Substance abuse prevalence and treatment among Latinos and Latinas

Expansion and evaluation of level II and III recovery residences for people taking medications for an opioid use disorder: project HOMES (Housing for MAR Expanded Services) study protocol

INTRODUCTION

As the US continues to battle the opioid epidemic, recovery residences remain valuable services for people in recovery. While there is a growing body of literature describing positive outcomes experienced by people who live in recovery residences, little is known about the experience of people who live in these residences while taking medications for an opioid use disorder (MOUD) as part of their recovery. Thus, this study has three aims: (1) expand the availability of recovery residences that meet the National Alliance for Recovery Residences standards in Texas and serve individuals taking medications for an opioid use disorder as part of their recovery; (2) evaluate recovery residences for people taking MOUD as part of their recovery; and (3) compare the cost-effectiveness of recovery residences to treatment-as-usual.

METHODS AND ANALYSIS

In collaboration with community partners, we opened 15 recovery residences in the State of Texas to house people taking MOUD as part of their recovery. We are collecting quantitative and qualitative data to evaluate outcomes at the intrapersonal, interpersonal, organisational and community levels. At the intrapersonal level, we are assessing changes in behavioural and psychosocial constructs using a longitudinal survey, objectively measuring current substance use with a point-of-interview breathalyser and urinalysis, and examining changes in healthcare utilisation using data obtained from a healthcare information exchange. We are collecting interpersonal data using in-depth individual interviews with residents and staff. We are collecting organisational data using field observation and a cost-effectiveness study, and we are collecting community data using neighbourhood mapping.

ETHICS AND DISSEMINATION

The UTHealth institutional review board approved all protocols. We will disseminate study findings via conference presentations, peer-reviewed publications and brief community reports.

The ACA Medicaid expansions and the supply of substance use disorder treatment services in Spanish

BACKGROUND

Given persistent disparities in substance use disorder (SUD) treatment for Spanish speakers, it is important to understand whether major health policy changes may improve access to linguistically competent services. We estimate changes in the supply of SUD treatment facilities that both accept Medicaid as payment and offer services in Spanish after the Medicaid expansions under the Affordable Care Act.

METHODS

We use data from the Mental Health and Addiction Treatment Tracking Repository for years 2010-2020 to calculate the number of facilities per 100 that offered both services in Spanish and accepted Medicaid as payment, facilities per 100 that accepted Medicaid as a form of payment overall, and facilities per 100 that offered Spanish language services overall. We use a difference-in-differences strategy exploiting variation in the timing of the Medicaid expansions across states, and county-level variation in the share of Spanish speaking Latinos across and within states.

RESULTS

We find that treatment facilities that both accepted Medicaid as a form of payment and offered Spanish language services increased by roughly 2-3 per 100, on average, in counties with the highest shares of Spanish speakers compared to counties with low to medium shares. This increase may be explained by more facilities accepting Medicaid as a form of payment.

CONCLUSION

The Medicaid expansions under the ACA produced a modest increase in the supply of SUD treatment facilities that both accepted Medicaid as payment and provided services in Spanish in areas with highest shares of Spanish speakers.

Addressing Hispanic Veterans that Live in Rural Area's Needs to Improve Suicide Prevention Efforts

Despite the alarming recent increase in suicide rates among Hispanic Veterans, suicide among this population remains relatively understudied and little is known about their needs and how to prevent suicide in this population. A mixed methods approach was utilized to conduct a needs assessment of community suicide prevention services and resources available to Hispanic Veterans living in rural areas in the Veterans Health Administration's Veterans Integrated Services Network (VISN) 8. Five themes related to the suicide prevention's needs and gaps in services were identified: (1) lack of adequate information; (2) disruptions in social support network; (3) limited or lack of access to services; (4) risky behaviors; and (5) natural disasters. Understanding the unique needs of Hispanic Veterans in rural communities and the gaps in services in these areas can help in the development of tailored suicide prevention efforts and potentially mitigate suicide disparities.

Anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation and quit problems among adult Latinx smokers

Cigarette smoking is associated with adverse physical and mental health among Latinx adults in the United States. The present investigation sought to explore the main and interactive effects of anxiety symptoms and anxiety sensitivity in relation to cigarette dependence, perceived barriers for smoking cessation, and severity of problems experienced when quitting among adult Latinx smokers. Participants included 338 Latinx adult daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that anxiety symptoms were associated with greater cigarette dependence, severity of problems when quitting, and perceived barriers for smoking cessation (effect size range: 2%-3% of variance), whereas anxiety sensitivity was related to severity of problems when quitting and perceived barriers for smoking cessation (effect size range: 2%-3% of variance). There was also a statistically significant interaction between anxiety sensitivity and anxiety symptoms for cigarette dependence; anxiety was related to cigarette dependence for Latinx smokers with higher levels of anxiety sensitivity, but not for those with lower levels of anxiety sensitivity. Overall, the present findings indicate that anxiety symptoms and anxiety sensitivity are relevant factors for better understanding cigarette dependence, problems experienced when trying to quit, and perceptions of barriers to quitting among adult Latinx smokers.

Implementation of a brief motivational intervention for alcohol and other drug using Latinx college students

Alcohol and other drug (AOD) use problems among college students continue to represent a public health epidemic. In 2019, historically high rates of binge-drinking and marijuana use were reported among college-age adults, and the detrimental effects of excessive AOD use in college, such as poorer academic performance, sexual assault, injury or overdoses, and a range of other negative consequences, have been well-documented. Thus, there is a continued need for effective implementation of evidence-based, cost-effective interventions aimed at reducing risks associated with collegiate AOD use. Guided Self Change (GSC) is a brief intervention involving motivational enhancement and cognitive-behavioral strategies and has demonstrated effectiveness in reducing AOD use problems. Its brevity, client-driven style, and concrete here-and-now focus are appealing to individuals struggling with mild to moderate AOD use problems. In order to successfully intervene with collegians with AOD use problems attending minority-serving institutions, GSC requires developmental and cultural tailoring. The current report describes the developmental and cultural tailoring of GSC for emerging adult Latinx collegians, as well as our consumer-driven addition of mindfulness content. Key components of our GSC program are documented through qualitative feedback, quantitative results, and case vignettes.

Experiences of sexist discrimination as a potential explanatory factor for alcohol and drug misuse among Latina young adult women

RATIONALE

Marianismo beliefs, or traditional female gender role beliefs among Latinas, have been found to serve as risk or protective factors linked with health risk behaviors in prior studies, including alcohol and drug misuse. However, limited research has examined potential factors that may contribute to or explain these associations. Sexist discrimination, which can serve as a significant stressor that may contribute to substance misuse, is one potential factor that may link marianismo beliefs and substance misuse among Latina young adult women.

OBJECTIVE

This study examined sexism as a potential mediator of hypothesized negative associations between five marianismo beliefs (Family Pillar, Virtuous and Chaste, Subordinate to Others, Silencing Self to Maintain Harmony, and Spiritual Pillar) and alcohol and drug misuse using structural equation modeling.

METHOD

Participants included 611 cisgender Latina full-time college student young adult women in the U.S. ages 18-26 who participated in an online cross-sectional survey about their health and behaviors.

RESULTS

Results delineated experiences of sexism as a significant risk factor for alcohol and drug misuse and as a potential explanatory factor that may partly explain associations between certain marianismo beliefs (i.e., Virtuous and Chaste beliefs) and substance misuse. Specifically, experiences of sexism partially accounted for the negative association between endorsement of the Virtuous and Chaste belief and increased alcohol and drug misuse among Latina young adults.

CONCLUSIONS

Prevention and intervention efforts should take a culturally responsive, gender-informed approach to address substance misuse among Latina young adults and address the negative influence of sexism on health.

Social Determinants Associated with Substance Use and Treatment Seeking in Females of Reproductive Age in the United States

Introduction: Females of reproductive age (FoRA; 15-49 years) are the demographic most likely to be diagnosed with a substance use disorder. Preventative treatment prior to or during pregnancy is critical. Stigma and social inequities can delay access to care. There is limited research examining social determinants of health (SDoH) and how they are related to substance use and treatment seeking in this demographic. Methods: We analyzed the 2016-2019 data from the United States National Survey on Drug Use and Health using multivariable logistic regression models. Statistically significant variables were conceptually linked to the Office of Disease Prevention and Health Promotion's (ODPHP's) SDoH framework's five domains. Results: From a total sample of 1,477,336 (weighted) pregnant people and 39,600,523 (weighted) FoRA, substance use was reported by 879,209 (2.14% [95% confidence interval = 2.13-2.15]). Pregnancy status was not associated with substance use or treatment seeking. Past-month substance use was associated with high educational attainment, an annual income <$20,000, a history of criminality, low religiosity, and having health insurance. Past-month treatment-seeking behavior was associated with older age, an annual income >$20,000, a history of criminality, and greater religiosity. Behavioral health support seeking in the past month was associated with some college education. Higher depression severity was associated with all the three models. Conclusions: Using the ODPHP's SDoH framework, we begin to elicit critical connections that can describe substance use and treatment-seeking practices in FoRA. We encourage additional research to inform public health, health care, behavioral health, and other support service programming.

The relative contribution of ethnic identity and ethnic discrimination on alcohol, tobacco, and other drug use disorders among Hispanic/Latin American individuals

INTRODUCTION

Racial/ethnic discrimination and ethnic identity, the affiliation and connection to one's ethnic group, are important for understanding alcohol, tobacco, and drug use disorders (AUD, TUD, DUD, respectively) among Hispanic/Latin American individuals. Although discrimination is a well-recognized risk factor, the role of ethnic identity is less understood. Moreover, no study has examined which of these factors is more important for informing AUD, TUD, and DUD. This information is necessary for creating effective prevention and treatment programs tailored for Hispanic/Latin American people. Herein we examined the role and relative importance of racial/ethnic discrimination and Hispanic ethnic identity on past year AUD, TUD, and DUD.

METHODS

Hispanic/Latin American participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III constituted the sample for this cross-sectional secondary data analysis. Participants (N = 7037) were 39.93 years old on average (SD = 15.32). More than half were female (56.1 %) and had family incomes below the median household income in the United States (58.7 %). Most had national origins in North America (79.3 %), including US dependent territories and Mexico. Confirmatory factor analysis (CFA) verified the psychometric properties of the discrimination and Hispanic ethnic identity measures. Logistic regressions, supplemented with dominance analysis, estimated the role and relative contribution of discrimination and Hispanic ethnic identity on the probability of past year AUD, TUD, and DUD.

RESULTS

The CFAs yielded adequate convergent validity and reliability for each construct. More racial/ethnic discrimination and a higher Hispanic ethnic identity related to a higher and lower probability of AUD, TUD, and DUD, respectively. The magnitude of the association between Hispanic ethnic identity and the probability of TUD exceeded that of racial/ethnic discrimination, but the converse was the case for AUD and DUD.

CONCLUSIONS

Prevention and treatment programs for TUD that highlight the value of having a strong sense of self as a member of a Hispanic ethnic group, and that encourage the individual to explore their Hispanic ancestry may prove effective among Hispanic/Latin American individuals, particularly those who have experienced racial/ethnic discrimination. Programs for AUD and DUD tailored for Hispanic Latin/American adults should also incorporate coping strategies to address experiences with racial/ethnic discrimination.

Mindfulness as an early intervention for hazardous alcohol use among non-treatment seeking Latine emerging adults: A mini-review

The age cohort referred to as emerging adults (ages 18-29 years old) demonstrates the most hazardous alcohol use in the United States (U.S.) Approximately one-third of emerging adults regularly engage in heavy episodic drinking (4/5 drinks in two hours females/males). Compared to their non-Latine White peers, Latine emerging adults in the U.S. report lower rates of heavy episodic drinking (HED) yet are at greater risk of developing a substance use disorder and experience more severe negative consequences from drinking alcohol. Despite their high-risk status, Latine emerging adults are less likely to seek treatment and have less access to innovative health-promoting resources, further exacerbating health inequities. Research has shown that practicing mindfulness can interrupt habituated cognitions, intrusive thinking, and automatic behaviors associated with hazardous drinking. However, Latine representation in MBI trials is minimal. This mini-review explores the potential value of mindfulness as an early intervention for hazardous alcohol use among Latine emerging adults. The review provides future directions for research, highlighting the need to design culturally and developmentally tailored MBIs that can provide a respectful, non-judgmental, and discrimination-free environment that appeals to Latine emerging adults. Additionally, conclusions are drawn regarding the possible benefits of pairing MBI with contingency management strategies to decrease attrition rates in MBI trials.

