The economic implications of the racial and ethnic disparities in the use of selective serotonin reuptake inhibitors*

ABSTRACT

Objectives: Previous studies have examined racial and ethnic disparities in the use of selective serotonin reuptake inhibitors (SSRI). This study aims to examine the economic implications of these disparities.

Research design and methods: In this retrospective observational study, the study sample was adult survey respondents with a diagnosis of depression from the Medical Expenditure Panel Survey (2002–2003). SSRI use was measured as the number of times when SSRIs were obtained. The racial and ethnic disparities in SSRI use were examined employing a negative binomial model. The economic implications of disparities were explored using a linear regression with SSRI use as an independent variable. Interaction terms between the variable for SSRI use and dummy variables for racial and ethnic groups were included to explore whether the relationships between SSRI use and health expenditures differ across racial and ethnic groups.

Results: The mean number of times of SSRI use was higher for non-Hispanic whites than non-Hispanic blacks (3.02 vs. 1.79; p < 0.05) and Hispanic whites (3.02 vs. 1.68; p < 0.05). These differences were still significant after adjusting for covariates (?p < 0.05). In the multivariate analysis, each time of SSRI use was associated with health expenditures of $301 higher. Neither dummy variables for racial and ethnic groups nor the interaction terms between these dummy variables and the variable for SSRI use were significant.

Conclusions: The lower use of SSRIs among minorities compared to non-Hispanic whites is associated with lower health expenditures among minorities. SSRI may be a proxy for improved access to health care due to under-treatment of depression in general. The main limitation of this study is that its observational nature does not allow the researchers to determine whether the association between SSRI use and the increase in health expenditures is a causal effect.     

The impact of racial and ethnic disparities in inhaled corticosteroid adherence on healthcare expenditures in adults with asthma

Purpose: The purpose of this study is to determine racial and ethnic disparities with the adherence to inhaled corticosteroids (ICSs) in adults with persistent asthma, and their association with healthcare expenditures.

Methods: A retrospective, cross-sectional study using the Medical Expenditure Panel Survey (MEPS) 2013–2014 data included patients ≥18 years with persistent asthma. Median medication possession ratio (MPR) was used to dichotomize adherence levels. Multivariate regression analysis was conducted to ascertain the association between adherence and race/ethnicity. Total expenditures and association with adherence were analyzed using a generalized linear model with a log link function and gamma distribution. Unadjusted expenditures were compared after bootstrapping.

Results: The average MPR of ICSs for the sample of 277 patients was 0.34. The average MPR level was 0.33 among whites, 0.37 among African-Americans and 0.35 among other minorities. The average MPR was 0.30 among Hispanics, and 0.35 among non-Hispanics. African-Americans were less likely to be adherent than whites (OR 0.95). Hispanics were less likely to be adherent (OR 0.4; CI 0.206–0.777). Higher adherence was associated with significantly higher total health expenditure than lower adherence ($19,223 vs. $12,840 respectively, p?<?.0001). African-Americans had slightly higher total expenditure compared to whites; however, other minorities had significantly lower health expenditures compared to whites (p?=?.01). Non-Hispanics spent significantly less on healthcare compared to Hispanics (p?=?.04).

Conclusions: Valuable insight into the economic cost of the disparities as they relate to persistent asthma provides further evidence of possible ethnic inequities that warrant addressing.     

Racial and ethnic disparities associated with the measure for drug-drug interactions among Medicare beneficiaries

