A survey of the San Diego-Tijuana cross-border binging. Methods and analysis

Emerging Adults' Substance use and Risky Behaviors in Club Settings

This article explores the prevalence of drug and alcohol use and related risks by attendees at electronic music dance events (EMDEs) in club settings. From six events located on the East and West Coasts, anonymous data were collected via self-report questionnaires, drug bioassays, and alcohol breath tests prior to entry (N = 240) and upon exit from the venues (N = 219). EMDEs were locations for identifying young adults who were aged 18 to 25 (70%), not college students (54%), and at risk for substance use. Nearly half of the sample (45%) were positive for drug use, and 60% were positive for alcohol use at entrance. Slightly more than one third (38%) were positive for drug use, and 59% were positive for alcohol use at exit. Only a small percentage of the sample converted from no use to drug use on premises (5.4%). Future investigations need to explore targeted substance use prevention strategies within this context.

The effect of cross-border mobility on alcohol and drug use among Mexican-American residents living at the U.S.-Mexico border

INTRODUCTION

Little epidemiological evidence exists on alcohol or other substance use and related problems along the U.S.-Mexico border, although the border has been the focus of recent media attention related to the escalating drug/violence "epidemic". The purpose of this study was to analyze the association of variables related to crossing the border (cross-border mobility) with three substance use outcomes reported for the last year: 1) heavy drinking (5+ drinks per day for men or 4+ for women), 2) alcohol use disorder (AUD), and 3) co-occurring heavy drinking and drug use (any use of illicit and/or non-medically prescribed drugs).

METHODS

Household surveys were conducted, using area probability sampling of 1565 Mexican-American residents, aged 18-65, living at the Texas-Mexico border in the metropolitan areas of Laredo and McAllen/Brownsville.

RESULTS

Among those 18-29, more frequent crossing of the border was significantly predictive of AUD (OR = 1.61, p < 0.01) and co-occurring heavy drinking and drug use (OR = 1.70, p < 0.01). Staying more than one full day was predictive of AUD (OR = 3.07, p < 0.001) and crossing to obtain over-the-counter or prescription drugs ("drug tourism") or for nightlife/drinking were predictive of heavy drinking (ORs = 4.14, p < 0.001; 3.92, p < 0.01, respectively), AUD (ORs = 7.56, p < 0.001; 7.68, p < 0.01, respectively) and co-occurring heavy drinking and drug use (ORs = 8.53, p < 0.01; 4.96, p < 0.01, respectively). Among those 30-65, staying more than a full day and crossing for pharmaceutical reasons were predictive of heavy drinking (OR = 2.54, p < 0.001; 2.61, p < 0.05, respectively) and co-occurring heavy drinking and drug use (OR = 3.31, p < 0.001; 4.86, p < 0.01, respectively), while none of the mobility variables were predictive of AUD in this age group.

CONCLUSIONS

Cross-border mobility may play an important role in substance use and problems, especially among those 18-29. Findings also highlight the importance of "drug tourism" in substance use across the age spectrum.

The influence of status on group drinking by young adults: a survey of natural drinking groups on their way to and from bars

BACKGROUND

Young people's social standing among friends and peers has been linked to general levels of drinking and has been shown to influence others' drinking. We extend previous research by examining young adults' status within their natural-occurring drinking groups as a predictor of their subsequent alcohol consumption and encouragement of group members' alcohol consumption during a night out at licensed drinking establishments, a salient context for heavy drinking and alcohol-related risk among young adults.

METHODS

We recruited same-sex young adult drinking groups (n = 104 groups; 63 all-male; average group size = 3.4 members; Mage = 21.86) on their way to drinking establishments to complete a survey-containing measures of member-nominated within-group status, likeability, and self-reported alcohol consumption-and a breathalyzer test. At the end of the evening, participants completed the same alcohol consumption measures and were asked to nominate group members who encouraged other members to drink that night.

