Ethnic Differences In Use Research Articles

Racial and Ethnic Variation in Complementary and Integrative Health Therapy Use Among US Veterans

White individuals are the greatest users of complementary and integrative health (CIH) therapies in the general population, but this might partially be due to differences in age, health condition, and location. Identifying the nuances in racial and ethnic differences in care is one important step to addressing them. To evaluate racial and ethnic differences in Veterans Affairs (VA)-covered CIH therapy use in a more nuanced manner by examining the association of 5 demographic characteristics, health conditions, and medical facility locations with those differences. Retrospective cross-sectional observational study of VA health care system users, using electronic health record and administrative data at all VA medical facilities and community-based clinics. Participants included veterans with nonmissing race and ethnicity data using VA-funded health care between October 2018 and September 2019. Data were analyzed from June 2022 to April 2023. Any use of VA-covered acupuncture, chiropractic care, massage therapy, yoga, or meditation/mindfulness. The sample consisted of 5 260 807 veterans with a mean (SD) age of 62.3 (16.4) years and was 91% male (4 788 267 veterans), 67% non-Hispanic White (3 547 140 veterans), 6% Hispanic (328 396 veterans), and 17% Black (903 699 veterans). Chiropractic care was the most used CIH therapy among non-Hispanic White veterans, Hispanic veterans, and veterans of other races and ethnicities, while acupuncture was the most commonly used therapy among Black veterans. When not accounting for the location of the VA medical facilities in which veterans used health care, Black veterans appeared more likely to use yoga and meditation than non-Hispanic White veterans and far less likely to use chiropractic care, while those of Hispanic or other race and ethnicity appeared more likely to use massage than non-Hispanic White veterans. However, those differences mostly disappeared once controlling for medical facility location, with few exceptions-after adjustment Black veterans were less likely than non-Hispanic White veterans to use yoga and more likely to use chiropractic care. This large-scale, cross-sectional study found racial and ethnic differences in use of 4 of 5 CIH therapies among VA health care system users when not considering their medical facility location. Given those differences mostly disappeared once medical facilities were accounted for, the results demonstrated the importance of considering facilities and residential locations when examining racial differences in CIH therapy use. Medical facilities could be a proxy for the racial and ethnic composition of their patients, CIH therapy availability, regional patient or clinician attitudes, or therapy availability.

Abstract WMP28: Ethnic Differences In Use Of Rehabilitation In The First 90 Days Following Incident Stroke

Introduction: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One possible explanation is that MAs receive less intense rehabilitation than NHWs. Our objective was to examine ethnic differences in use and type of rehabilitation in the first 90-days following stroke. Methods: Stroke cases were identified from the population-based Brain Attack Surveillance in Corpus Christi Project from Oct 2019-Oct 2021 and followed for 90 days for self-reported use of post-acute rehabilitation care. Sociodemographics, risk factors, stroke severity and treatment were ascertained from interviews and medical records. Functional outcome and depression were assessed at 90 days. Propensity score (PS) methods were used to balance characteristics by ethnicity and PS scores and other covariates were included in a logistic regression model of the association between ethnicity and the primary outcome of use of any rehabilitation. Results: Five hundred fifty-four stroke patients were included, with 66% MA and 49% women. MAs were younger, had lower education and income, worse pre-stroke function, more comorbidities, greater average BMI and worse functional outcome and depression at 90-days than NHWs. One-third of participants did not receive any rehabilitation. MAs (66.9%) were more likely to use any rehabilitation following stroke than NHWs (55.9%; p-value=0.01). After adjustment, MAs were 1.9 times (95% CI: 1.2-2.9) more likely to use any rehabilitation than NHWs. MAs were more likely to use outpatient (11.3% vs 4.8%) and home health rehabilitation (38.0% vs 29.8%) than NHWs, while no differences were noted in use of rehabilitation in inpatient or skilled nursing facilities. Conclusion: A high proportion of stroke survivors report no rehabilitation in the first 90 days following stroke. MAs report greater use of less intense forms of rehabilitation than NHWs despite worse outcomes. Future research should investigate barriers to use of more intense rehabilitation care, particularly in MAs, with the goal of maximizing recovery and reducing ethnic disparities.