Treatment barriers among young adults living with a substance use disorder in Tshwane, South Africa

Background

Despite increasing substance use globally, substance use treatment utilisation remains low. This study sought to explore and measure substance use treatment barriers among young adults in South Africa.

Methods

The study was done in collaboration with the Community-Oriented Substance Use Programme run in Tshwane, South Africa. A mixed methods approach employing focus group discussions with key informants (n = 15), a survey with a random sample of people using substances and receiving treatment (n = 206), and individual semi-structured interviews (n = 15) was used. Descriptive statistics and thematic analysis were used to analyse data.

Results

Contextual barriers seemed more prominent than attitudinal barriers in the South African context. Fragmented services, stigma-related factors, an information gap and lack of resources and support (contextual factors), perceived lack of treatment efficacy, privacy concerns, and denial and unreadiness to give up (attitudinal factors) were treatment barriers that emerged as themes in both quantitative and qualitative data. Culture and religion/spirituality emerged as an important barrier/facilitator theme in the qualitative data.

Conclusion

Interventions need to embrace contextual factors such as culture, and more resources should be channelled towards substance use treatment. Multi-level stakeholder engagement is needed to minimise stigmatising behaviours from the community and to raise awareness of available treatment services. There is a need for strategies to integrate cultural factors, such as religion/spirituality and traditional healing, into treatment processes so that they complementarily work together with pharmacological treatments to improve health outcomes.

Cannabis Use Patterns and Related Health Outcomes Among Spanish Speakers in the United States and Internationally

Cannabis and health research continue to largely ignore the usage patterns, perceptions, and medically related use in Spanish-speaking communities. The primary aim of this study was to collect data among Spanish-speaking communities on cannabis use that specifically characterizes granular demographic information, medically motivated and recreational use patterns including potency of products, medical motivations for use, and what perceptions are held as to risks and benefits. Secondarily, exploratory analyses were made to investigate potential effects of location or acculturation status. Five hundred forty-nine individuals completed the survey, including 294 residing in the United States (US) (Mage =31.8, SD=9.72; 154 women, 137 men, 3 non-binary and self-described individuals), 174 residing outside of the US (International) (Mage =26.6, SD=8.75; 77 women, 96 men, 1 non-binary and self-described individuals), and 81 who did not report country of residence (Unknown location) (Mage =26.7, SD=7.37; 17 women, 61 men, 3 non-binary and self-described individuals). Overall use was mostly recreational, while the US group was significantly more motivated by medical or combined medical and recreational reasons than the other two groups (p=0.02). The most common reason for medical use was anxiety or depression (14% of sample). The US group also smoked or vaporized significantly more often than the other two groups and was more likely to include daily users (p<0.001). The sample generally viewed the effects of cannabis use more favorably than negatively, but there were significant differences in these views between users and non-users. The rich heterogeneity suggested by these data belies the importance of taking an equity focused approach to cannabis research and will help to improve representation in the field.

The Role of Acculturation in the Relation Between Intimate Partner Violence and Substance Misuse Among IPV-victimized Hispanic Women in the Community

Hispanic women in the United States are disproportionately affected by intimate partner violence (IPV). One correlate of IPV among Hispanic women with important public health implications is substance misuse. However, limited research has identified culturally relevant factors that may impact the strength of the IPV-substance misuse association in this population. The present study examined the moderating role of acculturation in the relation between IPV types (i.e., physical, psychological, and sexual) and substance (i.e., alcohol and drug) misuse. Participants were 150 IPV-exposed Hispanic women in the community (M age = 35.13). IPV types, substance misuse outcomes, and acculturation were significantly and positively correlated with each other at zero-order. Moderation analyses indicated that the relations between IPV and substance misuse were stronger among Hispanic women with higher (vs. lower) levels of acculturation. These findings suggest the potential utility of considering acculturation when assessing and treating substance misuse among IPV-exposed Hispanic women.

Building a More Diverse and Inclusive Science: Mindfulness-Based Approaches for Latinx Individuals

Objectives

This article represents a call to action for the mindfulness field to be more diverse and inclusive of Latinx individuals. Building a diverse and inclusive science around mindfulness-based approaches (MBAs) that considers important group-level cultural and contextual information is an important public health challenge in need of innovative solutions.

Methods

We describe ways that the Latinx population is poised to benefit from MBAs. We further elucidate challenges, describe potential solutions, and outline a research agenda that may hold promise for building a more inclusive mindfulness movement.

Results

Our recommendations center around developing nuanced cultural adaptations to MBAs, engaging Latinx individuals in research, increasing the rigor of scientific studies pertaining to Latinx individuals, relying on implementation science to develop innovative methods for disseminating MBAs to Latinx individuals, developing training and certification mechanisms to increase diversity and representation of Latinx mindfulness teachers, and creating mechanisms for the oversight of MBAs within this group.

Conclusions

There has been a lack of inclusivity of Latinx individuals in the field of MBAs with regards to research studies, barriers to access for economically disadvantaged groups, and lack of diversity in its workforce. Considering the recognition of adverse social drivers of health that generate chronic stress and health disparities, the Latinx population is especially poised to benefit greatly from MBAs. A diverse and inclusive mindfulness science holds promise to enhance the effectiveness, acceptability, feasibility, and wide-scale dissemination and implementation of MBAs.

Do Trajectories of Sensation Seeking Vary by Sex and Child Maltreatment Subtypes?

Child maltreatment and elevated sensation seeking are associated with a wide range of negative outcomes. Longitudinal data from a study of Puerto Ricans living in two sociocultural contexts were used to determine whether child maltreatment subtypes, sex, or sociocultural context relate to trajectories of sensation seeking. Participants were 2,489 individuals from the Boricua Youth Study (48.5% girls) living in New York and in Puerto Rico (PR; 5-15 years old at Wave 1). Subtypes of child maltreatment were measured using child report on the Parent-Child Conflict Tactics Scale and the Sexual Victimization Scale at Wave 1. The association between child maltreatment subtypes, sex, sociocultural context, and previously established sensation-seeking trajectories across three waves of data collection was probed using multinomial logistic regression. Girls, but not boys, who experienced neglect (adjusted odds ratio; AOR; 95% confidence interval [95% CI] = 5.33 [1.35, 21.03]), or physical abuse (AOR [95% CI] = 3.66 [1.07, 12.54]), were more likely to have an elevated sensation-seeking trajectory than a normative trajectory. For boys, none of the maltreatment subtypes were linked to the elevated sensation-seeking class. Girls exposed to verbal abuse (AOR [95% CI] = 0.33 [0.15, 0.75]) and boys exposed to physical abuse (AOR [95% CI] = 0.39 [0.16, 0.97]) were less likely to belong to the low sensation-seeking class. No significant interactions between sociocultural context (i.e., PR vs. New York) and maltreatment subtype on the development of sensation seeking were found. This research suggests sensation-seeking levels vary by experiences of childhood maltreatment, and that sex moderates the relationship between child maltreatment experiences and sensation seeking, with an association between some maltreatment subtypes and elevated sensation-seeking trajectories found in girls, but not boys. These results underline the importance of considering sex when examining how child maltreatment relates to outcomes.

