Tyrone C. Cheng

Racial/Ethnic Differences in Access to Substance Abuse Treatment

A secondary dataset, Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003, was employed to examine racial/ethnic differences in access to specialty and non-specialty substance abuse treatment (compared with no access to treatment). The study found that non-Hispanic White Americans were (1) likelier than members of all racial/ethnic minority groups (other than Hispanics) to address substance abuse by accessing care through specialty addiction-treatment facilities, and were (2) also less likely to access substance abuse care through non-specialty facilities. Because non-specialty facilities may have staffs whose professional training does not target treating chronic, bio-psycho-social illness such as substance abuse, our results imply that treatment facilities deemed non-specialty may need to enhance staff training, in order to ensure individuals are properly screened for substance use conditions and are referred for or provided with effective counseling and medications as appropriate.

Discrimination's Role in Minority Groups’ Rates of Substance‐Use Disorder

This study asked whether, among the three largest American racial/ethnic minorities, presence/absence of current substance-use disorder is explained to any degree by social status and discrimination. It examined interaction effects involving discrimination and social status, exploring whether social-status factors are channeled through discrimination, fostering disorder. Logistic regression techniques were applied to data from the nationally representative dataset 2001-2003 Collaborative Psychiatric Epidemiology Surveys. Findings generally suggest that presence of substance-use disorder is likely to be associated with perceived discrimination. Significant interaction effects were also found: Discriminations strongest association with substance-use disorder was observed for Asian respondents with lower incomes and for Hispanic respondents with little education. This study significantly expands knowledge, since little research preceding it directly addressed relationships among social-status factors, discrimination, and substance-use disorder in minority populations. This studys results should encourage future researchers to further explore mechanisms of the mental health effects of discrimination.

Racial Differences in Co-Occurring Substance Use and Serious Psychological Distress: The Roles of Marriage and Religiosity

The study examined how marriage and religiosity can protect members of certain racial/ethnic groups against co-occurring substance use and serious psychological distress. Using the national dataset 2007 National Survey on Drug Use and Health, we analyzed data via multinomial logistic regression, observing several important results. Our findings generally support the deprivation-compensation thesis, in that religiosity elevates the mental health of racial/ethnic minority individuals more than that of Whites. We also found, however, that race/ethnicity moderates effects of education and poverty on the co-occurring behaviors, with Whites’ mental health benefiting more from wealth and education than Blacks’ or Hispanics’ mental health did.

The role of social structural factors in treatment of mental health disorder

Background Mental disorder implies a biopsychosocial condition, so adequate mental health treatment involves not just medical and pharmacological care but also psychotherapy or counseling. Aims The present study determined how social structural factors might explain accessing of primary care providers and specialty care providers in response to mental disorder, hypothesizing that the two broad types of care differ as to the likelihood of offering minimally adequate treatment. Method We analyzed data from the cross-sectional study called “2000–2001 Healthcare for Communities”, employing five imputed data sets to handle missing data and defining minimally adequate treatment of mental disorder as “at least four counseling sessions at any provider and prescribed medication”. Results While mental disorder can be treated in primary care or specialty facilities, our results show that minimally adequate treatment (as defined) is most likely to be obtained via specialty care. Conclusion For individuals with mental disorder, accessing only primary care creates social inequity, because care from specialty facilities is comparatively more adequate.

Disparities in Whites' versus Blacks' self-rated health: social status, health-care services, and health behaviors.

Using 2009 National Health Interview Survey data, we examined how social-status factors, variables describing health services, and health-related behaviors explained self-rated health among Black adults and among White adults. We wanted to evaluate whether self-rated health’s relationships with these three sets of variables were conditional on race. Our results overall indicated that social-status, health-care-services, and health-behaviors variables are important to the explanation of both groups’ self-rated health. But in this study, when all social-status, health-care-services, and health-behaviors variables were controlled, Black respondents’ self-reported health did not differ, on average, from White respondents’. Such a finding firmly suggests that the three sets of variables partially explain disparities in the groups’ self-reported health. In the end, our results showed racial health disparities to be partially explained by racial differences in distribution of health resources and health behaviors.

The impact of welfare reforms, health, and insurance status on welfare recipients' health care access.