Ethnic differences in utilization of online health information sources: A test of the social inequality hypotheses

The goal of the current study was to understand ethnic differences in use of online health information sources. Social stratification and social diversification hypotheses were used as study’s theoretical framework. The data were obtained from the 2017 Israel Social Survey (N = 2166). Multinomial and logistic regression techniques were used for the multivariate analysis. The results suggest that Israeli Arab respondents were less likely than Israeli-born Jewish respondents to seek health information using the Health Funds’ call centers or websites, other websites, and to utilize any number of the online health information sources. The findings provide a strong support for the social stratification hypothesis. The findings imply that members of minority population should be more encouraged to use (public) online health information sources as a means of taking greater responsibility for their health as well as for the health of their communities.

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

Racial and Ethnic Differences in Behavioral Problems and Medication Use Among Children With Autism Spectrum Disorders.

We examined racial and ethnic differences in the prevalence of behavioral problems measured by the Child Behavioral Checklist (CBCL), sleep disturbances measured by the Child Sleep Habits Questionnaire (CSHQ), and medication use among children with Autism Spectrum Disorders (ASD). We analyzed data from the Autism Treatment Network (ATN) dataset for 2,576 children ages 6 to 18 years of age diagnosed with ASD. Multivariable logistic regression accounting for age, gender, Diagnostic and Statistical Manual of Mental Disorders (4th Edition - Text Revision), diagnosis (Autistic Disorder, PDD-NOS, Asperger's Disorder), and parents' education did not show any racial or ethnic differences in behavioral challenges, conduct problems, or sleep disturbances for any of the groups, but Black children had lower odds of Total Problem Behaviors and Asian children had lower odds of Hyperactivity compared to White children. As a group, children from racial and ethnic minorities had lower odds of Total Problem Behaviors and Conduct Problems compared to White children. Hispanic children had lower odds of medication use for Behavioral Challenges, Total Problem Behaviors, Hyperactivity, and Conduct Problems. Asian children had lower odds of medication use for Behavioral Challenges, Total Problem Behaviors, and Hyperactivity; and had close to lower odds in medication use for Conduct Problems. Black children had lower odds for medication use for Total Problem Behaviors only. As a group, children from racial and ethnic minorities had lower odds for medication use for Behavioral Challenges, Total Problem Behaviors, Hyperactivity, and Conduct problems, but not for Sleep Disturbances. While these results are consistent with previous studies showing that White children are significantly more likely to receive psychotropic medication compared to children from racial and ethnic minority groups, we found no such differences for sleep challenges, suggesting that they are more consistently identified and equitably treated than other behavioral problems associated with ASD. We draw upon Andersen's (1995) Behavioral Model of Healthcare Use to suggest predisposing, enabling, and needs factors that may contribute to this pattern of racial and ethnic differences in the use of medications among children ASD.

Racial and Ethnic Differences in Use of State-Operated Inpatient Substance Abuse Services, 2004-2005 Versus 2010-2011.

This study examined ethnic-racial differences in referral source, length of stay, legal status, and diagnosis in state-operated substance abuse inpatient treatment in Connecticut. Data from 2004-2005 (N=1,484) and from 2010-2011 (N=4,529) were investigated with regression analyses. At both time points, African Americans were more likely than other groups to be referred by criminal justice sources, Hispanics were more likely than whites to be referred by other sources, and whites were more likely than African Americans to have emergency-crisis admissions; length of stay was shorter for Hispanics than for whites and longer for African Americans than for whites and Hispanics; and Hispanics were less likely than other groups to have an alcohol use disorder, more likely than other groups to have a drug use disorder, and more likely than whites to receive a discharge diagnosis of a personality disorder from cluster B. Targeted interventions to address racial-ethnic differences in inpatient addiction treatment are needed.

