title: Disparities in Latino substance use, service use, and treatment: implications for culturally and evidence-based interventions under health care reform.
abstract: BACKGROUND
  The goal of this systematic literature review was to enhance understanding of substance use, service use, and treatment among Latino subgroups to improve access to care and treatment outcomes in an era of health care reform.
  
  
  METHODS
  The authors used 13 electronic databases and manually searched the literature from January 1, 1978, to May 30, 2013. One hundred (69%) of 145 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus discussions and a content expert reconciled discrepancies.
  
  
  RESULTS
  Current rates of alcohol and substance abuse among Latinos are comparable to or surpass other U.S. ethnic groups. Disparities in access and quality of care are evident between Latinos and other ethnic groups. As a heterogeneous group, Latinos vary by geographic region in terms of substance of choice and their cultural identity takes precedence over general ethnic identity as a likely determinant of substance abuse behaviors. There is growing research interest in systems influencing treatment access and adherence among racial/ethnic and gender minority groups. However, studies on Latinos' service use and immediate treatment outcomes have been both limited in number and inconsistent in findings.
  
  
  CONCLUSIONS
  This review identified human capital, quality of care, and access to culturally responsive care as key strategies to eliminate disparities in health and treatment quality. Implications are discussed, including the need for effectiveness studies on Latinos served by systems of care that, under health care reform, are seeking to maximize resources, improve outcomes, and reduce variation in quality of care.
authors: School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, United States. Electronic address: erickgue@usc.edu.
authors: Erick G
authors: EG
authors: Guerrero
authors: Jeanne C
authors: JC
authors: Marsh
authors: Tenie
authors: T
authors: Khachikian
authors: Hortensia
authors: H
authors: Amaro
authors: William A
authors: WA
authors: Vega
mesh_terms: D002755:Choice Behavior; D003431:Cross-Cultural Comparison; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012933:Social Identification; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Disparities; Effective treatment; Health care reform; Latino substance use; Service use