Schmidt Laura A, Ye Yu, Greenfield Thomas K, Bond Jason
Institute for Health Policy Studies and the Department of Anthropology, History and Social Medicine, School of Medicine, University of California-San Francisco, 3333 California Street, San Francisco, CA 94118, USA.
Alcohol Clin Exp Res. 2007 Jan;31(1):48-56. doi: 10.1111/j.1530-0277.2006.00263.x.
This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings.
Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence.
While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care.
Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.
本研究报告了美国三大主要族裔群体中未满足的酒精服务需求程度的终生估计，并研究了可能导致服务使用方面族裔差异的因素。先前的研究对于酒精服务中族裔差异的存在给出了不一致的结果，一些研究表明少数族裔在治疗环境中的占比过高。
利用最新的全国酒精调查，我们比较了符合酒精滥用或依赖终生标准的白人、黑人和西班牙裔中与酒精问题终生服务使用相关的比率和因素。
虽然双变量分析显示在服务使用方面几乎没有族裔差异，但在包含酒精问题严重程度及其与族裔相互作用的多变量模型中，存在显著的族裔差异。在问题严重程度较高时，西班牙裔和黑人比类似的白人使用服务的可能性更小。总体而言，西班牙裔报告的酒精问题严重程度高于白人。然而，他们接受专科治疗和多种酒精服务的可能性较小，并且更有可能将经济和后勤障碍作为未获得护理的原因。
未来研究酒精服务中族裔差异的工作应采用能够解决族裔与服务使用中其他因素（如酒精问题严重程度）之间潜在混杂问题的分析方法。我们的研究结果表明，酒精问题严重程度较高的西班牙裔和黑人使用服务的比率可能低于类似的白人，而且，特别是对于西班牙裔来说，这可能部分归因于护理的财务和后勤障碍。