Ethnic differences in psychosocial service use among non-Latina white and Latina breast cancer survivors

ABSTRACTBackground: This study examined the use of psychosocial services (i.e., social work, psychiatric, psychological, and spiritual/pastoral services) among Latina and Non-Latina white breast cancer survivors. Methods: Survivors who received treatment in a Comprehensive Cancer Center in New York completed a mailed questionnaire about interest in help for distress, and psychosocial service use. Descriptive and non-parametric statistics were used to explore ethnic differences in use of, and interest in, psychosocial services. Results: Thirty-three percent of breast cancer survivors reported needing mental health or psychosocial services after their cancer diagnosis (33% Latinas, 34% whites); 34% of survivors discussed with their oncologist or cancer care provider their emotional problems or needs after the diagnosis (30% Latinas, 36% whites). Only 40% of the survivors who reported needing services received a referral for psychosocial services (42% Latinas, 39% whites). Sixty-six percent of survivors who reported needing services had contact with a counselor or mental health professional (psychiatrist, psychologist, or social worker) after their diagnosis (57% Latinas, 71% whites), and 61% of those needing services reported receiving psychosocial services (53% Latinas, 67% whites). Whites were significantly more likely than Latinas to have contact with a social worker (33% vs. 17%, respectively) and to receive psychotropic medication (15% vs. 0%, respectively). However, Latinas were significantly more likely to receive spiritual counseling than whites (11% vs. 3%, respectively). Conclusion: Our study revealed gaps for both groups; however, the gaps differed by group. It is crucial to study and address potential differences in the psychosocial services availability, acceptability, and help-seeking behaviors of ethnically diverse cancer patients and survivors.

A cohort study of ethnic differences in use of adjuvant chemotherapy and radiation therapy for breast cancer in New Zealand

BackgroundEthnic and socioeconomic inequities in use of breast cancer adjuvant therapy are well documented in many countries including the USA, and are known to contribute to lower breast cancer survival among minority ethnic and socioeconomically deprived women. We investigated ethnic and socioeconomic inequities in use of adjuvant radiotherapy and chemotherapy in a cohort of women with invasive breast cancer in New Zealand.MethodsAll women with newly diagnosed invasive breast cancer during 1999-2012 were identified from the Waikato Breast Cancer Register. Rates of chemotherapy use and radiotherapy use were assessed in women who were deemed to be eligible for chemotherapy (n = 1212) and radiotherapy (n = 1708) based on guidelines. Factors associated with use of chemotherapy and radiation therapy were analysed in univariate and multivariate regression models, adjusting for covariates.ResultsOverall, rates of chemotherapy and radiotherapy use were 69% (n = 836) and 87.3% (n = 1491), respectively. In the multivariate model, significantly lower rates of radiotherapy use were associated with Māori compared with NZ European (Odds Ratio [OR] = 0.63, 0.40-0.98), presence of comorbidity (OR = 0.49, 0.34-0.72), distance from hospital of over 100km (OR = 0.47, 0.23-0.96), mastectomy compared with breast conserving surgery (OR = 0.32, 0.17-0.56) and non-screen compared with screen detection (OR = 0.53, 0.35-0.79). No significant associations were observed between chemotherapy use and ethnic or socio-demographic factors.ConclusionsImproving access for radiotherapy, especially for women who are at a higher risk of not receiving optimum cancer therapy due to ethnicity, geography or socioeconomic status need to be recognized as a priority to reduce inequities in breast cancer care in New Zealand.

