Pro George, Camplain Ricky, Sabo Samantha, Baldwin Julie, Gilbert Paul A
Northern Arizona University.
University of Iowa.
J Health Dispar Res Pract. 2019 Fall;12(3):1-20.
Alcohol and drug abuse are widespread in the US. Substance abuse treatment services are effective, but utilization of services is low, particularly among African Americans, Hispanics, and women. Substance abuse is strongly associated with incarceration, and African Americans and Hispanics make up a disproportionate percentage of individuals with substance abuse problems involved in the criminal justice system. High treatment need, low treatment uptake, and the association between substance abuse and incarceration have led, in part, to correctional institutions filling the treatment gap by increasingly providing safety-net treatment services. We sought to better understand racial/ethnic and gender differences in determinants of treatment location (jail or prison versus non-correctional settings) among treatment-seeking adults.
We used repeated cross-sectional data from the National Survey on Drug Use and Health (2002-2016) to identify White, African American, and Hispanic past-year substance abuse treatment participants (n=6,435). We tested the modifying roles of race/ethnicity and gender on the association between several exposure variables and treatment locus using multiple logistic regression.
Ten percent of treatment participants utilized treatment services in a jail or prison, which varied by race/ethnicity (9% of Whites, 15% of African Americans, 12% of Hispanics) and by gender (11% of men, 9% of women). In our fitted models, we found that educational attainment and past-year employment status varied in effect size between African Americans and Whites. The associations for both variables were strongest among African Americans (Any college vs. Less than high school - adjusted Odds Ratio [aOR] = 0.23, 95% Confidence Interval [95% CI] = 0.08, 0.70; Ever unemployed vs. Never unemployed in the past year - aOR = 5.32, 95% CI = 1.94, 14.60). Health insurance status was significantly associated with treatment in a jail or prison only among Whites (Private vs. No insurance - aOR = 0.37, 95% CI = 0.19, 0.69). Co-occurring mental health diagnosis was significant only among African Americans (Any mental health diagnosis vs. none - aOR = 3.91, 95% CI = 1.38, 11.09). Employment and health insurance status were significant only among men (aOR = 2.18, 95% CI = 1.26, 3.77; aOR = 0.39, 95% CI = 0.22, 0.70, respectively).
We identified modifying roles for race/ethnicity and gender in the relationship between several factors and treatment utilization in a jail or prison versus non-correctional treatment settings. More numerous factors and stronger effect sizes were identified among African Americans and men in particular. Health promotion interventions promoting the uptake of substance abuse treatment should tailor services to align with the needs of those with the highest risk for incarceration.
酒精和药物滥用在美国十分普遍。药物滥用治疗服务是有效的，但服务利用率较低，尤其是在非裔美国人、西班牙裔和女性中。药物滥用与监禁密切相关，非裔美国人和西班牙裔在涉及刑事司法系统的有药物滥用问题的人群中所占比例过高。高治疗需求、低治疗接受率以及药物滥用与监禁之间的关联，在一定程度上导致惩教机构通过越来越多地提供安全网治疗服务来填补治疗缺口。我们试图更好地了解寻求治疗的成年人在治疗地点（监狱或看守所与非惩教场所）决定因素方面的种族/族裔和性别差异。
我们使用了来自全国药物使用和健康调查（2002 - 2016年）的重复横断面数据，以识别过去一年有药物滥用治疗经历的白人、非裔美国人和西班牙裔参与者（n = 6435）。我们使用多元逻辑回归测试了种族/族裔和性别对几个暴露变量与治疗地点之间关联的调节作用。
10%的治疗参与者在监狱或看守所接受治疗服务，这因种族/族裔（白人中的9%、非裔美国人中的15%、西班牙裔中的12%）和性别（男性中的11%、女性中的9%）而异。在我们拟合的模型中，我们发现教育程度和过去一年的就业状况在非裔美国人和白人之间的效应大小有所不同。这两个变量的关联在非裔美国人中最为强烈（上过大学与高中以下学历相比 - 调整后的优势比[aOR] = 0.23，95%置信区间[95%CI] = 0.08，0.70；过去一年曾失业与从未失业相比 - aOR = 5.32，95%CI = 1.94，14.60）。仅在白人中，健康保险状况与在监狱或看守所接受治疗显著相关（有私人保险与无保险相比 - aOR = 0.37，95%CI = 0.19，0.69）。共病心理健康诊断仅在非裔美国人中显著（有任何心理健康诊断与无诊断相比 - aOR = 3.91，95%CI = 1.38，11.09）。就业和健康保险状况仅在男性中显著（aOR分别为2.18，95%CI = 1.26，3.77；aOR = 0.39，95%CI = 0.22，0.70）。
我们确定了种族/族裔和性别在监狱或看守所与非惩教治疗场所中几个因素与治疗利用之间关系中的调节作用。在非裔美国人和男性中，特别是发现了更多的因素和更强的效应大小。促进药物滥用治疗接受度的健康促进干预措施应根据监禁风险最高人群的需求调整服务。