Black-White differences in barriers to specialty alcohol and drug treatment: findings from a qualitative study

The objective of this study was to explore, in-depth, differences in barriers to specialty alcohol and drug treatment services between Black and White participants with recent substance use disorders (SUD). We recruited 34 participants with a recent SUD of White and Black racial/ethnic descent for qualitative interviews. Interviews were coded to identify barriers to specialty treatment. We found that barriers related to stigma and lack of social support were more pervasive in the narratives of Blacks as compared to Whites. Results suggest that stigma and lack of perceived social support may impact Blacks more than Whites in seeking SUD treatment.

The impact of childhood trauma on substance use trajectories from adolescence to adulthood: Findings from a longitudinal Hispanic cohort study

BACKGROUND

Adverse Childhood Experiences (ACE) are associated with substance use in adolescence and adulthood. However, there is a lack of longitudinal research examining the effect of ACE on substance use trajectories from adolescence through emerging adulthood.

OBJECTIVE

This study examined the role of ACE in substance use trajectories among Hispanic emerging adults.

PARTICIPANTS

We surveyed a cohort of Hispanic adolescents (n = 1399) in Southern California across eight survey waves (beginning in 9th grade and continuing through emerging adulthood).

METHODS

Growth curve models were used to examine the effect of ACE on past 30-day cigarette, marijuana, and alcohol use over seven time points, and an interaction term of ACE ∗ time was included to investigate the cross-level effect of ACE.

RESULTS

ACE was a significant predictor at 9th grade across all substances. Every additional ACE was associated with significantly higher past 30-day cigarette use (β = 0.05, 95%CI = 0.01, 0.10), marijuana use, (β = 0.15, 95%CI = 0.06, 0.25) and alcohol use (β = 0.14, 95%CI = 0.06, 0.21). Across all models, cross level interactions between ACE and time indicated that young adults exposed to more ACE experience significantly steeper inclining trajectories of 30-day cigarette use (β = 0.05, 95%CI = 0.02, 0.68), marijuana use (β = 0.07, 95%CI = 0.03, 0.11), and alcohol use (β = 0.02, 95%CI = 0.02, 0.68) than young adults with fewer ACE.

CONCLUSION

ACE continue to have an impact on substance use trends through emerging adulthood. Results highlight the graded effect of ACE on substance use during and beyond adolescence and illustrate that ACE exposure is linked to an escalation of substance use frequency.

Racial/Ethnic Disparities in Mutual Help Group Participation for Substance Use Problems

Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct; so, it is paramount to understand whether they are as appealing to, and as effective for, racial or ethnic minority groups as they are for Whites. Nonetheless, no known comprehensive reviews have examined whether there are racial/ethnic disparities in mutual help group participation. Accordingly, this study comprehensively reviewed the U.S. literature on racial/ethnic disparities in mutual help participation among adults and adolescents with substance use disorder treatment need. The study identified 19 articles comparing mutual help participation across specific racial/ethnic minority groups and Whites, including eight national epidemiological studies and 11 treatment/community studies. Most compared Latinx and/or Black adults to White adults, and all but two analyzed 12-step participation, with others examining "self-help" attendance. Across studies, racial/ethnic comparisons yielded mostly null (N = 17) and mixed (N = 9) effects, though some findings were consistent with a racial/ethnic disparity (N = 6) or minority advantage (N = 3). Findings were weakly suggestive of disparities for Latinx populations (especially immigrants, women, and adolescents) as well as for Black women and adolescents. Overall, data were sparse, inconsistent, and dated, highlighting the need for additional studies in this area.

THE ASSOCIATION BETWEEN BEHAVIORAL AND ATTITUDINAL ACCULTURATION ON LATINX IMMIGRANTS AND U.S.-BORN LATINXS: A MULTIDIMENSIONAL ACCULTURATION MODEL

Disparities in access and utilization of substance abuse treatment (SAT) among Latinxs, accentuated by this population's rapid growth, create a public health issue. Although substance abuse literature has given more consideration to environmental factors and social support concerning treatment outcomes, current substance abuse models fail to address important contextual and cultural aspects for Latinxs in recovery, including acculturation. The proposed study aims to test out a multidimensional acculturation model on a sample of 131 Latinxs (M_age= 36.3; SD±10.4, 117 males, 49% immigrants) who recently completed SAT. Specifically, the proposed study employed a conditional process model using the PROCESS Macro for SPSS to examine the association between behavioral acculturation and substance use behavior in the past six months on nativity status at different levels of attitudinal acculturation. Results yielded that, after controlling for age and substance use, higher endorsement of U.S. mainstream cultural practices was associated with a higher frequency of days using alcohol among Latinx immigrants, specifically those reporting high and very high affiliation to the U.S. mainstream culture. Also, a negative association between U.S. mainland-born Latinx and frequency of days using illicit drugs in the past six months was observed, but only among those who endorse very high affiliation of U.S. mainstream culture.

Substance use prevalence rates among migrant and native adolescents in Europe: A systematic review

ISSUES

Migrant adolescents show specific risk and protective factors associated with substance use, but the extent to which prevalence rates differ between migrant and native-born youth in Europe remains unclear. The present study aims to provide a comprehensive review of all available substance use prevalence studies on differences in substance use between migrant and native-born adolescents in Europe.

APPROACH

In this systematic review, PubMed, Medline and Pre-Medline, EMBASE and PsycINFO were searched for articles comparing substance use prevalence rates (tobacco, alcohol, illicit drugs) between migrant and native-born adolescents or young adults aged 11 to 29 years in European countries. The Joanna Briggs Institute prevalence critical appraisal tool was used for quality assessment.