Use of alcohol, tobacco and illicit drugs among ethnic Norwegian and ethnic minority adolescents in Hordaland county, Norway: the youth@hordaland-survey

ABSTRACTObjective: To describe potential differences in unhealthy behaviours among ethnic Norwegian adolescents and minority adolescents from countries within the European Union, European Economic Area or US (EU/EEA countries) and adolescents from non-EU/EEA countries. Specifically, we aimed to investigate ethnic differences in use of alcohol, tobacco and illicit drugs, and potential confounding due to socio-demographic characteristics.Design: Cross-sectional population-based study of adolescents aged 16–19 (N = 10,122), with self-reported ethnicity as grouping variable, and self-reported use of alcohol, tobacco and illicit drugs as dependent variables.Results: We found that minority adolescents from EU/EEA and non-EU/EEA countries differed from ethnic Norwegian adolescents on important indicators of unhealthy behaviours. Compared to Norwegian adolescents, adolescents from EU/EEA were more likely to report having tried to smoke, to be a daily smoker and to ever having tried an illicit drug (adjusted odds ratio (OR) ranging from 2.01 to 3.74). They were, however, less likely to have tried snus (a form of smokeless tobacco; adjusted OR 0.64; confidence interval (CI) 95% 0.43–0.97) and to report daily snus use (adjusted OR 0.31; CI95% 0.15–0.67). There were no differences in having tried alcohol. Non-EU/EEA adolescents were less likely to have ever tried alcohol (OR 0.24; CI95% 0.18–0.31), snus (OR 0.47; CI95% 0.34–0.65) and to smoke (0.68; CI95% 0.52–0.91), and less likely to report daily snus use (OR 0.36; CI95% 0.21–0.62) compared to Norwegian adolescents. There were no differences with regard to having tried illicit drugs and reporting being a daily smoker. All differences observed were robust to adjustment for age, gender and family socio-economic status.Conclusion: The presents study identified important differences in unhealthy behaviours across different ethnic groups in Norway. The differences in the prevalence of unhealthy behaviours among ethnic minorities are still relevant in a public health perspective, and potential mechanisms should be investigated further.

Racial and Ethnic Differences in Use of Mammography Between Medicare Advantage and Traditional Medicare

Breast cancer is a leading cause of mortality for women in all racial/ethnic groups. We compared use of mammography by race/ethnicity in Medicare health maintenance organizations (HMOs), preferred provider organizations (PPOs), and traditional Medicare. We matched 495 836 women in HMOs and 81 480 women in PPOs who were aged 65 to 69 years during 2009 to women enrolled in traditional Medicare by race/ethnicity, Medicaid eligibility status, and geographic area. We identified mammography use from the Healthcare Effectiveness Data and Information Set for Medicare HMOs and PPOs and from claims data for traditional Medicare with the same specifications. We then compared racial/ethnic differences in rates of mammography in HMOs and PPOs to matched populations in traditional Medicare and estimated differences with z tests. All statistical tests were two-sided. Relative to matched white women, mammography rates were statistically significantly higher for black, Hispanic, and Asian/Pacific Islander women in HMOs (6.1, 5.4, and 0.9 percentage points, respectively; all P ≤ .003) and statistically significantly lower for all three groups in traditional Medicare (3.3, 7.4, and 7.7 percentage points, respectively; all P < .001). Similar improvements in mammography rates also were observed in PPOs among all minority groups relative to traditional Medicare. Higher rates of mammography in HMOs and PPOs were associated with a reversal of racial and ethnic differences observed in traditional Medicare. These differences may be related to lower patient cost-sharing and better systems to promote preventive services in managed care plans, as well as unmeasured characteristics or beliefs of minority women who enroll in these health plans relative to those in traditional Medicare.

