Racial/ethnic Disparities in Alcohol Outcomes and Health Service

 描述(申请人提供)：酒精使用障碍(AUD)是美国第三大死亡原因。与白人相比，AUDS对种族/族裔少数群体的影响存在着严重的差异。与白人相比，非洲裔美国人和西班牙裔美国人患上与酒精有关的肝病的风险更大，在控制酒精消费时，他们会经历更多与饮酒有关的社会后果，而且不太可能从酒精问题中恢复过来。查明这些差距的来源对于改善人口健康至关重要。最近在酒精文献中的研究认为，多种心理社会应激源的累积是调查种族/民族差异的一个框架。例如，贫穷和感觉到的种族/族裔歧视被确定为多重压力来源，当两者结合在一起时，会加剧饮酒的不良后果。需要更多的研究来确定与健康差距人群相关的公共应激源，如感知到的酒精成瘾的耻辱和感知到的性别歧视，在影响饮酒结果的体验时是否具有乘数性质。此外，需要照顾与酒精有关的问题的种族/少数民族也采用与白人不同的治疗形式。特别是，种族/族裔少数群体经常从非正式来源接受与酒精有关的护理，而不是接受成瘾治疗专家的护理。目前尚不清楚这些差异是否可以归因于健康差异。拟议研究的目标是使用纵向分析来估计贫困和种族/族裔在预测一段时间内酒精结果和治疗利用时的独特和倍增的影响。我们还将调查在使用结构方程模型预测AUD症状和酒精治疗使用时，常见心理社会应激源(感知到的酒精污名、感知到的种族/民族歧视和感知到的性别歧视)的潜在乘性性质。交叉性框架为调查酒精结果和治疗利用差异提供了一种创新的方法。我们将对全国酒精及相关疾病流行病学调查(NESARC)的第一波和第二波进行严格的分析。我们的纵向分析将克服目前关于交叉危险因素和酒精结果的文献的局限性。此外，对获得特定酒精治疗的种族/民族差异的潜在来源的审查几乎没有得到经验上的关注，我们在本申请中谈到了这一点。除了更好地了解为什么在控制酒精消费时，黑人、西班牙裔和土著美国人的酒精结果往往比白人更差，拟议的分析还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该越来越多地针对种族/少数民族，解决经济差距，和/或试图减少歧视和与酒精有关的耻辱。

 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.