Stage II Efficacy Trial of a Culturally Informed Brief Intervention to Reduce Alcohol Related Health Disparities and Treatment Inequities among Latinxs

旨在减少拉丁裔中与酒精相关的健康差异和治疗不平等的文化知情短期干预的第二阶段功效试验

• 批准号: 10681330
• 负责人: CRAIG A FIELD
• 金额: $ 62.72万
• 依托单位: UNIVERSITY OF TEXAS EL PASO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-10 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10681330
• 关键词: Academic Medical Centers; Acculturation; Address; Admission activity; Adopted; Alcohol abuse; Alcohol consumption; Alcohols; Behavior; Behavioral Mechanisms; Competence; Consumption; Data Analyses; Dimensions; Early identification; Effectiveness; Eligibility Determination; General Population; Harm Reduction; Health Disparities Research; Individual; Injury; Intervention; Intoxication; Knowledge; Latinx; Lead; Mediator; Medical; Medical center; Meta-Analysis; Modification; Motivation; Outcome; Outcome Study; Patients; Population; Process; Provider; Public Health; Randomized; Research; Research Support; Risk Factors; Science; Self Determination; Stress; Testing; Texas; Time; Universities; acceptability and feasibility; alcohol abuse therapy; alcohol related problem; alcohol use disorder; alcohol-related injury; behavior change; brief alcohol intervention; brief intervention; brief motivational intervention; community based participatory research; compare effectiveness; comparison intervention; cultural values; design; drinking; drinking behavior; efficacy testing; efficacy trial; ethnic difference; experience; flexibility; health disparity; help-seeking behavior; high risk drinking; injured; innovation; patient subsets; primary outcome; protective factors; psychologic; randomized trial; randomized, clinical trials; reduced alcohol use; response; satisfaction; secondary outcome; theories; trauma care; trauma centers; treatment as usual; treatment disparity; treatment effect

Abstract Our prior Stage III Randomized Clinical Trial (n=1496) evaluating ethnic differences in response to brief intervention showed that, compared to non-Latinxs Whites, Latinxs were more likely to reduce alcohol use in response to standard brief alcohol interventions that are not adapted to be culturally responsive (NA-BMI) versus treatment as usual1. In Stage I Community Based Participatory Research (Stage I CBPR), we developed a culturally informed brief motivational intervention (CI-BMI) which adopts a harm reduction approach and focuses on reducing alcohol problems and increasing treatment utilization 2. Through a flexible core approach, CI-BMI introduces substantial modifications to standard brief alcohol interventions to be culturally responsive and is theoretically grounded in self-determination theory (SDT)3-5. The result of Stage I CBPR was CI-BMI which 1) leverages cultural values and strengths while addressing the process of acculturation and acculturative stress; 2) is explicitly designed to meet the basic psychological needs of autonomy, relatedness, and competence by supporting autonomy to enhance autonomous motivation to change drinking behavior; and 3) focuses on harm reduction. Our Stage I CBPR (n=87) demonstrated that CI- BMI is feasible and acceptable in pretesting in a Level I Trauma Center5. We hypothesize that CI-BMI will lead to increased engagement in protective drinking behaviors, fewer alcohol problems as well as reduce barriers to help seeking and increase treatment utilization among underserved, non-treatment seeking Latinxs who engage in at risk drinking and are seriously injured. The proposed Stage II Efficacy Trial of CI-BMI will randomize 600 Latinxs admitted to a Level I Trauma Center at University Medical Center in El Paso, Texas to either NA-BMI or CI-BMI conducted by research staff from The University of Texas El Paso. Following admission for medical treatment of an injury, eligible Latinx patients will be those who screen positive for drinking at the time of their injury or engage in at risk drinking. The primary aims of the proposed study are to 1) test the efficacy of CI-BMI in comparison to NA-BMI on alcohol related harm reduction behaviors, alcohol problems, barriers to help seeking and treatment utilization among non-treatment seeking Latinxs and 2) examine the theoretically informed mechanism of behavior change based on SDT including providing autonomy support to meet the basic psychological needs that enhance autonomous motivation. Because the psychological processes underlying the intrasession mechanisms of change remain poorly understood, CI-BMI based on SDT will significantly advance the science and practice of brief interventions6. In addition, planned secondary data analysis will assess the influence of multi-dimensional acculturation/enculturation orientations and acculturative stress on alcohol related outcomes. The results of this study will lead to a theoretically informed and culturally response brief motivation intervention with enhanced generalizability to effectively address alcohol related health disparities and treatment inequities among non-treatment seeking Latinxs.

抽象的 我们先前的III期随机临床试验（n = 1496），评估了种族差异 简短的干预表明，与非latinxs白人相比，拉丁人更有可能减少酒精的使用 响应标准的短暂酒精干预措施，这些干预措施不适合文化响应（NA-BMI） 与往常一样与治疗相比1。在I阶段I社区的参与性研究（I阶段CBPR）中，我们 开发了一种文化知情的简短动机干预（CI-BMI），该干预采用了减少伤害的 方法并着重于减少酒精问题并增加治疗利用2。 核心方法，CI-BMI对标准短暂酒精干预措施进行了重大修改为 在文化上有响应性，理论上是自决理论（SDT）3-5的基础。第一阶段的结果 CBPR是CI-BMI，1）利用文化价值和优势，同时解决 文化和适应性压力； 2）明确设计以满足 通过支持自治来增强自主动力来增强自主性，相关性和能力 改变饮酒行为； 3）专注于减少伤害。我们的阶段I CBPR（n = 87）证明了Ci- BMI在I级创伤中心的测试中是可行的，可以接受。我们假设CI-BMI将领导 为了增加对保护性饮酒行为的参与，更少的酒精问题以及减少了障碍 帮助寻求和增加服务欠佳的，未处理的寻求拉丁裔的治疗利用 从事风险饮酒，并受到严重伤害。拟议的CI-BMI II期疗效试验将 随机对德克萨斯州埃尔帕索大学医学中心的I级创伤中心录取600个拉丁裔 由德克萨斯大学El Paso大学的研究人员进行的NA-BMI或CI-BMI。下列的 受伤的医疗入院，符合条件的拉丁患者将是那些筛查阳性的患者 在受伤时喝酒或冒险喝酒。拟议研究的主要目的是 1）与NA-BMI相比，测试CI-BMI对酒精相关的减少危害行为的功效 问题，帮助寻求和治疗利用的障碍在非治疗中寻求拉丁裔和2） 基于SDT检查理论上知情的行为变化机制，包括提供 自主支持以满足增强自主动机的基本心理需求。因为 内部变化机制基础的心理过程仍然很少理解，CI-BMI 基于SDT将大大提高简短干预措施的科学和实践6。此外，计划 次要数据分析将评估多维适应/培养方向的影响 以及对酒精相关结果的适应性压力。这项研究的结果将导致理论上 知情和文化反应的简短动机干预措施，并有效地概括 解决与酒精相关的健康差异和治疗不平等，在寻求拉丁裔的非治疗中。