Racial and Ethnic Differences in U.S. Women's Choice Of Reversible Contraceptives, 1995–2010

In the United States, unintended pregnancies disproportionately affect minority populations. Persistent disparities in contraceptive use between black and Hispanic women and white women have been identified, but it is unclear whether racial and ethnic differences in use of the most effective methods have changed. Data on 4,727 women from the 1995 National Survey of Family Growth and 5,775 women from the 2006-2010 cycle were used to examine the association between race and ethnicity and women's choice of reversible contraceptives according to level of method effectiveness. Stepwise multinomial logistic regressions were used to identify changes in this association between cycles. Analyses controlled for demographic, socioeconomic, family, religious, behavioral and geographic characteristics. The proportion of women using the most effective reversible contraceptive methods increased from 46% in 1995 to 53% in 2006-2010. In 1995, black and Hispanic women's use of the most effective reversible contraceptives did not differ from that of white women. By 2006-2010, however, black women were substantially less likely than white women to use highly effective reversible contraceptive methods rather than no method (relative risk ratio, 0.6). An analysis that combined the two data sets and included a term for the interaction between survey year and race and ethnicity found that relative to white women, black women were less likely in 2006-2010 than in 1995 to use more effective methods rather than no method (0.6). Further research is needed to identify factors that may be causing racial and ethnic disparities in contraceptive decisions to widen.

Mind-Body Techniques, Race-Ethnicity, and Depression among Urban Senior Center Participants

As the older adult population grows and becomes more diverse, more of its members are turning to complementary and alternative medicine (CAM). There are mixed findings regarding racial and ethnic differences in the use of CAM. This article explores racial and ethnic differences in use of a category of CAM known as mind-body techniques (MBT) among senior center participants with symptoms of depression. It also examines the relationship between use of MBT and depression severity. A cross-sectional survey was conducted with a representative sample of senior center participants in New York City, from which a subsample of those with depressive symptoms was drawn. Racial and ethnic differences in MBT use were identified, as was a significant negative relationship between MBT use and depression severity. African American elders were more likely to have used MBT than other racial or ethnic groups. When controlling for race or ethnicity, health status, and barriers to medical care, predictors of depression severity included health status, experiencing barriers to medical care, and Hispanic identity. Findings suggest that being female or younger is associated with a higher likelihood of using CAM. Contrary to some prior research, education level was not associated with use of MBT.

Highlights of This Issue

Previous studies have implicated dysregulated miR202 expression in follicular lymphoma. To explore this, Hoffman and colleagues performed ribonucleoprotein immunoprecipitation-microarray (RIP-Chip) analysis to identify potential targets of miR203. The authors also used the Ingenuity Pathway tool to investigate functional miR202 targets. Using human blood samples, genetic association analysis revealed a significant association between a germline mutation (rs12355840) in the miR-202 precursor and follicular lymphoma risk. This work suggests that miR202 expression may serve as a follicular lymphoma biomarker.Five-year breast cancer survival rates are lower among Hispanic and African American women than among Non-Hispanic White (NHW) women. Livaudais and colleagues examined racial and ethnic differences in use and duration of adjuvant hormonal therapy among 3,588 postmenopausal women enrolled in the Women's Health Initiative Extension Study. The authors did not find significant differences in use or duration of use of adjuvant hormonal therapy by race/ethnicity. These findings should be confirmed in other populations, and potential reasons for discontinuation of therapy should be explored.To examine the performance of candidate biomarkers for kidney tumors, Kim and colleagues evaluated a three-marker assay composed of nicotinamide N-methyltransferase (NNMT), L-Plastin (LCP1), and nonmetastatic cells 1 protein (NM23A). Plasma levels of these three proteins were highly elevated in patients with kidney cancer. In blind sample tests, the diagnostic accuracy of NNMT alone or the three-marker assay was 0.913 and 0.932, respectively, and the sensitivity of NNMT alone or the three-marker assay was 71.9% and 95.7%, respectively. This three-marker assay represents a promising serum test for the early detection of malignant kidney tumors.Studies have shown that low-dose aspirin and calcium are effective low-risk strategies for prevention of CRC. Pence and colleagues used Markov chain Monte Carlo simulations to compare the cost-effectiveness of aspirin and calcium in combination with colonoscopy for primary prevention of CRC. The study reports that low-dose aspirin or calcium supplementation, in addition to colonoscopy, may be beneficial strategies for CRC prevention at small, incremental costs. This study suggests that the efficacy of colonoscopy screening may be cost-effectively increased by appropriate chemoprevention regimens.

