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.

项目摘要/摘要 酒精使用障碍（AUDS）在美国高度普遍，并对个体施加大量燃烧， 家庭和社会。公众对aud和成瘾疾病的理解正在发展 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 健康）状况。尽管如此，对有AUD的人的个人和机构歧视仍然存在。为了 例如，与公众意识的转变相反，许多州仍然有酒精排除法（AELS）。 这些法律（这是统一事故和疾病政策规定的一部分）允许保险 各种类型的公司（事故，汽车，残疾，健康）拒绝对那些人遭受的伤害的承保范围 酒精受损。有人担心这样的法律可以防止或对医疗保健提供者造成抑制 测试受伤患者的血液酒精水平，筛查和识别患有酒精有关的问题的患者， 并引用治疗。结果，在过去的20年中，16个州和哥伦比亚特区 废除了艾尔斯。但是，废除的影响尚未得到科学评估。响应 NIAAA PA-17-135，拟议的研究将通过第一个严格的 分析AEL的重复如何影响寻求酒精治疗的行为，实践模式 医疗保健提供者，以及对这些法律的行为响应如何受到付款来源的影响。 此外，我们将研究重复这些法律的重要潜在意想不到的后果 这样做会增加饮酒问题。我们提出了一种准实验设计，利用了跨越的变化 随着时间的推移，州法律是自然实验。我们将使用来自五项大型国家调查的数据， 行政资料来源：治疗剧集数据集，州住院数据库，州紧急情况 响应数据库，全国毒品使用和健康调查以及行为风险因素 监视系统。我们还将使用NIAAA的酒精政策信息系统，并补充原始 法律研究和其他政策数据来源。该项目介绍了高公众的备受了解的领域 健康意义：国家医疗保健系统级别的潜力 - 保险公司排除法律 - 是 AUDS治疗的障碍 - 这个问题在AUDS的流行率是 增加和使用治疗服务很低。这项研究将增强我们对 保险排除法与物质有关的行为与结果之间的关系。在 对PA-17-135的回应，该项目提出了对不是的政策和政策影响的创新研究 理解。我们预计拟议的研究将提供证据基础，以告知未来 州和国家一级的立法行动，从而对公众产生有意义的积极影响 健康。