Racial/ethnic Disparities in Alcohol Outcomes and Health Service

 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。与白人相比，AUD对少数种族/族裔的影响存在巨大差异。非洲裔美国人和西班牙裔美国人患酒精相关肝病的风险更大，在控制酒精消费时经历更多与饮酒相关的社会后果，并且与白人相比，从酒精问题中恢复的可能性更小。查明这些差异的根源对改善人口健康至关重要。最近的研究在酒精文学认为，积累的多种心理社会压力作为一个框架，以调查种族/民族的差异。例如，贫穷和种族/民族歧视被认为是倍增的压力因素，如果两者结合起来，会加剧饮酒的不良后果。需要更多的研究来确定是否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感，在影响酒精结果的体验时，可能是倍增的。此外，需要治疗酒精相关问题的少数种族/族裔也采用与白人不同的治疗形式。特别是，种族/族裔少数群体往往从非正式渠道而不是戒毒专家那里获得与酒精有关的护理。目前尚不清楚这些差异是否可归因于健康差异。 拟议研究的目标是使用纵向分析来估计在预测酒精结果和治疗利用率时贫困和种族/民族的独特和倍增影响。我们还将调查常见的心理社会压力（感知酒精污名，感知种族/民族歧视和感知性别歧视）的潜在倍增性质时，预测AUD症状和酒精治疗利用率使用结构方程模型。交叉性框架提供了一种创新的方法来调查酒精的结果和治疗利用的差异。我们将对全国酒精及相关疾病流行病学调查（NESARC）的第1波和第2波进行严格分析。我们的纵向分析将克服目前文献中交叉危险因素和酒精结果的局限性。此外，在获得特定的酒精治疗的种族/民族差异的潜在来源的检查几乎没有得到经验的关注，我们在本申请中解决。除了更好地了解为什么黑人，西班牙裔和美洲原住民在控制酒精消费时往往比白人的酒精结果更差之外，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/或试图减少歧视和酒精相关的耻辱。

 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.