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 我们之前的 III 期随机临床试验 (n=1496) 评估了种族差异对 简短的干预表明，与非拉丁裔白人相比，拉丁裔更有可能减少饮酒 针对不适合文化响应的标准简短酒精干预措施（NA-BMI） 与常规治疗相比1。在第一阶段基于社区的参与性研究（第一阶段 CBPR）中，我们 开发了一种文化知情的简短动机干预（CI-BMI），该干预采用减少伤害的方法 方法，重点是减少酗酒问题和提高治疗利用率 2. 通过灵活的 CI-BMI 的核心方法对标准简短酒精干预措施进行了重大修改，以 文化上的响应，并在理论上以自决理论 (SDT)3-5 为基础。第一阶段的结果 CBPR 是 CI-BMI，它 1) 利用文化价值观和优势，同时解决以下过程： 文化适应和文化适应压力； 2）明确旨在满足基本心理需求 自主性、关联性和能力，通过支持自主性来增强自主动机 改变饮酒行为； 3) 注重减少伤害。我们的第一阶段 CBPR (n=87) 证明 CI- BMI 在一级创伤中心的预测试中是可行且可接受的5。我们假设 CI-BMI 将领先 加强对保护性饮酒行为的参与，减少酒精问题并减少饮酒障碍 帮助那些服务不足、不寻求治疗的拉丁裔寻求治疗并提高治疗利用率 从事危险饮酒并受到严重伤害。拟议的 CI-BMI 第二阶段疗效试验将 随机抽取 600 名入住德克萨斯州埃尔帕索大学医学中心一级创伤中心的拉丁裔患者， NA-BMI 或 CI-BMI 由德克萨斯大学埃尔帕索分校的研究人员进行。下列的 因受伤入院治疗，符合资格的拉丁裔患者将是那些筛查呈阳性的患者 受伤时饮酒或有危险饮酒。拟议研究的主要目的是 1) 测试 CI-BMI 与 NA-BMI 相比对减少酒精相关危害行为、酒精的功效 未寻求治疗的拉丁裔中寻求帮助和利用治疗的问题、障碍和 2) 研究基于 SDT 的行为改变的理论知情机制，包括提供 自主支持，满足增强自主动机的基本心理需求。因为 会话内变化机制背后的心理过程仍然知之甚少，CI-BMI 基于 SDT 将显着推进短期干预的科学和实践6。此外，计划 二次数据分析将评估多维文化适应/文化适应取向的影响 以及对酒精相关结果的文化压力。这项研究的结果将在理论上得出 知情和文化反应简短的动机干预，具有增强的普遍性，以有效地 解决未寻求治疗的拉丁裔中与酒精相关的健康差异和治疗不平等问题。