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A Selection of Notable Prior Grants

ER Screening for Alcohol Problems in the U.S. & Mexico, NIAAA R21 AA11503, Principal Investigator: Cheryl J. Cherpitel, Dr.P.H.

 

The aims of this Developmental Grant for Collaborative International Projects were to: (1) compare the sensitivity, specificity and efficiency of standard screening instruments and items for identifying harmful drinking and alcohol dependence among injured and non-injured Hispanic emergency room patients in California and in Mexico; (2) examine new measures which may be more efficient in identifying alcohol problems in Hispanic emergency room populations in California and Mexico; (3) compare the sensitivity, specificity and efficiency of screening instruments and items in the California and Mexico ER samples with their respective general populations. This project builds on and extends work funded by NIAAA to test standard screening instruments for harmful drinking/abuse and alcohol dependence in a largely Hispanic (specifically, Mexican American) emergency room (ER) population at the Santa Clara Valley Medical Center in San Jose (Santa Clara County), California. The project also builds on and extends work currently being carried out by the Mexican Institute of Psychiatry in three emergency rooms in Pachuca, Hidalgo, as part of a larger project of alcohol abuse, consequences, prevention and treatment, funded by the Mexican National Council of Technology and Science and the Ministry of Health.

Screening for Alcohol Problems in the Emergency Room, NIAAA R01 AA09271, Principal Investigator: Cheryl J. Cherpitel, Dr.P.H.

 

The project tested standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, History of Trauma scale) and developed new measures that were sensitive, specific, and efficient for identifying harmful drinking and alcohol dependence among injured and noninjured in emergency room settings; compared an abbreviated set of consequences of drinking and of dependency experiences with screening measures and with a standard diagnostic instrument (CIDI); and compared the associations of demographic and drinking characteristics with data of consequences and dependency experiences from the California Bay Area. The first site was the ER at the University of Mississippi Medical Center (a comparison of whites and Blacks), the second at the Santa Clara Valley Medical Center (a comparison of Blacks, Hispanics, and whites).

Alcohol and Mortality: Ethnic and Social Influences, NIAAA R01 AA10960, Principal Investigator: Thomas K. Greenfield, Ph.D.

 

Based on a representative national multiethnic sample first surveyed in 1984, the influence of ethnic and social background on the relationship between alcohol consumption and mortality was examined. More specifically, the following questions were addressed: Is there a differential impact of age on the alcohol consumption–mortality relationship?; What is the role of ethnicity-specific mortality patterns in relation to alcohol?; To what degree are social class and social integration confounding factors in the alcohol–mortality relationship?; Does the influence of ethnicity disappear when social class is adjusted for?

Impact of Alcoholic Beverage Warning Labels, NIAAA R01 AA08557, Principal Investigator, Thomas K. Greenfield, Ph.D.

 

Survey data analysis produced more definitive answers as to whether warnings on alcoholic beverages have preventive effects by (1) studying mechanisms of influence in target groups of men and women under 40, which produced findings bearing on label improvement, and (2) testing predictions of diffusion theory, specifically, differences in adoption rates for various outcome variables, e.g., beliefs, attitudes, and behaviors, across various demograpic subgroups. Moreover, the investigation assessed the policy context and potential indirect effects by continuing to survey public opinon regarding alcohol control policies and by doing content analysis of alcohol warning-related entries in five national newspapers.

Predictors of Screening and Brief Intervention, NIAAA R29 AA11713, Principal Investigator: Ruth Gassman, Ph.D.

 

Examined beliefs about the effectiveness of intervention; time involved, resources available, self-efficacy and organizational constraints; normative beliefs regarding support from reference groups; and individual knowledge about substance abuse as they relate to the actual practice of screening and brief intervention.

Drug Problems and Course of Homelessness, NIDA R01 DA09334, Principal Investigator: Marjorie J. Robertson, Ph.D.

 

Drug disorders are disproportionately high among homeless adults, and particularly among homeless women. The study addressed two emerging agendas in drug epidemiology.  The first is the examination of drug use and abuse in minority and underserved populations. The second is investigation of drug use and abuse among special populations who are at high risk of drug problems, but who are not likely to be captured in household studies. To address these questions, we used a unique longitudinal database on homeless adults that incorporates an extensive set of measures on drug use and abuse, drug dependence, and drug-associated behaviors.  We documented the nature, extent, and patterns of drug use and abuse in this population. Specifically, we (1) examined the relationship between drug use and the course of homelessness, and (2) investigated the mediating effects of service utilization and other variables on this relationship.

Drinking & Problem Epidemiology in Blacks & Hispanics, NIAAA R01 AA10013, Principal Investigator: Karen Trocki, Ph.D.

