance exclusionary laws--to be a barrier to treatment for AUDs—a question that is especially critical at a time when the prevalence of AUDs is increasing and use of treatment services is low. This research will enhance our understanding of the relationships between insurance exclusionary laws and substance-related behaviors and outcomes. In response to PA-17-135, this project proposes innovative research into policies and policy effects that are not well understood. We anticipate that the proposed study will provide an evidence base to inform future legislative actions at both the state and national levels, thereby having a meaningful positive impact on public health.

项目概要/摘要 酒精使用障碍（AUD）在美国非常普遍，给个人带来了沉重的负担， 家庭和社会对 AUD 和成瘾疾病的理解不断演变。 科学的进步证明了成瘾的神经生物学基础以及它是可以治疗的事实 然而，针对 AUD 患者的个人和机构歧视仍然存在。 例如，与公众意识的转变相反，许多州仍然有禁酒法（AEL）。 这些法律（《统一事故和疾病保险条款法》的一部分）允许投保 各种类型（事故、汽车、残疾、健康）的公司拒绝承保这些人所遭受的伤害 有人担心此类法律会阻碍或抑制医疗保健提供者。 测试受伤患者的血液酒精含量，筛查和识别那些有酒精相关问题的人， 并因此在过去 20 年中向 16 个州和哥伦比亚特区转诊。 已废除 AEL，但尚未对废除的影响进行科学评估。 NIAAA PA-17-135，拟议的研究将通过进行第一次严格的研究来解决这一关键的知识差距 分析废除 AEL 如何影响酒精治疗寻求行为、实践模式 医疗保健提供者，以及支付来源如何影响对这些法律的行为反应。 此外，我们将研究废除这些法律的一个重要的潜在的意外后果——是否 这样做会增加饮酒问题。 作为一项自然实验，我们将使用来自五次大型全国性调查的数据。 行政来源：治疗事件数据集、州住院患者数据库、州紧急情况 响应数据库、全国药物使用和健康调查以及行为风险因素 我们还将使用 NIAAA 的酒精政策信息系统，并辅以原始系统。 该项目涉及高度公众研究的一个高度不足的领域。 健康意义：国家医疗保健系统层面因素（保险排除法）的潜力 AUD 治疗的障碍——在 AUD 患病率很高的情况下，这个问题尤其重要 治疗服务的增加和使用率较低。这项研究将增强我们对治疗服务的了解。 保险排除法与物质相关行为和结果之间的关系。 作为对 PA-17-135 的回应，该项目提出了对政策和政策效果的创新研究， 我们预计拟议的研究将为未来提供证据基础。 州和国家层面的立法行动，从而对公众产生有意义的积极影响 健康。