>>WELCOME TO TODAY'S
WEBINAR ON REDUCING SIGNATURES
STATE REGULATOR AROUND ALCOHOL
USE DISORDER IN MINORITY
COMMUNITIES.
STIGMA AT HARMFUL LEVELS AS WELL
AS INTERNALIZATION OF STIGMA BY
SUBSTANCE USES IS WIDE SPREAD
AND MAY REPRESENT A SERIOUS
BARRIER TO TREATMENT SEEKING AND
TREATMENT ACCESS.
TODAY'S WEB NAINAR WILL FOCUS ON
A NOVEL INTERVENTION TO REDUCE
THE IMPACT OF STIGMA AMONG LATIN
X IMMIGRANTS AND ITS POTENTIAL
UTILITY IN THE AFRICAN AMERICAN
AND OTHER MINORITY COMMUNITIES.
MY NAME IS DIEDR'S ROACH AND I
SERVE AS A MEDICAL OFFICER IN
THE DIVISION OF TREATMENT AND
RECOVERY RESEARCH AT THE
NATIONAL INSTITUTE ON ALCOHOL
ABUSE AND ALCOHOLISM.
IT'S MY GREAT PLEASURE AND
PRIVILEGE TO INTRODUCE OUR
SPEAKERS FOR TODAY, START
NOTHING ORDER OF PRESENTATION
WITH DR. CHRISTINA LEE.
DR. LEE IS ASSOCIATE PROFESSOR
IN THE SCHOOL OF SOCIAL WORK AT
BOSTON UNIVERSITY SCHOOL OF
SOCIAL WORK.
ADDICTION FACULTY AT BU'S
[INDISCERNIBLE] CENTER, BOOF
THEOLOGY MEDICAL CENTER,
MOTIVATIONAL INTERVIEWING
TRAINING COMMITTEE MEMBER FOR
THE AMERICAN SOCIETY OF
ADDICTION MEDICINE AND A FACULTY
AFFILIATE AT BU'S CENTER FOR
ANTIRACIST RESEARCH.
SHE IS ALSO THE RESEARCH
CORRECTOR AT THE BU SCHOOL OF
SOCIAL WORKS CENTER FOR
INNOVATION AND SOCIAL WORK AND
HEALTH AND MENTOR'S GRADUATE AND
POST DOCTORAL SCHOLARS FROM
DIVERSE, RACIAL AND ETHNIC
GROUPS.
HER RESEARCH BRIDGES THE AREAS
OF INTERVENTION SCIENCE,
ADDICTION PSYCHOLOGY AND HEALTH
INIQUITIES.
TODAY, DR. LEE WILL PROVIDE AN
OVERVIEW OF THE CULTURALLY
ADAPTED STIGMA MITIGATION
INTERVENTION OR CASMI FOR WHOLE
USE AMONG LATIN X IMMIGRANTS.
MR. HUM BERT O [INDISCERNIBLE]
IS A CONSULTANT AT THE NONPROFIT
ORGANIZATION SPECIALIZING IN
INNOVATION POTENTIAL AND
BUILDING CAPACITY IN THE SOCIAL
SECTOR TO GENERATE EQUITABLE
SYSTEMATIC CHANGE.
HE IS A MASTER OF SOCIAL WORK
AND MASTER OF BUSINESS
ADMINISTRATION WITH EXPERIENCE
IN NONPROFITS SPANNING AREAS OF
HOMELESSNESS, MENTAL HEALTH,
EDUCATION, AND ADVOCACY.
AND HE HAS PARTICULAR EXPERTISE
IN SOCIAL INNOVATION.
MR. CAMARANA IS CO AUTHOR OF THE
BOOK--ADAPTIVE MI STUDY LED BY
DR. LEE, TODAY MR. CAMARENA WILL
DISCUSS COMMUNITY RESPONSES TO
THE CULTURALLY ADAPTED MOTIVATE
THE INTERVENTION OR CAMI.
DR. VICTOR FIGUEREO IS A
PROFESSOR THE UNIVERSITY OF
PITTSBURGH SOCIAL WORK.
HIS WORK FOCUSES ON
RACIALIZATION, THE INTERSECTIONS
OF RACE AND ETHNICITY AND ACCESS
TO HEALTH AND MENTAL HEGHT CARE
AS IT PERTAINS TO THE SOAK
LOGICAL WELL BEING AND DISTRESS
OF LATIN X INDIVIDUALS LIVING IN
THE UNITED STATES.
THE PURPOSE OF HIS WORKS IS TO
DEMYSTIFY THE ETHNIC AND RACIAL
HOMOGENEITY OF U.S. LATIN
Xss.
THE LIVED EXPERIENCE OF AFRO AND
BLACK LATIN Xs AND CONTRIBUTE
TO THE ELIMINATION OF LATIN X
HEALTH AND MENTAL HEALTH
DISPARITIES IN THE U.S.
HE IS THE AUTHOR OF
RACIALIZATION AND SOAK LOGICAL
DISTRESS AMONG U.S. LATIN X'S.
TODAY DR. FIGUEREOO WHICH WILL
DISCUSS DRINKING WITH THE CAMI,
MISS ROCIO MORIEL, WORKS WITH
PROVIDENCE HEALTH AND SERVICES
IN SOUTHERN CALIFORNIA, SHE
WORKS PROVIDING APPROPRIATE
HEALTH EEDUCATION AND
COUNSELING, LINKING COMMUNITY
MEMBERS TO APPROPRIATE CARE, AND
ADVOCATING FOR BEST APPROACHES
TO ADDRESSING COMMUNITY HEALTH
AND SOCIAL SERVICES NEEDS.
MISS MORIEL IS CURRENTLY
COLLABORATING WITH A COMMUNITY
SOCIAL WORKER IN A LOCAL
EMERGENCY DEPARTMENT TO ASSIST
PATIENTS WITH CARE MANAGEMENT
AND TO PROVIDE RESOURCES FOR ANY
HEALTHCARE SERVICES THEY MAY
NEED.
SHE RENTLY PARTNER WIDE UCLA ON
THE ALCOHOL RESEARCH STUDY FOR
LATINOS PROVIDING MOTIVATIONAL
INTERVIEWING FOR UNHEALTHY
DRINKING IN THE LATINO
COMMUNITY.
TODAY'S MISS MORIEL WILL DISCUSS
USING THE CAMI TO CONNECT TO A
HIGH RISK UNDOCUMENTED
POPULATION TO REDUCE DRINKING
DURING COVID.
AND FINALLY, WE WILL HEAR FROM
DR. TAMIKA ZAPOLSKI WHO IS A
INDIANA-PURDUE UNIVERSITY
Ph.D.
AND SHE IS ALSO CO DIRECTOR OF
THE ADOLESCENT BEHAVIOR HEALTH
RESEARCH PROGRAM, A
MULTIDISCIPLINARY OF TEAM
RESEARCHERS WITHIN THE INDIANA
UNIVERSITY CREATED TO IMPROVE
THE HEALTH AND WELL BEING OF
TEENAGERS, AND YOUNG ADULTS
THROUGH RESEARCH, EDUCATION AND
INTERVENTION, HER RESEARCH
FOCUSES ON RISK FOR SUBSTANCE
USE AND OTHER HEALTH BEHAVIORS,
AMONG AFRICAN AMERICANS.
GIVEN LIMITED INTEGRATIVE
LITERATURE ON UNDERSTANDING
AFRICAN AMERICAN RISK FOR
ALCOHOL USE AND RELATED
PROBLEMS, DOCTORS ZAPOLSKI
DEVELOPED A MODEL FOR ALCOHOL
USE THAT WAS RECENTLY PUBLISH
INDEED SOAK LOGICAL BULLETIN.
TODAY DR. ZAPOLSKI WILL DISCUSS
DRUG AND ALCOHOL USE AMONG
PLAQUE AMERICANS.
BEFORE WE BEGIN FEEL FREE TO USE
THE ACCEPTED LIVE FEEDBACK
BUTTON LOCATED AT THE TOP OF THE
VIDEOCAST PAGE TO SUBMIT PANELS
FOLLOWING TODAY'S PRESENTATIONS.
ALSO THIS WEBINAR WILL BE
ARCHIVEDOT NIH VIDEOCAST PAGE
FOR FUTURE VIEWING.
AND NOW, PLEASE JOIN ME IN
WELCOMING OUR FIRST SPEAKER FOR
TODAY DR. CHRISTINA LEE.
>>I'M VERY PLEASED TO
PRESENT THE EVIDENCE
BASE INTERVENTION, THE
CULTURALLY ADAPTED STIGMA
MITIGATION FOR ALCOHOL MISUSE
AMONG LATINO A/X IMMIGRANTS.
I WILL EXPLAIN THIS TALK AND
LOOKING AT ALL MY RESOWLTS OVER
THE YEARS, I HAVE REALIZE THAT
WHAT THE INTERVENTION ADDRESSES
ARE THE CONSEQUENCES OF BEING
STIGMATIZED FOR DIFFERENT
REASONS INCLUDING ALCOHOL,
HAVING IMMIGRANT STATUS OR
THROUGH 1'S RAISE.
SO DESCRIBING EARLY WORK,
HOWEVER, I WILL BE USING THE KEY
TERM CAMI, I ALSO FEEL VERY
PRIVATE SECTOR LEMMINGED TO HAVE
MY COLLEAGUES HERE TODAY, HUM
BERT O, DR. FIGUERO, AND
[INDISCERNIBLE].
THEY HAVE DONE A TON OF WORK AND
THEY WILL SHARE THEIR REALLY
VALUABLE PERSPECTIVES--HEALTH
DISPARITIES EVEN BEFORE IT
BECAME A CENTRAL FOCUS AND FOR
SUPPORTING RESEARCH THAT WAS
OUTSIDE THE BOX WITH THE GOAL OF
MINIMIZING HEALTH INENTIOUS
QUITYS RELATED TO HARMFUL
ALCOHOL USE.
RECENTLY, I THANKED MY STUDY
PARTICIPANTS BY POSTING MY
NOTICE IN A SPANISH LANGUAGE
NEWSPAPER IN BOSTON.
CAN YOU SEE THE LINK HERE IN THE
CENTER AND THE THANK YOU NOTICE
THAT WENT TO A SUMMARY OF THE
STUDY RESULTS EVERY DAY LANGUAGE
THAT WAS TRANSLATED INTO
SPANISH.
SO TO BEGIN IN 2002, I CHOSE TO
FOCUS ON LATIN X'S BECAUSE THE
EVIDENCE SHOWED AND STILL SHOWS
THAT DESPITE DRINKING ALCOHOL AT
RATES THAT ARE COMPARABLE TO
OTHER RACIAL ETHNIC GROUPS,
THERE REMAIN UNEXPLAINED
DISPARITIES IN HEALTH OUTCOMES,
RELATED TO ALCOHOL MISUSE AMONG
LATIN X'S, THESE INCLUDE HIGHER
RATES OF LIVER CIRRHOSIS, HIGHER
RATES EVER MOTE VORVEHICLE
CRASHES INVOLVING ALCOHOL AND
INCREASED ARRESTS DUE TO
DRUNKENNESS.
THESE PHYSICAL CONSEQUENCES SUCH
AS LIVER CIRRHOSIS ARE MOST
ASSOCIATED WITH A SPECIFIC HEAVY
PATTERN OF DRINKING.
THIS IS A RECENT ANALYSIS OF THE
NASDA, IF YOU LOOK AT THE
CENTER, YOU WILL SEE THE
PERCENTILES FOR BINGE DRINK
NOTHING THE PAST 30 DAYS.
WHITE NONLATINOS ARE IN THE
YELLOW, BLACK INDIVIDUALS ARE
REPRESENTED BY MAROON AND LATIN
X'S ARE IN GREEN.
SO YOU CAN SEE HERE THAT AMONG
HISPANIC MALES AND FEMALES IN
GREEN, THEY HAVE HIGHER RATES OF
BENCH DRINKING, 19.3% AMONG
HISPANIC MALES AND 16.2% AMONG
HISPANIC FEMALES.
THIS INFORMATION ON HEALTH
DISPARITIES MOLTIVATED THE
STUDY, AND TRIEWT DEVELOPMENT
AND TESTING, IT WAS--INVOLVEMENT
AND INPUT.
DRINKING OF THE COMMUNITY
ADVISORY BOARD WAS NEEDED AND
THAT REGULARLY CONSISTED OF
SPANISH BILING Y'ALL COMMUNITY
HEALTH WORKERS, PROVIDERS AND
COMMUNITY LEADERS, GIVING INPUT
TO WHAT THE COMMUNITY NEEDED AND
IN THE BEGINNING OF 2002, THEY
SAID WE NEED NOR TREATMENT SITES
THAT COULD SERVICE US IN
SPANISH.
AND SADLY IN 2022, THAT IS STILL
THE CASE.
