A Randomized Clinical Trial of Culturally Tailored MI
Condition: Alcohol Drinking
MeSH terms: Alcohol Drinking
Study type: Interventional

Summary: 
      Culturally-tailored empirically-based interventions are needed because Latinos suffer a
      greater burden of alcohol-related health disparities and negative social consequences
      compared to other racial/ethnic groups, are less likely to initiate and to remain in
      treatment, and are more likely to live in communities with a high density of alcohol outlets.
      Pilot data from the PI's (New Investigator) K award (AA014905), which will serve as the basis
      for the current proposed larger-scale study, demonstrated that culturally tailored
      motivational interviewing (CTMI) outperformed motivational interviewing (MI) that was not
      tailored to the needs of Latino heavy drinkers. The public health impact of this study will
      be to develop a program of early screening and brief intervention to reduce hazardous
      drinking among Latinos, to minimize the burden of illness and social consequences that
      disproportionately affect Latino communities.
    

Detailed description: 
      The proposed R01 research, in response to PA 10-100, "Alcohol Use Disorders: Treatment,
      Services Research, and Recovery", addresses the PA priority: Treatment for Health
      Disparities/Special Populations. Latinos, the largest and fastest growing ethnic group in the
      United States (U.S.), representing 14% of the population (1), are expected to grow to nearly
      29% of the population by 2050 (2-3). Like many immigrant groups adapting to U.S. culture,
      Latinos adopt the health behaviors of the mainstream population, such as hazardous drinking
      (4-6). Hazardous drinking is a pattern of drinking associated with increased alcohol related
      problems: injuries, violence, sexually transmitted diseases (7-15), and increased risk for
      developing an alcohol use disorder (abuse or dependence) (7, 10, 16). Latinos report a
      disproportionately greater burden of illness, injuries, workplace and legal problems (17-21)
      as a result of their alcohol consumption than other racial ethnic groups, including an
      elevated risk for alcohol-involved motor vehicle crashes and fatalities (20, 22).

      Early intervention prevents the need for more costly and complex alcohol treatment (23).
      According to the National Academy of Sciences, dissemination of empirically-based
      interventions that are culturally tailored is particularly needed among Latinos (23-24)
      because they suffer alcohol-related health disparities (18-20, 25-26) and because alcohol
      treatment utilization rates are lower among Latinos than among other minority racial/ethnic
      groups or Whites (27-29). Although evidence suggests that culturally tailored addiction
      treatment improves retention and treatment outcomes (30-31), progress in the field has been
      limited by the lack of prospective clinical trials comparing tailored to non-tailored
      treatment (23). The PI's (New Investigator) funded K award (AA014905) provided important
      pilot data demonstrating that culturally tailored motivational interviewing (CTMI)
      outperformed un-tailored motivational interviewing (MI). This study will be the basis for the
      current proposed study, which is a larger scale version of the pilot. The culturally tailored
      MI maintained MI components. The key modification in our Social Contextual Model of Cultural
      Tailoring was to tailor the MI to incorporate important acculturation stressors (32-33):
      limited financial resources and opportunities, loss of social networks, discrimination
      (34-38), and changing cultural values. The proposed study will investigate acculturation
      stress (39) as an influence on the relationship between acculturation and alcohol consumption
      behavior and treatment outcomes. Efforts will help build a comprehensive model of how
      acculturation stressors influence drinking behavior among Latinos (40). The CTMI is also a
      needed effort to tailor treatment to drinkers who experience the burden of multiple social
      contextual sources of disadvantage, including poverty, discrimination, and acculturation
      stress (40).

      Because the original pilot study goal was to isolate and test the effects of tailoring
      treatment, it was delivered in English. The current proposal extends the tailored treatment
      to Spanish-speaking Latinos. Providing the tailored treatment in Spanish addresses a major
      clinical need and increases external generalizability. The study's public health impact will
      be to provide early screening and brief intervention to reduce hazardous drinking among
      Latinos in communities that lack such services. By providing early screening and
      intervention, we hope to minimize the burden of illness and social consequences that
      disproportionately affect Latino communities. Impact on field: will be to contribute to an
      understanding of whether culturally tailored motivational intervention enhances treatment
      efficacy for Latinos compared to un-tailored treatment. Another contribution will be to
      explore the effects of translating and of tailoring MI. Short term goals are to compare the
      efficacy of an evidenced-based treatment, MI, against a culturally adapted version of MI
      among Latinos. Long term goals are to disseminate an easily trainable, conceptual model of
      culturally tailored empirically-based substance abuse treatment, understand how acculturation
      processes confer risk for increased hazardous drinking among Latinos, and to inform further
      tailoring of treatments for multiple stressors, including acculturation stress.

      Research Hypotheses:

      Primary Aim 1: Treatment Main Effect. Determine the efficacy of standard motivational
      interviewing (MI) compared to culturally tailored MI (CTMI) at two, six, and twelve month
      follow-up. We hypothesize that CTMI participants will report fewer alcohol-related negative
      consequences and fewer heavy drinking days at follow-up vs. MI participants.

      Primary Aim 2: Explore acculturation stress as a moderator of alcohol treatment outcomes for
      Latinos. We hypothesize that among participants with high acculturation stress, those in CTMI
      will improve more over time than those in MI (at 6 months). We also hypothesize that among
      those who receive CTMI, those with high acculturation stress may show greater improvement
      over time (at six months) than those with low acculturation stress.
    

Intervention name(s): Motivational Interviewing; Culturally Tailored MI
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The MI is a single brief motivational intervention lasting 1.5 hrs. The MI includes MI structured strategies tailored to the patient's readiness to change such as: the Typical Day exercise, the use of personal feedback reports (e.g., normative feedback about their drinking), discussions about the pros and cons of use, and completion of a change plan; It is designed to follow MI principles of invoking autonomy and emphasizing collaboration with the interventionist.; CTMI is a single brief motivational intervention lasting 1.5hrs. The CTMI follows the same sequence of structured strategies as the MI arm, and while the components in CTMI and MI are parallel, the focus within them is different. CTMI components culturally relevant material, such as acculturation stress. The CTMI components, which are MI structured strategies, are culturally tailored to address relevant concerns and issues. There are also culturally tailored feedback element, such as ethnic normative feedback related to drinking.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment