Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations.

OBJECTIVES: To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice. METHODS: Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015. RESULTS: A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described. CONCLUSIONS: On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness. PRACTICE IMPLICATIONS: Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

Using needs assessment to develop curricula for screening, brief intervention, and referral to treatment (SBIRT) in academic and community health settings.

This article describes the use of a brief needs assessment survey in the development of alcohol and drug screening, brief intervention, and referral to treatment (SBIRT) curricula in 2 health care settings in the San Francisco Bay Area. The samples included university medical center faculty (n = 27) and nonphysician community health and social service providers in a nearby suburban county (n = 21). Informed by curriculum development theory and motivational interviewing strategies, questions regarding clinical and educational priorities, perceived importance and confidence with screening and intervention techniques, and referral resource availability were included. Medical center faculty expressed greater concern about limited appointment time (P = .003), adequacy of training (P = .025), and provider confidence (P = .038) as implementation obstacles and had lower confidence in delivering SBIRT (P = .046) and providing treatment referrals (P = .054) than community providers. The authors describe their approach to integrating needs assessment results into subsequent curriculum development. Findings highlight potential differences between physician and nonphysician training needs.

A randomized trial to assess the effect of a research informational pamphlet on telephone survey completion rates among older Latinos.

PURPOSE OF THE STUDY: To assess the effects of receiving a research informational pamphlet produced by the federal Office for Human Research Protections on telephone survey participation rates of older Latinos, and illustrate the feasibility of nesting recruitment studies within other funded studies when stand alone funding for recruitment studies is limited. DESIGN AND METHODS: Latino patients aged ≥50 with ≥1 visit during the preceding year (N=1314) were sampled from three community clinics and a multi-specialty medical group. Patients were randomly assigned to receive or not receive a pamphlet that contained information on research participation in the initial mailing for the telephone survey study. Survey participation rates were compared between the pamphlet and no pamphlet groups. RESULTS: In a multivariate model, women (OR=1.4; 95% CI 1.1, 1.8), and those with public insurance (vs. no insurance; OR=1.7; 95% CI 1.1, 2.5) were more likely to participate, while those age 65+ (vs. age 50-54; OR=0.6; 95% CI 0.4, 0.8) were less likely to participate; there was no significant difference by pamphlet group (OR=0.8; 95% CI 0.7, 1.1). Nesting of the randomized trial of the recruitment pamphlet within the funded study required minimal additional resources. IMPLICATIONS: Recruitment methods that are more intensive than a pamphlet may be needed to enhance survey participation rates among older Latinos. Nesting recruitment trials within funded studies is a promising and efficient approach for testing recruitment strategies.

Reviews: developing culturally sensitive dementia caregiver interventions: are we there yet?

Despite evidence of ethnic differences in family caregivers' experiences, the extent to which caregiver interventions are culturally tailored to address these differences is unknown. A systematic review of literature published from 1980 to 2009 identified: differences in caregiving experiences of African American, Latino, and Chinese American caregivers; psychosocial support interventions in these groups; and cultural tailoring of interventions. Ethnic differences in caregiving occurred at multiple levels (intrapersonal, interpersonal, environmental) and in multiple domains (psychosocial health, life satisfaction, caregiving appraisals, spirituality, coping, self-efficacy, physical functioning, social support, filial responsibility, familism, views toward elders, use of formal services and health care). Only 18 of 47 intervention articles reported outcomes by caregiver ethnicity. Only 11 reported cultural tailoring; 8 were from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) initiative. Cultural tailoring addressed familism, language, literacy, protecting elders, and logistical barriers. Results suggest that more caregiver intervention studies evaluating systematically the benefits of cultural tailoring are needed.

Effectiveness of adult vaccination programs in faith-based organizations.