THE CAP ALSO GAVE INPUT TO THE
DEVELOPMENT AND AT THE END OF
THE STUDY, THE GROUP LISTENED TO
THE CAMI AUDIO TAPES AND SPANISH
AND ENGLISH AND GAVE THEIR
FEEDBACK, I ALSO FORMED A
WORKING PARTNERSHIP AT OUR
CLINICAL TRIAL SITE, THIS
COMMUNITY STAGE 1 TREATMENT
DEVELOPMENT GUIDELINES WHICH
LAID OUT THE IMPORTANCE OF
IDENTIFYING UNIQUE RISK FACTORS
BY INFORMING QUALITATIVE
RESEARCH, THE AIMS OF OUR FOCUS
GROUP WERE TO ASK LATIN X'S
UNMET CRITERIA FOR HEAVY
DRINKING TO TELL US ABOUT THEIR
EXPERIENCES LIVING HERE AND IN
THEIR PRIOR COUNTRIES AND WHAT
DRINKING LOOKED LIKE IN BOTH
CONTEXT.
THE IDEA WAS TO CAPTURE WHAT
CHANGED ABOUT ALCOHOL
COMSUMPTION BEHAVIOR IN THE
UNITED STATES AND WHY.
THE KEY FINDING WHICH WAS
PUBLISHED IN 2006 WAS THAT
SOCIAL STRESSORS RELATED TO
INTEGRATION AND ACULTERATION
SUCH AS WORK NOTHING JOBS THAT
WERE NOT COMMENSURATE WITH 1'S
LEVEL OF EDUCATION, BEING
SOCIALLY ISOLATED AND NOT HAVING
EASY ACCESS TO SOCIAL RESOURCES
LIKE TRANSLATORS OR
TRANSPORTATION.
AS WELL AS EXPERIENCES OF
DISCRIMINATION, WERE THE KEY
RISK FACTORS THAT PROMPTED
CHANGES IN DRINKING BEHAVIOR, IN
LATINO MEN AND WOMEN AFTER U.S.
IMMIGRATION.
THE NEXT 2 SLIDES IS TO
EMPHASIZE THAT DISCRIMINATION
AND STIGMA ARE DIFFERENT
PHENOMENON.
THIS IS IMPORTANT TO HELP
UNDERSTAND THE SCOPE OF WHAT WE
TARGETED.
THERE ARE SEVERAL LONG
DEFINITIONS FOR DISCRIMINATION,
HERE I'M USING THIS DEFINITION
WHERE KENDI POINTS OUT THAT
MAKING DISTINCTION BETWEEN
PEOPLE DIFFERENTLY IN FAVOR FOR
OR AGAINST SOMEONE COULD LEAD TO
MORE ISSUES--[AUDIO DISTORTED
]--PROMPTED THEM TO DRINK
ALCOHOL.
IN CONTRAST, STIGMA IS AN
ATTRIBUTE THAT REDUCES A PERSON
TO A DISCOUNTED 1 AND THIS IS
THE CLASSIC DEFINITION
OF----FROM SOCIAL RESOURCES
WHICH LEADS TO INDIVIDUAL
HEALING NOT DESERVING OF
INCLUSION.
THE IMPORTANT DISTINCTION IS
THAT WHEN PEOPLE FEEL
STIGMATIZED THERE MUST BE SOME
FORM OF POWER IMBALANCE BECAUSE
SOMEBODY NEEDS TO JUDGE SOMEBODY
ELSE AS BEING LESS THAN.
THESE EXPERIENCES ARE OFTEN
CAPTURED IN PARTICIPANT
REACTIONS TO BEING EXCLUDED AND
HERE'S A QUOTE IN RED WHERE A
PARTICIPANT DESCRIBES THESE
BARRIERS.
THIS PAPER IS WHERE I REFLECTED
OR DOCUMENTED THAT WE WERE
REALLY TARGETING IN THE
COMMUNITY NOW REFRAMED AS THE
CULTURALLY ADAPTED STIGMA
MEDICATION, WERE THE EFFECTS OF
STIGMA AND EXCLUSION.
THIS PAPER REPORTED FINDINGS OF
QUALITATIVE STUDY WITH
PARTICIPANTS AFTER THEY
COMPLETED THE CAMI.
THESE PARTICIPANTS ALL REPORTED
SIGNIFICANT DECREASES IN
DEPRESSIVE SYMPTOMS AS WELL AS
DECREASES IN HEAVY DRINKING.
ACCORDING TO MINORITY STRESS
THEORY, SOCIAL EXCLUSION AND
MARGINALIZATION LEADS TO POOR
MENTAL HEALTH WHICH THEN
INCREASES VULNERABILITY TO
UNHEALTHY BEHAVIORS LIKE HEAVY
DRINKING.
IN OUR STUDY, WE DIDN'T ASK OUR
PARTICIPANTS TO MAKE THESE
ASSOCIATIONS WITH US DIRECTLY
BUT HOWEVER, IN THEIR OWN WORDS
THEY TOLD US THAT THEY FELT
EXCLUDED FROM THE MAIN STREAM
AND SECONDLY THAT THIS
EXPERIENCE OF BEING EXCLUDED
CONTRIBUTED TO THEIR FEELINGS OF
LOW SELF-ESTEEM.
LASTLY, THEY REPORTED DRINKING
TO COPE WITH THESE FEELINGS.
SO THIS FINDING, FEELING
MARGINALIZED AND DRINKING TO
MINIMIZE FEELINGS OF STIGMA GET
QUALITATIVE EVIDENCE THAT PEOPLE
INTERNALIZE STIGMA AND THAT IT
MANIFESTS AFTER THE DRINKING.
SO, I BEGAN TO THINK OF THE CAMI
AS A STIGMA LITIGATION WHICH
POSSIBLY WORKS BECAUSE IT
DECOUPLED THE FEELING OF LOW
SELF-ESTEEM FROM BEING
DISCRIMINATED AGAINST.
THERE'S ESTABLISHED EVIDENCE,
DOCUMENT ASSOCIATIONS WITH
RACIAL DISCRIMINATION AND SIGMA
AND SUBSIDIARY STANCE MISUSE
AMONG MARGINALIZED GROUPS,
INCLUDING PEOPLE OF COLOR, THE
REFERENCES ON THE SLIDE ARE
SPECIFIC TO [INDISCERNIBLE], FOR
EXAMPLE, STUDIES HAVE
ESTABLISHED THAT THESE
EXPERIENCES INCREASE THE ODDS OF
ALCOHOL AND DRUG USE DISORDERS.
OTHER STUDIES HAVE DOCUMENTED
THAT THEY CONTRIBUTE TO
INCREASED PSYCHOLOGICAL DISTRESS
AND EVEN TO DEPTHS OF DESPAIR.
THE HYPOTHESIZED MECHANISM IS
THAT EXPERIENCES WITH STIGMA AND
DISCRIMINATION ERODE, PROTECTIVE
RESOURCES SUCH AS A SENSE OF
SELF-EFFICACY.
A STUDY DONE BY DR. COMAS-DIAS
ALSO NOTE THAD INTERNALIZED
OPPRESSION RESULT INDEED A
DECREASED SENSE OF SELF-WORTH
AND DECREASED SENSE OF
MOTIVATION.
SO WHILE WE SET OUT TO ADDRESS
EXPERIENCES RELATED TO
IMMIGRATION AND ACULTERATION AS
RISK FACTORS FOR UNHEALTHY
DRINKING, WE WERE ALSO
ADDRESSING DISCRIMINATION AND
THE EFFECTS BEING STIGMATIZED.
SO THE QUESTION WAS COULD WE
REVERSE THE ASSOCIATION BETWEEN
STIGMA, DISCRIMINATION AND
SUBSTANCE USE AND ALCOHOL USE IN
AIAN CULTURALLY ADAPTED
MOTIVATIONAL INTERVENING?
MANY OF YOU I'M SURE ARE
FAMILIAR WITH MI, SO I WILL
REVIEW THIS QUICKLY.
TO THE LEFT YOU SEE THE KEY MI
ACTIVE TREATMENT INGREDIENTS
THAT INCLUDE AUTONOMY AND
TECHNICAL MI ELEMENTS SUCH AS
ABILITY TO REFLECT.
IF MI IS PERFORMED AS INTENDED,
IT AFFECTS THE MEDIATORS IN THE
SKETCHER BOX, SUCH AS CHANGE
TALK OR STATEMENTS ABOUT CHANGE
WHICH IS A MORE WELL RESEARCH
MEDIATOR THAN SELF-EXPLORATION
WHICH IS A FOCUS OF OUR CURRENT
WORK.
AND THEN THESE ARE ON SUPPOSED
TO IMPACT OUTCOMES.
MI WAS DEVELOPED FOR PEOPLE IN
TREATMENT FOR ALCOHOL USE
DISORDERS SO IT'S NOT SURPRISING
THAT IT HAS A STRONGER EFFECT
SIZE FOR ALCOHOL THAN FOR OTHER
DRUGS TO USE.
MI IS TYPICALLY USED AS ADJUNCT
TREATMENT LIKES CONTINGENCY
MANAGEMENT.
IT'S ALSO BELIEVED THAT IT WORKS
WELL WITH RACIAL ETHNIC
MINORITIZED INDIVIDUALS BECAUSE
OF ITS FOCUS ON AUTONOMY, AND
EVOCATION, IT'S PRESUMED THAT
INDIVIDUAL WHO IS HAVE BEEN
OPPRESSED ARE NOT USINGED TO
HAVING THE OUTPATIENT SETTING TO
EXPRESS THEIR AUTONOMY.
BUT THE FINDINGS FOR MI FOR
PEOPLE OF COLOR ARE NOT AS CLEAR
CUT.
REPORTED INCREASE IN DRUG USES
COMPARED TO TREATMENT AS USUAL.
IN DISCUSSING THE NEGATIVE
EFFECTS OF MI FOR BLACK PEOPLE,
THE AUTHOR SUGGEST THAD
CULTURALLY ASHES DATA
PROTECTIONED MI MIGHT IMPROVE
EFFECTS AND THERE'S SOME
EVIDENCE FOR THIS IN THE 2000
STUDY DONE BY DOUGLAS AND
[INDISCERNIBLE] IN A SECOND
STUDY CHINESE PATIENTS WERE
TREATED WITH CARDIOVASCULAR
DISEASE REPORTED INN CREASES IN
ANXIETY AFTER RECEIVING MI
COMPARED TO TREATMENT AS USUAL
TO HAVE SEEN THOSE POSITIONS.
SO HOW DID THE ADAPT MI, WE
FOLLOWED THE PRINCIPLES OF
ADAPTATION, DESCRIBED BY DR. LAU
IN 2006.
SO THE FIRST PART IS TO IN
ADAPTING TREATMENT TO PRESERVE
THE ACTIVE TREATMENT INGREDIENTS
AND IF NEEDED TO ADD TREATMENT
COMPONENTS THAT ARE SPECIFIC TO
THE UNIQUE RISK FACTORS.
WE ADDED A COMPONENT DISCUSSING
EXPERIENCES OF STIGMA AND
DISCRIMINATION, IN THE
INTERVENTION AND THEY ALSO
INCLUDED INFORMATION ON HEALTH
DISPARITIES, SPECIFIC TO LATIN
Xs, WELL AZIZZ INFORMATION ON
ETHNIC NORMS SPECIFIC TO ALCOHOL
USE OR LATIN X'S.
RESULTS OF THE OPEN SERIES
TRIAL, WHICH WAS REPORTED IN
2011 INDICATED HIGH LEVELS OF
SATISFACTION AND THAT THE
TREATMENT GREETS WERE RETAINED.
WE THEN COMPLETED A SMALL
CLINICAL TRIAL REPORT INDEED
2013, WHICH INDICATED THAT THE
CAMI OUTPERFORM THE MI.
IN 2012, WE WERE FORTUNATE TO
RECEIVE FUNDING TO CONDUCT A
LARGE CLINICAL TRIAL.
A STRENGTH OF THIS STUDY WAS THE
GOLD STANDARD DESIGN, TESTING
THE CULTURALLY ADAPTED MI,
AGAINST MI ITSELF.
SO RANDOMIZATION IS IMPORTANT
BECAUSE THEN IT PERMITS CAUSAL
INFERENCES, MEANING THAT ANY
DIFFERENCES BETWEEN THE GROUPS
ARE DUE TO THE TREATMENT.
THE CAMI WAS 75 MINUTE SESSION,
THE DESCRIPTION OF THE CONTENT
IS HERE AT THE TABLE, AND THIS
SESSION AVERAGED ABOUT 75
MINUTES.
WE USED A THEY--THE KRETERAL
FRAMEWORK FOR ADAPTATION PUBLISH
INDEED 2016 TO UNDERSTAND HOW
THIS TREATMENT MIGHT WORK.
