Subaward: Sarah E. Zemore, PhD
Prime: University of Iowa, Paul Gilbert, PhD
Alcohol abuse and dependence are responsible for considerable public health harms; yet, the majority of people with an alcohol use disorder do not receive treatment, and some social groups are less likely than others to receive alcohol services. Specifically, racial/ethnic minorities appear less likely than Whites to obtain any help for problem drinking, receive specialty alcohol treatment, or attend 12-step groups. In addition, there are gender differences. Among those with alcohol use disorders, women are less likely to obtain treatment, more likely to present with comorbid conditions, and remain in treatment for shorter durations than men. Furthermore, gender may exacerbate racial/ethnic disparities. Among men, Latinos are less likely, and Blacks are equally likely, to receive alcohol services as Whites; however, both Black and Latina women have approximately one-quarter the odds of obtaining alcohol services as White women.
To date, the mechanisms responsible for disparities in use of alcohol services remain poorly understood. Much of the current literature suffers from methodological limitations (e.g., cross-sectional data; limited sampling). General population studies of alcohol services disparities are sparse, and no known study has explicitly tested mediators of such disparities. In response to PA-13-288 (Behavioral and Social Science Research on Understanding and Reducing Health Disparities), the study seeks to explain racial/ethnic and gender disparities in alcohol services use.
Using longitudinal data obtained in the National Epidemiological Survey of Alcohol and Related Conditions (NESARC), a representative sample of the US population that included oversamples of racial/ethnic minorities and young adults, we will examine use of specialty treatment and 12-step groups among White, Black, and Latino participants who met DSM-IV criteria for alcohol abuse or dependence at Wave 1 (2001-2002) and who completed a Wave 2 follow-up interview (2004-2005).
Drawing on Andersen’s Behavioral Model of Health Service Use, we will identify predisposing, enabling/inhibiting, and need factors associated with alcohol services use. Specific aims include: (1) testing in longitudinal data previously observed racial/ethnic and gender disparities in alcohol service use; (2) assessing whether differential levels of enabling factors (e.g., educational attainment; insurance coverage) and inhibiting factors (e.g., discrimination; drinking context) explain how gender moderates the effect of race/ethnicity on alcohol services use; and (3) assessing barriers to alcohol services use by race/ethnicity and gender among those with an AUD who did not seek any help for their drinking during the follow-up period.
By focusing on the combined effects of race/ethnicity and gender, the study will provide further information about sub-groups for whom risk of unmet alcohol treatment need is greatest, including racial/ethnic minorities and women. By testing potential mediators, findings will extend current knowledge about the mechanisms responsible for disparities and may identify leverage points for interventions to increase alcohol services use.
This study supports the NIAAA Strategic Plan to Address Health Disparities, which calls for research on alcoholism treatment and other health services use, and Healthy People 2020 objective SA-8.3, which calls for increasing the proportion of people with an alcohol use disorder who receive treatment. Findings will extend current knowledge about the mechanisms responsible for racial/ethnic and gender disparities and may identify the most efficient intervention points to increase alcohol services use.