The goal of this study is to supply service planners and policy makers with the best available data on themagnitude and sources of racial/ethnic disparities in substance abuse treatment services, and the economicand social consequences of substance disorders in minority populations in the US. In the first three aims, weapply the Institute of Medicine health disparity framework, which emphasizes that a disparity includes alldifferences in treatment between racial/ethnic groups that are mediated through factors other than healthstatus and preferences.
The first aim estimates and compares unmet need for substance abuse treatmentservices by racial/ethnic group (Asians, Latinos, African-Americans, and non-Latino whites).
The second aim calculates disparities in substance abuse treatment utilization for each racial/ethnic minority group relative tonon-Latino whites.
The third aim i dentifies and assesses the relative contribution of various mechanisms ofdisparities such as insurance, SES, language, and geography.
The fourth aim estimates the associationbetween substance disorders and labor market and public assistance outcomes in minority populations inorder to highlight the economic burden that potentially could be prevented by reducing disparities. Finally,the goal of the fifth aim is to disseminate policy-relevant findings generated from the prior four aims to keystakeholders in the health disparities and substance abuse field.Data come from four new, large, nationally representative data sets, the National Latino and AsianAmerican Study (NLAAS), the National Comorbidity Survey Replication study (NCS-R), the NationalEpidemiologic Survey on Alcohol and Related Conditions (NESARC) and the National Survey on Drug Useand Health (NSDUH). These surveys offer diagnostic information on substance and other mental disorders,treatment utilization information, and rich data on labor market outcomes, public assistance receipt and othersociodemographic factors. To estimate disparities, we apply non-linear models of service use recentlyintroduced in the health services research literature. To study mechanisms, we apply regression-baseddecomposition methods to understand what proportion of disparities can be explained by different sources.We test the sensitivity of our findings to several alternate definitions of need and treatment.Our findings will offer some of the best and most recent data available on the magnitude and sources ofnational racial/ethnic disparities in the utilization of substance abuse treatment. The study also will generatesome of the first information available about the potentially preventable labor market and public assistanceconsquences of substance disorders in minority populations. This information is critically needed to developeffective policies to remediate disparities, and, ultimately, to improve public health by reducing the burden ofsubstance disorders in racial/ethnic minority populations.
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