I'M GOING TO FOCUS ON 1
PARTICULAR ADAPTATION TEACHING A
STUDY THERAPIST ABOUT HOW TO
TALK ABOUT SIGMA IN A YAWN
JUDGMENT AND COLLABORATIVE
CONSTRUCTIVE ENVIRONMENT.
BECAUSE I THINK THIS IS THE MOST
PERINENT STIGMA INTERVENTION.
JUST A FEW NOTES, SURPRISINGLY
LITTLE IS KNOWN ABOUT HOW TO
DISCUSS DISCRIMINATION IN A
CLINICAL CONTEXT.
I THINK THERE ARE SEVERAL
REASONS FOR THIS.
CLIENTS OR PATIENTS MAY NOT WANT
TO REPORT SOMETHING OUT OF
EMBARRASSMENT, THEY MAY NOT FEEL
COMFORTABLE RAISING THESE ISSUES
WITH THEIR COUNSELOR, THEY MAY
PERCEIVE DISCRIMINATORY AND
PERHAPS TO OTHER PEOPLE BUT NOT
TO THEMSELVES.
THIS IS KNOWN AS PERSONAL GROUP
DISCREPANCY OR THEY MAY NOT
PERCEIVE THEMSELVES AS BEING
RACIALIZED.
THEY CAN ALSO BE MOTIVATIONAL
AMBIGUITY IN OTHER WORDS, PEOPLE
MAY NOT BE ABLE TO SEE A CLEAR
RACE BASED MOTIVES AND THAT'S
HIGHLY LIKELY BECAUSE WE LIVE IN
A RACE NEUTRAL SOCIETY WHERE THE
EFFECTS OF RACES ARE PRESENT BUT
RACE IS RARELY INDICATED.
ALSO LOW MOTIVATION, PEOPLE
REALLY TRIBUTE THAT TO THE
CENTER FOR EXCELLENCE ON AGINGS
OF BEING STIGMATIZED BECAUSE
MAYBE THEY'RE NOT AWARE OR THEY
DON'T MAKE THAT ASSOCIATION
THEMSELVES.
AT THE SAME TIME, SOCIAL
PSYCHOLOGY RESEARCHERS HAS SHOWN
THAT TALKING ABOUT THESE EVENTS
INFERS PSYCHOLOGICAL AND
PHYSICAL PEN FITS SUCH AS
LOWERED BLOOD PRESSURE OR
DECREASED [INDISCERNIBLE] AND
DECREASED REGRET.
FURTHER MORE NOT TALKING ABOUT
THESE THINGS HAS BEEN ASSOCIATE
WIDE INCREASED PSYCHOLOGICAL
DISTRESS AS WELL AS DETRIMENTS
IN PERFORMANCE.
SO WHAT DID THIS LOOK LIKE?
IN THE CAMI, THE PARTICIPANTS
COMPLETED BASE LINE ASSESSMENT
THAT ASKED QUESTIONS THAT
INCLUDED QUESTIONS ABOUT
EXPERIENCES OF DISCRIMINATION,
AND STRESSORS RELATED TO
IMMIGRATION STATUS.
HERE'S AN EXAMPLE OF PEOPLE
DISLIKE ME BECAUSE I'M HISPANIC.
WE THEN ASKED WHETHER THE EVENT
PROMPTED THEIR DRINKING OR IF
THEY HAD A THOUGHT ABOUT HAVING
A DRINK AFTER SUCH AN EVENT.
AND THIS IS HOW THEY ASKED,
PLEASE CLICK THE CENTER BOX
HERE, AGAIN, USING THE ITEM
EXAMPLE FROM THE PRIOR SLIDE,
STUDY THERAPISTS WERE TO SAY,
PEOPLE TRAINED FOR DIFFERENT
REASONS, HAVE YOU TOLD US--AFTER
A DISCUSSION, THE CLIENTS ARE
ASKED TO SHARE WHEN THEY HAD
EXPECTED FROM DRINKING ALCOHOL
OR DRINKING ALCOHOL EXPECTANCYS
AND THEN AFTER GETTING
PERMISSION FROM THE
[INDISCERNIBLE], THE STUDY
THERAPISTS OFFERED INFORMATION
OF THE ACTUAL ALCOHOL FOR
EXAMPLE, THAT DRINKING MAKES 1
FEEL MORE DEPRESSED AND THEN
FREE RADICALS FRAME THE
SITUATION AND THE EMERGENCIES,
BUT TO ME THE MOST IMPORTANT
PART WAS THAT WE WERE TALK ABOUT
EVENTS AND INTRODUCE THE IDEA
THAT THEIR RESPONSE WHICH WAS
HEAVY DRINKING WAS NOT AS
HELPFUL TO THEM AS THEY HAD
ORIGINALLY THOUGHT.
SO TO TO THE RESULTS.
HERE'S A CONSORT AND THE MAIN
STUDY AIMS OF THE LARGER TRIAL,
WE ARE CRUITED ABOUT 296 PEOPLE
AND ABOUT HALF WERE THE CAMI AND
HALF WERE TEST DISCRIMINATION.
YOU CAN SEE THE SECOND AIM WAS
TO TEST DISCRIMINATION AS A
TREATMENT MODERATOR.
THE ENGAGEMENT RESPONSE WAS
POSITIVE.
WE WERE ABLE TO RECRUIT UP TO
20% MORE WITHIN THE SAME STUDY
TIME PERIOD, AND WE HAD UP TO
80% RETENTION RATES, OVER 12
MONTHS AFTER THE INTER INTERVENTION
WAS DELIVERED.
HERE ARE THE PARTICIPANTS.
DESPITE LIVING IN THE UNITED
STATES FOR OVER 20 YEARS ON
AVERAGE, EVIDENCE INDICATES THEY
WERE NOT WELL INTEGRATED INTO
SOCIETY.
FOR EXAMPLE, ABOUT 60% WERE
UNEMPLOYED IN THE AVERAGE INCOME
WAS ABOUT 15,000 A YEAR.
SIXTY% WERE FROM THE CARIBBEAN
AND THIS IS CONSISTENT WITH
DEMOGRAPHIC ESTIMATES YOU KNOW
AT VIEWING NORTHEAST, MOST UP TO
90% EXPERIENCED DISCRIMINATION,
THIS IS A SAMPLE WITH A SERIES
CLINICAL PROFILE AS INDICATED BY
MEAN SPORT FOR ANXIETY AND
DEPRESSION THAT WERE ABOVE THE
CLINICAL CUT POINTS AND ALSO THE
MEAN AUDIT SCORE WAS OVER 16
INDICATING THAT ON AVERAGE OUR
PARTICIPANTS STRUGGLED WITH
ALCOHOL USE DISORDER.
FOR THE SAKE OF TIME I WILL
FOCUS ON ON 1 OUTCOME.
YOU CAN SEE THE TIME POINTS FROM
BASE LINE OF 12 MONTHS READING
LEFT TO RIGHT AND CAMI AND
REPRESENTED IN THE BOLD LINE.
SO AS YOU SEE HERE THERE WAS
SIGNIFICANT DECLINES IN BOTH
CONDITIONS FROM BASE LINE TO 12
MONTHS WITH CAMI TRENDING LOWER
AT EACH TIME POINT.
BUT THERE WERE NO SIGNIFICANT
DIFFERENCES BETWEEN THEM
OVERTIME.
WE THEN LOOKEDDA THE IMPACT OF
THE MODERATOR DISCRIMINATION IN
THE 2 STUDIES IN THIS FIRST
STUDY, WE LOOKED AT THE IMPACT
OF THE MODERATOR ON THE PRIMARY
OUTCOME, AND THE OUTCOME ON THE
NEGATIVE CONSEQUENCES ISSUES
BECAUSE WE ARE INTERESTED TO SEE
IF OUR APPROACH, WE CHECKED
TARGETED DISCRIMINATION STIGMA,
HAD DIFFERENT [INDISCERNIBLE]
FOR PEOPLE AND HIGHER AND LOWER
LEVELS OF DISCRIMINATION AND IN
OUR MODERATION ANALYSIS, WE
FOUND THAT AMONG INDIVIDUALS
WITH HIGHER--WHO REPORTED HIGHER
LEVELS OF DISCRIMINATION AT BASE
LINE, THOSE WHO RECEIVED THE
CAMI INTERVENTION REPORTED
SIGNIFICANTLY FEWER ALCOHOL
CONSEQUENCES AT 3 MONTHS
COMPARED TO THOSE WHO RECEIVED
AN ADAPTIVE MI.
WE DID NOT FIND THESE EFFECTS ON
THESE PURCHASES AS HIGHER OR
LOWER LEVELS OF HAD
DISCRIMINATION.
IN THIS SECOND STUDY, BECAUSE WE
HAD SEEN AN UNEXPECTED
SIGNIFICANT DECLINED IN THE CAMI
GROUP AND DEPRESSIVE SYMPTOMS,
FROM BASE LINE TO 12 MONTHS AND
GUIDED BY THEORETICAL MODELS OF
MINORITY STRESS WHICH POSITED
THAT EXPERIENCE OF STIGMA AND
DISCRIMINATION, ALSO CONTRIBUTED
TO INCREASED PSYCHOLOGICAL
DESTRESS.
WE HYPOTHESIZED THAT
DISCRIMINATION WOULD MODERATE
THE EFFECTS OF TREATMENT ON
DEPRESSION.
SO AS CAN YOU SEE ON THIS GRAPH
BOTH CONDITIONS AGAIN
DEMONSTRATED SIGNIFICANTLY LOWER
LEVELS OF DEPRESSIVE SYMPTOMS,
AT 6 AND 12 MONTHS COMPARED TO
BISE LINE AFTER CONTROLLING THE
GENDER, PLACE OF BIRTH,
HOUSEHOLD INCOME,
DISCRIMINATION, ACULTERATION AND
AGE.
AND THIS REPORTED SIGNIFICANTLY
FEWER DEPRESSIVE SYMPTOMS
COMPARED TO MI PARTICIPANTS AT
12 MONTHS.
SO THE TAKE AWAY FROM THE PAST 2
STUDIES IS THAT FOR THOSE
EXPERIENCING HIGH DISCRIMINATION
WHO RECEIVED THE CAMI, THERE WAS
SIGNIFICANT REDUCTIONS IN
ALCOHOL RELATED PROBLEMS AT 3
MONTHS AND REFRESESSED SYMPTOMS
AT 12 MONTHS.
SO I WILL PAUSE HERE AND REFLECT
ON WHAT THIS MEANS.
FIRST OF ALL WE WERE NOT VERY
SURPRISED AT THE LACK OF
TREATMENT BECAUSE OF THE RIGOR
OF THE CARRIER.
NOT ONLY WAS IT MI ITSELF BUT
THE--ANSWER THE QUESTION FOR
WHOM DOES TREATMENT WORK BEST.
THIRDLY, ANOTHER QUESTION TO ASK
IS WHAT ARE THE MECHANISMS
THROUGH WHICH ADAPTATION WORKS,
CURRENTLY WE'RE INVESTIGATING
SELF-EXPLORATION WHICH IS A KEY
OUTCOME FOR PSYCHOTHERAPY AND
WHICH IS ALSO VIEWED AS A
NECESSARY ANTISEEDENT TO KEEP
THE CHANGE AS A POTENTIAL
MECHANISM.
WITH REGARDS TO WORK TO DATE
CONTRIBUTING TO UNDERSTANDING
HOW INTERVENTIONS MIGHT BE USED
TO MITIGATE THE EFFECTS OF
DISKRIM NATION AND STIGMA, I
THINK THE CAMI AND CASMI SHOWS
THAT WE MUST CREATE THE SPACE
FOR PEOPLE TO TALK ABOUT
EXPERIENCES THAT MAY BE
CHALLENGING FOR THE COMMISSION
AS WELL.
SECOND, OUR STUDY GIVES SOME
INSTRUCTION ON HOW TO HAVE THESE
CONVERSATIONS ABOUT SENSITIVE
TOPICS.
IN OUR EXPECTANCY CHALLENGE WE
SOUGHT TO MITIGATE THE EFFECTS
OF DISCRIMINATION BY DISRUPTING
THE LINK BETWEEN STRESS AND
HEAVY DRINKING AND OTHER PARTS
OF THE INTERVENTION IS THOUGHT
TO PROMOTE SELF-EFFICACY.
SO GOING BACK TO THE
LAST SECOND STUDY, THIS WAS
CULTURALLY ADAPTED MET AND SBCM,
AND THE CONTROL CONDITION WAS
THE NIAAA PASMMENT RETHINKING
DRINKING.