RESULTS

Multilevel analysis revealed that higher-status members engaged in the most alcohol consumption (via both self-report and breathalyzer) but in heavier drinking groups only. Higher-status members also encouraged the most alcohol consumed by others, regardless of levels of group drinking. Further, even though being liked by one's peers was positively related to intoxication that night, it did not account for the significant relationship between within-group status and drinking.

CONCLUSIONS

Results suggest that peer-related prevention programs for young adults' problem drinking may benefit from focusing on the structure and dynamic of young people's drinking groups. Also, programs targeting peer norms may be more successful if they incorporate status-related issues.

Risk behaviors among HIV-positive gay and bisexual men at party-oriented vacations

OBJECTIVE

This study examined substance use (intended and actual), unprotected sex, and HIV disclosure practices (disclosure and questioning) among HIV-positive men who have sex with men (MSM) at two party-oriented vacations, where substance use and sexual risk may be heightened.

METHOD

A random sample of 489 MSM attending one of two party-oriented vacations participated in PartyIntents, a short-term longitudinal survey. Nearly half (47%) completed a follow-up assessment at the event or online for up to 2 weeks after the event. We examined rates of baseline intentions to use substances, actual substance use, and unprotected intercourse among HIV-positive men in attendance.Rates among HIV-negative men were estimated for comparison. Multiple logistic regression was used to assess the impact of illegal drug use and HIV status on unprotected anal intercourse (UAI).

RESULTS

HIV-positive attendees (17%) were significantly more likely than HIV-negative attendees to use nitrite inhalants (or "poppers") (24.3% vs. 10.7%). HIV-positive attendees were also significantly more likely to have insertive UAI (64.3% vs. 34.1%) and receptive UAI (68.8% vs. 22.2%). Multivariate models showed associations between HIV status and illegal drug use with UAI (for HIV status, odds ratio [OR] = 4.5, p = .001; for any illegal drug use, OR = 16.4, p < .001). There was no evidence that the influence of drug use moderated risk by HIV status. Rates of HIV disclosure and questioning did not differ by HIV status.

CONCLUSIONS

HIV-positive men attending these events engaged in higher rates of illegal drug use and sexual risk than HIV-negative men. Prevention campaigns targeting MSM at high-risk events should include messages geared toward HIV-positive men.

Factors associated with genotype clustering of Mycobacterium tuberculosis isolates in an ethnically diverse region of southern California, United States

Mycobacterium tuberculosis (Mtb) isolates with identical genotypes, found in different patients, are most likely the result of recent transmission. Mtb strains with closely related genotypes, called clonal complexes, are most likely derived from one another. We examined Mtb genotypes from southern California TB patients from 2005 through 2008 to complete the first comprehensive molecular epidemiology analysis of this complicated and ethnically diverse region. Mtb genotypes were characterized with spoligotype and MIRU-12 typing. MIRU-VNTRplus was utilized to assign genotypes to global lineages and complete cluster analyses. Associations between patient characteristics and genotype clustering and clonal complexes were evaluated using logistic regression and frequency analysis. Of 832 Mtb isolates analyzed, 480 (58%) fell into 94 strain clusters. The majority of isolates were identified as being in the EA1 (31%), LAM (17%) and Haarlem (15%) lineages, but 13 different lineages were found in this region. TB patients with clustered isolates were more likely to be homeless (AOR 3.44, 95% CI 1.65, 7.18) and male (AOR 1.57, 95% CI 1.17, 2.10). Of the 480 clustered strains, 388 aggregated into six clonal complexes. Over 45% of reported TB cases were clustered and likely resulted from recent transmission events. Patients with clustered Mtb isolates that were grouped into clonal complexes had unique socio-demographic characteristics. These data suggest that TB is being transmitted in relatively insular community networks defined by race/ethnicity and country of origin. The addition of clonal complex analysis to simple cluster analysis provides important public health insights into the local transmission of TB in ethnically diverse regions with diverse Mtb genotypes.