BackgroundDrug-drug interactions (DDIs) cause many preventable hospitalizations and admissions. Efforts have been made to raise DDI awareness and reduce DDI occurrence; for example, Medicare Part D Star Ratings, a health plan quality assessment program, included a DDI measure. Previous research reported racial and ethnic disparities in health services utilization and that racial and ethnic minorities, compared with non-Hispanic whites (whites), may be less likely to be targeted for a similar measure, a Star Ratings adherence measure for diabetes medications.ObjectiveThis study aimed to investigate whether any racial and ethnic disparities are associated with the DDI measure in Part D Star Ratings among Medicare populations with diabetes, hypertension, and hyperlipidemia.MethodsThis cross-sectional study analyzed a 2017 Medicare Part D data sample, including 3,960,813 beneficiaries. Because the inclusion in the denominator of the Star Ratings DDI measure was determined by the use of a list of target medications, the likelihood of using a listed target medication was compared between racial and ethnic minorities and whites. Individuals with diabetes, hypertension, and hyperlipidemia were included in the analysis owing to the high prevalence of these conditions. Patient- and community-level characteristics were adjusted by logistic regression.ResultsOf the entire study sample, 26.2% used a target medication. Compared with whites, most racial and ethnic minorities were less likely to use a target medication. For example, among individuals with diabetes, blacks, Hispanics, Asians/Pacific Islanders, and others had, respectively, 14% (odds ratio 0.86 [95% CI 0.84–0.88]), 5% (0.95 [0.93–0.98]), 12% (0.88 [0.84–0.92]), and 10% (0.90 [0.87–0.93]) lower odds compared with whites. Findings were similar among hypertension and hyperlipidemia cohorts, except that Hispanics had similar odds of use as whites.ConclusionMost racial and ethnic minorities may have lower likelihood of being targeted for the DDI measure compared with whites. Future studies should examine whether these disparities affect health outcomes and devise new DDI measures for racial and ethnic minorities.     

Correlates of Blunt Smoking Among African American,Hispanic/Latino,and White Adults: Results From the 2014 National Survey on Drug Use and Health

Background: Blunt use is highly prevalent in the United States and has been associated with several negative health consequences, such as an increased risk for cardiovascular and pulmonary diseases. Although recent studies have identified characteristics (e.g., gender) that are associated with blunt use, it is unclear if these factors correlate with blunt use equally across racial/ethnic groups. Methods: Using cross-sectional data from the 2014 National Survey on Drug Use and Health, this study aimed to determine if demographic, health and substance use correlates of current (i.e., past 30-day) and lifetime blunt use were similar across 37,628 non-Hispanic African American, Hispanic/Latino and non-Hispanic White adults. Results: Findings revealed 8.3% of African American, 3.3% of Hispanic/Latino and 2.5% of White adults reported current blunt smoking. Across all racial/ethnic groups, age and current and lifetime cigarette and illicit drug use were associated with current and lifetime blunt use. However, gender, educational level, income, current alcohol use and self-reported health status were differentially associated with current and lifetime blunt use across racial/ethnic groups. Employment status and lifetime depression were not associated with blunt use behaviors among any of the racial/ethnic groups. Conclusions: The relationship between gender, socioeconomic status, alcohol use and self-reported health status and blunt use differs among African American, Hispanic/Latino and White adults. Researchers and providers should consider the heterogeneity in factors that are associated with blunt use when designing prevention and treatment interventions for African American, Hispanic/Latino and White adult blunt smokers.     

Correlates of Treatment Retention Among Multi-Ethnic Youth with Substance Use Problems: Initial Examination of Ethnic Group Differences

ABSTRACT

Aims: To explore (1) the influence of pretreatment and treatment factors on treatment retention among a multi-ethnic sample of adolescents and (2) the potential differential influence of pretreatment and treatment factors on treatment retention within each ethnic subgroup. Participants: A multi-ethnic sample of 420 adolescent juvenile offenders in treatment for substance use problems (U.S.-born Hispanics n = 222; foreign-born Hispanics n = 94; African-Americans n = 66; and non-Hispanic Whites n = 38). Design: Cross-sectional data were examined using analysis of variance (ANOVA) testing putative differences in treatment retention for the entire sample (N = 420) for the following factors: (1) ethnicity, (2) psychiatric comorbidity, and (3) treatment variables. The second set of analyses examines differences in treatment retention associated with these factors within the ethnic subgroups. Finally, supplementary analyses were conducted to explore the potential influence on retention of the following cultural factors: (a) ethnic orientation, (b) perceived discrimination, and (c) acculturation level (for Hispanic youth only). Findings: Consistent with prior research, results indicated that non-Hispanic White adolescents had significantly higher treatment retention than the ethnic minority adolescents (p = .003). The particular factors related to treatment retention varied greatly across the four ethnic subgroups; however there were no differences in treatment retention by any of the cultural variables. Conclusions: Taken together, the results suggest that ethnic minority youth continue to drop out of treatment at higher rates than their non-Hispanic White counterparts, and the factors associated with treatment retention vary greatly across ethnic groups.     

