title: Explaining racial/ethnic differences in adolescent substance abuse treatment completion in the United States: a decomposition analysis.
abstract: OBJECTIVE
  To identify contributors to racial/ethnic differences in completion of alcohol and marijuana treatment among adolescents at publicly funded providers.
  
  
  METHODS
  The 2007 Treatment Episode Data Set provided substance use history, treatment setting, and treatment outcomes for youth aged 12-17 years from five racial/ethnic groups (N = 67,060). Individual-level records were linked to variables measuring the social context and service system characteristics of the metropolitan area. We implemented nonlinear regression decomposition to identify variables that explained minority-white differences.
  
  
  RESULTS
  Black and Hispanic youth were significantly less likely than whites to complete treatment for both alcohol and marijuana. Completion rates were similar for whites, Native Americans, and Asian-Americans, however. Differences in predictor variables explained 12.7% of the black-white alcohol treatment gap and 7.6% of the marijuana treatment gap. In contrast, predictors explained 57.4% of the Hispanic-white alcohol treatment gap and 19.8% of the marijuana treatment gap. While differences in the distribution of individual-level variables explained little of the completion gaps, metropolitan-level variables substantially contributed to Hispanic-white gaps. For example, racial/ethnic composition of the metropolitan area explained 41.0% of the Hispanic-white alcohol completion gap and 23.2% of the marijuana completion gap. Regional differences in addiction treatment financing (particularly use of Medicaid funding) explained 13.7% of the Hispanic-white alcohol completion gap and 9.8% of the Hispanic-white marijuana treatment completion gap.
  
  
  CONCLUSIONS
  Factors related to social context are likely to be important contributors to white-minority differences in addiction treatment completion, particularly for Hispanic youth. Increased Medicaid funding, coupled with culturally tailored services, could be particularly beneficial.
authors.affiliation: Robert Wood Johnson Health and Society Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: bsaloner@gmail.com.
authors.forename: Brendan
authors.initials: B
authors.lastname: Saloner
authors.affiliation: Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Carson
authors.affiliation: Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lê Cook
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000208:ethnology; D000437:Alcoholism / Q000208:ethnology / Q000628:therapy; D002648:Child; D005006:Ethnicity / Q000208:ethnology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000208:ethnology / Q000628:therapy; D010349:Patient Compliance / Q000208:ethnology* / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000208:ethnology / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000208:ethnology* / Q000628:therapy*; D014481:United States
keywords: Decomposition; Disparities; Race/ethnicity; Substance abuse treatment