MY COMMENTS ARE KIND OF
RESTRICTED TO THE MET BECAUSE
THAT IS WHAT I SUPERVISED PEOPLE
ON, THIS WAS CONDUCTED DURING
COVID SO WE HAD TO GO FROM
IN-PERSON TO PHONE BASED
DELIVERY BUT WHAT REALLY STRUCK
ME IN LISTENING TO THE COMMUNITY
HEALTH WORKER SYSTEM JUST WHAT A
LIFE LINE THEY WERE TO THE
PARTIC PLAN TO ANALYZE BY AGES,
MANY OF WHOM WERE REALLY HIGH
RISK AND VERY VULNERABLE AND
MANY OF THEM WERE UNDOCUMENTED.
SO GETTING RIGHT TO THE RESULTS
OF HERE IS A PICTURE OF THE
OKAY--I DON'T KNOW IT'S
NOT--OKAY, GREAT.
OF THE INTENT TO TREAT ANALYSIS.
YOU CAN SEE SIGNIFICANT DECLINES
FAVORING THE INTERVENTION
CONDITION IN RED, ON THE
OUTCOMES, AVERAGE DRINKS PER
WEEK, PERCENT HEAVY DRINKING
DAYS AND AMOUNT OF CONSEQUENCES
AT WEEK 26.
AND THIS IS ADJUSTED FOR AGE,
GENDER, EMPLOYMENT STATUS AND
DEPRESSION, CO-MORBIDITIES,
SELF-REPORTED ALCOHOL PROBLEMS
AT BASE LINE AUDIT SCORES.
HERE'S ANOTHER INTERESTING
FINDING, WE THEN LOOKED AT
DIFFERENCES IN TREATMENT
OUTCOMES BY DELIVERY TYPE.
THIS SLIDE SHOWS--DIDN'T SEEM TO
MATTER.
YOU CAN SEE AGAIN THE IN-PERSON
MET, THE GREEN IS PHONE
DELIVERED MET, BOTH OUTPERFORMED
THE CONTROL CONDITION.
SECONDLY, THE PHONE SEEMED TO
HAVE EVEN GREATER IMPACT
ALTHOUGH, THIS COMPARISON IS NOT
SIGNIFICANT.
IN TALKING ABOUT THE IMPACT ON
THE STUDY, AFTER IT ENDED ON
PARTICIPANTS AFTER THE STUDY
ENDED, THE COMMUNITY HEALTH
WORKERS NOTED THAT PARTICIPANTS
HAD A VERY POSITIVE RESPONSE AS
YOU SEE IN THIS QUOTE.
WE ALSO TALKED A LOT ABOUT HOW
THE COMMUNITY HEALTH WORKERS
WERE CULTURALLY ADAPTED TO
TREATMENT DURING SUPERVISION.
WE TALKED A LOT ABOUT THE
CULTURAL VALUE OF RESILIENCE,
YOU CANY - A SAMPLE REFLECTION
OF THE EXPWM ITED ARES AS THE
TRANSLATION IS, I SEE YOU ARE
VERY STRONG AND HAVE ENDURED A
LOT AND HAVE SURVIVED.
BUT I DO THINK THAT IT OVER
EMPHASIS AND RESILIENCE CAN BE A
DOUBLED EDGED SWORD BECAUSE IT
CAN TURN INTO SELF-BLAME AND THE
REFUSAL TO SEEK HELP.
SO IN OUR SESSIONS WE HAVE TO
BALANCE THAT SELF-A LIAISONNANCE
AGAINST RAISING AWARENESS FOR
OTHER EXTERNAL FACT ORS THAT
COULD INCLUDE--CHWs AND
PREPARE THAT AGAINST CHW
DELIVERY OF INTEGRATED WRAP
AROUND PRIMARY CARE INTERVENTION
AND WE'RE ALSO TRYING TO
UNDERSTAND THE PROCESS OF
IMPLEMENTATION.
SO IN CLOSING, I WOULD SAY THAT
IN A RECENT KEEPER, IT WAS
IDENTIFIED AS 1 OF THE FEW
STUDIES TO INVESTIGATE STIGMA AS
A KEY MODERATOR, WE WOULD
SUGGEST USING A SCREENING
QUESTION ON DISCRIMINATION OR
STIGMA TO BE PART OF THE AUK
INTERVENTION FOR LATIN X'S AND
WE ALSO HOPE THAT THE GROUPS
WERE STUDYING, WILL HAVE RESULTS
FOR THEIR TESTS.
SOME OF THEIR SELECTED QUOTES
LISTED HERE, ECHO SOME THINGS
IDENTIFIED IN THE CASMI.
AND I WANT TO FINALLY CLOSE BY
SAYING THAT I CAN HAVE AN IDEA
BUT IT REALLY TAKES OTHER PEOPLE
WITH THEIR WISDOM TO HELP
UNDERSTAND AND TO HAVE INSIGHTS
ABOUT THIS APPROACH AND I'M
REALLY HAPPY THAT THE CASMI
PROJECTS HAVE GIVEN
OPPORTUNITIES TO ENGAGE IN
RESEARCH WHICH HELPED PEOPLE
PROFESSIONALLY AND PERSONALLY
AND ACADEMICALLY.
IT'S MY GREAT PLEASURE TO
INTRODUCE MY FIRST COLLEAGUE,
ROBERTO CAM ARENA, WHO IS I HAD
THE PRIVATE SECTOR EDGE OF
COLLABORATING WITH IN THE STUDY,
I LEARNED SO MUCH IN OUR
SESSIONS AND HIS REFLECTIONS
ABOUT HOW THIS WORK CONNECTS TO
THE BROADER PICTURE WHICH IS TO
IMPROVE IMMIGRANT HEALTH.
THANK YOU.
>> THANK YOU CHRISTINA AND I
WILL SAY THAT, YOU KNOW AS
SOMEBODY WHO PARTICIPATED VERY
EARLY ON IN THE CAMI
INTERVENTION, IT WAS--IT'S
REALLY NICE TO BE ABLE TO SEE
HOW A LOT OF THE THINGS THAT
FELT INTUITIVE OR THAT I WAS
SEEING IN MY REP WITH THE FOLKS
THAT I WAS ENGAGING WITH, ARE
REALLY NOW EVIDENCE-BASED AND I
SEE IT IN A CONCRETE WAY THAT
REALLY SUPPORTS THESE FEELINGS
THAT WE HAVE, THAT I THINK A LOT
OF TIMES WHEN WE'RE IMPLEMENTING
THESE KINDS OF STRATEGIES IN A
COMMUNITY BASED SETTING WE HAVE
AN IDEA THAT THINGS ARE MOVING
FORWARD AND WE KIND OF GET A
SENSE OF WHAT WORKS AND WHAT
DOESN'T WORK, BUT IT'S REALLY
NICE TO SEE THIS BEING NOW IN
THE EVIDENCE-BASED APPROACH THAT
KIND OF CONFIRMS AND WE CAN FIND
OF TAKE IT ON WITH A BIT MORE
CONFIDENCE.
I WOULD LIKE TO TALK A BIT ABOUT
WHAT CHRISTINA WAS MENTIONING IN
TERMS OF THE ISOLATION WHICH WAS
REALLY 1 OF THE KEY THINGS THAT
I SAW WHEN WORKING WITH PEOPLE
IS HOW THEIR EXPERIENCE AS THE
LATIN X PERSON AND
ERESPONSIBLELY AS AN IMMIGRANT
REALLY DROVE DISCONNECTION AND
THE ISOLATION FROM A LOT OF
THEIR SUPPORTS AND HOW THE
ABILITY TO HAVE THE CAMI STUDY
TO PUT THAT FRONT AND STUDY SO
THAT PEOPLE CAN MAKE CONNECTIONS
WAS REALLY INSTRUMENTAL IN
MAKING THE INTERVENTION
EFFECTIVE.
WHAT PEOPLE WERE--THE STUDY WAS
IN BOSTON AND SO FOR EXAMPLE,
DURING THE SNOWPOCOLYSE, THERE
WAS A LOT OF ISOLATION WHERE YOU
WOULDN'T HAVE CONTACT WITH
PEOPLE IN YOUR SURROUNDINGS AND
WE SEE THAT IN THE WINTER
WEATHER OR TIME WHEN PEOPLE
COULDN'T ENGAGE IN SOCCER
PRACTICE OR DO THINK THEY WOULD
NORMALLY BE OUT IN A PARK, A LOT
OF TIMES THEY TURN TO ALCOHOL TO
BE ABLE SUPPLEMENT WHAT WAS A
LACK OF CONNECTION.
SO THE STUDY WAS AN ABILITY FOR
UTION TO BE ABLE TO PUT THAT ON
THE TABLE AND EXPLORE THAT WITH
PEOPLE GIVEN THE OPPORTUNITY TO
SEE IF THERE IS OR ISN'T
CONNECTIONS IN A VERY WELCOMING
WAY THAT WASN'T JUDGMENTAL AND
THAT REALLY WAS JUST ALLOWED
PEOPLE TO UNDERSTAND WHAT THAT
WAS LIKE, PARTICULARLY FOR THE
IMMIGRANT PERSON WHO WAS SEVERE
MITRALLERRING OR AT THE VERY
LEAST REALLY MORPHING THEIR
CONNECTIONS FROM THEIR COUNTRY
OF ORIGIN, WHAT IS IT LIKE FOR
THEM TO NOT BE ABLE TO HAVE THE
SAME ACCESS OR SAME RELATIONSHIP
WITH NEIGHBORS OR FRIENDS AND
THE INSTITUTIONS THEY WERE
PREVIOUSLY CONNECT WIDE?
WHAT'S IT LIKE TO HAVE THIS
ISOLATION IN TERMS OF CULTURAL
AND LANGUAGE KIND OF DISTANCES
AND GAPS WHERE IT'S NOT REALLY
POSSIBLE TO NAVIGATE THE WORLD
IN THE SAME WAY AND DOES THAT
MEAN FOR YOU AND HOW YOU'RE
PERCEIVED AND WHAT YOU FEEL, A
LOT OF TIMES WHAT WE WOULD TALK
ABOUT WAS THIS GAP WOULD EXIST
AND HOW ALCOHOL WAS REALLY
SOMETHING TO HELP PEOPLE COPE
WITH THIS DISCONNECTION, WITH
THE ISOLATION THAT THEY WERE
FEELING AND IMPLEMENTING BOTH
THE CULTURALLY--ELEMENT OF THE
INTERVENTION WAS A REALLY
EFFECTIVE WAY OF HAVING PEOPLE
BE ABLE TO BRING IT UP TO BE
ABLE TO ADDRESS THINGS, MAKE
CONNECTIONS THAT WEREN'T REALLY
THERE FOR THEM BUT MAYBE
SOMETHING THAT WAS MORE OF A GUT
FEELING WAS NOT EXPLICITLY
STATED SO THE DESIGN OF THE
STUDY WHICH INCORPORATED
CULTURAL ELEMENTS PURPOSEFULLY
THROUGHOUT THE CONVERSATION WAS
A VERY NICE WAY TO WELCOME
PEOPLE INTO EXPLORING HOW THEIR
ALCOHOL BEHAVIOR DOES OR DOES
NOT DRIVE SOME OF THE ALCOHOL
COMSUMPTION WHEN CHRISTINA
POINTED OUT IN THE STUDY OF, YOU
KNOW THIS EVENT LED YOU TO
DRINK, WELL, LET'S EXPLORE THAT.
LET'S TALK ABOUT THAT.
THOSE WERE HELPFUL DESIGN
CHOICES THAT ALLOWED PEOPLE TO
FEEL MORE COMFORTABLE IN THE
SESSION, FEEL LIKE THERE'S A
CONCERN FOR YOUR CULTURAL
IDENTITY AND HOW THAT INFORMS
WHO YOU ARE AND IF REALLY HELPED
PEOPLE BY SAYING, I KNOW THAT,
YOU KNOW LIFE IS FAR MORE
COMPLEX THAN IT MIGHT SEEM AND
SO LET'S KIND OF LEAN INTO THOSE
COMPLEXITIES PLUS, EXPLORE THEM
TOGETHER, BE ABLE TO HAVE A
CONVERSATION ABOUT HOW THAT
RELATES TO YOUR LIFE GOALS AND
HOW THAT RELATES TO ALCOHOL
COMSUMPTION.
THOSE THINGS WERE REALLY HELPFUL
PART OF THE DESIGN INTERVENTION
AND I'M DPLAD TO SEE THAT IT'S
SUPPORTED THROUGH THE EVIDENCE.
WITH THAT, I WILL PASS IT OVER
TO MY COLLEAGUE VICTOR WHO WILL
BE SHARING MORE ABOUT HIS
EXPERIENCE IN THE DESIGN.
>> GOOD AFTERNOON, EVERYONE
I'M DR. FIGUEREO, I HAVE THE
PRIVILEGE OF WORKING WITH
DR. CHRISTINA LEE WITH THE CASMI
PROJECT AS A CODER.
I'VE BEEN LISTENING TO TAPES
BETWEEN THERAPISTS AND CLIENTS
CODING THERAPIST CHARACTERISTICS
AND DIFFERENT DIMENSIONS OF
CLIENT ENGAGEMENT SO I'M HAPPY
TO BE HERE IN THIS WEBINAR TO
BRIEFLY SHARE MY OBSERVATIONS AS
A CODER.