KEY FINDINGS

Fifteen studies met the inclusion criteria. The findings unanimously showed lower alcohol use in migrant compared to native-born adolescents, in particular among migrant adolescents from non-European countries and/or with a Muslim background. For tobacco and illicit drug use, findings were mixed.

IMPLICATIONS

The results suggest a healthier behaviour profile among migrants than among native-born adolescents regarding alcohol use. Therefore, it would be beneficial to develop interventions to support migrant communities in maintaining their healthier alcohol use practices upon arrival in the host country.

CONCLUSION

Compared to native-born adolescents, migrant adolescents are less likely to use alcohol. The findings on tobacco and illicit drug use were mixed. A European standard for surveys regarding substance use among adolescents is needed to investigate fluctuations, causes, and consequences of substance use differences between migrants and natives at the European level.

La Cultura Cura: Latino Culture, Shared Experiences, and Recovery in Northern Californian Anexos

This article examines the anexo's use of Latino culture and shared experiences to promote recovery and its appeal to 1.5- and second-generation Latinos. Anexos are grassroots recovery groups with origins in Mexico that offer a residential Alcoholics Anonymous program in Latino communities. Data were gathered from a two-year (2014-2016) ethnographic study of anexos in Northern California and were analyzed thematically. Despite having access to publicly funded treatment, many 1.5- and second-generation Latinos accessed anexos based on cultural familiarity, shared experiences, and a desire to recuperate cultural practices lost during their substance use.

Grassroots interventions for alcohol use disorders in the Mexican immigrant community: A narrative literature review

This narrative literature review addresses grassroots interventions for alcohol use disorders as practiced in Mexican immigrant communities. These organic efforts are 24-hour AA groups, or anexos, fourth and fifth step AA groups, juramentos, and curanderismo. Literature was identified using PubMed and CINAHL and limited to works published from 2000 to 2018. In all, three publications on 24-hour groups were found, two on fourth and fifth step groups, four on juramentos, and one on curanderismo use. The review offers insight on their practices and concludes that the interventions' cultural resonance provides advantages over cultural competency AUDs programs developed in public health.

Women's Barriers to Specialty Substance Abuse Treatment: A Qualitative Exploration of Racial/Ethnic Differences

To explore barriers to specialty substance abuse treatment programs among women with recent substance use disorders by race/ethnicity. Qualitative interviews were conducted with 28 women of White, Black, and Latino racial/ethnic descent who reported a substance use disorder in the past 5 years. Interviews were conducted by telephone and were audio-recorded. A codebook was developed using the Theory of Planned Behavior to code and identify barriers within the domains of attitudes, subjective norms, and perceived control toward specialty treatment. Frequencies for coded themes were then compared across all participants and by race/ethnicity. We identified several key differences in barriers to treatment by race/ethnicity. Attitudinal barriers were more pervasive among the narratives of Latinas relative to Black and White women. Latinas were more likely to report not needing treatment and that treatment would not be effective; Latinas were the only group to describe cultural barriers to treatment. Within the subjective norms domain, namely stigma and lack of support, were key barriers. Stigma was more pervasive among the narratives of Latinas and Black women than White women; Latinas were more likely to report a lack of social support for using treatment than both Black and White women. Findings provide deeper insight into barriers that may be contributing to racial/ethnic disparities in the use of substance abuse treatment among women.

Substance use among Latino international and domestic college students

While the United States hosts the greatest number of international students in the world, Latino international students remain understudied, especially in regards to substance use. The present study tests differences between Latino international and Latino domestic undergraduates in how they use alcohol, cigarette, and illicit drugs. Participants (N = 786 students, 386 international and 400 domestic, 65% female, mean age = 21.2 years) were a subsample of Latino students surveyed in the 2009 American College Health Association's revised National College Health Assessment (ACHA-NCHA II). Results indicate that Latino international students reported more alcohol use than Latino domestic students, but had similar use of cigarettes and illicit drugs. Among international students, gender, participation in Greek life, cigarette use, marijuana use, and year in school were associated with alcohol use. Similarly, gender, cigarette use, and marijuana use were significantly related to international students' binge drinking. Prevention and research implications are discussed.

The relationship of mindfulness and mindfulness-related practices with alcohol use among Hispanics/Latinx

Hispanics/Latinx (H/Ls) are the largest ethnic minority group in the U.S., and three of the four leading causes of death are associated with problematic alcohol use. This study examined the relationship between mindfulness and alcohol use among H/Ls and whether differences emerged by sub-ethnicity. Participants (N = 341; 49.7% female; average age=28.57) were H/Ls currently living in the U.S. Survey questions were answered online in English or Spanish. Participants primarily endorsed engaging in informal mindfulness practices (47.5%), spiritual practices (25.2%), and mindfulness meditation (24.6%). No significant differences emerged among H/L sub-ethnicities. Spiritual practices and higher mindfulness were associated with less problematic alcohol use among the entire sample. Similar results were found among drinkers-only. Findings shed light on commonly used mindfulness practices and indicate that very few differences emerge among H/L sub-ethnicities on mindfulness practices and general mindfulness. The delivery/tailoring of mindfulness-based interventions (MBIs) may not need to differ amongst H/L sub-ethnicities in the U.S. Aspects of mindfulness appear protective regarding problematic alcohol use, suggesting that future MBIs that increase mindfulness should be explored for this population.

Substance Use, Service Provision, Access & Utilization among Foreign-Born Communities in the United States: A Mixed Methods Study

The prevalence of substance use among the foreign-born has gained increasing attention. Cumulative migration stressors - including historical trauma, violence, family separation, and poverty - present challenges to human service systems wherein services may not adequately meet the needs of these groups. Objectives: This study explores the challenges and realities of substance use, substance use service provision, and delivery of services among the increasingly diverse immigrant population using multiple perspectives. This study is based on data from a larger mixed methods study that assessed the human service landscape pertaining to the immigrant population in a mid-western region of the United States. Methods: This transformative mixed methods study used a community based participatory research approach. Data were collected from human service providers (HSPs), informal service providers, and local community leaders through surveys (n = 64), in-depth interviews (n = 23), and six focus group discussions (n = 48). A weaving approach was used to integrate findings from quantitative and qualitative data. Results: Participants recognize substance use as an issue that needs immediate attention among increasingly diverse immigrant communities. Community members and human service organizations identified several emergent themes including patterns and occurrence of substance use, barriers to care, and proposed system changes. Conclusions: Given that only 28% of responding organizations list substance use as part of their core services, the need for organizational collaborations with a focus on culturally responsive evidence-based services is proposed.

