Racial/ethnic Disparities in Alcohol Outcomes and Health Service

酒精结果和健康服务方面的种族/民族差异

• 批准号: 9340854
• 负责人: Joseph Edwin Glass
• 金额: $ 8万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-03 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9340854
• 关键词: Address; Affect; African American; Alaska Native; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohols; American Indians; Asians; Attention; Caring; Cause of Death; Data; Disadvantaged; Discrimination; Economics; Epidemiology; Equation; Ethnic Origin; Ethnic group; Exposure to; Face; Foundations; Frequencies; Goals; Health; Health Services; Heavy Drinking; Hispanic Americans; Hispanics; Individual; Interview; Investigation; Literature; Liver diseases; Medical; Methods; Modeling; National Institute on Alcohol Abuse and Alcoholism; Native Americans; Nature; Outcome; Persons; Population; Poverty; Race; Research; Risk; Risk Factors; Sex Discrimination; Source; Specialist; Surveys; Symptoms; Time; Treatment outcome; United States; addiction; adverse outcome; alcohol abstinence; alcohol abuse therapy; alcohol availability; alcohol related problem; alcohol use disorder; drinking; ethnic difference; ethnic discrimination; ethnic minority population; experience; follow-up; health disparity; help-seeking behavior; improved; informal care; innovation; medical specialties; minority health; population health; preference; psychosocial; public health intervention; racial and ethnic; racial and ethnic disparities; social; social stigma; stressor; treatment disparity

 DESCRIPTION (provided by applicant): Alcohol use disorders (AUDs) are the third leading cause of death in the United States. Profound disparities exist in the consequences of AUDs for racial/ethnic minorities when compared to Whites. African Americans and Hispanics have a greater risk of developing alcohol-related liver disease, experience more social consequences related to drinking when controlling for alcohol consumption, and are less likely to recover from alcohol problems when compared to whites. Identifying the sources of these disparities is critical to improving population health. Recent studies in the alcohol literature have considered the accumulation of multiple psychosocial stressors as a framework to investigate racial/ethnic disparities. For instance, poverty and perceived racial/ethnic discrimination have been identified as multiplicative stressors when experienced in combination, which exacerbates the adverse outcomes of drinking. More research is needed to determine if commons stressors pertinent to health disparity populations, such as the perceived stigma of alcohol addiction and perceived gender discrimination, may be multiplicative in nature when influencing the experience of alcohol outcomes. Moreover, racial/ethnic minorities in need of care for alcohol-related problems also utilize different forms of treatment than Whites. In particular, racial/ethnic minorities often receive alcohol-related care from informal sources as opposed to addiction treatment specialists. It is unknown if these differences can be attributed to health disparities. goal of the proposed research is to use longitudinal analyses to estimate the unique and multiplicative influences of poverty and race/ethnicity when predicting alcohol outcomes and treatment utilization over time. We will also investigate the potential multiplicative nature of common psychosocial stressors (perceived alcohol stigma, perceived racial/ethnic discrimination, and perceived gender discrimination) when predicting AUD symptoms and alcohol treatment utilization using structural equation models. An intersectionality framework provides an innovative method to investigate alcohol outcome and treatment utilization differences. We will apply rigorous analyses to Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Our longitudinal analyses will overcome limitations of the current literature on intersecting risk factors and alcohol outcomes. Moreover, the examination of the potential sources of racial/ethnic differences in obtaining specific alcohol treatments has received almost no empirical attention, which we address in this application. In addition to gaining a better understanding of why Black, Hispanic, and Native Americans tend to have worse alcohol outcomes than whites when controlling for alcohol consumption, the proposed analyses could inform whether public health interventions to reduce alcohol consumption and improve treatment utilization should increasingly target racial/ethnic minorities, address economic disparities, and/or attempt to reduce discrimination and alcohol-related stigma.

 描述（由申请人提供）：酒精使用障碍（AUD）是美国第三大死亡原因，与白人和西班牙裔相比，AUD 对少数族裔的影响存在巨大差异。与白人相比，白人有患酒精相关肝病的风险，在控制饮酒时会经历更多与饮酒相关的社会后果，并且从酒精问题中恢复的可能性较小，这对于改善人口状况至关重要。最近的酒精文献研究将多种社会心理压力源的积累视为调查种族/民族差异的框架，例如，贫困和感知到的种族/民族歧视被认为是多重压力源，这会加剧这种压力源。需要更多的研究来确定与健康差异人群相关的公共压力源，例如酒精成瘾的耻辱感和性别歧视，在影响酒精结果的体验时是否可能具有倍增性。需要治疗酒精相关问题的少数族裔也采用与白人不同的治疗方式，特别是少数族裔/族裔经常从非正式渠道接受与酒精相关的护理，而不是成瘾治疗专家。拟议研究的目标是利用纵向分析来估计贫困和种族/民族在预测酒精结果和治疗利用率随时间变化时的独特和乘数影响。常见的社会心理压力源使用结构方程模型预测 AUD 症状和治疗利用时，交叉性框架提供了一种创新方法来研究酒精结果和治疗利用差异。国家酒精及相关疾病流行病学调查 (NESARC) 的第一波和第二波我们的纵向分析将克服当前关于交叉危险因素和酒精结果的文献的局限性。此外，还可以检查种族/民族差异的潜在来源。在获得特定的酒精治疗几乎没有受到实证关注，我们在本申请中除了更好地理解为什么黑人、西班牙裔和美洲原住民在控制酒精消费时酒精结果往往比白人更差之外，还提出了分析。可以告知减少酒精消费和提高治疗利用率的公共卫生干预措施是否应更多地针对少数种族/族裔、解决经济差距和/或尝试减少歧视和与酒精相关的耻辱。