ALCOHOL HEALTH SERVICES RESEARCH IN 2 INDIAN POPULATIONS

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American Indian (AI) populations are at special risk for alcohol problems. Mortality statistics indicate that the ratios of age-adjusted mortality rates for American Indians and Alaska Natives (AIANs) compared to the US "All Races" were 6.7 for alcoholism and 4.4 for chronic liver disease and cirrhosis. The high prevalence of alcohol problems significantly impacts the health service systems dedicated to AIAN populations. At the same time, investigators and commentators have raised significant concerns about the overall availability, accessibility, and acceptability of alcohol services available to this population. Meanwhile, the service delivery systems for AIANs are undergoing radical changes with the tribes assuming greater responsibility for the purchasing and delivery of services. Despite the high prevalence of alcohol problems and concerns about service for such difficulties, almost no empirically derived findings exist regarding the prevalence patterns, and correlates of service utilization for alcohol use and related problems among AIs. This proposal presents a plan for secondary quantitative analyses of the recently completed American Indian Service Utilization, Psychiatric Epidemiology and Risk Protective Factors Project (AI-SUPERPFP) AI-SUPERPFP with a coordinated ethnographic primary data collection to address the following aims. Specific Aim 1: To depict the prevalence and patterns of alcohol-related service utilization within 2 AI populations. Further, to portray the perceived availability, accessibility, and acceptability of these services. Specific Aim 2: To study the relationship between alcohol problem recognition and indicators of problematic use. Specific Aim 3: To develop models of service utilization for those with alcohol-related problems employing the Stress-Coping Model of Treatment Entry as a theoretical framework. Specific Aim 4: To expand this and other contemporary theoretical frameworks using integrated ethnographic and quantitative methods. The proposed analyses of this first large-scale, community-based epidemiologic study of AIs will provide insights into the prevalence, patterns, and correlates of service utilization for alcohol use and related problems. Thus, it represents an opportunity to significantly advance our understanding of these issues among AIs. This multidisciplinary effort combines qualitative and quantitative methodologies to test and refine contemporary theoretical frameworks; promising to inform alcohol- related services research in other populations. Finally, the new understandings of service utilization for alcohol problems that promise to emerge from the proposed work will guide the development of newly emerging delivery models for this unique and important population.