This study explores ways in which welfare reforms have affected utilization of four health services (physician visits, hospital care, prescription medication, and dentist visits) and the impact of health insurance on these services. A secondary data analysis of a nationally representative sample of 1,259 non-elderly adult current and former welfare recipients shows that use of health services is significantly affected by state-specific welfare policy, health insurance, and race/ethnicity, when other variables are controlled. More restrictive state welfare policies were variously associated with lower likelihood of using dental care, visiting a physician and using prescriptions. Non-Hispanic whites in the sample were more likely than members of other racial/ethnic groups to use prescriptions; Hispanics were less likely than non-Hispanic whites to visit physicians or dentists. The proportion of respondents reporting fair or poor health was three times as great as the estimated proportion of non-elderly adults reporting fair or poor health in the general population. Policy implications are discussed.

Intimate Partner Violence and Welfare Participation A Longitudinal Causal Analysis

This longitudinal study examined the temporal-ordered causal relationship between intimate partner violence (IPV), five mental disorders (depression, generalized anxiety disorder, social phobia, panic attack, posttraumatic stress disorder [PTSD]), alcohol abuse/dependence, drug abuse/dependence, treatment seeking (from physician, counselor, and self-help group), employment, child support, and welfare participation. It was a secondary data analysis of records of 571 women; the records were extracted from the study “Violence Against Women and the Role of Welfare Reform” (VAWRWR). Results from generalized estimating equations (GEE) showed that experiencing controlling behaviors reduced likelihood of welfare participation whereas experiencing physical abuse increased it. Significant impact on welfare participation was wielded by panic attack, drug abuse/dependence, and employment; treatment seeking and child support made no significant impact. The study found no significant mediating effect wielded by panic attack, drug abuse/dependence, employment, or child support on welfare participation’s relationship to controlling behaviors or physically abusive behaviors experienced. Implications for intervention are discussed.

Maltreatment and Families' Receipt of Services: Their Associations With Reunification, Kinship Care, and Adoption

We examined matched services’ impact on reunification, kinship care, and adoption through secondary data analysis with a sample (extracted from the National Survey of Child and Adolescent Well-Being) of 1,760 children who experienced foster care and their permanent caregivers. Permanent caregivers included biological parents, step parents, relatives, and adoptive parents. Event history analysis showed (a) reunification was likelier when permanent caregivers received housing and cash assistance, and less likely when they received other services (e.g., employment services, health care services); (b) kinship care was less likely when employment, mental health, or substance abuse services were received; and (c) adoption was less likely when employment, domestic violence, legal, or health care services were received. Maltreatment did not impact permanency significantly. Implications for social work are discussed.

Racial Disparities in Intimate Partner Violence Examined Through the Multiple Disadvantage Model

This research adopted the perspective of the multiple disadvantage model to explore racial disparities in intimate partner violence (IPV) against women and IPV’s links to social structural factors, social relationships, substance use, and health/mental health and access to related services. The study used data from 6,588 women who completed the National Violence Against Women Survey; linear regression was conducted separately for four ethnic groups. Results consistently showed physical assaults to increase with posttraumatic stress disorder symptoms. For African Americans, increases in assaults were linked to injury, disclosing IPV to friends/family as well as medical professionals, Medicaid use, and drug use; decreases, in turn, were linked to past assault by ex-partners. For Latinas, increases in assaults were associated with eight factors: being married, number of ex-partners, depression, disclosing IPV to friends/family and disclosing to mental-health professionals, drug use, alcohol abstinence, and partner’s frequent alcohol use. For European Americans, increases in assaults were linked to number of ex-partners, injury, low income, Medicaid use, disclosing IPV to friends/family as well as mental-health professionals, and alcohol abstinence; decreases were associated with age and with other health insurance coverages. For women of other ethnicity, increases were linked to number of ex-partners, disclosing IPV to mental-health professionals, Medicaid use, drug use, and woman’s own as well as partner’s alcohol abstinence; decreases in this ethnicity category were linked to past assault by ex-partners. Intervention and policy implications are discussed.

Onset Drinking: How It Is Related Both to Mother's Drinking and Mother–Child Relationships

Employing the National Longitudinal Survey of Youth (NLSY) as a sample of adolescents and their mothers, the present study connected the onset of adolescents’ drinking to certain posited risk and protective factors characterizing their families. Via event history analysis and the discrete-time method, the data analysis involved more than 6,331 pair-interview-year units. The results show that both peer influences and mothers daily alcohol consumption enhance the risk that an adolescent aged between 10 and 14 years will begin drinking. At the same time, the quality of a mothers relationship with her child is an important posited protective factor delaying onset drinking.