A current re-examination of racial/ethnic disparities in the use of substance abuse treatment: Do disparities persist?

OBJECTIVE

Racial/ethnic disparities in the use of substance abuse treatment services have been documented. The objective of this study was to re-examine if racial/ethnic disparities in the use of treatment still exist using current data collected post-implementation of the Affordable Care Act.

METHODS

Data were pooled from the National Survey on Drug Use and Health survey years 2015, 2016, and 2017. Analyses were limited to adult White, Black, and Latino participants who met DSM-IV criteria for a past-year substance use disorder (n = 12,070). Hierarchical multivariate logistic regression models examined the role of race/ethnicity on past-year use of (1) any substance abuse treatment services and (2) specialty treatment. Important covariates included socio-demographics, problem severity, and perceived treatment need. A sub-analysis was also conducted that was limited to participants who reported having health insurance to explore the role of insurance status on treatment utilization by race/ethnicity.

RESULTS

Findings showed that Latinos and Blacks significantly underutilized specialty treatment relative to Whites. These relationships were statistically significant after controlling for socio-demographic characteristics, problem severity, and perceived treatment need. However, when analyses were limited to only those with health insurance, Black-White disparities became non-significant, while Latino-White disparities persisted.

CONCLUSIONS

Findings highlight that Black-White and Latino-White disparities in the use of substance abuse treatment still persist. However, Black-White disparities may be limited to only those who are uninsured. Public health implications are discussed.

Disaggregating Hispanic American Cancer Mortality Burden by Detailed Ethnicity

BACKGROUND

Hispanics are the largest minority population in the United States (18%). They represent a heterogeneous and growing population. Cancer is the leading cause of death among Hispanics, yet few studies have described cancer mortality burden by specific Hispanic group nationwide.

METHODS

Cancer-related deaths from U.S. death certificates for the years 2003-2012 were analyzed for decedents identifying as Mexican, Puerto Rican, Cuban, and Central or South American. We calculated descriptive statistics, including potential years of lives lost (PYLL), age-adjusted rates, standardized mortality ratios, and fitted JoinPoint regression models, to evaluate annual trends by Hispanic group, using non-Hispanic Whites (NHW) as the reference population.

RESULTS

We identified 287,218 cancer-related deaths among Hispanics and 4,570,559 among NHWs. Mortality trends were heterogeneous across Hispanic groups. Female NHWs and male Puerto Ricans had the greatest rates of adjusted PYLL per 1,000 (NHWs, 19.6; Puerto Ricans, 16.5). Liver cancer was ranked among the top 5 cancer-related deaths for every Hispanic group, but not for NHWs. Stomach cancer mortality was twice as high for most Hispanic groups when compared with NHWs and especially high for Mexicans [male standardized mortality ratio (SMR), 2.07; 95% confidence interval (CI), 2.01-2.13; female SMR, 2.62; 95% CI, 2.53-2.71].

CONCLUSIONS

We observed marked heterogeneity in cancer mortality across Hispanic groups. Several cancers affect Hispanics disproportionately compared with NHWs. Screening programs in Hispanics should be considered for stomach and liver cancer.

IMPACT

Disaggregated analysis of Hispanics is needed to fully understand cancer burden among the diverse Hispanic population and is critical for cancer prevention and control efforts.

Alcohol Use among Latinx Early Adolescents: Exploring the Role of the Family

The present study describes results of a randomized three-group repeated measures study that examined whether augmenting a culturally-based parent education program (Familias) can strengthen the effects of a youth intervention (kiR) in reducing rates of alcohol consumption among Latinx adolescents. A stratified random sample of 462 Latinx early adolescents from a Southwestern city participated in this study. Ordinary Least Squares regression results show that receiving the parental and youth curricula components and two other family practices were significantly associated with lower rates of alcohol consumption at Wave 2. Findings support the notion that prevention efforts that include a culturally grounded parent component could be a more effective strategy to help Latinx youth refrain from alcohol use than youth-only programs.

Interaction Between Stress and Addiction: Contributions From Latin-American Neuroscience

Drug addiction is a chronic neuropsychiatric disorder that escalates from an initial exposure to drugs of abuse, such as cocaine, cannabis, or heroin, to compulsive drug-seeking and intake, reduced ability to inhibit craving-induced behaviors, and repeated cycles of abstinence and relapse. It is well-known that chronic changes in the brain’s reward system play an important role in the neurobiology of addiction. Notably, environmental factors such as acute or chronic stress affect this system, and increase the risk for drug consumption and relapse. Indeed, the HPA axis, the autonomic nervous system, and the extended amygdala, among other brain stress systems, interact with the brain’s reward circuit involved in addictive behaviors. There has been a growing interest in studying the molecular, cellular, and behavioral mechanisms of stress and addiction in Latin-America over the last decade. Nonetheless, these contributions may not be as strongly acknowledged by the broad scientific audience as studies coming from developed countries. In this review, we compile for the first time a series of studies conducted by Latin American-based neuroscientists, who have devoted their careers to studying the interaction between stress and addiction, from a neurobiological and clinical perspective. Specific contributions about this interaction include the study of CRF receptors in the lateral septum, investigations on the neural mechanisms of cross-sensitization for psychostimulants and ethanol, the identification of the Wnt/β-catenin pathway as a critical neural substrate for stress and addiction, and the emergence of the cannabinoid system as a promising therapeutic target. We highlight animal and human studies, including for instance, reports coming from Latin American laboratories on single nucleotide polymorphisms in stress-related genes and potential biomarkers of vulnerability to addiction, that aim to bridge the knowledge from basic science to clinical research.

Childhood Abuse, Religious Involvement, and Lifetime Substance Use Disorders among Latinas Nationwide

BACKGROUND

Childhood abuse is a major behavioral health concern and imposes lasting sequelae on mental and physical health, including lifetime substance use disorders (LT-SUD). Yet, gender-specific research examining this early trauma and substance use in Latina-Americans (Latinas) is scarce. No study has explored the relationship between collectivist cultural factors and LT-SUD in this largest minority-female subgroup of the United States' population.

OBJECTIVES

Based on coping theory, this study investigated the association between childhood abuse, cultural factors, and LT-SUD among Latinas nationwide.