Binge drinking and psychoactive drug use in a cohort of European youths

Background

TEN-D by Night is an international, multicentre, cross-sectional portal survey conducted on a large sample of young people in six European countries. This paper aims to investigate the alcohol and psychoactive drug consumption of this sample, with a focus on the prevalence of binge drinking and the poly-drug habits of the TEN-D cohort.

Design and Methods

The study population consisted of 4695 young people attending recreational sites on weekend nights. The intervention included two questionnaires and two psychoactive substance detection tests performed at the entry and exit of the recreational sites. A multivariate logistic regression model was used to predict the probability of binge drinking.

Results

Binge drinking was reported by 20% of the males and 13% of the females (P=0.001) before entry into the recreational sites and by 18% of the males and 11% of the females before entry into the clubs (P<0.001). Poly-drug use was reported by 71% of the males and 66% of the females. Living with a parent (OR 1.57; P=0.01), seeking employment (OR 1.66; P=0.005) and cannabis consumption (several times per month and several times per week, OR 1.94 and 3.66, respectively, P<0.05) were associated with binge drinking.

Conclusions

Our survey showed that it is possible to identify individuals and groups at higher risk of binge drinking. This identification would allow for a focus on specific targets and would facilitate the redesign of prevention programmes. The increased use of psychoactive substances among youths should be studied extensively to promote successful prevention campaigns.

PartyIntents: a portal survey to assess gay and bisexual men's risk behaviors at weekend parties

PartyIntents examines whether portal survey methods could be used to anonymously survey gay and bisexual men about HIV-risk behaviors before and after a weekend party-oriented vacation. The study recruited 97% of eligible men and of these 489 participants 47% completed the follow-up assessment. Approximately one half of the men intended to use illegal drugs over the weekend, and almost 20% thought that they might have anal intercourse and not use a condom. The methodology can be applied and provides useful information about HIV risk at these events, though refinements may be needed to increase the follow-up rates.

A European study on alcohol and drug use among young drivers: the TEND by Night study design and methodology

Background

Young individuals are the age group with the highest risk of car accidents. One of main explanations relies on the use of psychoactive substances (alcohol, illegal and medicinal drugs), which are known to be major risk factors of road accidents, and whose consumption is almost universally more common among younger drivers. Although the correlation between psychoactive substances use and decrease in driving performance has been established in controlled experimental or laboratory settings, few studies were conducted in naturalistic circumstances. The TEND by Night project has been designed to evaluate the relationship between driving performance and psychoactive substances assumption in young drivers enrolled at typical places of consumption.

Methods/Design

The TEND by Night project, endorsed by the European Commission, is a multidisciplinary, multi-centric, cross-sectional study conducted in six European countries (Italy, Belgium/Netherlands, Bulgaria, Spain, Poland and Latvia). The study population consists of 5000 young drivers aged 16-34 years, attending recreational sites during weekend nights. The intervention is based on the portal survey technique and includes several steps at the entrance and exit of selected sites, including the administration of semi-structured questionnaires, breath alcohol test, several drug assumption test, and measurement of the reaction time using a driving simulator. The main outcome is the difference in reaction time between the entrance and exit of the recreation site, and its correlation with psychoactive substances use. As a secondary outcome it will be explored the relationship between reaction time difference and the amount of consumption of each substance. All analyses will be multivariate.

Discussion

The project methodology should provide some relevant advantages over traditional survey systems. The main strengths of the study include the large and multicentric sample, the objective measurement of substance assumption (which is typically self-reported), the application of a portal survey technique and the simultaneous evaluation of several psychoactive substances.

Tuberculosis from Mycobacterium bovis in binational communities, United States

The incidence in San Diego is increasing and is concentrated mostly in persons of Mexican origin.

