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

摘要 我们先前的III期随机临床试验(n=1496)评估种族差异对 简短的干预显示，与非拉丁裔白人相比，拉丁裔白人更有可能减少饮酒 对不适应文化反应的标准短暂酒精干预(NA-BMI)的反应 与通常的治疗相比1。在第一阶段以社区为基础的参与研究(第一阶段CBPR)中，我们 开发了一种文化知情的简短动机干预(CI-BMI)，采用了减少伤害的方式 方法和重点是减少酒精问题和提高治疗利用率2.通过灵活的 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，将 具有文化响应性，理论上以自决理论(SDT)3-5为基础。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)明确设计以满足人的基本心理需求 自主性、关联性和能力，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。我们的第一阶段CBPR(n=87)显示CI- BMI在I级创伤中心5的预测试中是可行和可接受的。我们假设CI-BMI将引领 增加对防护性饮酒行为的参与，减少酒精问题，并减少 寻求帮助并提高服务不足、不寻求治疗的拉丁裔人的治疗利用率 从事危险饮酒，伤势严重。拟议的CI-BMI第二阶段疗效试验将 将600名拉丁裔患者随机送入德克萨斯州埃尔帕索大学医学中心的I级创伤中心，以 由德克萨斯大学埃尔帕索分校的研究人员进行的NA-BMI或CI-BMI。跟随 入院治疗受伤，符合资格的拉丁裔患者将是那些筛查呈阳性的人 在受伤时饮酒或从事有危险饮酒行为。拟议研究的主要目的是 1)测试CI-BMI和NA-BMI在与酒精相关的减少伤害行为方面的有效性 不寻求治疗的拉丁裔中的问题、寻求帮助和治疗利用的障碍和2) 考察基于SDT的行为改变的理论知晓机制，包括提供 自主支持，满足增强自主动机的基本心理需求。因为 CI-BMI对内向变化机制背后的心理过程仍知之甚少 以SDT为基础将大大推进短暂干预的科学和实践6。此外，计划 二次数据分析将评估多维文化适应/文化融合取向的影响 以及与酒精相关的结果的文化适应压力。这项研究的结果将在理论上导致 知情和文化反应短暂的动机干预，具有增强的普遍性，以有效 解决不寻求治疗的拉丁裔中与酒精有关的健康差距和治疗不平等问题。

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.