METHODS

Using the National Latino and Asian American Study we performed three-step logistic regressions to investigate LT-SUD for 1,427 Latinas, following three preplanned steps: (1) childhood physical and sexual abuse (CPA and CSA) with LT-SUD; (2) known correlates as controls; and (3) cultural strength factors.

RESULTS

The prevalence rates of CPA and CSA were 28.0% and 18.4%, and that of LT-SUD was 4.8%. Religious attendance at a weekly level was negatively related to LT-SUD. Alongside English proficiency, discrimination, and social support, however, CPA and religious coping were positively associated with LT-SUD. Conclusion/Importance: Childhood physical abuse is an early risk factor for long-term substance use, viewed as a negative coping strategy. Religious attendance may have potential protection for Latinas. The victimization history may lead to coexisting positive (e.g., pursing social support, religious coping) and negative (e.g., SUD) coping behaviors within Latino communities.

Understanding barriers to specialty substance abuse treatment among Latinos

BACKGROUND

National studies have documented that Latinos are less likely to use specialty substance abuse treatment (e.g., rehabilitation programs, in/out-patient services) than other racial/ethnic groups. Disparities in treatment utilization are particularly pronounced between Latinos and Whites. Few national studies have explicitly examined barriers to treatment by race/ethnicity, and current results are inconclusive. The purpose of this study was to gain a better understanding of barriers to specialty substance abuse treatment among Latinos.

METHODS

In 2017-2018, in-depth qualitative interviews were conducted with 54 White, Black, and Latino participants who met eligibility criteria for a recent substance use disorder. Participants were recruited via online ads and screened for eligibility through an online survey. Interview questions were grounded in the Theory of Planned Behavior (TBP): Participants were asked about treatment-related barriers in the domains of attitudes, subjective norms, and perceived control. Interviews were transcribed verbatim and coded by two independent coders. Barriers were compared across all interviews and by race/ethnicity.

RESULTS

Latinos were significantly more likely to report attitudinal and subjective norm barriers than their White and Black counterparts. Within the attitudes domain, results suggested that Latinos largely avoided specialty treatment due to barriers stemming from cultural factors, perceived treatment efficacy, recovery goals, and perceived treatment need. In the area of subjective norms, stigma and perceived lack of social support from family were more pervasive among Latinos' narratives. Lastly, in terms of perceived control, a minority of Latinos reported logistical barriers to treatment.

CONCLUSION

Specialty substance abuse treatment services have been found to be effective regardless of race/ethnicity. Understanding why Latinos use specialty treatment at low rates is key to reducing existing racial/ethnic disparities related to substance abuse. This study identified several malleable barriers that interventions can target to increase Latinos' utilization of treatment. These barriers may also be key to explaining Latino-White disparities in treatment utilization.

Risks of opioid abuse among uninsured primary care patients utilizing a free clinic

The annual number of opioid prescriptions for pain relief has been increasing in the United States. This increase has raised concerns about prescription opioid abuse and overdose. The purpose of this study was to examine opioid risks (risk factors that increase the chance of opioid abuse) among uninsured primary care patients utilizing a free clinic. Data were collected using a self-administered paper survey in the waiting room of the free clinic from May to July 2017 (N = 506). Higher levels of somatic symptoms were associated with higher levels of opioid risks. U.S.-born English speakers had higher levels of opioid risk than non-U.S.-born English speakers and Spanish speakers. Being employed was associated with higher levels of opioid risk while attending college or being postcollegiate was related to lower levels of opioid risk. Research surrounding best practices, prescription trends, and population risk is vital in driving health and social policy. Further research would benefit from examining where people are obtaining opioids. In addition, further research on opioid abuse among Hispanic populations would be beneficial. Finally, future studies should examine how prescribing practices are different among free clinic health professionals in comparison to health care professionals working in-patient or at for-profit clinics.

Sociocultural determinants of substance misuse among adult Latinas of Caribbean and South and Central American descent: A longitudinal study of a community-based sample

Few studies have examined the socio-cultural determinants of alcohol and drug misuse trajectories among adult Latinas. To assess the associations between socio-cultural determinants and alcohol and drug misuse, we used a longitudinal design to follow a sample of adult Latina mother-daughter-dyads (N = 267) for ten years, and collected four waves of data. They were adult Latinas of Caribbean, South and Central American descent. Specifically, this study investigated the effects of the following factors: (1) Individual Determinants (e.g., socioeconomic conditions, mental health, and medical status); (2) Cultural Determinants (e.g., acculturation to US culture); (3) Interpersonal Determinants (e.g., interpersonal support, relationship stress, mother-daughter attachment, intimate partner violence); (4) Community Determinants (e.g., neighborhood related stress); and (5) Institutional Determinants (e.g., religious involvement, involvement with the criminal justice system). Using hierarchical modeling, we found that taking prescribed medication on a regular basis for a physical problem, religious involvement, and mother-daughter attachment were negatively associated with drug misuse, while involvement in criminal activity was positively associated with drug misuse. Regarding alcohol misuse, results showed that age at arrival in the United States, number of years in the United States, and religious involvement were negatively associated with alcohol misuse, while involvement in criminal activity was positively associated with alcohol misuse. Based on our findings, explicit implications are provided for culturally relevant interventions.

Effect of Middle School Interventions on Alcohol Misuse and Abuse in Mexican American High School Adolescents: Five-Year Follow-up of a Randomized Clinical Trial

IMPORTANCE

Substance abuse preventive interventions frequently target middle school students and demonstrate efficacy to prevent early onset and use of alcohol and illicit drugs. However, evidence of sustained results to prevent later patterns of alcohol misuse and more serious alcohol abuse disorders has been lacking, particularly for US Latino populations.

OBJECTIVE

To test whether a universal middle school prevention program can reduce the frequency of alcohol misuse and rates of alcohol use disorder 5 years after implementation with a Mexican American sample.

DESIGN, SETTING, AND PARTICIPANTS

A previous randomized clinical trial was conducted with 516 Mexican American 7th graders and at least 1 parent who identified as having Mexican origin. Three annual cohorts of families were recruited from rosters of 4 middle schools and randomized to the 9-session Bridges/Puentes family-focused group intervention or a workshop control condition. Recruitment, screening, pretest, and randomization occurred in the same academic year for each cohort: 2003-2004, 2004-2005, and 2005-2006. Data acquisition for the follow-up assessments of late-adolescent alcohol misuse and abuse, which were not included in the initial randomized clinical trial, was conducted from September 2009 to September 2014; analysis was conducted between August 2016 and July 2017. In this assessment, 420 children (81.4%) of the sample were included, when the majority were in their final year of high school.

