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

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

Current medical trainees (n = 54) and dental trainees (n = 59) reviewed 32 vignettes varying systematically in sex, age, ethnicity, and alcohol concern cues. Trainees used 0-100 visual analog scales (VASs) to rate the likelihood of discussing the patient's alcohol use (VAS1), the likelihood that the patient has AUD (VAS2), comfort discussing alcohol use with the patient (VAS3), and the likelihood of referring to AUD-related treatment (VAS4). Idiographic regressions characterized individuals' decision-making policies. Group-level analysis determined the influence of trainee ethnicity and trainee type on patient ethnicity cue use.

Almost all (96%-100%) trainees reliably used the alcohol concern cue when providing ratings. About 25%-56% of trainees used ethnicity as a cue. Trainee ethnicity did not significantly affect ethnicity cue use when evaluating vignettes (t < 1.37, p > .17; d < 0.56). Analyses indicated that medical trainees weighed the alcohol concern cue more heavily than dental trainees for VAS1.

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