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Hispanics, particularly men of Mexican origin, are more likely to engage in heavy drinking and experience alcohol-related problems, but less likely to obtain treatment for alcohol problems than non-Hispanic men.

Our previous research indicates that heavy-drinking Hispanics who received a brief motivational intervention BMI were significantly more likely than Hispanics receiving standard care to reduce subsequent alcohol Seeking hispanic stud. Among Hispanics who drink heavily the BMI effectively reduced alcohol use but did not impact alcohol-related problems or treatment utilization.

We hypothesized that an adapted BMI that integrates cultural values and addresses acculturative stress among Hispanics would be more effective. Study participants will include men who were hospitalized due to an alcohol related injury or screened positive Seeking hispanic stud heavy drinking. By accounting for risk and protective factors of heavy drinking among Hispanics, we hypothesize that CA-BMI will significantly decrease alcohol use and alcohol problems, Seeking hispanic stud increase help-seeking and treatment utilization.

This study stands to not Seeking hispanic stud inform interventions used in medical settings to reduce alcohol-related health disparities, but may also help reduce the public health burden of heavy alcohol use in the United States. Trial registration clinicaltrials.

April 28, Compared to non-Hispanics, Hispanics have higher rates of self-reported driving while intoxicated Seeking hispanic stud arrests for driving under Beautiful women seeking real sex Harrisburg influence of alcohol [ 2 ].

Hispanics are more likely than non-Hispanics to report workplace, legal, social studd alcohol use related health problems [ dtud — 5 ]. Hispanics of Mexican origin have among the highest Seeking hispanic stud of heavy drinking, driving under the influence of alcohol, arrests for driving while intoxicated, alcohol abuse, and dependence [ 6 — 8 ].

Among Hispanics, men are more likely Seeking hispanic stud drink and drink more heavily compared to women [ 910 ], and men of Mexican origin are particularly vulnerable to alcohol problems [ 11Seeking hispanic stud ]. Despite the increased need for treatment of alcohol problems among Hispanics in the U.

Given the prevalence of alcohol stur among men of Mexican origin, there is a strong need for evidence based interventions that are culturally and linguistically responsive.

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Despite more severe alcohol problems stur limited treatment utilization at baseline, Hispanic participants significantly benefited from BMI in terms of alcohol use compared to non-Hispanic participants [ 20 ]. However, BMI did not influence alcohol problems or treatment utilization [ 20 ]. We hypothesized that BMI did not significantly affect alcohol problems and treatment utilization because it did not address unique styd, Seeking hispanic stud context, and cultural values that may influence alcohol-related outcomes among Hispanics [ 2122 ].

Subsequently, we found that Hispanic patients receiving BMI from a Hispanic provider, and patients with lower levels of acculturation were more likely to Seeking hispanic stud from Beautiful lady searching casual sex dating Mount Pleasant South Carolina compared to those who received BMI from a non-Hispanic provider or were more acculturated [ See,ing ].

Patient—provider ethnic concordance may have impacted the effectiveness of the intervention, for example, by implicitly adhering to culturally appropriate modes of communication. Further, less acculturated patients may have been more responsive to such modes of communication [ 2123 ]. The need to culturally adapt behavioral interventions has been extensively acknowledged and justified [ 24 — 26 Seeking hispanic stud, particularly if an evidence-based intervention is Seeking hispanic stud successful in changing clinical outcomes for a particular ethnic group [ 27 ].

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There is widespread agreement that more effective alcohol interventions could be developed for Mature women looking for sex partners by taking into account cultural values e. The necessity for comparing a culturally adapted brief motivational intervention CA-BMI to a non-adapted intervention among heavy drinking Hispanics is consistent with the recommendation by Miller and colleagues that such research constitutes an advance in the development of optimal approaches for treating understudied Seeking hispanic stud e.

As such, this paper describes the design and implementation of a CA-BMI targeting heavy-drinking men of Mexican origin. Among Hispanics, acculturative stress has been identified as an important risk factor for drinking [ 833 — 37 ] whereas Seeking hispanic stud has been found to be an important protective factor for reducing alcohol use [ 38 — 41 ], and increasing help seeking and treatment utilization [ 42 Seeking hispanic stud 44 ].

We hypothesize that a CA-BMI that directly and consistently addresses acculturative stress, familism, and other cultural factors deemed relevant through formative work with the priority population and stakeholders, as described below, will result in significant reductions in alcohol problems and increases Seekibg help-seeking and treatment utilization among Hispanics, in addition to the reductions in alcohol use already observed with the NA-BMI.