The epidemiology of tuberculosis (TB) in the United States is changing as the incidence of disease becomes more concentrated in foreign-born persons. Mycobacterium bovis appears to be contributing substantially to the TB incidence in some binational communities with ties to Mexico. We conducted a retrospective analysis of TB case surveillance data from the San Diego, California, region from 1994 through 2005 to estimate incidence trends, identify correlates of M. bovis disease, and evaluate risk factors for deaths during treatment. M. bovis accounted for 45% (62/138) of all culture-positive TB cases in children (<15 years of age) and 6% (203/3,153) of adult cases. M. bovis incidence increased significantly (p = 0.002) while M. tuberculosis incidence declined (p<0.001). Almost all M. bovis cases from 2001 through 2005 were in persons of Hispanic ethnicity. Persons with M. bovis were 2.55× (p = 0.01) as likely to die during treatment than those with M. tuberculosis.

At the borders, on the edge: use of injected methamphetamine in Tijuana and Ciudad Juarez, Mexico

Injection drug use is of increasing concern along the US-Mexico border where Tijuana and Ciudad (Cd.) Juarez are located. Methamphetamine has long been manufactured and trafficked through Mexico, with low rates of use within Mexico. With methamphetamine use now considered epidemic in the United States, and with associated individual and community harms such as HIV, STDs, domestic violence and crime, there is concern that rates of methamphetamine in the Northwestern border regions of Mexico may be rising. We conducted a qualitative study to explore the context of injection drug use in Tijuana and Cd. Juarez and included questions about methamphetamine. Guided in-depth interviews were conducted with 10 male and 10 female injection drug users (IDUs) in Tijuana and 15 male and 8 female IDUs in Cd. Juarez (total N = 43). Topics included types of drug used, injection settings, access to sterile needles and environmental influences. Interviews were taped, transcribed verbatim and translated. Content analysis was conducted to identify themes. The median age of injectors in both cities was 30. Methamphetamine was injected, either alone or in combination with other drugs by injectors in both Tijuana (85%) and Cd. Juarez (17%) in the 6 months previous to interview. Several important themes emerged with respect to methamphetamine use in both cities. IDUs in both cities considered methamphetamine to be widely used in Tijuana and infrequently used in Cd. Juarez, while the converse was true for cocaine. In both cities, stimulant (either cocaine or methamphetamine) use was widespread, with 85% in Tijuana and 83% in Cd. Juarez reporting current use of a stimulant, most often used in combination with heroin. Some injectors reported knowledge of local manufacturing and one had direct experience in making methamphetamine; some cross-border use and trafficking was reported. Injectors reported concerns or experience with serious health effects of methamphetamine such as abscesses or tuberculosis. Our study suggests that injected methamphetamine is entrenched in Tijuana and that Cd. Juarez may experience a methamphetamine outbreak in the future. Robust targeted interventions for both injected and non-injected methamphetamine should be a public health priority in both cities.

Person and environment predictors of blood alcohol concentrations: a multi-level study of college parties

AIMS

This study builds upon previous research by assessing the relationship of breath blood alcohol concentrations (BrAC) to environmental and individual characteristics.

DESIGN

We conducted a multi-level study of college parties. Our design included observational measures of party environments, a brief self-administered questionnaire, and the collection of breath samples from partygoers.

SETTING

Data were collected in private residences of students living in a neighborhood adjacent to a large public university located in the Southwestern United States.

PARTICIPANTS

A total of 1,304 individuals attending 66 parties participated in the study.

MEASURES

Observational measures of party characteristics were made by 2 trained research assistants at each party. Four to 5 trained interviewers administered a brief field survey to partygoers at each party. In addition, the trained interviewers collected breath samples using handheld breathalyzer devices.

