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Funded by NIH R01AA021136

Senior Scholar Panel on Mixed Methods: Perspectives on advancing Health Equity through Interdisciplinary Research. Christina S. Lee July 13, 2017 Robert Wood Johnson New Connections Symposium University of Massachusetts, Boston. Funded by NIH R01AA021136. Goals.

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Funded by NIH R01AA021136

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  1. Senior Scholar Panel on Mixed Methods: Perspectives on advancing Health Equity through Interdisciplinary Research Christina S. LeeJuly 13, 2017Robert Wood Johnson New Connections SymposiumUniversity of Massachusetts, Boston Funded by NIH R01AA021136

  2. Goals • How the research minimizes health inequity related to substance use • Health inequities = disparities that are socially determined; systematic inequality between more and less advantaged social groups, is avoidable and preventable, thus unfair • Use of mixed methods in intervention design • Formative research to inform a clinical trial

  3. Examples of inequity • Limited access to early care • Higher rate of liver failurea,b, c • Higher rates of alcohol dependence among suicide completers who are Latino/as • Latinos are less likely than non-Latino whites to receive treatment for their alcohol use (Chartier & Caetano, 2010) • Latino/as with more serious comorbid problems at time of addiction treatment entryd,e,f • Compared to non-Latino whites, Latinos experience more negative social and legal consequences related to drinking (Mulia et al., 2009) • Higher severity alcohol problemse, f, g • Driving under the influenceh • Crash-related fatalitiesi,j,k • Higher injury ratesl aGreenfield, 2001; Keyes et al., 2012, Yoon & Yi, 2007; bGil & Vega, 2001; d Stinson, Grant, et al., 2001; eSchmidt et al., 2006; fMulia et al., 2009; gWitbrodt et al., 2014; hCaetano & Clark, 2000; iBaker et al., 1998; jCherpitel et al., 2001; kVoas et al., 2002; lCampos-Outcalt et al., 2002

  4. How the research addresses inequity • Increases access to care by providing evidence-based treatment in Spanish • Scientific question: Adaptation of interventions will enhance implementation and dissemination (Cabassa & Baumann, 2013) • No rigorous clinical trial has demonstrated efficacy of adaptation

  5. Small randomized controlled trial (2005-2010) • Target audience: heavy drinking Latino/as in the Northeast • Objective: reduce hazardous drinking and related harms

  6. Stage I Treatment Development (2005-2010) • 2006 Focus group: Identify unique risk/resiliency factors influencing drinking behavior among Hispanics in the Northeast • Informed measure development and adaptation (MI) • Open series trial to pilot the adapted treatment(N=25) • 2010 RCT Pilot Trial (n=57) aRounsaville, Carroll, & Onken, 2001. A stage model of behavioral therapies research. Clinical Psychology: Science and Practice, 8, 133-142; bLee et al., 2011; cLee et al., 2013

  7. Focus Group Studya • N=36, 48% female, 23-56 years, South/Central America (39%) and Caribbean (24%) • 6 focus groups (3 female, 3 male), with bilingual RA • 4/5 drinks @ least once past month • Example of findings: • Social isolation • “I’ve seen people here that do very well…then you see them and they are really sad. And they say, you know what, I don’t want to be here anymore, I don’t want to live this life, I am always going to work, home, work, home, and they do a crazy thing and they go back. Because they miss the comradely and the freedom of knocking on your neighbors door, “what are you cooking today, can I have some”. Stuff like that, they miss that, they miss the affection, the love, the warmth, and they go back to that. Because they miss it”. a Lee, López, Colby, Tejada, Garcia-Coll, & Smith, 2006. Social processes underlying acculturation: a study of drinking behavior among immigrant Latinos in the Northeast United States. Contemporary Drug Problems, 33, 585-609.

  8. Publication based on focus group findings, 2006

  9. Implications • Stressors of living in a new social context affected drinking behaviora • Feeling of isolation exacerbated by fact that Latino communities are smaller in Northeast, compared with states with larger, well-connected minority communities • 8.7% in Providence vs. 32% California • Informed new measure for ongoing larger-scale RCT, as well as ideas on how to operationalize stress in the RCT • Interpretation of findings in collaboration with social epidemiologists aRoom, 2005. Multicultural contexts and alcohol and drug use as symbolic behavior. Addiction Research and Theory, 13 (4), 321-331.

  10. A measure was developed based on the focus group findings, and is currently being tested in the larger randomized trial (#2) as a potential treatment moderator

  11. RCT #2 (AAR01021136, 2012-2017) • Randomized clinical trial (AAR01021136) • Aim1: Compare efficacy of standard MI to culturally adapted MI among Latinos who drink at risky levels • Aim 2: Explore acculturation stress as a moderator of alcohol treatment outcomes for Latinos • Assumption: Alcohol interventions should address environmental (poverty, language barriers, unsafe neighborhoods), social (loss of social networks and social status) and/or societal (e.g., discrimination) stressors to increase efficacya,b,c aAbraido-Lanza et al. 2006; bCaplan, 2007; cZemore et al., 2011)

  12. Research Team (Funded by NIAAA, R01021136 (11/12-11/17)) • Co-Investigators • Dharma Cortes, Ph.D. • Suzanne Colby, Ph.D. • Damaris Rohsenow, Ph.D. • Joanna Almeida, Sc.D. • Luis Falcon, Ph.D. • Research Staff • Tonya Tavares, M.S., Project Director • Gabrielle Dishy, B.S. • Alana Drexler, B.A. • Julissa Ayala, B.A. • Elian Roberts, M.A. • MI Therapists • Andrew Flannery, MSW • Humberto Camerena, MSW • Felix Truede, Psy.D grad • Deanne Riggs, MSW • Tyler Sparkman, PhD grad • Bilingual MITI Coding Lab • Dharma Cortes, Ph.D.* • Joanna Almeida, Sc.D.* • Tonya Tavares, M.S. • Julissa Ayala, B.A.* • Gabrielle Dishy, B.A.* • Janelle Alabiso, PhD grad student Motivational Interviewing Health Disparities Lab website: http://www.northeastern.edu/cslee

  13. Extra slides

  14. Measure development: Perceived acculturation stress and alcohola • Adaptation of Caetano et al., 1987 • n= 57, 55% men, 35 years, 55% from Caribbean, moderately acculturated (SASH 3.12, SD = .78), 87% hazardous drinkers • After controlling for acculturation, income, and education, perceived acculturation stress predicted unique variance in alcohol problems (R2 = 0.19, F (1,46) = 13.27, p = <.01) aLee, Colby, Rohsenow, López, Hernández, & Caetano (2013). Acculturation stress and drinking problems among urban heavy drinking Latinos in the Northeast. Journal of Ethnicity in Substance Abuse, 12, 308-320.

  15. Examples • “It bothers me that family members I am close to do not understand my new values” • “You come to this country full of hopes to get ahead and realize that what you do is fall behind” • “I miss my family and friends who live far from me” (1 = not at all stressful; 2 = not very, 3 = somewhat, 4 = very, 5 = extremely stressful) • How often do you drink when you find yourself in that situation? (1 = Never, 2 = rarely, 3 = sometimes, 4 = most of the time, 5 = always)

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