Substance Use by Immigrant Generation in a U.S.-Mexico Border City

Nativity and the risk of opioid use disorder among Hispanic/Latinx women in primary care in Los Angeles, CA

BACKGROUND

While rates of opioid use disorder (OUD) are lower among women compared to men, nativity may have disproportionate impacts on OUD risk among Hispanic/Latinx women but remain understudied.

OBJECTIVE

To assess the association between country of birth and reported OUD risk among low-income Hispanic/Latinx women in primary care in Los Angeles, CA.

METHODS

This was a cross-sectional study of 1189 non-pregnant, Hispanic/Latinx women attending two federally qualified health centers in Los Angeles between March and July 2013. OUD risk was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and moderate-to-high risk was defined as ASSIST score ≥ 4.

RESULTS

Overall, 4.2% of women (n = 49) were at moderate-to-high risk for OUD. Risk for OUD was higher among US-born women compared to foreign-born women (6.7 vs. 1.7%; p < .01), those who reported 2+ chronic medical conditions (p < .01), and those who were at moderate-to-high risk for other substance use disorders (p < .01). In multivariable logistic regression analyses, being U.S.-born was independently associated with being at moderate-to-high risk for OUD among Hispanic/Latinx women as compared to those who were foreign-born (AOR = 2.8; 95% CI 1.2-6.8).

CONCLUSION

Among low-income Hispanic/Latinx women presenting to primary care, one in twenty patients is at-risk for OUD. The odds of moderate-high risk of OUD were three times as high in US-born compared to foreign-born women, and higher among those with chronic medical conditions and those at risk of other substance use disorders. Gender-specific and culturally-tailored screening for OUD may inform overdose prevention interventions for US-born Hispanic/Latinx women.

Immigrants, refugees and cannabis use

Immigration typically occurs from low- to high-income countries and regions. Unfortunately, these wealthier areas also have higher rates of cannabis use (e.g. European Union and the US). This systematic review aimed to summarize available studies on cannabis use among immigrants, refugees, and asylum seekers. In addition, evidence on the association between immigration and cannabis use was reviewed. The rates of cannabis use were lower among immigrants than natives. The risk and protective factors to cannabis use were quite similar to those of the native populations. The population at greatest risk for cannabis use were refugees, males, singles, non-religious, those with lower educational level, living in urban areas, with friends that use cannabis and/or other drugs. Cannabis use tend to increase over generations, and acculturation seems to play a pivotal role. First generation migrants report equal or lower consumption of cannabis when compared with the majority population with a subsequent increase in following generations, with a clear association with acculturation factors. A higher cannabis use was found among migrants with lower cultural congruity as well as a higher level of culture assimilation. This use seems to be unrelated to alcohol or illicit drugs consumption, but possibly associated with tobacco smoking.

Gender Differences in Methamphetamine Use Initiation and Trajectory of Use Among People Who Use Methamphetamine in a Mexico-U.S. Border City

INTRODUCTION

Methamphetamine (meth) is a stimulant increasing in use and its prevalence has not yet been determined on the Mexico-U.S. border. Few studies highlight gender differences in meth use, trajectory, and initiation by gender. Ciudad Juárez, Mexico, across the border from El Paso, Texas, has an established stimulant using population and lies on drug trafficking route. This study assessed gender differences in drug and meth use patterns among people meth people use meth.

MATERIAL AND METHODS

This cross-sectional study included 150 people with recent meth use, age 21 years or older, and living in Ciudad Juárez. Measures collected included sociodemographic characteristics, cross-border mobility, drug and meth use characteristics. Statistically (p-value<0.05) and marginally (p-value<0.10) significant gender differences were determined using appropriate bivariate tests.

RESULTS

The sample included 45 cisgender women, five transgender women, and 100 cisgender men with a mean age of 30.9 years. Men had significantly higher rates of snorting meth by nose in powder or rock forms while trans/women more frequently using meth in pill form. Men had higher rates of crossing the border for work, with meth and to obtain meth. Trans/women reported higher rates of acquiring meth from main sexual partner and initiating meth use in Mexico.

DISCUSSION

There are gender differences in patterns of meth use and initiation.

CONCLUSIONS

Sample of people who use meth in general population can be achieved. These findings point to a need for evidence-based meth use reduction treatment programs that are culturally appropriate and tailored for gender.