Elderly persons of African American and Latino descent have lower rates of immunizations after adjustment for insurance and education. Interventions that use faith-based organizations (FBOs) are promising but have not been well evaluated. We examined the effectiveness of an FBO adult vaccination program in minority communities. From December 2003 through January 2004 and November 2005 through February 2006, 15 churches were randomized to intervention with onsite adult vaccinations or to comparison with no vaccinations. Participants were eligible if they had not been previously vaccinated with pneumococcal vaccine, did not regularly receive influenza vaccine, were aged > or =65 years, and had a clinical indication for vaccination. Baseline and follow-up surveys were conducted. Primary outcome was rates of influenza and pneumococcal vaccinations. The study sample (N=186) was 44% African American, 43% Latino, 8% White, and 3% Asian. Of those eligible, 90 of 112 (80%) in the intervention group used the influenza vaccine compared to 32 of 70 (46%) in the comparison group (P < .001). Of those eligible, 58 of 88 (66%) in the experimental group used the pneumococcal vaccine compared to 20 of 57 (35%) in the comparison group (P < .001). Participants in the intervention group were significantly more likely to receive influenza vaccinations (odds ratio [OR] 4.8, 95% confidence interval [CI] 2.5-9.4) and pneumococcal vaccination (OR 3.6, 95% CI 1.8-7.2). More than ninety percent of all participants reported willingness to participate in FBO education and promotion programs. This onsite, FBO adult vaccination program was effective in increasing vaccination rates and may be promising for decreasing raciallethnic disparities in vaccination rates.

Mentoring in community-based participatory research: the RCMAR experience.

Community-based participatory research (CBPR) has been identified as a useful strategy to overcome disparities in minority elders. However, little consensus exists with respect to appropriate CBPR training and mentoring mechanisms. In this paper, we summarize the mentoring activities in each of the six currently funded Resource Centers on Minority Aging Research (RCMAR). In addition to mentoring trainees and/or junior faculty, we also explore the bi-directional mentoring that occurs when faculty at academic health centers develop partnerships with members of their target communities.

Focus group interviews on racial and ethnic attitudes regarding adult vaccinations.

UNLABELLED: Adult immunizations have dramatically improved the health of many Americans. In the United States, researchers have documented disparities in the utilization of adult vaccinations between whites and racial and ethnic minority populations. This article examines racial and ethnic attitudes regarding recommended adult vaccinations. METHODS: Four adult focus groups (N=22) were conducted in community churches in San Francisco, CA. Participants were either age-appropriate or had clinical indications to receive a strong recommendation for influenza and pneumococcal immunizations but had not been routinely immunized against influenza and had never been vaccinated against pneumococcal disease. Content analysis was used to analyze narrative data and identify emerging themes. RESULTS: Participants reported that they lacked information about the benefits or potential side effects of influenza and pneumococcal vaccinations and that their physicians were not routinely informing them of, or recommending, these vaccinations. Meanwhile, most participants expressed a willingness to be vaccinated against pneumococcal infection and influenza. All focus group participants felt that community churches were a potential venue for delivery of adult vaccines. CONCLUSIONS: Many adult racial and ethnic minorities have basic information regarding the influenza vaccine but lack sufficient information regarding the benefits of pneumococcal vaccinations. Physicians should provide information regarding adult vaccinations to all patients. On-site vaccination and vaccine education programs in community churches may be successful in increasing the utilization of adult vaccinations in unvaccinated church populations.

Ethnic minority older adults participating in clinical research: developing trust.

OBJECTIVE: African American, Latino, and American Indian older adults are underrepresented in clinical research studies. A significant barrier to participation in research is mistrust of the scientific community and institutions. The aims of this article are to discuss the lack of representation of ethnic minorities in clinical research. METHODS: This article presents a review of the literature regarding medical research mistrust. Also described are the trust-building activities of the Resource Centers on Minority Aging Research (RCMAR), federally funded centers focused on research and aging in communities of color. DISCUSSION: The RCMAR centers are building trust with the communities they serve, resulting in the recruitment and retention of ethnic minority older adults in clinical research studies and health promotion projects. Implications are discussed for other researchers toward building trust with ethnic minority elders to increase their participation in research.