SO TO BEGIN, I WILL BE
CONTEXTUALIZING JUST A BIT OF
THE IMPORTANCE OF THE ROLE OF
DISCRIMINATION, FOLLOWED BY
SHARING AGAIN SOME OF MY
OBSERVATIONS AS A CODER.
SO FROM BOTH MY PERSONAL LIFE,
CLINICAL PRACTICE AND RESEARCH,
I'VE LEARNED THAT DISCRIMINATION
IS UNFORTUNATELY PART OF THE
LIVED EXPERIENCES OF THAT NEXT
INDIVIDUAL'S IN THE UNITED
STATES.
DUE TO SYSTEMIC OPPRESSION SUCH
AS STRUCTURAL RACISM, COLORSISM,
ETHNOSENT RISM, XENOPHOBIA,
HOMOPHOBIA, BASED ON MINORITY
STRESS THEORY AND
INTERSECTIONALITY INTERSECTING
SIGMA WORSENS FOR LATIN X
INDIVIDUALS LIVINGA THE
INTERSENSIONS OF STIGMATIZED
IDENTITIES, AND EXPERIENCING
THESE IN MANY AREAS OF THE THEIR
LIVES INCLUDING HEALTHCARE AND
WORKPLACE SETTINGS.
IT'S BECAUSE THESE SYSTEMIC
FORMING OF APREGZ, IT'S BECAUSE
THEY INTERSECT AND INTERLOCK AND
WORK TOGETHER THAT THERE IS
MINORITY STRESS AND
INTERSECTIONALITY REALLY HELP US
TO UNDERSTAND THE ADDITIONAL
BURDENED THAT LATIN X'S WHO LIVE
AT THE INTERSECTIONS OF MULTIPLE
STIGMATIZED IDENTITIES, THE
BURDEN THAT THE ADDITIONAL
BURDENS THEY BEAR, FOR EXAMPLE,
AFRO-LATIN Xs, TRANSGENDER
LATIN X'S.
AND FOR THOSE OF US WHO
UNDERSTAND OR FOR THOSE OF US
WHO ARE FAMILIAR WITH THE
RESEARCH ON ALCOHOL AND DRINKING
KNOW THE LINKS BETWEEN STRESS
AND DRINKING.
WE KNOW THAT DISCRIMINATION CAN
LEAD TO STRESS AND THAT DRINKING
CAN BE A COPING STRATEGY TO DEAL
WITH THE EFFECTS OF HAD-DEAL
WITH EVENTS OF DISCRIMINATION
AND THE BURDENS THEY LEAVE.
THIS IS WHY ROOTS SO CRUCIAL TO
AGAIN FOR DISCRIMINATION TO BE
BE A CENTRAL ASPECT OF THIS
PROJECT.
AND SO, AS A CODER, MY
OBSERVATIONS, I NOTED THAT CASMI
DOES HAVE THE POTENTIAL TO--DOES
PROVIDE SPACE FOR LATIN X FOLKS
TO DISCUSS EXPERIENCES OF
DISCRIMINATION.
--I'VE NOTED THAT THAT 1 OTHER
THING THAT COME UP IS FOR
PARTICIPANTS, THEM TALK ABOUT
THE PRESSURE OF BEING
AMERICANIZED.
AND SO WHEN ASKED ABOUT GOALS,
OR STRESSORS, SOME PARTICIPANTS
REFERRED TO AND TALKED ABOUT
HAVING TO LEARN ENGLISH OR
LEARNING ENGLISH THAT BEING
CRUCIAL IN ORDER TO IMPROVE
THEIR SOCIOECONOMIC STATUS AND
POSITIONING, SO THEY DON'T HAVE
TO WORK MULTIPLE JOBS.
AND THE PRESSURE TO LEARN
ENGLISH IS A REFLECTIVE OF THE
STRUCTURAL BARRIERS THAT SPANISH
SPEAKING FAMILIES FACE IN ORDER
TO ACCESS MORE LIFE
OPPORTUNITIES.
ANOTHER EXAMPLE, I'VE NOTED FROM
OBSERVATIONS ARE--WERE WHEN
PARTICIPANTS WOULD TALK ABOUT,
THERE'S 1 IN PARTICULAR I WOULD
SHARE, HAVING TO HIDE THEIR
HERITAGE WHEN THEY LIVED AROUND
FEWER LATIN X FOLKS IN FEAR OF
BEING OTHERRED OR DISCRIMINATED
AGAIN.
AND SO FOR THIS, THEY SEE AS A
MORE INTERNALIZED FORM OF
OPPRESSION OF DISCRIMINATION TO
HAVE TO ACTIVELY HIDE AND TO
FEEL THAT YOUR CULTURE AND
HERITAGE IS NOT ACCEPTED IN YOUR
OWN NEIGHBORHOOD OR ENVIRONMENT
OR COMMUNITY.
OTHER EXAMPLES FROM OBSERVATIONS
INCLUDE PARTICIPANTS DISCUSSING
AND BEING DISCRIMINATED AGAINST
BY OTHER LATIN X FOLKS FROM
THESE COMMUNITIES, FOR EXAMPLE,
YOU PUERTO RICANS ARE TOO LOUD.
SO THIS MAKES THIS EXAMPLE AND
THE REST OF THEM CANs LED TO
AS HUMBERTO AS MENTIONED, LEVELS
OF ISOLATION AND MORE ISOLATION
ON TOP OF COMING--MOVING
NONAPOPTOTIC THE UNITED STATES
NOT BEING AROUND FAMILY WHO ARE
STILL IN THEIR HOME COUNTRY.
AND SO, HIGH LEVELS OF
ISOLATION, HIGHER LEVELS OF
STRESS THAT PARTICIPANTS STATED
ARE REASONS WHY THEY DRINK.
YOU KNOW I DRINK TO RELAX FOR
EXAMPLE, I DRINK TO FORGET, I
DRINK TO FORGET A BAD DAY, I
DRINK TO DISSTRUCTURALLY MY OWN
MIND, TO FORGET ABOUT THE PAST.
AND SO THIS IS JUST A FEW
EXAMPLES, AGAIN I NOTED CODING
IS STILL ONGOING FOR THE SPANISH
LANGUAGE INTERVIEWS BUT THEY
REALLY--MY OBSERVATIONS TELL ME
JUST HOW WARRANTED IT IS AND FOR
THEM TO EXPLORE HOW PARTICIPANTS
TALK ABOUT DISCRIMINATION IN THE
INTERVIEWS.
AND HOW WE CAN DISCUSS
DISCRIMINATION AND CHANGE TALK,
CHANGE ENGAGE; CHANGE PLANS
REGARDING THEIR DRINKING AND SO
FROM MY EXPERIENCES, IT'S JUST
BEEN A PRIVILEGE TO BE ABLE TO
HEAR THE VULNERABILITY IN THOSE
TAPES FROM THE PARTICIPANTS AND
THE RESILIENCE THEY'VE SHOWN IN
THOSE 1 SESSIONS AND SO, YEAH.
SO I THINK YOU ALL FOR JUST
ALLOWING ME THIS TIME JUST TO
SHARE MY PRESENCES AND AT THIS
POINT, YEAH, I WOULD LIKE TO
PASS IT OFF TO DR. MORIEL.
>> HI, GOOD AFTERNOON,IME
PROFESSOR MORIEL, THANK YOU
DR. FIGUEROA, I WORK WITH
PROVEULENCE HEALTH AND SERVICES,
I AM A COMMUNITY HEALTH WORKER.
I WAS LUCKY ENOUGH TO WORK WITH
DR. CHRISTINA LEE ON THIS
PROJECT AND SO, LITTLE BIT ABOUT
MY EXPERIENCE WORKING WITH THE
LATINO COMMUNITY.
SO AS A COMMUNITY HEALTH WORKER,
I NOTED THE IMPORTANCE TO HAVE A
CLOSE UNDERSTANDING OF THE
COMMUNITY THAT I SERVE.
SO THIS IS SOMETHING THAT I HAVE
BEEN DOING FOR QUITE SOMETIME
AND SO WE DO OUR BEST TO DELIVER
WHAT THE COMMUNITY NEEDS.
YOU KNOW I MADE SURE TO CREATE A
TRUSTING RELATIONSHIP THAT WILL
ENABLE, YOU KNOW KIND OF LIKE A
LIAISON BETWEEN OUR SERVICES AND
THE COMMUNITY, YOU KNOW TO HELP
FACILITATE ACCESS TO OUR
SERVICES.
I DO STRONGLY BELIEVE A ROLE OF
THE COMMUNITY HEALTH WORKER
DEPENDS ON THE CULTURAL SETTING
AND SO WHEN I WAS PRESENTED THIS
PROJECT OF, YOU KNOW WORKING
WITH THE LATINO COMMUNITY--THAT
WERE PARTICIPATING.
YOU KNOW BESIDES DOING THE
ASSESSMENTS THAT WE NEEDED TO
DO, THAT NEEDED TO BE COMPLETED,
YOU KNOW WITH--I MADE IT TO
REALLY DO MORE THAN THAT.
I NEEDED TO TALK TO THE
PARTICIPANTS AND REALLY EXPLAIN
WHAT THIS WHOLE EXPERIENCE WAS
GOING TO BE ABOUT.
YOU KNOW MORE OFFENSE THAN NOT
THERE WAS A LOT OF RESISTANCE
FROM THE PARTICIPANT FROM THE
COMMUNITIES, YOU KNOW JUST
BECAUSE AS MENTIONED BEFORE, A
LOT OF THESE--A LOT OF THESE
COMMUNITY MEMBERS DID FEEL A
LITTLE--THEY FEEL A LITTLE
DISCRIMINATED AND YOU KNOW I GOT
A LOT OF, IS THIS AA MEETINGS?
AM I GOING TO AN AA MEETING?
I DON'T HAVE PROBLEMS.
I DON'T HAVE ISSUES.
WHY AM I DOING THIS, YOU KNOW?
AND I THINK IT WAS IMPORTANT TO
HIGHLIGHT THE IMPORTANCE EFFECT
OF JUST OVERALL OUR HEALTH, YOU
KNOW OVERALL JUST HOW THIS CAN
AFFECT OUR HEALTH IN THE LONG
RUN.
SO YOU KNOW WE STARTED THIS
BEFORE COVID, SO A LOT OF IT WAS
PERSON TO--YOU KNOW, IN-PERSON
AND AND SO IT WAS EASY TO DO
THESE SESSIONS WITH THEM, YOU
KNOW ONCE WE HAD TO CONVERT TO
VIRTUAL.
YOU KNOW IT WAS A LITTLE
DIFFERENT NOW, I HAD TO FIND
WAYS TO REALLY ENGAGE THESE
PARPII SYSTEMS PANTS IN OUR
SESSIONS.
YOU KNOW WHEN I THINK IT WAS
FACE-TO-FACE, A LOT OF THEM
WERE--I THINK DEALING MORE
ISSUES WITH, YOU KNOW I'M
DRINKING BECAUSE I WORK TOO
MUCH, I'M DRINKING BECAUSE I
HAVE, YOU KNOW FAMILY ISSUES.
I'M DRINKING BECAUSE, YOU KNOW
I'M UNDOCUMENTED AND THIS IS THE
ONLY WAY I CAN COPE WITH THIS,
OR, YOU KNOW JUST DIFFERENT WAYS
OF COPING WITH WHAT THEY WERE
GOING THROUGH AT THE MOMENT
VERSUS WHEN WE TURNED OVER TO
VIRTUAL AND THE WHOLE WORLD JUST
SHUT DOWN ON US, A LOT WERE
COPING WITH THIS IN THE SENSE
OF, YOU KNOW I'M DRINKING
BECAUSE I LOST MY JOB, I'M
DRINKING BECAUSE, YOU KNOW MY
FAMILY, WE'RE GOING THROUGH SOME
STUFF.
I'M DRINKING BECAUSE I'M
UNDOCUMENTED AND I CAN'T FIND A
JOB, YOU KNOW?
AND I THINK THAT WAS VERY, VERY
HARD ON A LOT OF PEOPLE, YOU
KNOW AND I THINK WHEN I HAD
THESE SESSIONS WITH THESE
PARTICIPANTS, LIKE I MENTIONED
BEFORE, I TRIED TO CREATE A SAFE
SPACE AS MUCH FOR THEM.
YOU KNOW, WE TALKED ABOUT
EVERYTHING THAT WAS GOING ON
WITH THEM.
I MADE SURE THEY FELT
COMFORTABLE ENOUGH, YOU KNOW?