Widening the Disparity Gap: Differences in Outcomes for Racial and Ethnic Groups in Youth Substance Abuse Prevention Programming

Abstract

This study examined racial and ethnic differences in the outcomes of a universal evidence-based program targeted to children and adolescents. Using data collected in 2015 and 2016 from the Alcohol: True Stories Hosted by Matt Damon program (N?=?925), the study found the outcome of perceptions on risk of harm from alcohol use significantly different between the group of White respondents and the group of non-White respondents, and between the group of Hispanic respondents and the group of non-Hispanic respondents. Program effectiveness was found only among White and non-Hispanic respondents, widening the already existing gap between these populations.     

Racial and Ethnic Differences in Referral Source for Substance Abuse Treatment Admissions for Youths

This study examined racial and ethnic differences in admissions to substance abuse treatment and in the referral source in admissions to treatment. The 2012 Treatment Episode Data Set (N = 117,862) was used and included African-American, Hispanic, non-Hispanic White, and other racial/ethnic youths, ages 12 to 17. Age at admission to treatment, racial and ethnic differences in primary substance used, and co-occurrence of a psychiatric problem were found to be statistically significant. Health care providers were 3 times more likely to refer youths with psychiatric problems and the school system was 2 times more likely to refer Hispanic youths to treatment. Implications are discussed.     

The economic burden of fibromyalgia: comparative analysis with rheumatoid arthritis*

ABSTRACT

Objective: To quantify and compare direct costs, utilization, and the rate of comorbidities in a sample of patients with fibromyalgia (FM), a poorly understood illness associated with chronic widespread pain that is commonly treated by rheumatologists, to patients with rheumatoid arthritis (RA), a well studied rheumatologic illness associated with inflammatory joint pain. Patients with both illnesses were isolated and reported as a third group. A secondary analysis of work loss was performed for an employed subset of these patients.

Research design and methods: Retrospective cohort analysis of Thomson Reuters MarketScan administrative healthcare claims and employer-collected absence and disability data for adult patients with a diagnosis of FM (ICD-9-CM 729.1) and/or RA (ICD-9-CM 714.0x,–714.3x) on at least one inpatient or two outpatient claims during 2001–2004.

Main outcome measures: The 12-month healthcare utilization, expenditures, and rates of comorbidities were quantified for all study-eligible patients; absence and short-term disability days and costs were quantified for an employed subset.

Results: The sample included 14?034 FM, 7965 RA, and 331 FM?+?RA patients. Patients with FM had a higher prevalence of several comorbidities and greater emergency department (ED) utilization than those with RA. Mean annual expenditures for FM patients were $10?911 (SD?=?$16?075). RA patient annual expenditures were similar to FM: $10?716 (SD?= $16?860). Annual expenditures were almost double in patients with FM+RA ($19?395, SD?= $25?440). A greater proportion of patients with FM had any short-term disability days than those with RA (20 vs. 15%); and a greater proportion of patients with RA had any absence days (65 vs. 80%). Mean costs for absence from work and short-term disability in the FM and RA groups were substantial and similar. The FM+RA group was of insufficient sample size to report on work loss.

Limitations: The availability of newer and more expensive FDA-approved medications since 2004 is not reflected in our findings. This analysis was restricted to commercially insured patients and therefore may not be generalizable to the entire U.S. population.

Conclusions: The burden of illness in FM is substantial and comparable to RA. Patients with FM incurred direct costs approximately equal to RA patients. Patients with FM had more ED, physician, and physical therapy visits than RA patients. Patients in both groups had several comorbidities. Patients with FM+RA incurred direct costs almost double those of the patients with either diagnosis alone. FM and RA patients incurred similar overall absence and short-term disability costs.     

Are There Racial Ethnic Differences in Indigent, Inner-City Clients With Dual-Diagnosis?