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Ethnic Disparities in Antipsychotic Drug Use in British Columbia: A Cross-Sectional Retrospective Study

Racial and Ethnic Differences in Use of Intubation for Periviable Neonates

Racial/ethnic minorities report preferences for resuscitative care at the end of life. The main objective of this study was to determine if there are racial/ethnic differences in use of intubation for periviable neonates. We hypothesized that infants born to black and Hispanic women are more likely to be resuscitated compared with infants born to white women. We conducted a retrospective cohort study of state-level maternal and infant hospital discharge data of women who delivered between 23.0 and 24.6 weeks' gestation linked to birth and death certificate data for California, Missouri, and Pennsylvania from 1995 to 2005 (N = 9632). Overall, 78.9% of the population was aged 18 to 35 years, and almost half were nulliparous; 19.4% of the women were black, 36.6% were Hispanic, and 33.4% were white. Approximately 30% had less than a high school education, and 49.2% were federally insured. Overall, 44.7% of periviable neonates were intubated. In multivariable analyses adjusting for sociodemographic characteristics, black and Hispanic race/ethnicity was significantly associated with neonatal intubation (odds ratios [ORs]: 1.14 [95% confidence interval (CI): 1.01-1.29] and 1.22 [95% CI: 1.10-1.36], respectively). In models controlling for clustering at the level of the delivery hospital, black race remained a predictor of neonatal intubation (OR: 1.25 [95% CI: 1.07-1.46]), but differences among Hispanics dissipated (OR: 1.12 [95% CI: 0.98-1.27]). Racial/ethnic differences exist in patterns of periviable resuscitation, which may reflect underlying differences in patient preference. Alternatively, institutional practices or resources may account for these differences. These findings have important implications for patient care and institutional practice. Our results lay the foundation for additional work to investigate how social, cultural, and institutional factors influence patient-provider decision-making regarding periviable care.

Racial and Ethnic Differences in Use of Intubation for Periviable Neonates

Racial and Ethnic Differences in Use of Intubation for Periviable Neonates

Socioeconomic and ethnic differences in use of lipid-lowering drugs after deregulation of simvastatin in the UK: The Whitehall II prospective cohort study

BackgroundWe examined socioeconomic and ethnic differences in use of lipid-lowering drugs after deregulation of simvastatin in the UK for adults with moderate or high risk of coronary heart disease. Methods3631 participants in the Whitehall II cohort study (mean age 62.7years, 91% white) were informed of their risk of coronary heart disease, based on Framingham score, before deregulation (2002–2004). The use of prescribed lipid-lowering drugs and use of over-the-counter simvastatin were analysed as outcome variables, after deregulation (2005–2007). Results2451 participants were at high risk and 1180 at moderate risk. 20% moderate-risk and 44% high-risk participants reported using prescribed lipid-lowering drugs although no over-the-counter simvastatin was used. Prescribing rates did not differ between employment grades (an index of socioeconomic position), but was higher among South Asian high-risk compared with White high-risk participants (odds ratio 1.64, 95% CI 1.21–2.23). Of the high-risk participants, 44% recalled their increased coronary heart disease risk. South Asian high-risk participants were less likely to recall than White high-risk participants (odds ratio 0.65, 95% CI 0.46–0.93). Furthermore, high risk participants with middle (odds ratio 0.74, 95% CI 0.61–0.89) and low (odds ratio 0.52, 95% CI 0.37–0.74) employment grades were less likely to recall than those with high grades. ConclusionSocioeconomic and ethnic differences in reported use of lipid-lowering drugs were small, but the use of these drugs in general was much lower than recommended and the participants did not utilise over-the-counter statins. Ethnic minorities and lower socioeconomic position groups were less likely to be aware of their increased coronary risk.

