Dataset Information

Predictors of Alcohol Use in Safety-Net Primary Care: Classism, Religiosity, and Race.

ABSTRACT: Class-based discrimination may impact problematic drinking in low-income populations, which may be buffered by personal religiosity. However, little is known how race may impact this association. The purpose of this study was to examine racial differences in the effect of class-based discrimination on problematic drinking as moderated by comfort with God and determine if there were conditional direct effects of class-based discrimination on problematic drinking by race. In this cross-sectional study, participants (N?=?189) were patients of an urban, safety-net primary care clinic who completed questionnaires assessing experiences of class-based discrimination, attitudes toward God, and alcohol use. Data were collected from 2015 to 2016 and analyzed using the Hayes PROCESS macro. There was a significant main effect for class-based discrimination predicting problematic drinking. Two-way interaction analyses identified a significant comfort with God by race interaction with greater comfort with God associated with less problematic drinking among white but not black respondents. Conditional direct effects showed that experiences of class-based discrimination were associated with problematic drinking at low and moderate but not high levels of comfort with God in black participants, whereas none were observed for white participants. This study provides insight on how personal religiosity, class-based discrimination, and race may intertwine to shape problematic alcohol use in primarily low-income, urban patients. Clinicians' awareness of risk and protective factors, as well as how race tempers the effects of such factors, is vital in providing better care for this population.

SUBMITTER: Trujillo MA

PROVIDER: S-EPMC7317315 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Predictors of Alcohol Use in Safety-Net Primary Care: Classism, Religiosity, and Race.

Trujillo Michael A MA Smith Erin R ER Griffin Sarah S Williams Allison B AB Perrin Paul B PB Rybarczyk Bruce B

Journal of addiction 20200616

Class-based discrimination may impact problematic drinking in low-income populations, which may be buffered by personal religiosity. However, little is known how race may impact this association. The purpose of this study was to examine racial differences in the effect of class-based discrimination on problematic drinking as moderated by comfort with God and determine if there were conditional direct effects of class-based discrimination on problematic drinking by race. In this cross-sectional s ...[more]

PMID: 32612865

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Project description:BackgroundQuality metrics, pay for performance (P4P), and value-based payments are prominent aspects of the current and future American healthcare system. However, linking clinic payment to clinic quality measures may financially disadvantage safety-net clinics and their patient population because safety-net clinics often have worse quality metric scores than non-safety net clinics. The Minnesota Safety Net Coalition's Quality Measurement Enhancement Project sought to collect data from primary care providers' (PCPs) experiences, which could assist Minnesota policymakers and state agencies as they create a new P4P system. Our research study aims are to identify PCPs' perspectives about 1) quality metrics at safety net clinics and non-safety net clinics, 2) how clinic quality measures affect patients and patient care, and 3) how payment for quality measures may influence healthcare.MethodsQualitative interviews with 14 PCPs (4 individual interviews and 3 focus groups) who had worked at both safety net and non-safety net primary care clinics in Minneapolis-St Paul Minnesota USA metropolitan area. Qualitative analyses identified major themes.ResultsThree themes with sub-themes emerged. Theme #1: Minnesota's current clinic quality scores are influenced more by patients and clinic systems than by clinicians. Theme #2: Collecting data for a set of specific quality measures is not the same as measuring quality healthcare. Subtheme #2.1: Current quality measures are not aligned with how patients and clinicians define quality healthcare. Theme #3: Current quality measures are a product of and embedded in social and structural inequities in the American health care system. Subtheme #3.1: The current inequitable healthcare system should not be reinforced with financial payments. Subtheme #3.2: Health equity requires new metrics and a new healthcare system. Overall, PCPs felt that the current inequitable quality metrics should be replaced by different metrics along with major changes to the healthcare system that could produce greater health equity.ConclusionAligning payment with the current quality metrics could perpetuate and exacerbate social inequities and health disparities. Policymakers should consider PCPs' perspectives and create a quality-payment framework that does not disadvantage patients who are affected by social and structural inequities as well as the clinics and providers who serve them.

