A Randomized Clinical Trial Of Culturally Tailored MI

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DESCRIPTION (provided by applicant): This application addresses the priority area Treatment for Health Disparities/Special Populations. Epidemiological and psychosocial research indicates that Latinos suffer greater adverse effects from hazardous drinking compared to other racial/ethnic groups, including higher rates of cirrhosis fatality and alcohol-involved motor vehicle crashes. Culturally-tailored empirically-based interventions are needed because Latinos suffer alcohol-related health disparities, are less likely to initiate and to remai in treatment, and are more likely to live in communities with high density of alcohol outlets. However, research on the field is challenged by the lack of studies comparing tailored to non-tailored treatments. We have pilot data from the PI's (New Investigator) K award (AA014905) demonstrating that culturally tailored motivational interviewing (CTMI) outperformed motivational interviewing (MI) that was not tailored to the needs of Latino heavy drinkers. This study will be the basis for the current proposed study, which is a larger scale version of the pilot. The key modification was to incorporate social stressors in the context of acculturation. Thus, in the proposed study, we will also explore acculturation stress as an influence on the relationship between acculturation and alcohol consumption behavior. The public health impact of this study will be to develop a program of early screening and brief intervention to reduce hazardous drinking among Latinos in communities that may lack such services. By providing early screening and intervention, we hope to minimize the burden of illness and social consequences that disproportionately affect Latino communities. Study Design: 357 Latino men and women who meet criteria for hazardous drinking (> 5/occasion for men, >4/occasion for women) will be recruited from the community. Following informed consent, they will complete a baseline assessment in either Spanish or English, and will then be randomized to receive either un-tailored motivational intervention (MI) or a culturally-tailored motivational intervention (CTMI). Participant randomization will be balanced by language preference, gender, alcohol severity, acculturation stress, and negative consequences, to ensure there is equivalent representation in each cell. Participants will be contacted by research assistants unaware of treatment assignment at 2, 6, and 12 months follow-up. Primary Aim 1: It is hypothesized that those randomized to receive the tailored treatment will report fewer alcohol- related negative consequences and fewer heavy drinking days at follow-up vs. those randomized to receive the un-tailored treatment. Primary Aim 2: Explore acculturation stress as a moderator of alcohol treatment outcomes. Long term goals: Develop a model of care that is easily disseminated in the community, and to generate theoretically-informed hypotheses to better understand how acculturation stress and processes confer risk for increased drinking among Latinos. We expect that this project will contribute needed knowledge about the role of acculturation stress in alcohol drinking behavior and treatment response.