? DESCRIPTION (provided by applicant): Alcohol use disorders (AUDs) are the third leading cause of death in the United States. Profound disparities exist in the consequences of AUDs for racial/ethnic minorities when compared to Whites. African Americans and Hispanics have a greater risk of developing alcohol-related liver disease, experience more social consequences related to drinking when controlling for alcohol consumption, and are less likely to recover from alcohol problems when compared to whites. Identifying the sources of these disparities is critical to improving population health. Recent studies in the alcohol literature have considered the accumulation of multiple psychosocial stressors as a framework to investigate racial/ethnic disparities. For instance, poverty and perceived racial/ethnic discrimination have been identified as multiplicative stressors when experienced in combination, which exacerbates the adverse outcomes of drinking. More research is needed to determine if commons stressors pertinent to health disparity populations, such as the perceived stigma of alcohol addiction and perceived gender discrimination, may be multiplicative in nature when influencing the experience of alcohol outcomes. Moreover, racial/ethnic minorities in need of care for alcohol-related problems also utilize different forms of treatment than Whites. In particular, racial/ethnic minorities often receive alcohol-related care from informal sources as opposed to addiction treatment specialists. It is unknown if these differences can be attributed to health disparities. goal of the proposed research is to use longitudinal analyses to estimate the unique and multiplicative influences of poverty and race/ethnicity when predicting alcohol outcomes and treatment utilization over time. We will also investigate the potential multiplicative nature of common psychosocial stressors (perceived alcohol stigma, perceived racial/ethnic discrimination, and perceived gender discrimination) when predicting AUD symptoms and alcohol treatment utilization using structural equation models. An intersectionality framework provides an innovative method to investigate alcohol outcome and treatment utilization differences. We will apply rigorous analyses to Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Our longitudinal analyses will overcome limitations of the current literature on intersecting risk factors and alcohol outcomes. Moreover, the examination of the potential sources of racial/ethnic differences in obtaining specific alcohol treatments has received almost no empirical attention, which we address in this application. In addition to gaining a better understanding of why Black, Hispanic, and Native Americans tend to have worse alcohol outcomes than whites when controlling for alcohol consumption, the proposed analyses could inform whether public health interventions to reduce alcohol consumption and improve treatment utilization should increasingly target racial/ethnic minorities, address economic disparities, and/or attempt to reduce discrimination and alcohol-related stigma.

R03AA023639

2015-09-20

2018-08-31