FINDINGS

Hierarchical linear modeling analyses revealed significant variation at the party and individual levels. At the individual level, motivations to socialize were significantly associated with lower BrAC, while drinking games and providing the sample after 11:00 pm were associated with higher BrACs. At the party level, large parties were significantly associated with lower BrACs while reports of many intoxicated partygoers were associated with higher BrACs. Finally, we identified a significant gender by theme party interaction, indicating women had higher BrACs at theme parties relative to nontheme parties; however, BrACs for men were similar regardless of the type of party attended.

CONCLUSIONS

Alcohol consumption among young adults in natural settings is a function of both person and environmental factors.

Injecting drug users' experiences of policing practices in two Mexican-U.S. border cities: public health perspectives

BACKGROUND

Previous research has identified the impact of law enforcement practices on the behaviours and health of injection drug users (IDUs). We undertook a qualitative study of IDUs' experiences of policing practices in two Mexican cities on the U.S. border.

METHODS

In 2004, two teams of Mexican interviewers conducted in-depth interviews with IDUs residing in Tijuana and Ciudad Juarez (Cd. Juarez), Mexico, who had injected drugs at least once in the prior month. Topics included types of drug used, injection settings, access to sterile needles and experiences with police. Field notes and transcribed interviews were analysed to identify emergent themes.

RESULTS

Amongst the 43 participants, most reported that it is common for IDUs to be arrested and detained for 36h for carrying sterile or used syringes. Most reported that they or someone they knew had been beaten by police. Interviews suggested five key themes relating to police influence on the risk environment: (1) impact of policing practices on accessibility of sterile syringes, (2) influence of police on choice of places to inject drugs (e.g., shooting galleries), (3) police violence, (4) police corruption and (5) perceived changes in policing practices.

CONCLUSION

Findings suggest that some behaviour of police officers in Tijuana and Cd. Juarez is inconsistent with legal norms and may be negatively influencing the risk of acquiring blood-borne infections amongst IDUs. Implementing a comprehensive and successful HIV prevention programme amongst IDUs requires interventions to influence the knowledge, attitudes and practices of law enforcement officers.

Multimethod measurement of high-risk drinking locations: extending the portal survey method with follow-up telephone interviews

Portal survey techniques involve multimodal assessments (e.g., self-report, biologic, and observational) in high-risk drinking and drug-use settings. Our investigation expanded the portal survey methodology to include follow-up assessments of emerging adult women recruited at the border as they cross to and from Mexico south of San Diego, California. The feasibility of the follow-up procedure was established, and the limitations of the technique clarified. Follow-up participants and nonparticipants did not differ by age or reported victimization. Data indicated that 8% of women experience negative events on their return to the United States after a night of binge drinking. These experiences could only be captured in a follow-up survey, as they happened after participants left the border area.

A qualitative exploration of gender in the context of injection drug use in two US-Mexico border cities

Injection drug use is of increasing concern along the U.S.-Mexico border where Tijuana and Ciudad (Cd.) Juarez are located. We conducted a qualitative study to explore the context of drug use, with a focus on gender differences. In-depth interviews were conducted with 10 male and 10 female injection drug users (IDUs) in Tijuana and 15 male and 8 female IDUs in Cd. Juarez. Topics included types of drugs used, injection settings, access to sterile needles and environmental influences. Interviews were taped, transcribed and translated. Content analysis was conducted to identify themes. Several themes emerged with respect to gender: (a) how drugs were obtained; (b) where drugs were used; (c) relationship dynamics surrounding drug use; and (d) sex in exchange for money or drugs. Men reported buying and injecting in shooting galleries and other locations, whereas women tended to buy and inject drugs with people they knew and trusted. All men reported having shared syringes in shooting galleries, often with strangers. In these two cities, venue-based interventions may be more appropriate for male IDUs, whereas personal network interventions may be more appropriate among female IDUs.