AND SO, AT THE END OF OUR
SESSIONS WE CREATED GOALS FOR
THEM, SO WHEN THEY WOULD COME
BACK, WE WOULD TALK ABOUT IT,
YOU KNOW, AND THE--BUT A LOT OF
PARTICIPANTS DID FEEL A LITTLE
BIT UPSET WHEN THEY DIDN'T
COMPLETE THEIR GOALS BUT I THINK
IT WAS A TIME FOR THEM TO REALLY
SIT DOWN AND JUST TALK ABOUT
EVERYTHING THAT THEY COULD HAVE,
YOU KNOW--THEY HAD THE SPACE
WHERE THEY SAID, WELL, LET'S SEE
HOW WE CAN WORK THIS OUT, YOU
KNOW WHERE WE WOULD SAY, OKAY,
WELL, AT LEAST YOU MADE THIS
CHANGE.
I USED TO ALWAYS TELL MY
PARTICIPANTS IF YOU MADE A
LITTLE CHANGE, YOU MADE A
CHANGE, YOU MADE SOMETHING AND
SO MORE OFTEN THAN NOTHING WE'RE
GRATEFUL FOR THAT AND I WANTED
THEM TO REALLY HAVE THAT VISION
AND REALLY SEE THAT AND SO, YOU
KNOW, I THINK THAT REALLY
MOTIVATED THEM TO KEEP GOING.
AND SO EVERY TIME THAT YOU KNOW
WE WOULD JUST TALK ABOUT HOW WE
CAN DO THINGS BETTER, YOU KNOW
AND OKAY, WHAT ARE WE GOING TO
DO NEXT TIME?
AND SO I THINK A LOT OF TIMES,
YOU KNOW, ALTHOUGH THERE WERE A
FEW TIMES WHERE, YOU KNOW THEY
FELT THE NEED TO TALK TO ME AND
SAY THIS IS WHAT'S GOING ON, YOU
KNOW I DID--YOU KNOW LISTEN TO A
LOT OF PARTICIPANTS THAT WERE
JUST GOING THROUGH VERY, VERY
HEAVY ISSUES AND SO, I WANTED
THEM TO FEEL LIKE THEY CAN JUST
TALK TO ME ABOUT ANYTHING, YOU
KNOW?
AND I THINK AT THE END OF OUR
SESSIONS, THEY WERE--THEY WERE
VERY, VERY APPRECIATIVE OF
EVERYTHING WE WOULD DO FOR THEM
AND YOU KNOW JUST HELPING THEM
SEE THAT, YOU KNOW?
AND A LOT OF TIMES, THEY SAID,
WOW, LIKE, I DIDN'T EXPECT THIS,
YOU KNOW?
I DIDN'T EXPECT TO FEEL BETTER
AFTER TALKING TO YOU.
YOU KNOW I WRITE DOWN MY GOALS
AND I PUT THEM ON THE
REFRIGERATOR ASK EVERY MORNING I
SEE THAT AND ONCE I COMPLETE A
GOAL, I'M HAPPY TO DO THAT SO I
THINK YOU KNOW, CIRCLING BACK TO
JUST EVERYTHING, WORKING WITH
THE COMMUNITY, YOU HAVE TO
REALLY UNDERSTAND IT AND BUILD
THAT TRUST WITH THEM AND YOU
KNOW, USING, YOU KNOW
MOTIVATIONAL INTERVIEWING.
IT'S--IT WAS A DIFFERENT
APPROACH TO REALLY HELPING THEM
SEE AND MOTIVATING THEM TO
REALLY, YOU KNOW WANT TO MAKE A
CHANGE IN THEIR DRINKING.
AND SO, YOU KNOW IT WAS GREAT TO
SEE A LOT OF PARTICIPANTS JUST
KIND OF SAY, WELL, YOU KNOW NOW,
I'M GOING OUT FOR A WALK.
YOU KNOW, I'M DRINKING THIS NOW,
I'M DRINKING WATER MORE OR YOU
KNOW IT'S JUST--I WAS ABLE TO
JUST TO SEE A LOT OF CHANGE IN
THE PARTICIPANTS.
SO, BUT YEAH, OVERALL IT WAS A
GREAT EXPERIENCE TO REEL
KEEPSAKESLY LISTEN AND MOTIVATE
THE PARTICIPANTS IN EVERY WHICH
WAY THAT WE CAN.
THANK YOU.
AND I THINK I WILL PASS IT OVER
TO DR. ZAPLSKI.
>> THANK YOU.
GO AHEAD AND SHARE MY SCREEN.
ALL RIGHT, THANK YOU SO MUCH SO
I WILL FOLLOW UP WITH THOSE
GREAT PRESENTATIONS AND
DISCUSSION TO TALKING ABOUT
STIGMA AND RACISM, SPECIFICALLY,
FOR BLACK AMERICANS.
AND A LOT OF THE THINGS DO
PARALLEL WELL WITH THE WORK THAT
HAS BEEN DESCRIBED FOR THE LATIN
X COMMUNITY.
SO, JUST TO GET A LITTLE
BACKGROUND FOR SUBSTANCE USE
AMONG BLACK AMERICANS COMPARED
TO WHITE INDIVIDUALS, BLACK
INDIVIDUALS TEND TO REPORT LOWER
RATES OF ALCOHOL AND TOBACCO
USE, BUT COMPARABLE OR MORE
RECENTLY HIGHER RATES OF
MARIJUANA OR CANNABIS USE.
SO I WANT TO SHOW THE DATA FROM
THE NATIONAL STUDY OF DRUG USE
AND HEALTH FOR INDIVIDUALS 12
AND OLDER WHERE YOU CAN SEE
PRETTY SIGNIFICANT DECREASE OR
LOWER PREVALENCE RATE OF ALCOHOL
USE ARE, SIGHTLY LOWER FOR
TOBACCO AND SLIGHTLY HIGHER FOR
MARIJUANA OR CANNABIS.
AND WHAT'S INTERESTING ABOUT THE
FINDINGS PARTICULARLY FOR
ALCOHOL IS ALTHOUGH BLACK
AMERICANS GENERALLY REPORT LOWER
USE OF ALCOHOL USE, MORE
ABSTINENCE, THEY EXPERIENCE MORE
PROBLEMS ASSOCIATE WIDE ALCOHOL
USE, THIS INCLUDES MORBIDITY,
MORTALITY, LIVER CIRRHOSIS,
ALCOHOL DEPENDENT SYMPTOMS AS
WELL AS A SLEW OF SOCIAL
PROBLEMS WHETHER IT'S WITHIN
ENVIRONMENTS AND THE HOME,
ACCIDENTS, THINGS IN THE
WORKPLACE AS WELL AS LEGAL
CONSEQUENCES FROM ALCOHOL USE.
YOU SEE SIMILAR FINDINGS FOR
TOBACCO SO AGAIN, JUST OFFERING
THE NATIONAL DRUG USE OF HEALTH,
OVERALL PREVALENCE RATE OF
SMOKING, ALSO, FEWER QUANTITY
AND FREQUENCY AS WELL STARTING
LATER OF A CIGARETTE USE BUT
IRONICALLY, HAVING HIGHER RATES
OF DEATH FROM SMOKING RELATED
DISEASES AMONG BLACK AMERICANS
AND THEN CANNABIS USE, SEEING
MORE RECENTLY THERE HAS BEEN
HIGHER RATES OF CANNABIS USE IN
THE PAST AND PREVIOUS DECADES IT
WAS LOWER BUT THERE'S STILL THIS
HIGHER PROGRESSION FROM USE TO
DISORDER SYMPTOMS AND THEN
OUTSIDE OF THAT, YOU KNOW
THERE'S COMPARABLE LEVELS OF
CANNABIS USE, THERE IS GREATER
PROBLEMS, PARTICULARLY LEGAL
PROBLEMS FROM CANNABIS USE FOR
BLACK AMERICANS.
AND SO, WITH ALL THIS BEING
SAID, YOU CAN UNDERSTAND THE
NEED TO UNDERSTAND WHY PEOPLE
ARE ENGAGING IN SUBSTANCE RUES
BUT PARTICULARLY GIVEN THE
CONSEQUENCES OF HAVING TREATMENT
BEING ABLE TO DISCIPLINARY
CREASE THE SUBSTANCE USE
PROBLEMS AMONG BLACK AMERICANS.
AND WE DO FIND FROM LOOKING AT
DATA FOR SUBSTANCE USE
SUBSTANCES THAT THEY ARE SEEKING
OUT OR ENGAGE NOTHING TREATMENT
AT COMPARABLE RATES TO OTHER
RACIAL ETHNIC GROUPS AND AT
TIMES EVEN HIGHER UTILIZATION OF
SUBSTANCE USE SERVICES.
HOWEVER, THERE IS LOWER
TREATMENT SATISFACTION ALMOST
CONSISTENTLY, LOWER ENGAGEMENT
ONCE THEY'RE IN SERVICES AND
PRETTY SIGNIFICANT HIGHER RATES
OF NOT COMPLETING, SO ENDING
SERVICES EARLY.
AND SO THERE'S A LOT OF DATA TO
SUPPORT THIS, I WANT TO
HIGHLIGHT A FEW.
SO USING--IT'S NOT GREAT FOR ANY
GROUP, SO IT'S ABOUT 50% FOR
WHITE ADULTS, LATIN X IS 46% AND
40% FOR BLACK ACULTS AND THESE
FINDINGS WERE ALSO FOUND FOR
LOOKING AT HOLD OLDER
POPULATIONS SO THIS WAS ANOTHER
STUDY FOR 65 AND UP AND FOUND
THAT COMPARED TO WHITE OLDER
ADULTS, THE BLACK OLDER ADULTS
WERE 37 PERCENT LESS LIKELY THAN
THE WHITE INDIVIDUALS TO
COMPLETE SUBSTANCE USE SERVICES.
SO JUST SHOWING THIS, JUST
VISUALLY, BASED ON SUBSTANCE
TYPE, AND YOU FIND THAT 1 OF THE
WORST RATES OF COMPLETION IS
ACTUALLY FOR ALCOHOL, ALCOHOL
TREATMENT, ONLY SECOND TO
METHAMPHETAMINES, SO AGAIN
OVERALL LOWER RATES OF
COMPLETION, BUT PARTICULARLY
WHEN WE THINK ABOUT ALCOHOL,
THERE IS CONCERN ABOUT SO WHY IS
THIS THE CASE, WHAT'S GOING ON,
WHY--NOT COMPLETING TREATMENT,
THEY'RE ENGAGE NOTHING
TREATMENT, STARTING TREATMENT
BUT NOT FINISHING, NOT SATISFIED
WITH IT, AND SO, WHAT ARE SOME
THINGS THAT WE NEED TO CONSIDER
TO HELP WITH THAT.
AND THIS REALLY DOES ALIGN WELL
WITH WHAT HAS BEEN DISCUSSED
EARLIER WITH ISSUES OF STIGMA
AND RACISM WHICH HAS ALSO BEEN
IDENTIFIED FOR BLACK AMERICANS.
SO JUST TO GIVE A DEFINITION FOR
STIGMA, THIS IS JUST HEALTH
RELATED STIGMA FOR SUBSTANCE USE
DISORDER IS ABOUT THE PROCESS,
IN WHICH SOCIAL GROUPS ARE
DEVALUED, REJECTED OR EXCLUDED
ON THE BASIS OF THAT CONDITION
AND THIS CAN HELP ACROSS GROUPS,
IT CAN HAPPEN WITHIN THE
INDIVIDUAL, CAN HAPPEN ACROSS
CONTEXT THAT AN INDIVIDUAL
ENGAGES IN, SO WITHIN
THEMSELVES, THEY CAN INTERNALIZE
NEGATIVE MESSAGES ABOUT
SUBSTANCE USE, PERCEIVED STIGMA
FROM THEMSELVES AND OTHERS
AROUND THEM AND POSSIBLY AVOID
THEM ENGAGING IN TREATMENT, BUT
WE CAN ALSO THINK ABOUT THE
PUBLIC AND STEREOTYPES ARE
PREJUDICE, THEY MIGHT BE ABOUT
INDIVIDUALS WITH SUBSTANCE USE
DISORDER THAT IS FOUND WITHIN
THE HEALTHCARE FIELD WITH THE
PROFESSIONALS AND THOSE ENGAGED
IN TREATING AND HELPING ALSO
HAVING STIGMA RELATED TO
SUBSTANCE USE DISORDER AND THEN
STRUCTURALLY, WE AND SEE STIGMA
AND POLICIES AND DIFFERENT
PROCEDURES THAT DECREASE
OPPORTUNITIES FOR PEOPLE TO BE
ABLE TO RECEIVE SUBSTANCE USE
DISORDER TREATMENT.
NOW RACISM, AND CHRISTINA TALKED
ABOUT THE DIFFERENCE AS WELL, IS
DIFFERENT.