OBJECTIVE: An exploratory, cross-sectional study examined personal, clinical, and treatment characteristics among non-Hispanic Caucasian, non-Hispanic African American, and Hispanic indigent, inner-city clients with co-occurring disorders. METHODS: Men and women, 20-50 years old who met DSM-IV criteria for concurrent mood and substance use disorders were eligible. Inpatients, persons in detoxification programs, or incarcerated inmates were excluded. Assessments covered sociodemographic characteristics, clinical diagnoses, substance use, psychosocial variables, health care utilization and treatment history. RESULTS: Two hundred volunteers were screened, and 145 were eligible to enroll. Racial ethnic group differences in the distribution of mood and substance use disorders and medical diseases were evident. Receiving psychiatric treatment and psychiatric medications significantly differed among racial ethnic groups with Caucasians more likely to receive these services than African Americans or Hispanics. African Americans and Hispanics were also more likely than Caucasians to test positive for their drug of choice and for other drugs as well. Serious medical illnesses were evident in about half of the sample, and the distributions of these illnesses significantly differed among racial ethnic groups. There were no significant differences in hospitalization or emergency room visits among racial ethnic groups. CONCLUSIONS: Indigent, inner-city clients have multiple psychiatric and medical problems that warrant continuity of care. However, few doctor's visits for medical illnesses, lack of psychotropic medications, staggering unemployment, and homelessness were common in our sample. These results present healthcare and social service professionals with potentially serious treatment challenges. Better recognition and understanding of racial ethnic needs in those with co-occurring disorders are needed.     

Ethnicity/race and the diagnosis of depression and use of antidepressants by adults in the United States

The objective of this study is to discern ethnic/race-specific (black, Hispanic, white) population-adjusted rates of US office-based visits documenting a diagnosis of depression, and the extent of the use of antidepressant pharmacotherapy for its treatment. Data from the National Ambulatory Medical Care Survey for the time-frames 1992-1997, and 2003-2004, were partitioned into four, 2-year time intervals for trend analysis among patients aged 20-79 years. From 1992-1993 to 2003-2004, the annualized rate of visits documenting a diagnosis of depression increased from 10.9 to 15.4 per 100 US population for whites, from 4.2 to 7.6 for blacks, and from 4.8 to 7.0 for Hispanics. A concomitant diagnosis of depression and antidepressant use increased from 6.5 to 11.4 per 100 for whites, from 2.6 to 5.2 for blacks, and from 3.0 to 5.6 for Hispanics. It can be concluded that by 2003-2004, diagnostic and treatment rates were comparable among blacks and Hispanic, but were less than half the observed rates for whites.     

Racial and ethnic differences in preference-based health status measure

ABSTRACT

Objective: To document the racial and ethnic differences in individuals' perception of their general health status assessed by preferencebased measures.

Methods: Using the 2003 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of 20?428 people with reported concurrent EuroQol (EQ‐5D) US scores were included in the study. Given the upper-bound of preference-based scores at 1.0, a two-part model was derived to identify the relationship between race/ethnicity and the preference-based score after controlling for individual demographic covariates, comorbidity profile, and functional and activity limitations. In order to generalize the results to the whole US population, the complex survey sampling design of the MEPS was taken into account using the specified sample weight, variance estimation stratum, and primary sampling unit.

Results: In the fully adjusted model, Asians were more likely to report being in full health (score of 1.0) than Whites by 4.2 percentage points (?p < 0.05), whereas no differences were identified for Blacks and Hispanics compared to Whites. Beyond health and disease conditions, education and income explained the racial/ethnic difference for EQ‐5D score for Blacks and Hispanics relative to Whites, but this was not the case between Asians and Whites. No clinically important differences were identified between racial/ethnic groups for individuals not reporting full health.

Conclusions: This study adds to the literature of health-related quality of life (HRQoL) by providing additional empirical evidence at the US national level to demonstrate racial/ethnic differences assessed by preference-based measures. Healthcare researchers and clinicians need to be aware that Asians are more likely to perceive a higher preference-based score than Whites, given the same health and disease conditions. Subgroup analysis may be considered regarding the optimal decision making and conclusions based on cost-effectiveness analysis.     

Mindfulness-based relapse prevention with racial and ethnic minority women

Racial and ethnic disparities in the treatment of addiction have been acknowledged for several years, yet little is known about which empirically supported treatments for substance use disorders are more or less effective in treating racial and ethnic minority clients. The current study was a secondary analysis of a randomized clinical trial of two evidence-based treatments, mindfulness-based relapse prevention (MBRP) and relapse prevention (RP), as part of a residential addiction treatment program for women referred by the criminal justice system (n = 70). At 15-week follow-up, regression analyses found that racial and ethnic minority women in MBRP, compared to non-Hispanic and racial and ethnic minority women in RP, reported significantly fewer drug use days (d = .31) and lower addiction severity (d = .65), based on the Addiction Severity Index. Although the small sample size is a limitation, the results suggest that MBRP may be more efficacious than traditional treatments for racial and ethnic minority women.     

Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States

BackgroundHealth care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States.MethodsA cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population.ResultsA total of 1140 (weighted = 13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p = 0.001) as compared to privately insured.ConclusionsA difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.     

Perceived discrimination among racial and ethnic minority drug users and the association with health care utilization

ABSTRACT

People who use drugs (PWUDs) are at increased risk for several medical conditions, yet they delay seeking medical care and utilize emergency departments (EDs) as their primary source of care. Limited research regarding perceived discrimination and PWUDs’ use of health care services exists. This study explores the association between interpersonal and institutional racial/ethnic and drug use discrimination in health care settings and health care utilization among respondents (N?=?192) recruited from methadone maintenance treatment programs (36%), HIV primary care clinics (35%), and syringe exchange programs (29%) in New York City (n?=?88) and San Francisco (n?=?104). The Kaiser Family Foundation Survey of Race, Ethnicity, and Medical Care questionnaire was utilized to assess perceived institutional racial/ethnic and drug use discrimination. Perceived institutional discrimination was examined across race/ethnicity and by regular use of ERs, having a regular doctor, and consistent health insurance. Perceived interpersonal discrimination was examined by race/ethnicity. Perceived interpersonal drug use discrimination was the most common type of discrimination experienced in health care settings. Perceptions of institutional discrimination related to race/ethnicity and drug use among non-Hispanic Whites did not significantly differ from those among non-Hispanic Blacks or Hispanics. A perception of less frequent institutional racial/ethnic and drug use discrimination in health care settings was associated with increased odds of having a regular doctor. Awareness of perceived interpersonal and institutional discrimination in certain populations and the effect on health care service utilization should inform future intervention development to help reduce discrimination and improve health care utilization among PWUDs.     

The effect of adjunctive mood stabilizers on antipsychotic utilization pattern and health resource utilization for Medicaid enrollees with schizophrenia

ABSTRACT

Background: Prescribing adjunctive mood stabilizers to manage schizophrenia is prevalent, despite the lack of substantial evidence to support the long-term use of this treatment regimen.

Objective: The objective of this study was to assess the impact of using adjunctive mood stabilizers on antipsychotic utilization, total health expenditures, inpatient hospital­izations, long-term care stays, and emergency room (ER) visits for patients with schizophrenia.

Methods: Georgia Medicaid claims from 1999 through 2001 were analyzed to identify recipients diagnosed with schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD?9?CM]: 295.XX). The treatment groups consisted of subjects who received combination therapy of mood stabilizers and anti­psychotics (including both atypical and typical medica­tions), while the comparison group consisted of subjects who were on antipsychotic medications without exposure to the mood stabilizers under investigation. Four treatment groups (valproate, lithium, carbamazepine, and combina­tion mood stabilizer therapy) were formed based on the mood stabilizers patient received. Differences in annual health care use and expenditures were estimated between propensity score matched treatment and comparison groups controlling for comorbidity, prior utilization, demographic, and health provider specialty.

Results: During the 1?year observation period, subjects in treatment groups filled an average of 200-days supply of adjunctive mood stabilizers. These adjunctive mood stabilizer recipients had significantly longer antipsychotic treatment durations than the subjects who did not have exposure to mood stabilizers (valproate + antipsychotic vs. antipsychotic only, net difference: 56.47 days, p < 0.0001; lithium + antipsychotic vs. antipsychotic only, net difference: 90.25 days, p < 0.0001; carbamazepine + antipsychotic vs. antipsychotic only, net difference: 41.27 days, p = 0.0439; multiple mood stabilizers + anti­psychotic vs. antipsychotic only, net difference: 83.14 days, p < 0.0001). The intensive pharmacotherapy associated with treatment groups resulted in $900–$1300 higher pharmacy costs than the comparison groups (valproate + antipsychotic vs. antipsychotic only, net difference: $1218.43, p < 0.0001; lithium + antipsychotic vs. antipsychotic only, net difference: $985.79, p = 0.0015; carbamazepine + antipsychotic vs. anti­psychotic only, net difference: $911.63, p = 0.0497; multiple mood stabilizers + antipsychotic vs. antipsychotic only, net difference: $1281.91, p < 0.0047). However, there were no statistically significant differences for total health expenditures, hospitalizations, emergency room visits, and nursing home admissions between propensity-matched treatment and control groups.

