The Role of Ethnicity in Alcohol Screening-related Decision Making by Medical and Dental Trainees.

Abstract

Objective: Chronic heavy alcohol use increases risk for developing alcohol use disorder (AUD), leading to adverse health outcomes. Evidence suggests patient demographics are used to make treatment decisions, which contributes to barriers to AUD treatment experienced by Hispanic/Latino (H/L) individuals. This study characterized the use of ethnicity in alcohol use assessment and treatment referral among medical (MT) and dental trainees (DT).

Method: Current MT (n=54) and DT (n=59) reviewed thirty-two vignettes varying systematically in sex, age, ethnicity, and alcohol concern cues. Trainees used 0-100 visual analog scales (VASs) to rate likelihood of discussing the patient's alcohol use (VAS1), likelihood the patient has AUD (VAS2), comfort discussing alcohol use with the patient (VAS3), and likelihood of referring to AUD-related treatment (VAS4). Idiographic regressions characterized individuals' decision-making policies. Group-level analysis determined the influence of trainee ethnicity and trainee type on patient ethnicity cue use.

Results: Almost all (96-100%) trainees reliably used the alcohol concern cue when providing ratings. 25-56% of trainees used ethnicity as a cue. Trainee ethnicity did not significantly affect ethnicity cue use when evaluating vignettes (t<1.37, p>.17, d<.56). Analyses indicated MT weighed the alcohol concern cue more heavily than DT for VAS1.

Conclusions: Results suggested that a substantial proportion of trainees reliably used patient ethnicity to make alcohol treatment-related decisions, consistently to the potential detriment of H/L patients. Finally, lower weighting of alcohol concern among DT than MT in all but one judgment suggests DT may not view alcohol screening as part of their professional role as strongly as MT.