 

This study involved a national probability sample of Blacks and Hispanics in 1994. The survey, as the one in 1984, was conducted together with a national survey of the U.S. population (n=2,000) conducted that same year. One of the aims of the 1994 survey was to allow for trends analysis in drinking patterns, problems, attitudes toward drinking and drunkenness in a comparative frame among whites, Blacks and Hispanics. This was the first time trends analysis were conducted on alcohol-related data on representative national samples of Blacks and Hispanics. Such analyses are specially important now that trends suggesting a decrease in alcohol consumption have been detected among whites but not among Blacks and Hispanics. New cross-sectional analyses on alcohol expectancies, attitudes toward drinking, reasons for drinking and recognition and views on alcohol policies in minority communities were also done. These analyses were aimed at covering several important gaps in the alcohol literature with Blacks and Hispanics, as follows: (a) description and testing of the factor structure of alcohol expectancy, attitudes toward drinking and reasons for drinking; (b) assessment of the relationship between expectancies, attitudes and reasons for drinking and drinking patterns; and (c) support for alcohol control policies and factors that underlie it. Taken together, these trends and cross-sectional analyses provided a major contribution to the study of alcohol problems among Blacks and Hispanics. Results assessed present levels of drinking and problems, as well as the sociocultural environment surrounding alcohol use behavior among Blacks and Hispanics. The knowledge generated by these findings may impact the development and implementation of prevention strategies to minimize heavy drinking and alcohol problems among these two ethnic groups in the U.S.

Alcohol Epidemiology: Welfare Client Longitudinal Study, NIAAA R01 AA10015, Principal Investigator: Constance Weisner, Dr.P.H.

 

This research examined the epidemiology of alcohol problems in relation to protracted unemployment, poverty and reliance on welfare in a two-wave panel study of welfare recipients. Time 1 data were collected in 1989 under the auspices of the Alcohol Research Group's Community Epidemiology Laboratory project. Subjects were interviewed in-person at the time that they applied for public assistance through the General Assistance and Aid to Families with Dependent Children programs. This project involved face-to-face interviews with these same subjects after a five-year time interval. We examined the nature of change in substance use patterns and problems, as well as their influences on change in recipients' employment status, poverty level and welfare dependency. Moreover, the project emphasized the analysis of substance use among women, single mothers and ethnic minorities, all of whom are significantly over-represented in the welfare population.

From Epidemiology of Alcohol Problems: National Alcohol Research Center, P50 AA05595, Influence of Health Warnings on Ethnic Gravidas, Component Director/PI: Lee Ann Kaskutas, Dr.P.H.

 

Abstention from alcohol is recommended during pregnancy to prevent Fetal Alcohol Syndrome. Continued consumption among some subgroups suggests that information about the risk either is not reaching some pregnant women, or is reaching them but is being interpreted skeptically or negatively and thus ignored. How pregnant women respond to abstention warnings was address by a pilot study targeting women most at risk, urban Native Americans and African Americans. Culturally appropriate questions were piloted with 90 Native American and 90 African American women (with 30 white women as a comparison group) in Los Angeles, assessing consumption during pregnancy and interpretation of warnings against drinking while pregnant. Results informed a larger R01 epidemiological study concerned with how to best influence minority women's decisions about perinatal drinking.

Substance Abuse & Service Dynamics among Welfare Clients, NIAAA R21 AA12159, Principal Investigator: Laura Schmidt, Ph.D.

This study expanded health services analyses of the NIAAA-funded Welfare Client Longitudinal Study, one of the only longitudinal data sets currently available that allows for in-depth investigations of the relationships between alcohol problems and subsequent dependency on public services in representative samples of welfare recipients. Samples of individuals in the Aid to Families with Dependent Children (AFDC) and General Assistance (GA) programs throughout a large Northern California County were interviewed in 1989 as they applied for welfare services, and were then followed and re-interviewed in 1995. Secondary analyses of these data examined the roles that problem drinking and drug use play in promoting patterns of welfare dependency and long-term unemployment through by focusing at the level of service entry and exit events. In particular, the study examined the degree to which alcohol problems make individuals prone to repeat welfare dependency, and to patterns of welfare use characterized by short lengths of stay, adverse circumstances at the time of leaving the welfare system, exits from welfare into unstable employment situations, and ultimately, welfare returns. Key substantive goals of the project were to develop event history models of exits and returns to welfare that bring about a better understanding of the role that alcohol problems play in these service dynamics. Analyses also considered the roles that different kinds of social service and alcohol treatment interventions play in successful exits from welfare, and in altering patterns of repeat dependency over time. The validity and precision of these findings were informed by two additional kinds of methodological analysis. First, by linking self-report data with administrative records data on the same individuals, the study bridged the gap between administrative records and self-report studies, examining the validity of these two alternative approaches to studying histories of service utilization. Second, by developing classifications of alcohol- and drug-related circumstances leading to recipients’ first exit from welfare, the study produced more refined measures of reasons for exiting welfare, and more generally, gained insight into how alcohol enters into the circumstances by which people leave the welfare system during exit events.

Alcohol, Services, Treatment & Work in Homeless Adults, R01 AA12019, Principal Investigator: Cheryl Zlotnick, Ph.D.

 

This health services research study used an existing NIMH-funded, epidemiological data set to examine whether homeless adults with alcohol problems are more likely to obtain work if they have societal contacts (i.e., social support from family and friends, social services, and treatment services). This timely study was informed by important changes in welfare reform policies that mandate work in conjunction with entitlement benefits. Several statistical techniques including logistic regression and path regression models were used to: (1) describe the nature and patterns of alcohol problems (and other comorbidities) among homeless adults, and test the relationship between alcohol problems and work in this group; (2) document patterns of societal contact (such as family, friends, treatment, health care and social service agencies) and test its association with work among homeless adults; and then devise a multidimensional measure representing societal contacts (i.e., contacts from family, friends, treatment, and social service agencies) among homeless adults; and (3) test the model that alcohol problems and societal contacts have an association with work.

 

Perceptions of Moderate Drinking: Paths to Adaptation, NIAAA R29 AA11327, Principal Investigator: Nancy Ann Piotrowski, Ph.D.

 

The primary aim of this study was to clarify perceptions of moderate alcohol consumption in the general population, vulnerable populations, and in professionals who provide treatment and social services to moderate drinking clientele. Three previously collected probability-based datasets were used to examine relationships between drinking pattern, history of alcohol-related problems, and perceptions of alcohol to self-labeling as a moderate drinker for a general population sample, a sample of individuals applying for welfare, and a sample of arrestees. Two new datasets collected as part of this application examined these relationships among self-identified moderate drinkers in the general population, vulnerable populations (e.g., mental health, primary care, welfare/social service recipients), and in individuals identifying as providers of treatment and social services to moderate drinking clientele. Pilot data for this study suggested that perceptions of moderation are related to alcohol expectancies, current drinking, and drinking history. This study investigated these relationships and hypothesized important differences in perceptions of moderation by population. A secondary methodological aim of this study was to evaluate different recruitment strategies for attracting self-identified moderate drinkers from diverse groups into research and assessment settings.

 

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Epidemiology of Alcohol Problems: Risk of AIDS, NIAAA R01 AA08564, Principal Investigator: Karen Trocki, Ph.D.

 

Our goal in the past five years has been to explore how drinking behaviors are associated with sexual risk behaviors. In that time period, six surveys (two on local samples and four on national samples) and several experimental studies were designed and carried out to test this association.  We considered sexually transmitted disease outcomes in pursuing the association between drinking behaviors and sexual risk behaviors. The specific aims detailed below were addressed through: (1) the collection of data on drinking and sexual risk behavior in conjunction with the Alcohol Research Group’s (ARG) 1995 National Alcohol Survey; (2) an interview and medical record study of 1,050 patients in Alameda County’s Public Health STD clinics; and (3) continuing analysis of selected data in existing ARG data sets. Specific aims were: (a) to investigate which aspects of drinking are associated with higher incidence and prevalence of sexually transmitted diseases; (b) to investigate which aspects of sexual risk behavior are associated with higher incidence and prevalence of sexually transmitted diseases; (c) to build models of the association of drinking, sexual risk behavior and STD outcomes using cross-sectional and longitudinal data; (d) to investigate epidemiological variations in these models as a function of gender, age, ethnicity and other demographic factors; (e) to investigate theoretical explanations for the association of drinking, sexual risk behaviors, and STD outcomes, such as common causality by “third” variable factors (problem behavior, anti-social personality, impulsivity, situational factors); and, finally, (f) to bridge the gap between research and prevention by investigating the applicability of the Theory of Planned Behavior to understanding STD outcomes under problematic and non-problematic circumstances.

 

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Helping as an Expression of Spirituality, Fetzer Institute grant, Principal Investigator: Lee Ann Kaskutas, Dr.P.H.

 

This study focused on helping behaviors and argued that good works as manifested by helping activities are integral to the study of the relationship between spirituality and recovery. We drew on the theory of the Helper Therapy Principle which posits a therapeutic benefit from the activity of helping: that in helping another person, the helper is helped. Helping others is evident in the mutual help program of Alcoholics Anonymous, as well as in dominant treatment approaches like the Minnesota Model, the Social Model and the Therapeutic Community. The primary aim of this study was to examine the role of helping behaviors and helper therapy in the relationship between spirituality and recovery. To do this, we developed and validated a Helper Therapy Scale that measures helping behaviors in recovery. In developing items for the scale, we took special care to include potential helping activities for persons with different lengths of sobriety, including newcomers who may be in treatment (or not) as well as those with much longer time sober (5 years plus). To assess traditional measures of spirituality, we also administered Fetzer’s short forgiveness scale, Pargament’s brief religious coping scale, and the daily spiritual experience instrument (long form). AA involvement was captured using our Alcoholics Anonymous affiliation scale.