Project description:ImportanceAlthough brief intervention is effective for reducing problem alcohol use, few data exist on its effectiveness for reducing problem drug use, a common issue in disadvantaged populations seeking care in safety-net medical settings (hospitals and community health clinics serving low-income patients with limited or no insurance).ObjectiveTo determine whether brief intervention improves drug use outcomes compared with enhanced care as usual.Design, setting, and participantsA randomized clinical trial with blinded assessments at baseline and at 3, 6, 9, and 12 months conducted in 7 safety-net primary care clinics in Washington State. Of 1621 eligible patients reporting any problem drug use in the past 90 days, 868 consented and were randomized between April 2009 and September 2012. Follow-up participation was more than 87% at all points.InterventionsParticipants received a single brief intervention using motivational interviewing, a handout and list of substance abuse resources, and an attempted 10-minute telephone booster within 2 weeks (n = 435) or enhanced care as usual, which included a handout and list of substance abuse resources (n = 433).Main outcomes and measuresThe primary outcomes were self-reported days of problem drug use in the past 30 days and Addiction Severity Index-Lite (ASI) Drug Use composite score. Secondary outcomes were admission to substance abuse treatment; ASI composite scores for medical, psychiatric, social, and legal domains; emergency department and inpatient hospital admissions, arrests, mortality, and human immunodeficiency virus risk behavior.ResultsMean days used of the most common problem drug at baseline were 14.40 (SD, 11.29) (brief intervention) and 13.25 (SD, 10.69) (enhanced care as usual); at 3 months postintervention, means were 11.87 (SD, 12.13) (brief intervention) and 9.84 (SD, 10.64) (enhanced care as usual) and not significantly different (difference in differences, β = 0.89 [95% CI, -0.49 to 2.26]). Mean ASI Drug Use composite score at baseline was 0.11 (SD, 0.10) (brief intervention) and 0.11 (SD, 0.10) (enhanced care as usual) and at 3 months was 0.10 (SD, 0.09) (brief intervention) and 0.09 (SD, 0.09) (enhanced care as usual) and not significantly different (difference in differences, β = 0.008 [95% CI, -0.006 to 0.021]). During the 12 months following intervention, no significant treatment differences were found for either variable. No significant differences were found for secondary outcomes.Conclusions and relevanceA one-time brief intervention with attempted telephone booster had no effect on drug use in patients seen in safety-net primary care settings. This finding suggests a need for caution in promoting widespread adoption of this intervention for drug use in primary care.Trial registrationclinicaltrials.gov Identifier: NCT00877331.

Project description:BackgroundImplementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States).MethodsIn a 12-month trial, families of children (age 7-12 years; body mass index ≥85th American percentile for age and sex; 74% self-identified as Hispanic/Latino; n = 360) were randomly assigned to receive Standard Care Alone or Standard Care + Enhanced Program. An English/Spanish bilingual staff provided the Standard Care Alone consisting of quarterly semi-structured pediatrician visits targeting family-based behavioral changes. The Standard Care + Enhanced Program was enriched with eight Skill-Building Core and monthly Post-Core Support sessions.ResultsThe mean body mass index Z-score declined in both arms (P < 0.01) with no significant difference between the Standard Care Alone (0.12 kg [SE: 0.03]) and Standard Care + Enhanced Program (0.15 kg [SE: 0.03]) arm (P = 0.15). Compared to the Standard Care Alone, the Standard Care + Enhanced Program resulted in significantly greater improvements in total cholesterol (P = 0.05), low-density lipoprotein cholesterol (P = 0.04), aspartate aminotransferase (P = 0.02), and alanine transaminase (P = 0.03) concentrations.ConclusionsSafety-net primary care settings can provide efficacious pediatric weight management services. Targeted family-based behavioral counseling helps overweight/obese children achieve a modest body mass index Z-score improvement. A more intensive lifestyle intervention program may improve some metabolic parameters.Trial registrationClinicalTrials.gov Identifier: NCT00851201 . Registered 23 February 2009.

Project description:BackgroundDuring the past decade the malaria control community has been successful in dramatically increasing the number of households that own mosquito nets. However, as many as half of nets already in households go unused. This study examines the factors associated with use of nets owned in Ghana.MethodsThe data come from an August 2008 survey in Ghana of households with a pregnant woman or a guardian of a child under five, conducted during the rainy season. 1796 households were included in this analysis, which generated a sample of 1,852 mosquito nets. Using each net owned as the unit of analysis, multivariate logistic regression was used to examine the relationship of net used last night with 23 potentially explanatory variables having to do with characteristics of the household, of the respondent, and of the net. Odds Ratios, p-values, and confidence intervals were calculated for each variable to develop an explanatory model.ResultsThe final multivariate model consisted of 10 variables statistically associated with whether or not the net was used the prior night: rural location, lower SES, not using coils for mosquito control, fewer nets in the household, newer nets and those in better condition, light blue colour, higher level of education of the guardian of the child under five, knowing that mosquitoes transmit malaria, and paying for the net instead of obtaining it free of charge.ConclusionsThe results of this study suggest that net use would increase in Ghana if coloured nets were made available in mass distributions as well as in the commercial market; if programmes emphasize that malaria is caused only by night-biting mosquitoes, and that nets protect against mosquitoes better than coils and need to be used even if coils are burning; if donated nets are replaced more frequently so that households have nets that are in good condition; and if there were support for the commercial market so that those who can afford to purchase a net and want to choose their own nets can do so.

Dataset Information

Predictors of Alcohol Use in Safety-Net Primary Care: Classism, Religiosity, and Race.

Publications

Predictors of Alcohol Use in Safety-Net Primary Care: Classism, Religiosity, and Race.

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