Stage II Efficacy Trial of a Culturally Informed Brief Intervention to Reduce Alcohol Related Health Disparities and Treatment Inequities among Latinxs

摘要 我们之前的III期随机临床试验（n=1496）评估了 简短的干预表明，与非拉丁裔白人相比，拉丁裔白人更有可能减少饮酒 针对不适合文化响应的标准简短酒精干预措施（NA-BMI） 与常规治疗相比1.在第一阶段基于社区的前瞻性研究（第一阶段CBPR），我们 开发了一种文化知情的简短动机干预（CI-BMI）， 方法，并侧重于减少酒精问题和提高治疗利用率2。通过柔性 核心方法，CI-BMI对标准的简短酒精干预措施进行了实质性修改， 在文化上敏感，并以自决理论为理论基础3-5。第一阶段的结果 CBPR是CI-BMI，它1）利用文化价值观和优势，同时解决 文化适应和文化适应压力; 2）明确旨在满足 自主性，相关性和能力，通过支持自主性来增强自主动机， 改变饮酒行为; 3）注重减少危害。我们的I期CBPR（n=87）表明，CI- BMI在一级创伤中心的预测试中是可行和可接受的5。我们假设CI-BMI会导致 增加保护性饮酒行为的参与，减少酒精问题，并减少 帮助寻求和提高服务不足，非寻求治疗的拉丁裔人的治疗利用率， 喝高了，严重受伤了。拟定的CI-BMI II期疗效试验将 随机抽取600名入住德克萨斯州埃尔帕索大学医学中心一级创伤中心的拉丁裔， NA-BMI或CI-BMI由德克萨斯大学埃尔帕索分校的研究人员进行。以下 入院接受治疗的伤害，合格的拉丁裔患者将是那些谁屏幕上呈阳性， 在受伤时饮酒或从事危险饮酒。拟议研究的主要目的是 1)测试CI-BMI与NA-BMI相比在减少酒精相关伤害行为、酒精 问题，寻求帮助的障碍和非寻求治疗的拉丁裔之间的治疗利用和2） 研究基于SDT的行为改变的理论机制，包括提供 自主支持，满足基本的心理需求，增强自主动机。因为 心理过程的内在机制的变化仍然知之甚少，CI-BMI 基于SDT的研究将显著推进短期干预的科学和实践6。此外，计划 二次数据分析将评估多维文化适应/文化适应取向的影响 和文化适应压力对酒精相关结果的影响。这项研究的结果将导致一个理论上的 知情和文化反应的简短动机干预，增强了普遍性， 解决非寻求治疗的拉丁裔人中与酒精相关的健康差异和治疗不公平问题。

Abstract Our prior Stage III Randomized Clinical Trial (n=1496) evaluating ethnic differences in response to brief intervention showed that, compared to non-Latinxs Whites, Latinxs were more likely to reduce alcohol use in response to standard brief alcohol interventions that are not adapted to be culturally responsive (NA-BMI) versus treatment as usual1. In Stage I Community Based Participatory Research (Stage I CBPR), we developed a culturally informed brief motivational intervention (CI-BMI) which adopts a harm reduction approach and focuses on reducing alcohol problems and increasing treatment utilization 2. Through a flexible core approach, CI-BMI introduces substantial modifications to standard brief alcohol interventions to be culturally responsive and is theoretically grounded in self-determination theory (SDT)3-5. The result of Stage I CBPR was CI-BMI which 1) leverages cultural values and strengths while addressing the process of acculturation and acculturative stress; 2) is explicitly designed to meet the basic psychological needs of autonomy, relatedness, and competence by supporting autonomy to enhance autonomous motivation to change drinking behavior; and 3) focuses on harm reduction. Our Stage I CBPR (n=87) demonstrated that CI- BMI is feasible and acceptable in pretesting in a Level I Trauma Center5. We hypothesize that CI-BMI will lead to increased engagement in protective drinking behaviors, fewer alcohol problems as well as reduce barriers to help seeking and increase treatment utilization among underserved, non-treatment seeking Latinxs who engage in at risk drinking and are seriously injured. The proposed Stage II Efficacy Trial of CI-BMI will randomize 600 Latinxs admitted to a Level I Trauma Center at University Medical Center in El Paso, Texas to either NA-BMI or CI-BMI conducted by research staff from The University of Texas El Paso. Following admission for medical treatment of an injury, eligible Latinx patients will be those who screen positive for drinking at the time of their injury or engage in at risk drinking. The primary aims of the proposed study are to 1) test the efficacy of CI-BMI in comparison to NA-BMI on alcohol related harm reduction behaviors, alcohol problems, barriers to help seeking and treatment utilization among non-treatment seeking Latinxs and 2) examine the theoretically informed mechanism of behavior change based on SDT including providing autonomy support to meet the basic psychological needs that enhance autonomous motivation. Because the psychological processes underlying the intrasession mechanisms of change remain poorly understood, CI-BMI based on SDT will significantly advance the science and practice of brief interventions6. In addition, planned secondary data analysis will assess the influence of multi-dimensional acculturation/enculturation orientations and acculturative stress on alcohol related outcomes. The results of this study will lead to a theoretically informed and culturally response brief motivation intervention with enhanced generalizability to effectively address alcohol related health disparities and treatment inequities among non-treatment seeking Latinxs.