Conclusions: There were no differences in health care costs or utilization of ER, long-term care, and inpatient services between schizophrenia patients who did and did not receive adjunctive mood stabilizer; however, longer anti­psychotic treatment durations were observed in patients receiving adjunctive mood stabilizers. Interpretation of these results is limited by the unknown selection bias between the treatment and the comparison groups and the relatively small number of patients in some treatment groups. The development of a better-controlled study to further evaluate this treatment regimen is warranted.     

Economic,clinical, and humanistic outcomes (ECHOs) of pharmaceutical care services for minority patients: A literature review

BackgroundThe U.S. population of racial/ethnic minorities continues to increase; however, health disparities and poor health outcomes among many of them continue to be a major public health problem confronting the U.S. health care system.ObjectivesThe objective of this review was to summarize published pharmaceutical care services literature reporting economic, clinical, and/or humanistic outcomes (ECHOs) among racial/ethnic minorities. Studies that reported differences by race/ethnicity and studies where most participants were from multiracial/ethnic minorities were included.MethodsPubMed and International Pharmaceutical Abstracts databases were searched for articles that reported the effects of pharmaceutical care on ECHOs among racial/ethnic minorities published between January 1980 and November 2010. The literature review was focused on racial groups that included black/African-American, Native American, Indian American Asian, Alaska Native, Native Hawaiian, and Pacific Islander patients, and ethnic group that was non-white Hispanic/Latino patients.ResultsThere were 24 articles that studied the impact of pharmaceutical care on ECHOs by race/ethnicity or where most participants were from multiracial/ethnic minorities. Twenty-three studies reported that pharmaceutical care has a positive impact on health outcomes of the studied populations. About half of the studies meeting inclusion criteria evaluated only 1 type of patient outcome, primarily clinical outcomes. Education/consultation and medication/therapy management were the most commonly evaluated types of pharmaceutical care services throughout the studied groups. Comprehensive disease management was evaluated mainly in multiracial/ethnic populations and blacks/African-Americans. Few studies adopted randomized controlled designs, which make it difficult to attribute changes in patient outcomes to the provision of pharmaceutical care. Nine studies that involved cooperation between pharmacists and other medical professionals reflect an increased tendency for interprofessional collaboration in the current health care system.ConclusionThis review shows that there is a positive relationship between pharmaceutical care and ECHOs in patients from racial/ethnic minority groups. However, more studies are needed to document the effects of pharmaceutical care on reducing racial/ethnic health disparities and to determine which interventions are most effective among certain groups with health disparities.     

Race/Ethnic Differences in Alcohol Abuse Among Youth

ABSTRACT

Objective: Black and Hispanic youth are less likely to abuse alcohol than White youth. However, the reasons for these race/ ethnic differences in alcohol abuse are unclear. The present study explores whether the variations can be explained, in part, by racial/ethnic differences in attitudes toward risk.

Method: The National Household Survey of Drug Abuse, 2001 (n = 32,798) is used to explore race/ethnic differences in risk-taking attitudes and whether these attitudes serve to mediate race/ethnic differences in heavy drinking and drinking and driving.

Results: Bivariate analyses reveal that Black and Hispanic youth have lower rates of alcohol abuse and a lower propensity for risk-taking than White youth. Logistic regressions reveal that the differences in risk-taking explain (but do not completely account for) observed differences in alcohol abuse. These findings are present for both males and females. Results more generally reveal that social and economic ad vantages are associated with risk-taking attitudes and thus indirectly contribute to alcohol abuse.

Conclusions: Researchers have long been surprised that minority youth exhibit lower rates of alcohol abuse than White youth since socioeconomic disadvantage often contributes to substance abuse. However, the present study suggests that social and economic disadvantages might also suppress risk-taking propensities, which in turn may reduce the incidence of alcohol abuse. Additional research is needed to understand the mechanisms by which social and cultural resources affect attitudes toward risk.