Hispanic health disparities and housing: Comparing measured and self-reported health metrics among housed and homeless Latin individuals

Previous studies argue that Hispanics are healthier and less likely to experience homelessness than other populations in their same socioeconomic position. However, earlier studies have not explored the relationship between housing status and health for Latin individuals. This study examines 1) the health disparities between homeless and housed Hispanics in El Paso, Texas, and 2) the Hispanic health and homelessness paradoxes using an intersectional framework to understand health risks. A large number of Hispanic residents of El Paso (N = 1152) were surveyed. Demographic, health, and housing data were collected. We contribute to the literature by providing detailed health indicators for homeless Hispanics. To our knowledge, this is the first study to examine health disparities between housed and homeless Hispanics. Bivariate analysis, as well as data coded from interviews, indicated that homeless Hispanics were more likely to have barriers to care, less likely to have health insurance, slightly more likely than housed Hispanics to experience mental illness, alcoholism, and addiction, and more likely to be underdiagnosed for health problems, including hypertension. This study shows how certain traditional methods for collecting health data, including self-rated health and reported diagnoses, can be ineffective at revealing health disparities. This paper calls for innovative, mixed-methods approaches to understand the social and structural determinants of health for marginalized populations.

Sick Enough? Mental Illness and Service Eligibility for Homeless Individuals at the Border

This paper measures mental illness among individuals experiencing homelessness in a border city and compares it to the general housed population. We use original data from a homeless survey conducted in El Paso, Texas. Respondents self-reported any possible mental illness or related symptoms. We find that mental illness is not disproportionally common among the homeless, yet this is something that is often claimed by laypersons, some social service workers, and some researchers that limit sampling to institutionalized settings where formal mental illness is often among the prerequisites for admission. We find that “severe mental illness” among homeless persons is 6.2% (only around 2–3% higher than the general population), and “any mental illness” is 20.8% (only 1–3% higher than in the general population). Our results are consistent with other research focusing on street samples.

Hispanic Health Paradox at the Border: Substance, Alcohol, and Tobacco Use among Latinx Immigrants Seeking Free or Reduced-Cost Care in Southernmost Texas

OBJECTIVE

Although substantial research has explored the Hispanic health paradox (HHP) and suggests that Latinx immigrants experience positive health outcomes relative to those born in the United States, less research has assessed the role of immigration status. Our aim was to examine this role in Latinx health.

METHODS

Using survey data collected at two free/reduced-cost clinics in southernmost Texas, we examined differences in the mental and self-rated health, substance, alcohol, and tobacco use of low-income patients by undocumented/documented immigrant and US-born/naturalized citizen status (N = 588).

RESULTS

Based on ordinary least squares regression results, undocumented Latinx immigrants report lower negative self-rated health (coefficient -0.27, 95% confidence interval -0.50 to -0.01) and lower depressive symptoms (coefficient -0.34, 95% confidence interval -0.67 to -0.02]) compared with their US citizen peers (P < 0.05). Logistic regression results suggest that undocumented and documented Latinx immigrants do not differ in alcohol, tobacco, or substance use relative to their citizen peers.

CONCLUSIONS

Despite facing potentially adverse social environments, undocumented Latinx immigrants experience positive health outcomes relative to US-born/naturalized citizen peers.

Border Residents’ Perceptions of Crime and Security in El Paso, Texas

Research has continued to show the overall safety of the U.S. border region contrary to the widespread belief about the insecurity of the U.S.-Mexico border and frequent claims for the need to secure the border in order to prevent the spread of violence into the rest of the country. Rarely do we ask how border residents feel about safety and crime, which could shed significant light on the claims that the border is an insecure warzone posing a threat to the entire country. While calls to secure national borders are common, outsiders’ perceptions of an unsafe border are not supported by official crime rates and statistics, Border Patrol apprehensions, or the everyday experiences of people in American cities along the U.S.-Mexico border. This paper investigates the perception of crime and security, as expressed by the residents of El Paso, Texas, a large city located along the U.S.-Mexico border and directly across from Ciudad Juárez, Mexico. Data come from a National Institutes of Health (NIH) funded survey that asked 919 residents about their perceptions of crime, sense of security and safety in their neighborhood and the city in general. The results show that the overwhelming majority of border city residents feel safe and that those who are undocumented and raised in El Paso are the most likely to report feeling safe or very safe. We also find that the foreign-born population had a statistically significant lower felony conviction rate than those who were U.S.-born, an important qualifier in discussions over immigration and its connection with violence and crime. Contrary to sensationalized claims about border violence, residents of El Paso do not display any of the sense of insecurity experienced in neighboring Ciudad Juárez, Mexico. We present hypotheses about possible causes for these low levels of violence in the U.S.-side of the border and discuss the dissonance between the reality on the border and perception outside of the border region.