title: Ethnic disparities in clinical severity and services for alcohol problems: results from the National Alcohol Survey.
abstract: BACKGROUND
  This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings.
  
  
  METHODS
  Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence.
  
  
  RESULTS
  While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care.
  
  
  CONCLUSIONS
  Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.
authors.affiliation: Institute for Health Policy Studies and the Department of Anthropology, History and Social Medicine, School of Medicine, University of California-San Francisco, 3333 California Street, San Francisco, CA 94118, USA. Laura.Schmidt@ucsf.edu
authors.forename: Laura A
authors.initials: LA
authors.lastname: Schmidt
authors.forename: Yu
authors.initials: Y
authors.lastname: Ye
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Greenfield
authors.forename: Jason
authors.initials: J
authors.lastname: Bond
mesh_terms: D000293:Adolescent; D000328:Adult; D000436:Alcoholics Anonymous; D000437:Alcoholism / Q000453:epidemiology* / Q000534:rehabilitation*; D044383:Black People / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012947:Social Work; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American