A Randomized Clinical Trial Of Culturally Tailored MI

描述(由申请人提供)：本申请涉及健康差异/特殊人群的优先领域治疗。流行病学和心理社会研究表明，与其他种族/族裔群体相比，拉美裔人因危险饮酒而遭受更大的不利影响，包括更高的肝硬变死亡率和与酒精有关的机动车撞车事故。需要根据文化量身定做以经验为基础的干预措施，因为拉美裔人遭受与酒精相关的健康差距，不太可能开始和拒绝治疗，而且更有可能生活在酒精销售点密度较高的社区。然而，该领域的研究受到了挑战，因为缺乏将定制治疗与非定制治疗进行比较的研究。我们有来自PI(新调查者)K奖(AA014905)的试点数据表明，文化定制的动机面试(CTMI)优于不是为拉美裔酗酒者量身定做的动机面试(MI)。这项研究将是当前拟议研究的基础，该研究是试点的更大规模版本。关键的修改是将社会压力源纳入文化适应的背景下。因此，在拟议的研究中，我们还将探讨文化适应压力对文化适应与饮酒行为之间关系的影响。这项研究对公共卫生的影响将是制定一个早期筛查和短暂干预的计划，以减少可能缺乏此类服务的社区中拉美裔人的危险饮酒。通过提供早期筛查和干预，我们希望将对拉丁裔社区造成不成比例影响的疾病和社会后果的负担降至最低。研究设计：将从社区招募357名符合危险饮酒标准的拉丁裔男性和女性(男性5人/场合，女性4人/场合)。在知情同意后，他们将完成西班牙语或英语的基线评估，然后随机接受非量身定制的动机干预(MI)或文化定制的动机干预(CTMI)。参与者的随机化将根据语言偏好、性别、酒精严重程度、适应文化压力和负面后果进行平衡，以确保每个单元中有同等的代表性。研究助理将在2个月、6个月和12个月的随访中与参与者联系，而不知道治疗分配。主要目的1：假设与随机接受非定制治疗的患者相比，随机接受定制治疗的患者在随访时报告的酒精相关负面后果和大量饮酒天数会更少。主要目的2：探讨文化适应应激对酒精治疗结果的调节作用。长期目标：开发一种易于在社区传播的护理模式，并产生理论上知情的假设，以更好地理解文化适应压力和过程如何增加拉美裔饮酒的风险。我们期望这个项目将有助于了解文化适应压力在饮酒行为和治疗反应中的作用。

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.