Understanding Outcome Disparities in Alcohol Treatment

描述(由申请人提供)：酒精治疗结果中的种族差异是一个全国性的问题。这些结果差异有多种可能的解释，包括获得治疗的机会不同，寻求和完成治疗的动机不同，以及文化和社会人口因素。社区和其他环境因素也可能起到作用，以及先前的治疗经验。我们提出了一种对现有酒精治疗数据进行二次数据分析的方法，利用多层建模方法。拟议的二次分析是对洛杉矶县酒精和药物治疗计划参与者1998、1999和2000年的年度数据集进行的，其中包含低收入客户公共资助诊所以少数群体为重点和非少数群体为重点的治疗结果。该分析将从少数民族群体、地理和社区因素方面评估治疗的相对有效性，并揭示有助于取得积极结果的治疗计划特点。这些关于每个治疗计划的相对成功评级的信息将与治疗计划的成本/效益分析相结合。我们的分析方法结合了关于社区和地理因素的系统级数据，以及客户人口统计数据和治疗计划特征，这些都可能与治疗结果的差异有关。洛杉矶县特别适合解决这些关于治疗机会和结果方面的差异的问题。总人口超过950万，高加索人、非裔美国人和拉美人的多种族混杂(分别占县总人口的31.1%、9.5%和44.6%)。拟议研究的具体目标如下：(1)确定受试者人口、地理位置和治疗计划与治疗结果中的种族差异的关系；(2)确定非裔美国人、拉丁裔和高加索人的治疗结果差异模式是否因性别和种族而不同

DESCRIPTION (provided by applicant): Racial disparities in alcohol treatment outcomes are a national problem. There are a number of possible explanations for these disparities in outcomes, including differential access to treatment, different motivations to seek and complete treatment, as well as cultural and sociodemographic factors. Neighborhood and other environmental triggers may also play a role, as well as prior treatment experience. We propose a secondary data analyses of existing alcohol treatment data, utilizing a multilevel modeling approach. The proposed secondary analysis is of the Los Angeles County Alcohol and Drug Treatment Program Participant annual data sets for years 1998, 1999 and 2000, which contain minority focused as well as non-minority focused treatment outcomes in publicly funded clinics for low income clients. The analysis will evaluate the relative effectiveness of the treatments in terms of minority groups, geographic and neighborhood factors, as well as reveal the treatment program characteristics that contribute to positive outcomes. This information about the rating of relative success of each treatment program will be combined with a cost/benefit analysis of treatment programs. Our analytical approach incorporates system level data on neighborhoods and geographic factors, as well as client demographics, and treatment program characteristics, which may all be related to disparities in treatment outcomes. The county of Los Angeles is uniquely appropriate to address these questions regarding disparities in treatment access and outcome. With a total population of over 9.5 million, and with a multiracial mix of Caucasians, African-Americans and Latinos (31.1 %, 9.5% and 44.6% of the total county population, respectively). The specific aims of the proposed research are as follows: (1) to determine the relationship of client demographics, geographic location, and treatment program and racial disparities in treatment outcomes; (2) to determine if the patterns of disparities in treatment outcomes differ by gender and by race for African Americans, Latinos and Caucasians