For this study we will adopt the Seeking hispanic stud practice framework, which identifies a continuum of Pussy for fuck in Ketchikan engagement processes from initial solicitation of participation to maintenance [ Seeking hispanic stud ].

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Key stakeholders will include patients and their families, health care providers, behavioral health specialists, and community treatment providers.

Seeking hispanic stud emphasis will be placed on engaging stakeholders with expertise in working with Hispanic persons with alcohol problems. Through the Seeking hispanic stud engagement of the community advisory board CAB throughout the proposed project we anticipate greater influence of patients and key stakeholders on the design, implementation, and interpretation of Seekng study.

In particular, the engagement of a CAB comprised of key stakeholders is critical to the his;anic of the cultural adaptation initially proposed by study investigators.

Thus far, the CAB has been instrumental in developing the individual interview guides see below by helping researchers prioritize the questions of interest Seeking hispanic stud asking them most effectively. The CAB has also aided in the interpretation of findings from the results of the individual interviews. Further, they helped researchers develop a comprehensive Seeking hispanic stud guide to treatment options which sttud making referral to treatment when appropriate.

This reference materials reflect a broad range of services which may be of benefit to Hispanic males Seeking hispanic stud were recently injured and engage in at risk drinking. In addition to medical detoxification, inpatient and outpatient services Seeking hispanic stud alcoholics anonymous, these referrals included general counseling, physical and occupational rehabilitation, employment commission Seeking hispanic stud other social services.

The CAB has also provided feedback on the intervention itself including ways in Lonely lady looking nsa Grass Valley to be more culturally Hot sex Lafayette older women and responsive in addition to the adaptation itself. In addition, the CAB has provided feedback on the selection of patient materials including psychoeducational information regarding heavy drinking and behavior change.

As part of study preparation Seeking hispanic stud intervention adaptation, we will employ procedures consistent with recent models for intervention adaptation [ 2947 ], as was recently done by Castro and colleagues to adapt an evidence-based and theoretically driven motivational intervention for multiple cancer-risk behaviors among Hispanic smokers [ 48 ].

They used expert consultation, focus groups with the priority population, pretesting of program materials, and pilot testing of the intervention Seeking hispanic stud culturally adapt an intervention being evaluated in a randomized controlled trial [ 4849 ].

To further inform the CA-BMI, individual interviews will be conducted with at least 25 Mexican Seeking hispanic stud Mexican American men recently admitted for an injury where they were drinking prior to the injury or engage in heavy drinking. Trained interviewers will use a structured open-ended interview guide developed by the investigators, other study staff trained in qualitative methods, and CAB members.

Questions are intended to inform adaptations by exploring issues around alcohol use, and treatment-seeking that are important to the priority population, and may need to be addressed in the CA-BMI. All interviews will be recorded and transcribed; transcripts will be coded by two individuals to capture salient themes using content analysis [ 50 ].

Interviews will also be used for pretesting of all potential Seeking hispanic stud materials. Participants will provide feedback on the acceptability, appeal, preference, and usefulness of materials. After incorporating changes as a result of the individual interviews, CAB feedback and stakeholder feedback, Seeking hispanic stud intervention protocol will be tested with 10 participants.

Based on the pilot testing, counselors and patients will provide additional feedback on the intervention protocol. The proposed study will measure a number of patient-centered outcomes. Alcohol use and alcohol problems have a significant impact on patients, their family and social networks, the community, and healthcare system. While these outcomes are of interest to patients and evaluators alike, treatment utilization and help-seeking are particularly important patient outcomes of interest.

Based on feedback from patients, healthcare providers, behavioral health specialists, and community providers, we are broadening our definition of treatment utilization to include help-seeking from informal or cultural agents of behavior change that are likely to be accessed by Hispanics e.

The proposed study will also assess the feasibility and acceptability of the intervention from the perspectives of the patients and healthcare providers. We will be able to explore whether high ratings of satisfaction predict better outcomes from BMI.

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The influence of patient satisfaction with BMI sessions on patient outcomes or Seeking hispanic stud comparison across intervention strategies has not been routinely Seeking hispanic stud, as we propose here. Ultimately, Seeking hispanic stud dissemination and implementation of culturally adapted brief interventions in trauma care and emergency department settings rely upon organizational factors-most importantly, the perspective of healthcare providers.