THIS IS THINKING ABOUT A SYSTEM
IN WHICH WE'RE STRUCTURING AND
ASSIGNING VALUE BASED ON THE WAY
SOMEONE LOOKS IN THIS CASE, RACE
THAT UNFAIRLY ADVANTAGES SOME
INDIVIDUALS AND COMMUNITIES AND
UNFAIRLY DISADVANTAGES OTHERS
AND I'M USING THE DEFINITION BY
DR. KAMARA JONES FOR RACISM, AND
RACISM CAN BE SEEN AT DIFFERENT
LEVELS, 1 LEVEL THAT PARALLELS
WHEN WE TALK ABOUT STIGMA, WHAT
THAT OPPORTUNITY IS AT THE
STRUCTURAL LEVEL, IS STRUCTURAL
OR INSTITUTIONAL RACISM AND THIS
IS DIFFERENTIAL ACCESS TO GOODS
AND SERVICES BASED ON RACE.
AND SO WE THINK ABOUT THIS FOR
SUBSTABS USE SERVICES AND
TREATMENT, WHERE ARE THE
SERVICES PROVIDED?
IN WHAT COMMUNITIES ARE THEY
PROVIDED?
HOW EASY IS IT TO ACCESS THOSE
SERVICES?
WHAT THE DATA SHOWS IS THAT IT'S
MORE DIFFICULT, ALTHOUGH
MEASURES ARE ENGAGING IN
TREATMENT, IT'S HARD TO TO FIND
TREATMENT, NONAPOPTOTIC THE
GENERALLY EASILY ACCESSIBLE IN
HIGH PROPORTION OF RACIAL ETHNIC
MINORITY COMMUNITIES AND
TRANSPORTATION TO GET TO THOSE
SERVESZS AND MORE DIFFICULT, SO
THERE'S BARRIERS TO JUST
ACCESSING CARE THERE, WE NEED TO
LOOK AT OUTSIDE OF WHAT YOU GET
INTO TREATMENT AND WHAT HAPPENS
AT THAT STAGE.
AND SO, WHAT WE NEED TO DO
AGAIN, TALKING THIS THROUGH IS
DECREASE STIGMA FOR COMMUNITY
PERCEPTIONS OF SUBSTANCE USE
TREME AND SUBSTANCE USE
DISORDER, DECREASED STIGMA
WITHIN THE HEALTHCARE
PROFESSION, RIGHT IF SOMEONE
DOES COME IN, THE NEXT THING
THEY MAY NEED IS AN ADDITIONAL
PAIR BARE, PEOPLE HAVE
EXPERIENCED DISCRIMINATION, AND
INDIVIDUALS COMING IN TO GET
CARE AND STRUCTURALLY HOW DOE WE
MAKE SERVICES AVAILABLE IN
ENVIRONMENTS THAT'S EASILY
ACCESSIBLE IN WHICH PEOPLE FEEL
SAFE AND SUPPORTED WHICH PAIRS
NICELY WITH THE OTHER
PRESENTATIONS ABOUT COMMUNITY
AND BUILDING SUPPORT AND HAVING
A SAFE PLACE.
SO THINKING ABOUT BLACK
AMERICANS, 1 PLACE THAT HAS BEEN
LOOKED AT AS A GREAT PLACE TO
PROVIDE SUBSTANCE USE SERVICE IS
TD BLACK CHURCH AND I'M NOT
HIGHLIGHTING MY WORK BUT A WORK
BY A CLOSE FRIEND AND COLLEAGUES
DR. JORDAN, AND SO RELIGION AND
SPIRITUALITY HAS BEEN A CENTER
STONE FOR MANY BLACK
COMMUNITIES--TO SHOW THAT 65-80%
OF BLACK ADULTS ATTEND CHURCH,
SO THIS IS A PLACE WHERE THEY'RE
ALREADY GOING AND THEY'RE
ALREADY GOING TO TALK ABOUT
SUBSTANCE ABUSE ISSUES WITH THE
CLERGY FOR SEEKING EXPHELGT
SUPPORT.
SO SHE CONDUCTED A PILOT OF
FEASIBILITY OF PROVIDING
SUBSTANCE USE TREATMENT IN THE
BLACK CHURCH AND USING LOCAL
PEOPLE WITHIN THE COMMUNITY AS
FACILITATORS FOR PROVIDING THE
TREATMENT AND DOG IT IN A PLACE
WHERE INDIVIDUALS ALREADY WERE
AND SO, THIS IS A--IT WAS AN 8
WEEK PROGRAM WITH 7 SESSIONS AND
THIS JUST KIND OF SHOW WHAT IS
IT LOOKED LIKE, IT WAS CBT, SO
COMPUTER BASED TRAINING FOR
COGNITIVE BEHAVIORAL THERAPY, I
APOLOGIZE FOR MY DOG IN THE
BACKGROUND BUT IT WAS VERY
STRUCTURED WHERE THEY DID DO
URINE SAMPLES AND THEY PROVIDED
SPIR YITUAL SESSIONS WHERE THEY
TALKED ABOUT THEY HAD PRAYER,
INCLUDED SINGING, BUT ALSO HAD A
SESSION OF CBT DAHLINGER WAS ON
TASK WITH EACH INDIVIDUAL
COMPLETED WITH THE WORK LOAD AND
THEN THEY ENGAGED IN PRAYER
AFTERWARDS WITHIN A COMMUNITY
ENVIRONMENT AT THE CHURCH.
AND AGAIN THIS WAS THE PILOT
DATA SHE HAD PUBLISHED.
YOU SEE PEOPLE DID MEET CRITERIA
FOR SEVERE SUBSTANCE USE
DISORDER BASED ON DSM 5 AND
THINKING ABOUT FEASIBILITY BUT
ACCEPTABLE, ARE THEY COMPLETING
THE TREATMENT, ARE THEY FEELING
SUPPORTED, DO THEY CONTINUE TO
FIND IT EFFECTIVE?
AND 39 OUT OF 40 PARTICIPANTS,
AND AND ALSO TO MODULE SO WHICH
IS AMAZING AND NOT ONLY THAT A
SCALE OF 4.5 OUT OF 5, THEY WERE
HIGHLY SATISFIED WITH THE
TREATMENT THEY RECEIVED.
AGAIN, SO THIS IS JUST SAYING WE
CAN DO BETTER, RIGHT?
WE CAN PROVIDE THE SERVICES IN
PLACES WHERE PEOPLE ARE, WE CAN
MAKE SURE THAT IT IS WHERE
PEOPLE FEEL SAFE, SUPPORTED AND
ADDRESSING NEEDS THEY HAVE AND
HAVING PEOPLE AROUND THEM THAT
ARE ALSO SUPPORTIVE, RIGHT?
REDUCING THOSE BIASES AND
STIGMA.
AND SO SHE'S HAS NOW EXPABDED
THIS TO AN RO1 AND ADDICTION
TREATMENT IN THE BLACK COMMUNITY
WHICH IS REALLY GREAT BECAUSE
IT'S EXPAND THANKSGIVING IDEA
WHERE WE HAVE COMMUNITY-BASED
PARTICIPATORY RESEARCH WHERE THE
COMMUNITY IS INVOLVED.
WHERE WE'RE NOT JUST COMING IN
AND DOING PROGRAMS AND NEEDING
THE COMMUNITY TO BE IN THAT
PROCESS, COMPARED TO WHAT
EVERYBODY HAS BEEN TALKING ABOUT
WITH THE CASMI PROJECT.
THIS IS PEOPLE WITH COMMUNITY
LIVED EXPERIENCE, DECREASING
STIGMA RELATED TO SUBBANCE USE
DISEAREDDERS AND HAVING
FLEXIBILITY BY HAVING THE
COMMUNITY INVOLVED AND MAKING
SURE THAT IT'S CULTURALLY,
RELATED, RIGHT, APPLICABLE TO
THE EXPERIENCES AND NEEDS OF THE
COMMUNITY.
AND LASTLY, MAKING SURE IT'S
CULTURALLY RELEVANT, ALSO WITHIN
THIS, IS THE BLACK CHURCH IS A
CENTRAL COMPONENT TO IT WITH
SPIRITUALITY BEING HIGHLY
INTEGRATED AND TO THAT
INTERVENTION.
SO THAT'S A LOT ABOUT STIGMA,
BUT I WANT TO NOW SWITCH A
LITTLE BIT TO TALK ABOUT OTHER
THINGS TO CONSIDER WITHIN
TREATMENT FOR SUBSTANCE USE
DISORDER THAT CAN AGAIN HELP
WITH ADDRESSING WHERE THERE'S A
STRAP FOR BLAD INDIVIDUALEN
GAUGING BUT NOT COMPLETING AND
NOT FEELING THE QUALITY OF THE
SERVICE THAT'S PROVIDED.
SO THINGS TO CONSIDER HERE IS
RACISM, DISCRIMINATION, CULTURAL
FACTORS THAT ARE NOT GENERALLY
INCORPORATED INTO THE
INTERVENTIONS AND TREATMENTS
THAT ARE PROVIDED FOR SUBSTANCE
USE.
SO, THIS IS NOW TAKING A BIT
STEP EARLIER INTO DEVELOPMENT
SINCE I DO A LOT OF MY WORK WITH
ADOLESCENCENTS AND YOUNG ADULTS
WUWITHIN THESE MODELS ARE IF
EARLY INITIATION AND ENGAGEMENT
IN SUBSTANCE USE, WE ALSO USE
ADULTS AS WELL, THERE'S KIND OF
CORE FACTORS THAT WE THINK ARE
INVOLVED, SO PERSONALITY,
SOCIOLOGICAL DEMOGRAPHIC
VARIABLES, WHAT BEHAVIORAL LIST
THEY MIGHT HAVE, AGGRESSION, OR
OTHER EXTERNALIZING DISORDERS
FOR YOUTH FAMILY COMPOSITION,
PEER INFLUENCE, COMMUNITY
FACTORS AND STRESS.
HOW ARE THOSE THINGS INVOLVED IN
RISKS FOR SUBSTANCE USE AND WE
CONSIDER THOSE CROSS CULTURAL,
THAT WILL BE TRUE FOR ALMOST
ANYONE.
HOWEVER WHEN WE LOOK AT MODELS
THAT HAD USED JUST THOSE TYPE OF
RISK FACTORS FOR SUBSTANCE USE,
THEY GENERALLY DON'T DO WELL FOR
RACIAL ETHNIC MINORITIES,
PARTICULARLY BLACK YOUTH, SO
THIS IS THE DATA SHOWING THIS
FOR PREDICTING BINGE DRINKING
AND AGAIN PREDICTING 10% OF THE
VARIANTS IN BINGE DRINKING.
THAT'S MY DOG AND SO, AGAIN,
WE'RE SEEING THAT THERE'S THINGS
THAT ARE MISSING IN
UNDERSTANDING THE SUBSTANCE USE.
SO--I'M SORRY--SO, YOU KNOW WHAT
I HAVE USED IN MY RESEARCH IS
USING SOCIAL ECOLOGICAL MODEL AS
WELL AS SOCIETIES NORMS AND
POLICIES BUT ALSO UNDERSTANDING
THE IMPORTANCE OF RACISM AS IT
RELATES TO ALL OF THESE LEVELS,
WE TALKED A LITTLE BIT ABOUT THE
STRUCTURAL BUT THE INDIVIDUAL,
THE INTERACTIONS WITH FAMILY AND
PEERS, THE COMMUNITY.
IT HAPPENS IN SO MANY DIFFERENT
LEVELS THAT WE NEED TO
UNDERSTAND THE BREATH, THE
FREQUENCY OF WHICH IT OCCURS AND
HOW IT CAN IMPACT SUBSTANCE USE
ON A DAILY, WEEKLY, YEARLY LIFE
LONG LEVEL FOR RACIAL ETHNIC
MINORITIES.
SO I DID A STUDY JUST TO SHOW
THAT.
WE HAVE SOME DATA ALREADY THAT
HAS BEEN PRESENTED SHOWING
DISCRIMINATION BEING AN
IMPORTANT RISK FACTOR BUT I WANT
TO SHOW THAT THIS COULD PREDICT
ABOVE AND BEYOND THESE OTHER
CULTURALLY--CROSS CULTURAL
FACTORS, AGAIN TRYING TO PROVIDE
IMPERICAL SUPPORT FOR THE NEED
TO FOCUS ON THESE FACTORS
BECAUSE THEY ARE VERY RELEVANT
AT RISK FOR SUBSTANCE USE FOR IN
THIS CASE, FOR BLACK YOUTH AND
YOUNG ADULTS.
SOPHISTICATED ASKED WAS JUST
CANNABIS AND ALCOHOL USE AMONG
BLACK ADOLESCENTS, IT IS IN
COLLABORATION WITH DR. GENE
BRODY AND A TEAM AT THE
UNIVERSITY OF GEORGIA.
AND THIS WAS A STUDY WE HAD TO
FOLLOW UP, BLACK FAMILIES, BLACK
CHILDREN, FOR 14 YEARS, STARTING
WHEN THEY WERE 11, ALL THE WAY
TO 21.