The sidewalk survey: a field methodology to measure late-night college drinking

Alcohol use is highly prevalent among U.S. college students, and alcohol-related problems are often considered the most serious public health threat on American college campuses. Although empirical examinations of college drinking have relied primarily on self-report measures, several investigators have implemented field studies to obtain objective measures of alcohol consumption (blood alcohol concentration) from students in ecologically valid settings. This article describes the methodology of breath-test field survey that is being conducted on the grounds of San Diego State University. Descriptive summaries of the data collected through spring 2003 are provided, and limitations to methodology are discussed.

Portal surveys of time-out drinking locations: a tool for studying binge drinking and AOD use

Portal surveys, defined as assessments occurring proximal to the entry point to a high-risk locale and immediately on exit, can be used in different settings to measure characteristics and behavior of attendees at an event of interest. This methodology has been developed to assess alcohol and other drug (AOD) use at specific events and has included measuring intentions to use collected at entry and reported use on exit, as well as chemical tests for AOD consumption at both entrance and exit. Recent applications of the portal survey procedure to electronic music dance events that occur in established venues (e.g., bars or nightclubs) are discussed.

The impact of Ontario's extended drinking hours on cross-border cities of Windsor and Detroit

PURPOSE

This study evaluated the cross-border safety impact of extended drinking hours from 1:00 to 2:00 a.m., in licensed establishments in Ontario, Canada.

METHODS

This study examined patterns in total and alcohol-related casualties in: (1) Windsor, Ontario, Canada compared to Detroit, Michigan, US with a 2:00 a.m. closing time, and (2) Ontario compared to Michigan for overall trends. The criterion outcome indicators were: (1) monthly motor vehicle casualties (major injuries and fatalities) for the city-regions of Windsor and Detroit and (2) Ontario and Michigan monthly motor vehicle fatalities occurring between 11:00 p.m. and 3:00 a.m. for 4 years pre- and 3 years post-policy change. In order to examine cross-border drinking consequences, data were disaggregated to assess trends of motor vehicle injury collisions involving vehicles with US licence plates and with US drivers aged 16-20 in the Windsor region; similarly trends were assessed for motor vehicle injury collisions involving vehicles with Ontario licence plates in the Detroit region.

RESULTS

The Windsor region total motor vehicle casualty data showed a non-significant pre-post increase, while the Detroit region showed a statistically significant decrease for total motor vehicle casualties. In the Windsor region, a significant increase was found for alcohol-related motor vehicle casualties after the drinking hours were extended. However, the Detroit region showed a statistically significant decrease in alcohol-related motor vehicle casualties concomitant with Ontario's drinking hour extension. No similar trends were found for the province of Ontario and the state of Michigan as a whole. Moreover, a significant decrease was found for injury collisions involving vehicles with Ontario licence plates in the Detroit region but no similar pattern was found for injury collisions involving vehicles with US licence plates and with 16-20-year-old US drivers in the Windsor region.

DISCUSSION

These data seem to support a cross-border impact of the Ontario extended drinking policy. A significant increase in alcohol-related motor vehicle casualties was found in the Windsor region and concomitantly, significant decreases in total and alcohol-related motor vehicle casualties were found in the Detroit region after the extended drinking hours amendment. The Ontario government's belief that the extended drinking hour policy would "reduce the number of patrons who cross the border when Ontario's bars and restaurants close" may have been realized.

"Vivo para consumirla y la consumo para vivir" ["I live to inject and inject to live"]: high-risk injection behaviors in Tijuana, Mexico

