Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 6, pp 1192–1199 | Cite as

Racial/Ethnic Differences in Alcohol and Drug Use Outcomes Following Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Federally Qualified Health Centers

  • Ethan Sahker
  • DeShauna Jones
  • Donna A. Lancianese
  • George Pro
  • Stephan ArndtEmail author



Substance use disorders (SUDs) pose a significant public health concern. Previous findings, while equivocal, demonstrate screening, brief intervention, and referral to treatment (SBIRT) is effective in reducing substance use and improving overall health. While race/ethnic and sex differences in SBIRT outcomes exist, racial/ethnic differences within sex groups remain unclear. The present study sought to quantify differences within race/ethnicity and sex in drug and alcohol use following SBIRT screenings.


Using health service data (N = 29,121) from a Midwestern state in four federally qualified health centers (FQHC) from 2012 to 2016, we assessed racial/ethnic and sex differences in the effect of SBIRT screening on alcohol and drug use between visits. We used McNemar’s tests and multiple logistic regression to predict substance use at follow-up visits.


We found a significant race/ethnicity by sex interaction predicting a positive alcohol prescreening (p < 0.001), precipitating a full alcohol screening, and subsequent hazardous drinking (p < 0.001) at full alcohol screening follow-up. Black males demonstrated the largest reduction in positive alcohol prescreenings at follow-up (9.24%). Patients identifying as White, Black, or Other demonstrated a reduction in hazardous drinking, though effect sizes were small and not clinically meaningful. No interactions in our drug outcome models were significant.


SBIRT is useful in addressing health services equity among Black and male populations. Public health policy should support universal substance use screening and targeting interventions for underserved groups in clinical facilities likely to benefit the most. Resources should be directed to groups with the most pressing SUD treatment needs.


Health disparity Substance use Federally qualified health centers Substance use services 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Data were existing and reidentified prior to authors receiving the dataset. Thus, informed consent was not obtained and deemed unnecessary by the IRB.

Ethical Approval

Research was determined to be non-human subjects by the IRB.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Counseling Psychology Program, Department of Psychological and Quantitative Foundations, College of EducationUniversity of IowaIowa CityUSA
  2. 2.Iowa Consortium for Substance Abuse Research and EvaluationUniversity of IowaIowa CityUSA
  3. 3.Office of Consultation and Research in Medical Education, Carver College of MedicineUniversity of IowaIowa CityUSA
  4. 4.Center for Health Equity ResearchNorthern Arizona UniversityFlagstaffUSA
  5. 5.Department of Psychiatry, Carver College of MedicineUniversity of IowaIowa CityUSA
  6. 6.Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityUSA

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