 

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Public Sector Managed Care: A Comparative Evaluation, NIDA R01 DA11406, Principal Investigator: Martha Beattie, Ph.D.

This study was a natural experiment that compares access, costs, outcomes, and cost effectiveness in Santa Clara’s managed care system to two counties without substantial managed care characteristics. Baseline and outcome data was collected for randomly selected clients from each county during calendar years 2000 and 2001. Clients were followed for 12 months after admission. Major project goals were to investigate: (1) the relative equity of access to services for special (women and ethnic minority) populations; (2) the relative severity of substance abuse clients upon entry to treatment; (3) the relative costs of treatment per client; (4) relative client satisfaction and outcomes (substance abuse, medical, legal, family/social, employment, and psychiatric); (5) short term and longer term client treatment outcomes; and (6) cost effectiveness of care along the same dimensions. Important sub groups of clients will also be analyzed: (a) substance abusers with and without psychiatric co-morbidity; (b) male and female clients; (c) Caucasian and Latino/Hispanic clients; and (d) Caucasian and all ethnic minority clients. 

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Medical vs. Social Model Day Treatment: Outcome & Cost, NIAAA R01 AA11279, Principal Investigator: Lee Ann Kaskutas, Dr.P.H.

 

Medical model programs are in general more expensive than nonclinical orientations, such as the social model approach, although the effectiveness and cost of medical versus social model day treatment have not been assessed. Given the range and severity of problems commonly found among alcohol treatment clients, a question remains of what is the optimum approach for rehabilitation and whether this differs by gender, ethnicity, and psychiatric comorbidity. This study undertook a controlled, random assignment comparison of two approaches to day treatment—the medical model and the social model—in “real world” agencies serving a heterogenous population reflective of many urban communities of individuals seeking help for their drinking. Using an intent to treat model, the study compared the effects of day medical model treatment and day social model treatment during the course of the care provided. It investigated differences in the approach taken to substance abuse treatment at the two programs, including the number and content of scheduled activities and services received, the role of staff, and areas stressed by the respective orientations. It compared post-treatment outcome and improvement rates in the areas of abstinence and alcohol consumption and drug use, levels of medical and psychiatric problems, levels of employment, legal and family/social problems, and supportiveness of social networks towards abstinence, and considers utilization of corresponding health and social services. The study aimed to identify patient characteristics associated with successful treatment outcomes in each program orientation, and aspects of treatment associated with improvement at six and 12 months post-treatment. Finally, it compared the costs of day medical model and day social model treatment, and assesses relative cost and effectiveness of the two programs.

 

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Implementing Welfare Reform: Changing Strategies for Managing Substance Abuse at the Local Level, RWJ 047653 to PHI, Principal Investigator: Laura Schmidt, Ph.D.

 

The principle objectives of this project were to study the implementation of welfare reform guidelines that impact substance abuse at the local level and to document the intended and unintended consequences that have arisen out of this implementation process. We did so through a case study of a large California county. We used archival analysis of documents on the policy development process, key informant interviews of policymakers, and ethnographic observation of day-to-day life in welfare offices. The project focused on the local level because, under federalism and welfare reform’s devolution of federal authority, this is largely where the policymaking and implementation process unfolds.

This project addressed the development and implementation of these four policy measures using two approaches. In the first component of the study, we use archival analysis and key informant interviews to trace the development of policies that impact substance abuse in the federal and California state welfare reform debates since the mid-1990s. Our objectives here were to examine the arguments and justifications for targeting substance abuse problems in the welfare population, the public image of substance abusers in the debate, and the similarities and differences between welfare policies in California and those in other areas of the US. The second component of the study used ethnographic methods, including in-depth interviews with welfare workers and participant observation in county welfare offices. Our objectives here were to examine how welfare reform policies that impact substance-abusing clients are actually being implemented on a day-to-day basis, to describe welfare workers’ attitudes towards and strategies for managing substance abuse problems in their clientele, and to analyze how workers interact with clients whom they conclude have substance abuse problems.

 

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Malt Liquor/Fortified Wine Use and Ethnicity in the U.S., NIAAA R21 AA13532, Principal Investigator: Thomas K. Greenfield, Ph.D.

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Last updating of page: November 8, 2005