AND SO, THE GOAL OF THIS WAS TO
LOOK AT THOSE FACTORS THAT WE
CONSIDER CROSS CULTURAL AND ALSO
HAVE A CULTURAL RISK DOMAIN
WHICH WAS RACIAL DISCRIMINATION,
AND AGAIN WHAT WE FOUND ON
SUPPORTING HYPOTHESIS, THAT WE
DO SEE THAT SOME OF THESE OTHER
FACTORS DO PREDICT A
CONSISTENTLY FROM EACH
SUBSTANCE, RACIAL DISCRIMINATION
PREDICTED, CONSISTENTLY FOR EACH
SUBSTANCE FOR THE BLACK YOUTH,
WHEN SOME OF THESE OTHER 1S THAT
WERE CONSIDERED CROSS CULTURAL
DID NOT, SO WHAT THIS IS REALLY
HIGHLIGHTS IS THE NEED FOR US TO
FOCUS AND TO INCLUDE RACISM INTO
MODELS, INTO SUBSTANCE USE AND
TO TREATMENTS BECAUSE THIS IS 1
OF THESE FACTORS THAT IS
SIGNIFICANT IS CAN HELP US
PROVIDE BETTER UNDERSTANDING OF
WHAT'S GOING ON TO HELP THOSE
THAT WE'RE WORKING WITH, THE
MOST DIVERSE COMMUNITY
UNDERSTAND HOW THIS TYPE OF
STRESSOR CAN IMPACT SUBSTANCE
USE AS WELL AS PROVIDING COPING
SKILLS AND HOW TO ADDRESS IT AND
REDUCE THAT IMPACT.
CO TRANSACTIVATOR PART I'VE DONE
IN MY WORK ARE RACIAL
MICROAGGRESSIONS WHICH ARE BRIEF
EVERYDAY EXCHANGES, SO THESE ARE
THE MACROLARGE EVENTS WHICH ARE
ALSO VERY TRAUMATIZING AND
STRESSFUL AND THESE RACIAL
MICROAGGRESSIONS ARE SUSHTLE,
THEY CAN BE VERBAL, NONVERBAL,
FEELING WATCH WHD YOU GO TO THE
STORE, POLICED, PEOPLE SAYING
THINGS LIKE CAN I TOUCH YOUR
HAIR OR WHERE ARE YOU FROM?
OR YOU TALK REALLY GOOD FOR
BEING BLACK OR X, WHATEVER, YOU
KNOW WHATEVER IESHES DENTITY SO
AGAIN, THEY'RE UNINTENTIONAL BUT
THEY RELEASE UNFEELING,
ISOLATED, UNSAVE ASK ALIENATED
AND WE WANT TO SHOW AGAIN THESE
ARE IMPORTANT STRESSORS FOR
SUBSTANCE USE FOR OTHER
STRESSORS THAT PEOPLE USE, SO WE
DID A STUDY LOOKING AT TRAUMA
USING TRADITIONAL TRAUMA
MEASURES, IN MANY DIFFERENT
STRESSORS THAT PEOPLE EXPERIENCE
AND THEN SPECIFICALLY RACIAL
MICROAGGRESSIONS THAT HAPPEN
ACROSS DIFFERENT SEGMENTS OF
SOMEONE'S LIFE AND AGAIN WE
FOUND THAT IN PREDICTING PROBLEM
ALCOHOL USE THAT THE RACIAL
MICROAGGRESSIONS PREDICTED ABOVE
AND BEYOND TRAUMA AND THE TRAUMA
DID PREDICT CANNABIS USE,
ALCOHOL AND OTHER
MICROAGGRESSIONS DID PROMPT
CANNABIS USE, SO ALL THIS TO SAY
IT'S IMPORTANT TO INCLUDE THOSE,
THERE'S ALSO OTHER CULTURALLY
RELEVANT FACTORS SUCH AS RACIAL
IDENTITY, AND RACIAL ETHNIC
SOCIALIZATION, IT CAN BE
IMPORTANT TO INCLUDE
INTERVENTIONS AND TREATMENTS TO
HELP ADDRESS THE ISSUES AND THE
COMMUNITY AND THE INDIVIDUALS
FACE SO ALL THIS WILL SAY IF WE
DO THESE THINGS WE CAN INCREASE
ACCESS AND SUBSTANCE USE
TREATMENT, AND WE CAN INCREASE
ENGAGEMENT OF PARTICULARLY BLACK
AMERICANS COMPLETION RATES OF
TREATMENTS AND ULTIMATELY
DECREASE SUBSTANCE USE AND
OUTCOMES AND DECREASE
DISPARITIES IN OUTCOMES ACROSS
DEVELOPMENT.
>> THANK YOU, THOSE WERE ALL
GREAT PRESENTATIONS.
I KNOW WE PROBABLY ONLY HAVE A
LITTLE BIT OF TIME FOR QUESTIONS
IF ANYBODY IN THE AUDIENCE WANTS
TO SEND ANY OF US A QUESTION,
PLEASE DO.
>> I CERTAINLY THINK IT'S SO
INTERESTING TO SEE ALL OF THE
EVIDENCE KIND OF POINTING IN
SUMULAR DIRECTIONS AND WHAT'S
THE--I JUST WANTED TO THANK
EVERYBODY FOR PARTICIPATING.
I--OKAY, SOME QUESTIONS ARE
COMING IN.
--SO I THINK THERE IS A NEED, I
BELIEVE IN ACADEMIA, IT'S HAVING
MORE BUT I DON'T KNOW HOW MUCH
IN JUST A GENERAL PUBLIC, IS
BEING DISCUSSED.
BUT I THINK HAVING THESE
DISCUSSIONS DEMYSTIFYS IT AND
HELPS PEOPLE THAT ARE
EXPERIENCING
THIS--NEURNOT--YOU'RE NOT JUST
THINKING THESE THINGS ARE
HAPPENING AND THEY'RE NOT, BUT
THEY ARE AND THEY ARE IMPORTANT
AND IMPACTFUL:
>> THAT'S A GREAT POINT, THE
FACT THAT THERE'S ALWAYS
DIVISION BETWEEN WHAT WE'RE
DOING IN RESEARCH VERSUS WHAT
PEOPLE HERE AND TALK ABOUT IN
LIKE THE COMMUNITY AND WHEN I
WAS MEETING WITH SOME PEOPLE, WE
WERE TALKING AND I PLAYED SOME
OF THE TAPE, AND THEY SAID, THIS
GOES ON, THIS IS EVERY DAY LIFE,
YOU KNOW BEING DISCRIMINATED
AGAINST, BUT IT'S IMPORTANT TBR
OTHER PEOPLE TO KNOW AND TO HEAR
IT.
AND TO KNOW THAT IT HURTS--THAT
IT AFFECTS US.
SO IT'S INTERESTING.
GO AHEAD HUMBERTO.
>> I WANT TO HIT SOMETHING
BECAUSE I COMPLETELY AGREE AND I
THINK THAT ANOTHER ELEMENT THAT
IS REALLY HELPFUL IS TO THINK
ABOUT HOW ARE WE GOING TO BE
TRAINING THE CLINICIANS TO HAVE
THESE CONVERSATIONS?
BECAUSE IT'S SO CLEAR THAT
RACISM PLAYS SUCH A CRITICAL
ROLE IN PEOPLE'S EXPERIENCES AND
PEOPLE'S ALCOHOL COMSUMPTIONS.
BUT YOU KNOW THROUGH 1 OF THE
SLIDES THAT TAMIKA HAD SLAIRED
SAID, THESE ARE THINGS I RESERVE
FOR MY BLACK CLINICIANS, MAYBE
IT WAS VICTOR BUT I THINK THAT'S
REALLY TELLING OF, YOU KNOW
PEOPLE WANT TO MAKE SURE THAT
WHEN THEY'RE TALKING TO
SOMEBODY, THE PERSON GETS IT AND
YOU'RE NOT HAVING TO EXPLAIN
KIND OF WHAT YOU MEAN OR THE
CULTURAL IMPLICATIONS ARE OR
EVEN THIS KIND OF CONCERN OF
WILL THIS PERSON UNDERSTAND WHAT
I'M SAYING OR WILL THEY ALSO
JUDGE ME AND I THINK THAT WE
HAVE A LONG WAY TO GO BECAUSE
THE MAJORITY OF SERVICE
PROVIDERS ARE WHAT?
AND SO WE NEED TO MAKE SURE THAT
PEOPLE ARE THANK YOU, THAT WAS
THAT'S VERY STRIKING TO PICK UP.
WELL, AGAIN,--I DON'T KNOW THAT
THE SPECIFIC INTERVENTIONS WE
TALKED ABOUT HAVE BEEN REP
LIAISON KAILTED TO THESE
COMMUNITIES BUT I KNOW THEY ARE
DOING IT CULTURALLY ADAPTED AND
TAILORED PROGRAMMING WITHIN THE
NATIVE COMMUNITY.
>> THAT'S GREAT.
THANK YOU.
>> I WILL JUST END WITH 1 MORE
QUESTION, I KNOW PEOPLE ARE
HANGING ON, BUT THIS IS A
QUESTION FOR YOU DR. SAPOLSKI,
CAN WE USE--INSTEAD OF QUESTIONS
CAN WE USE THE DAILY BASIS THEA
YOU SHARED AND RECOMMEND
ANTICIPATIONS TO GENERALIZE TO
MOST COMMUNITIES THE UNITED
STATES, I BELIEVE IT'S MAYBE
MOST BLACK COMMUNITIES, IN THE
UNITED STATES, HOPING I GOT THE
QUESTION RIGHT.
>> I'M NOT SURE WHICH DATA
YOU'RE REFERRING TO BUT I MEAN,
YEAH, THE DATA I PROVIDE WORK
FOR ALMOST EXCLUSIVELY,.
>> YOU CAN GO--
>> RECOMMENDATION, YES, YES.
>> YEAH, YEAH, THE DATA I
PROVIDED WERE THERE, BUT THERE
ARE STUDIES THAT DO REPLICATE
AND THERE ARE STUDIES WE HAVE
DONE THAT HAVE INCLUDED RACIAL
ETHNIC GROUPS AS WELL.
AND MANY OF THEM DO REPLICATE
ACROSS GROUPS SO I--I WOULD SAY
ACROSS THE BOARD, AND FOR ME,
AND MY WORK AS AN EDUCATOR I DO
TALK TO MY STUDENTS, ON BEING
CULTURALLY INFORMED AND HOW TO
HAVE THESE CONVERSATIONS WITHIN
OUR WORK AND MAKE IT PART OF THE
CONVERSATION, EVERYONE HAS A
CULTURE AND A FACTOR ON THIS AND
IT'S IMPORTANT FACTORS
WHENSOEVER THOSE MAY BE, AND
PEOPLE IDENTIFY THEMSELVES SO I
WOULD SAY, I USE THIS FOR
OUTSIDE OF RACE ETHNICITY, TALK
ABOUT THESE THINGS INVOLVED.
>> JUST 1 LAST QUESTION, THAT IS
WERE THERE--WAS COMMUNITY
SUPPORT GROUPS MENTION INDEED
THE CONVERSATION WITH CLIENTS OR
PARTICIPANTS LIKE AA MEETINGS, I
GUESS THAT COULD BE A QUESTION
FOR HUMBERTO VICTOR OR RECEDO?
>> WERE THERE ANY COMMUNITY
SUPPORT GROUPS, WAS THAT EVER
MENTIONED IN THERE THAT'S THE
QUESTION.
>> I WOULD SAY THOSE ARE
DEFINITELY THINGS THAT WERE
SURFACED.
AND YOU KNOW, IT REALLY, HOW
PEOPLE IF AT ALL WERE CONNECT
WITH THESE SERVICES, SOMETIMES,
YOU KNOW, I GUESS IT WOULD BE
SUPERINTERESTING TO SEE THE
LEVEL OF ACULTERATION AND THE
CONNECTION TO GROUPS
PARTICULARLY WITH RECENT
IMMIGRANTS IT WAS CHALLENGING TO
KNOW WHAT GROUPS EXIST AND HOW
TO GET CONNECTED BUT, A LOT OF
FOLKS WERE--WERE MORE CONNECTED
WITH SOCIAL GROUPS IN
PARTICULAR.
>> YEAH, THAT WOULD BE IMPORTANT
BECAUSE OF WHAT YOU LED WITH
CONCERNING THE PROFOUNDNESS OF
THE ISOLATION THAT YOU--THAT
REALLY PARTICIPANTS SHARED WITH
YOU.
>> OKAY, WELL, AGAIN, THANK YOU
TO EVERYBODY WHO'S ATTENDED AND
THANK YOU ALL ON THE PANEL
WHO'VE SHARED YOUR COMMENTS AND
HAVE BEEN VERY ENLIGHTENING