Disparity in Use of Psychotherapy Offered in Primary Care Between Older African‐American and White Adults: Results from a Practice‐Based Depression Intervention Trial

The purpose of this study was to assess ethnic differences in use of psychotherapy (having met at least once with a psychotherapist) for late-life depression in primary care. Participants were identified through a two-stage, age-stratified (60-74, > or =75) depression screening of randomly sampled patients from 20 practices in New York City, Philadelphia, and Pittsburgh in a practice-randomized trial. Practices were randomly assigned to usual care or to an intervention with a depression care manager who worked with primary care physicians to provide algorithm-based care. Depression status based on clinical interview and any use of psychotherapy within the 2-year follow-up interval were the primary dependent variables under study. The focus was on 582 persons with complete data. Participants were sorted into major depression (n=385, 112 African American and 273 white) and clinically significant minor depression (n=197, 51 African American and 146 white) based on clinical diagnostic assessment. Persons who self-identified as African American were less likely than whites to use interpersonal therapy (IPT) if they had minor depression, even after adjusting for potentially influential variables including age, cognitive functioning, and whether the dose of antidepressant was adequate (adjusted odds ratio (AOR)=0.22, 95% confidence interval (CI)=0.06-0.80). Ethnicity was not significantly associated with IPT use in persons with major depression (AOR=0.71, 95% CI=0.37-1.37). Older African Americans with minor depression were less likely than whites to use psychotherapy. Targeted strategies are needed to mitigate the disparity in use of psychotherapy.

Differences in service utilization and barriers among Blacks, Hispanics, and Whites with drug use disorders

BackgroundTreatment for drug use disorders (DUD) can be effective, but only a small proportion of people with DUD seek or receive treatment. Research on racial and ethnic treatment differences and disparities remains unclear. Understanding racial and ethnic differences and disparities in drug treatment is necessary in order to develop a more effective referral system and to improve the accessibility of treatment. The purpose of the current study was to explore the role of race and ethnicity in service utilization.MethodsUsing data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), this study examined racial and ethnic differences in use of 14 types of treatment services for DUD and 27 different treatment barriers among persons who met lifetime criteria for a DUD. Multivariate logistic regression analyses were used to examine service utilization and barriers among the racial and ethnic groups, while adjusting for other sociodemographic and clinical variables.Results and discussionAmong Blacks, Hispanics and Whites in the overall NESARC sample, approximately 10.5% met criteria for at least one lifetime drug use disorder. Approximately 16.2% of persons with a lifetime DUD received at least one type of service. Overall, this study indicated that Whites were less likely to report receiving help for drug-related problems than Blacks, Blacks used a greater number of different types of services, and no racial and ethnic differences were observed with respect to perceived barriers to drug treatment. However, by examining types of services separately, a complex picture of racial and ethnic differences emerges. Most notably, Whites were most likely to use professional services, whereas Blacks were most likely to use 12-step and clergy. The service use pattern of Hispanics most resembled that of Whites.ConclusionWhile structural barriers to accessing treatment were observed, broad-based educational programs and interventions that are appropriately targeted to racial and ethnic groups remains an important area for prevention and treatment.

Capitation and Racial and Ethnic Differences in Use and Cost of Public Mental Health Services

This study investigated racial and ethnic differences in the probability of mental health service use and costs of treatment before and after the implementation of capitated financing. Models were created to test effects on utilization and costs of African American, Latinos, and white mental health consumers. As service use and costs declined under capitation, Latino, and white levels of use and cost tended to converge. African American utilization patterns in the capitated areas tended to parallel their white counterparts. Differential rejection by, or exclusion of, African American and Latino consumers did not appear to occur in response to capitation.