Injection drug use is a growing problem on the US-Mexico border, where Tijuana is situated. We studied the context of injection drug use among injection drug users (IDUs) in Tijuana to help guide future research and interventions. Guided in-depth interviews were conducted with 10 male and 10 female current IDUs in Tijuana. Topics included types of drug used, injection settings, access to sterile needles, and environmental influences. Interviews were taped, transcribed verbatim, and translated. Content analysis was conducted to identify themes. Of the 20 IDUs, median age and age at first injection were 30 and 18. Most reported injecting at least daily: heroin ("carga", "chiva", "negra"), methamphetamine ("crico", "cri-cri"), or both drugs combined. In sharp contrast to Western US cities, almost all regularly attended shooting galleries ("yongos" or "picaderos") because of the difficulties obtaining syringes and police oppression. Almost all shared needles/paraphernalia ["cuete" (syringe), "cacharros" (cookers), cotton from sweaters/socks (filters)]. Some reported obtaining syringes from the United States. Key themes included (1) pharmacies refusing to sell or charging higher prices to IDUs, (2) ample availability of used/rented syringes from "picaderos" (e.g., charging approximately 5 pesos or "10 drops" of drug), and (3) poor HIV/AIDS knowledge, such as beliefs that exposing syringes to air "kills germs." This qualitative study suggests that IDUs in Tijuana are at high risk of HIV and other blood-borne infections. Interventions are urgently needed to expand access to sterile injection equipment and offset the potential for a widespread HIV epidemic.

Operation safe crossing: using science within a community intervention

AIMS

To evaluate a large drunk-driving enforcement program at the US/Mexican border to reduce the number of youths crossing the border to drink in Tijuana. This paper also describes the research data used to develop and manage the program. Data from a border breath-test survey were used to dramatize the problem and gain public support for action. The data were also used to help design the enforcement effort and measure progress in reducing the cross-border drinking problem.

DESIGN

The number of news events generated around the occurrence of special enforcement efforts were used to measure project activity and to predict changes in the numbers of youths crossing into Mexico, their returning BACs and reductions in alcohol-related crashes during a 3-year period.

SETTING

An urban county on the Mexican border.

PARTICIPANTS

Underage youths aged 18-20 years and young adults aged 21-30 years residing in San Diego County.

MEASUREMENTS

Immigration and Naturalization Services provided population counts of the number of individuals crossing each weekend night from Tijuana into the United States through the San Ysidro border facility. Breath-test surveys of a random sample of these returning crossers provided data on the number of US residents visiting bars and nightclubs in Tijuana and on alcohol consumption at Tijuana bars and nightclubs. Night-time had-been-drinking crash data involving young drivers in several California counties served as an outcome measure of public health and safety.

FINDINGS

Analysis of data involving more than 2 million pedestrians returning from Tijuana indicated that the Operation Safe Crossing program reduced the number of late-night crossers by 31.6%.

CONCLUSIONS

Effective use of data through media advocacy programs to support an enforcement effort can reduce alcohol-related crashes.

South of the border: a legal haven for underage drinking

AIMS

The research describes the characteristics and motivations of youthful San Diego County residents who patronize the bars and nightclubs in Tijuana, Mexico.

DESIGN

Two random-digit-dial surveys of San Diego County residents-one group aged 18-20 years and one aged 21-30 years-was conducted during a 2-year period. Those who reported having visited the bars in Tijuana in the last year were compared with those who had not.

SETTING

All respondents were residents of San Diego County, California, USA.

PARTICIPANTS

The study comprised 2200 youths between 18 and 30 years of age.

MEASUREMENTS

The interview protocol included questions covering demographic characteristics, drinking and drug-use history, experience with Tijuana bars, and ratings of bar features in San Diego and Tijuana.

FINDINGS

About half of the 18-20-year-olds and a third of the 21-30-year-olds reported visiting bars in Tijuana at least once in the past 12 months. Race, age, gender, heavy drinking and drug-use history were significantly associated with visits to Tijuana bars. The price of alcohol and the perceived freedom to get drunk in Tijuana bars were considered attractive features leading to cross-border drinking.

CONCLUSIONS

The features of the alcohol service in Mexican bars that attract youthful drinkers (low cost and liberal availability of alcohol, lack of formal controls, and presence of heavy drinkers) are similar to those present in other drinking locales that lead to drunkenness. Thus, a better understanding of the characteristics and motivations of the US youths patronizing bars in Tijuana can lead to improved interventions to reduce heavy, risky drinking.