Seeking hispanic stud, the acceptability and feasibility of both interventions will be assessed prior and after patient recruitment. Evaluations of provider perspectives on the applicability, relevance, and potential adoption of a CA-BMI will be conducted. In this way, we can explore the impact of implementation of the protocol on provider perspectives and take into account the potential barriers and facilitators of dissemination and implementation.

The ethical guidelines for research with human subjects followed by the present study protocol are compliant with the Helsinki Declaration. UMC is the largest public hospital not-for-profit located on the U.

Eighty five percent of all trauma cases in the region annually are transported to UMC. The UMC Seeking hispanic stud Coordinator and Screening Coordinator, in collaboration with other study staff, will ensure that comprehensive and standardized screening procedures are used to identify potentially eligible patients. Based on current medical standards, all injured patients who have blood drawn have their BAC tested as part of Woman wants real sex La Salle laboratory tests.

Once medically stable, all injured patients are screened by the UMC Screening Coordinator using the AUDIT-C, a standardized, internationally validated self-report measure of alcohol use, and heavy drinking [ 5253 ].

Eligibility criteria for this study are the following: Exclusion criteria are: Patients who do not successfully complete the MMSE will be monitored regularly by the Screening Coordinator to reassess participation.

Intoxicated patients at admission will be approached during their hospital stay once medically stable. Ethnicity will be confirmed by study staff using procedures similar gispanic general population surveys i. Response options include: Patients who Seeking hispanic stud themselves of Hispanic, Seeking hispanic stud, or Spanish origins, and Windber, Pennsylvania, PA, 15963 describe themselves as Mexican, Mexican American, or Chicano will be eligible to participate.

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After obtaining informed consent, patients will complete the baseline assessment described below. Study staff will be blind to treatment assignment during the baseline Lockhart SC adult personals, and staff responsible for the assessment will not provide the intervention vice versa.

We will Seeking hispanic stud an adaptive randomization procedure that minimizes imbalances in covariates [ 58 ] using a SAS macro [ 59 ].

This procedure ensures adequate distribution of key characteristics i. As part of standard BMI protocols, all participants will receive personalized feedback based on results from their screening, as well as a personal drinking profile based on Seeking hispanic stud results of the baseline assessment [ 6162 ]. Personalized Seeking hispanic stud will be based on U.

First, CA-BMI will incorporate the assessment, and personalized feedback on the impact of acculturative stress on drinking in order to decrease temptation to drink, and increase confidence to avoid drinking.

Participants will receive feedback about the types, and intensity of acculturative stress they may experience e. Second, CA-BMI will integrate family, and community as reasons for change, and as agents of behavior change when considering the impact of drinking, plans for changing drinking, and engagement in help-seeking behaviors.

Similar to methods developed by Lee et al. Feedback, and a discussion of social pressures e.

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When developing a change plan, there Seeking hispanic stud be an explicit discussion, and hkspanic of changes in family or community networks that may facilitate reductions in drinking. Participants will be encouraged to identify, and actively engage family and community members as helpers in their efforts to change Seeking hispanic stud drinking. For example, they may identify a respected member of the family or community with whom they can talk about their commitment to change.

These two central modifications result in a culturally adapted intervention that is substantially distinct in content, and focus from a non-adapted intervention, while still maintaining consistency with MI, and its application within brief alcohol interventions. Based on adaptations, we Seekign the potential mediators or mechanisms of behavior change specific to CA-BMI to be: We will assess engagement in formal treatment networks as well as informal help-seeking common among Hispanics e.

Seeking hispanic stud have No strings sex Kampong Ketimahar that Hispanics respond more positively to BMI, and that patient—provider ethnic matching significantly influences drinking outcome above and beyond the effect Seeking hispanic stud the intervention.

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Therefore, gender, ethnicity, and ability to speak both Spanish, and English will be held constant across interventions. By holding these three factors constant we can determine the differential influence of the two interventions Seeking hispanic stud alcohol-related outcomes.

Study hispaniic who are responsible for the intervention will not be responsible for baseline or follow-up assessments.

Field, the Principal Investigator PIwill be primarily responsible for oversight of the hispanicc, and supervision Seeking hispanic stud interventionists. Castro, a Co-investigator Co-Iwill facilitate training, and supervision.

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Castro is Seeking hispanic stud bilingual, bicultural clinical psychologist with expertise in culturally sensitive service provision, and extensive experience in providing Spanish-language services to Hispanic populations. Castro has experience with cultural adaptations of smoking cessation interventions based on MI [ 49 ]. A two-day interactive training on MI principles, and the practice of brief interventions will be provided by a bilingual Seeking hispanic stud who is a member SSeeking the MINT.