This project proposes the first study to examine whether culturally related constructs explain ethnic and racial differences in parents' willingness to prescribe psychotropic drugs to youth. Despite 20 years of increasing prescriptions to minors, Black and Latino children remain half as likely as White children to receive medication. Socio-demographic and clinical variables do not account for the difference, which parallels findings of greater Black and Latino skepticism toward psychotropic medication. 'Cultural factors' are said to explain the difference, but they have rarely been theorized or measured directly in large non-clinical and clinical samples of parents. Familism, traditionalism, fatalism, religiosity, beliefs about causes of youth disorders, perceived psychiatric medication treatment of youth stigma, acceptability of corporal punishment, and acceptability of psychotropic medication may be such factors. If so, then they should mediate the relationship between ethnicity/race and willingness to prescribe. The study will test this assumption using attitudinal and socio-demographic data collected during telephone interviews in English and Spanish with 1224 Black, Latino, and White parents or guardians of 5-17-year-old children, drawn by random-digit dialing from one ethnically diverse South Florida county. The sample will be stratified by ethnicity and race, with each of three equal-sized strata (n=408) further equally stratified by presence (n=204) or absence (n=204) in household of children with emotional or behavior problems, enabling adequate group comparisons to test - both in a general population sample of parents and in a sample of parents whose children might be referred for mental health treatment evaluation - the mediating role of culturally related constructs within a structural equation model. Potentially moderating influences of gender and SES on the model will also be tested. By increasing our ability to interpret ethnic and racial group differences more accurately, we may improve the cultural competence and fit of preventive and clinical interventions aimed at culturally diverse families. Moreover, given an uncertain benefit-to-risk ratio of psychotropic prescriptions to youth, it remains undetermined whether at a population level ethnic and racial differences should be understood as a health disparity favoring the majority because of White youths' greater exposure to drugs' benefits, or, conversely, as a public health advantage for minority youths because of their lesser exposure to drugs' risks. This study takes a logical first step toward exploring culturally embedded reasons for the majority's enthusiasm as well as for minorities' skepticism. PUBLIC HEALTH RELEVANCE: This is the first research to date that directly addresses various potential cultural factors that may mediate, in parents, the decision to have psychotropic drugs prescribed to their children. Authors have often suggested that cultural factors play a role in producing observed differences in prescription rates among ethnic and racial groups, but no model so far has specified these possible factors and their relationships. If cultural factors impact psychotropic drug prescription practices with youth, this study will be help to understand these factors more accurately, which could lead to improved outreach, educational, and clinical interventions for families and youths with mental health problems.
