Study Reveals Inequities in Alcohol Screenings, Resulting In Missed Opportunities for Treatment

Race, ethnicity, education and insurance status can determine the quality of alcohol screenings and care

Emeryville, CA (September 8, 2022) – Some racial and ethnic groups are not receiving adequate screening for alcohol use in clinical settings, according to a new study from the Alcohol Research Group (ARG), a program of the Public Health Institute, in collaboration with RTI International. Published today in Preventive Medicine Reports, the study looked at predictors such as gender, age, race and ethnicity, education, and insurance status, and their interaction of alcohol screening quality.

Alcohol screening quality was determined by alcohol quantity screening, that is, by measuring if health care professionals asked individuals not only if they drink, but also how much they drink—which is essential to identify heavy drinkers and provide appropriate treatment. High episodic drinkers (HED) were those who drank five or more drinks of alcohol on one occasion and high-intensity drinkers (HID) were those who drank eight or more drinks of alcohol on one occasion.

Results showed that Hispanic, Black, and Other racial and ethnic respondents generally received quality alcohol screening less often than White respondents. For example, while 61.2% of White respondents received quality screening, only 48.3% of Black respondents received comparable screening. The research identified education as an additional important predictor of screening, showing that Hispanic, Black, and Other racial and ethnic respondents with a high school education or less received quality screening least often (41.8%). In the high episodic drinkers group (those who drank 5 or more drinks on one occasion), among respondents with public insurance (Medicare and Medicaid) and a high school education or less, only 24.5% were asked about the quantity of alcohol that they drank.

Administered by health professionals, alcohol screening and brief intervention (ASBI) is an evidence-based preventive service used to identify and help individuals drinking beyond recommended limits. Past research has shown that while most adults in the U.S. are asked about their alcohol use in general terms, far fewer have been specifically asked how much they drink.

“Not fully capturing how much a client drinks alcohol can result in those individuals missing vital preventive care, like alcohol counseling, and lead to unintended disparities in alcohol-related health services,” explained lead study author and biostatistician Meenakshi Sabina Subbaraman. “In addition, what this research found was inequities in the health care system where people of color and low-income individuals or those without a college education aren’t receiving the same quality of care when compared to their counterparts.”

“This research is important and shines a spotlight on the need to address inequities in how the ASBI is being used and who’s benefiting from it,” Subbaraman added.

In other findings, among the HED and HID subgroups, only 11.8% of respondents aged 18-34 with public insurance were asked how much they drink alcohol by a doctor.

“This alarmingly low rate of quality screening may be explained by the fact that those under 35 often have fewer health conditions and may be considered a lower priority by those working in the health care field,” Subbaraman said. “Still, heavy alcohol drinking is highest in younger adults. Our findings suggest that those who could benefit the most from a comprehensive alcohol screening that measures how much a person drinks are frequently being missed.”

“The study team calls for a greater focus on systemic inequities in the health care system, to ensure that people of color and low-income individuals receive equitable access to alcohol screenings and quality treatment, if needed.”

Support for this paper was provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) under award number P50AA005595 (W.C. Kerr, PI) at the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About the Alcohol Research Group

For over 60 years, the Alcohol Research Group (ARG) has been actively engaged in critically needed alcohol- and other drug-related public health research. We study drinking and other drug use and how these and other factors such as gender, race/ethnicity, sexual identity, socioeconomic disparities, and environmental differences affect health. ARG is also home to the NIAAA-funded National Alcohol Research Center and training program. Please visit arg.org.

ARG is a program of the Public Health Institute, an independent nonprofit organization, dedicated to promoting health, well-being and quality of life for people throughout California, across the nation and around the world. Please visit phi.org.

About RTI International

RTI International is an independent, nonprofit research institute dedicated to improving the human condition. Clients rely on us to answer questions that demand an objective and multidisciplinary approach—one that integrates expertise across the social and laboratory sciences, engineering and international development. We believe in the promise of science, and we are inspired every day to deliver on that promise for the good of people, communities and businesses around the world. For more information, visit www.rti.org.