Addressing health disparities by providing evidence-based treatment in the Black Church

通过在黑人教会提供循证治疗来解决健康差异

基本信息

批准号：
10473530
负责人：
Ayana Jordan
金额：
$ 56.17万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-20 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10473530
关键词：
Address Adult African American population Alcohol consumption Alcohols Area Black Populations Black race Caring Characteristics Church Clinical Trials Cognitive Therapy Communities Complex Coping Skills Diagnosis E-learning Evaluation Evidence based treatment Gender Health Services Accessibility Healthcare Heavy Drinking Homelessness Illicit Drugs Improve Access Individual Intervention Interview Jordan Measures Medical Mental Health Modeling National Institute on Alcohol Abuse and Alcoholism Outcome Outpatients Participant Pathway interactions Population Quality of life Race Randomized Randomized Clinical Trials Sampling Severities Site Social support Substance Use Disorder System Technology Training Treatment outcome Trust Underserved Population addiction alcohol abuse therapy alcohol use disorder base comorbidity drinking ethnic identity follow-up health disparity improved interest low socioeconomic status marginalized population medical specialties novel primary outcome relative cost satisfaction secondary outcome social health determinants social stigma standard care substance use treatment comparison treatment effect

项目摘要

ABSTRACT Black/African-Americans use alcohol and illicit drugs at the same rates as their White counterparts but are much more likely to suffer negative substance related consequences. Moreover, they are less likely to initiate treatment when compared with other racial groups; and when they do, are significantly less likely to complete treatment or to be offered evidence-based treatments. Stigma, mistrust of the medical system, lack of health care coverage, complex pathways to care, lower socioeconomic status, and the scarcity of culturally-informed treatment may all be factors underlying low treatment initiation and engagement. Thus, offering treatment in alternative settings, such as the Black Church, a highly trusted entity in Black communities, is a novel, and potentially highly disseminable strategy for improving both access to evidence-based treatments and alcohol treatment outcomes for this important population. Technology-based treatments are an emerging strategy for reaching underserved populations and can address barriers to delivering interventions in novel settings. One such strategy, computer-based training for Cognitive Behavioral Therapy (CBT4CBT), has been demonstrated in multiple randomized clinical trials to be safe and effective in reducing alcohol and other substance use, both as an add on to treatment, and as a stand-alone treatment, relative to standard care. We recently demonstrated the feasibility of both conducting a rigorous clinical trial as well as delivering CBT4CBT in the Black Church, which demonstrated overwhelming levels of interest and enthusiasm from Black adults with AUD, as well as highly promising levels of engagement and treatment completion. We now propose an 8-week randomized clinical trial in which 200 Black adults with primary AUD will be randomized to either CBT4CBT in the Black church or referral to standard treatment in a specialty addiction setting, with a 9- month follow-up to evaluate durability of treatment effects. Primary outcomes include retention (initiation of treatment, engagement for at least 4 weeks) and percent days abstinent from alcohol (PDA). Selected participant characteristics (e.g., gender, ethnic identity, religiosity, severity of AUD, mental health diagnoses, and vulnerabilities in the social determinants of health) will be evaluated as potential moderators of outcome. Secondary outcomes include satisfaction with care, expansion of social support networks, reduction in heavy drinking days and in WHO drinking levels, effects on comorbid substance use, and overall quality of life. Moreover, if CBT4CBT is demonstrated to be effective with Black adults with AUD in this setting, this would represent an inexpensive strategy to address health disparities that could be disseminated with relative ease among the large network of denominations serving Black individuals in the US.

抽象的黑人/非裔美国人使用酒精和非法药物的比例与白人相同，但更有可能遭受与物质相关的负面后果。此外，他们不太可能发起与其他种族群体相比所受到的待遇；当他们这样做时，完成任务的可能性就会大大降低治疗或提供循证治疗。耻辱、对医疗系统的不信任、缺乏健康护理覆盖范围、复杂的护理途径、较低的社会经济地位以及缺乏文化知识治疗可能都是导致治疗启动率和参与度低的因素。因此，提供治疗另类设置，例如黑人教会，一个在黑人社区中高度信任的实体，是一种小说，并且提高循证治疗和酒精获取机会的潜在高度传播策略这一重要人群的治疗结果。基于技术的治疗是一种新兴策略覆盖服务不足的人群，并可以解决在新环境中提供干预措施的障碍。一这种基于计算机的认知行为治疗训练（CBT4CBT）策略已得到证实在多项随机临床试验中表明，在减少酒精和其他物质的使用方面，两者都是安全有效的相对于标准护理，可以作为治疗的补充，也可以作为独立的治疗。我们最近证明了进行严格的临床试验以及交付的可行性黑人教会中的 CBT4CBT 表现出了压倒性的兴趣和热情患有 AUD 的黑人成年人，以及非常有希望的参与度和治疗完成度。我们现在提议进行一项为期 8 周的随机临床试验，其中 200 名患有原发性 AUD 的黑人成人将被随机分配到要么在黑人教会进行 CBT4CBT，要么转介到特殊成瘾环境中进行标准治疗，评分为 9- 一个月的随访以评估治疗效果的持久性。主要结果包括保留（开始治疗、参与至少 4 周）和戒酒天数百分比 (PDA)。已选择参与者特征（例如性别、种族认同、宗教信仰、AUD 的严重程度、心理健康诊断、和健康问题社会决定因素中的脆弱性）将作为结果的潜在调节因素进行评估。次要结果包括对护理的满意度、社会支持网络的扩大、重型患者的减少饮酒天数和世界卫生组织饮酒水平、对共病物质使用的影响以及总体生活质量。此外，如果 CBT4CBT 被证明对这种情况下患有 AUD 的黑人成年人有效，这将代表了一种解决健康差异的廉价策略，可以相对容易地传播是为美国黑人服务的大型教派网络之一。