ALCOHOL HEALTH SERVICES RESEARCH IN 2 INDIAN POPULATIONS

美国印第安人（AI）群体面临酒精问题的特殊风险。 死亡率统计数据表明，美国印第安人和阿拉斯加原住民（AIAN）与美国"所有种族"相比，酒精中毒的年龄调整死亡率为6.7，慢性肝病和肝硬化为4.4。 酗酒问题的高度流行严重影响了专门为AIAN人口提供的保健服务系统。 与此同时，调查人员和评论员对这一人群可获得的酒精服务的总体可用性、可获得性和可接受性提出了重大关切。与此同时，为土著民族提供服务的系统正在发生根本性的变化，各部落在购买和提供服务方面承担了更大的责任。尽管酒精问题的高患病率和对这些困难的服务的关注，几乎没有经验得出的结果存在有关的流行模式，和相关的服务使用酒精的使用和相关的问题之间的认可机构。 本提案提出了一项计划，对最近完成的美国印第安人服务利用、精神病学流行病学和风险保护因素项目（AI-SUPERPFP）进行二次定量分析，并协调人种学主要数据收集，以实现以下目标。 具体目标1：描述2个AI人群中酒精相关服务利用的患病率和模式。此外，描绘感知的可用性，可访问性，和这些服务的可接受性。 具体目标2：研究酒精问题识别与问题使用指标之间的关系。 具体目标3：以治疗进入的压力应对模式为理论框架，发展酒精相关问题患者的服务利用模式。 具体目标4：使用综合民族志和定量方法扩展这一理论框架和其他当代理论框架。这是第一个大规模的，以社区为基础的流行病学研究的AIs的拟议分析将提供深入了解的患病率，模式和相关的服务利用酒精使用和相关问题。 因此，这是一个机会，大大提高我们对这些问题的认识，在认可机构。 这一多学科的努力结合了定性和定量的方法来测试和完善当代的理论框架;有希望为其他人群中与酒精相关的服务研究提供信息。 最后，对酒精问题服务利用的新认识，承诺出现从拟议的工作将指导新出现的交付模式，为这个独特的和重要的人口的发展。

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.