INTERVENTIONS

The 9-session Bridges/Puentes intervention integrated youth, parent, and family intervention sessions that were delivered in the spring semester at each school, with separate groups for English-dominant vs Spanish-dominant families. The control workshop was offered during the same semester at each school, also in English and Spanish.

MAIN OUTCOMES AND MEASURES

Primary outcomes were diagnostic assessment of lifetime alcohol use disorder in the 12th grade, 5 years after the intervention, based on the Diagnostic Interview Schedule for Children and past-year frequency of alcohol use, binge drinking, and drunkenness based on the 2001 Youth Risk Behavior Survey.

RESULTS

Of the 420 participants, 215 (51.2%) were girls (mean [SD] age, 17.9 [0.62] years). The intervention reduced the likelihood of having an alcohol use disorder (β = -.93; SE, 0.47; P = .047; odds ratio, 0.39). Intervention associations with past-year alcohol use frequency, binge drinking, and drunkenness were moderated by baseline substance use. The intervention reduced the frequency of alcohol use (β = -.51; SE, 0.24; P = .04; Cohen d = 0.43) and drunkenness (β = -.51; SE, 0.26; P = .049; Cohen d = 0.41) among youth who reported any previous substance use at baseline (T1 initiators) but not among those who had not initiated any substance use (T1 abstainers) at baseline. For past-year binge drinking, the intervention finding did not reach statistical significance among T1 initiators (β = -.40; SE, 0.23; P = .09) or T1 abstainers (β = .23; SE, 0.14; P = .11).

CONCLUSIONS AND RELEVANCE

Study results support an association between a universal middle school intervention and alcohol misuse and alcohol use disorders among Mexican American high school students and implementation of universal middle school interventions to reach Latino communities.

Gender and ethnic differences in primary care patients' response to computerized vs. in-person brief intervention for illicit drug misuse

This study is a secondary analysis from a randomized clinical trial of computerized vs. in-person brief intervention (BI) for illicit drug misuse among adult primary care patients (N=359; 45% Female; 47% Hispanic) with moderate-risk illicit drug misuse as measured by the World Health Organization's Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). This study examined differences in response to the two brief intervention strategies (both based on motivational interviewing) on the basis of gender and ethnicity, comparing non-Hispanic males, non-Hispanic females, Hispanic males, and Hispanic females. Participants were assessed at baseline, 3-, 6-, and 12-month follow-up with the ASSIST. Trajectories in Global Continuum of Illicit Drug Risk Scores were examined using a generalized linear mixed model. There were significant differences in response to computerized vs. in-person BI over time on the basis of gender-ethnic subgroups (Gender×Ethnicity×Condition×Time interaction; p=0.03), with Hispanic males tending to respond more favorably to the computerized BI and Hispanic females tending to respond more favorably to the in-person BI. There was no clear differentiation in response to the two BIs among non-Hispanic males, while among non-Hispanic females the pattern of change converged following baseline differences. Consideration of gender and ethnic differences in future studies of BI is warranted.

Mental health of heroin users with differing injection drug use histories: A non-treatment sample of Mexican American young adult men

BACKGROUND

While the comorbidity of mental health and injecting heroin has been documented, current research is limited by describing the mental health of people who inject drugs without a comparison group and by the lack of research on nontreatment samples in the United States, particularly among Hispanics. The purpose of this study was to examine the association of injecting history (never, former, occasional, and daily) and multiple outcomes of global and mental health using a sample of U.S.-based Latinos not currently in treatment.

METHODS

Data are from a sample of street-recruited Mexican American young adult men (n=275) in San Antonio, TX. Multiple logistic regression and structural equation modeling were used.

RESULTS

Overall 54% of men reported lifetime injecting drug use (20.7% former users, 11.1% occasional users, and 21.9% daily users). We found varying prevalence rates of global and mental health status among different histories of injecting. After covariate adjustment, daily injecting remained strongly associated with all four outcomes: perceived poor health status (AOR=4.39; p≤0.001), psychological distress (AOR=2.78; p≤0.05), depression (AOR=4.37; p≤0.001), and suicidal ideation (OR=4.75; p≤0.001). Acculturation, gang membership, and incarceration history also emerged as important factors.

CONCLUSION

This study provides new information about the relationship between mental health and injecting heroin use.

FINDINGS

Support the need to consider mental health states among people who inject drugs, and to examine varying histories of injecting with socially and culturally relevant factors.

Determinants of driving under the influence of alcohol or drugs among latino immigrants in miami-dade county, florida

Little is known about the pre- and postimmigration drinking and drunk- and drugged-driving behavior of Latino immigrants. Despite showing risky drinking behaviors, many recent immigrants of low socioeconomic status (SES) do not drive while impaired by alcohol (DWI) due largely to limited access to a vehicle. This effort examines the DWI and driving while impaired by drugs (DWID) behaviors of Latino immigrants who have access to a vehicle. Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, Florida. Bivariate analyses and logistic regression were applied. Preimmigration DWI and DWID was the best predictor of postimmigration DWI and DWID. Future interventions should make efforts to (a) identify immigrants who had DWI and DWID in their country of origin and (b) design and deliver specific and culturally relevant messages to persuade them not to engage in DWI and DWID after immigration.

Undocumented Immigration, Drug Problems, and Driving Under the Influence in the United States, 1990-2014

OBJECTIVES

To examine the influence of undocumented immigration in the United States on 4 different metrics of drug and alcohol problems: drug arrests, drug overdose fatalities, driving under the influence (DUI) arrests, and DUI deaths.

METHODS

We combined newly developed state-level estimates of the undocumented population between 1990 and 2014 from the Center for Migration Studies with arrest data from the Federal Bureau of Investigation Uniform Crime Reports and fatality information from the Fatality Analysis Reporting System and the Centers for Disease Control and Prevention Underlying Cause of Death database. We used fixed-effects regression models to examine the longitudinal association between increased undocumented immigration and drug problems and drunk driving.

RESULTS

Increased undocumented immigration was significantly associated with reductions in drug arrests, drug overdose deaths, and DUI arrests, net of other factors. There was no significant relationship between increased undocumented immigration and DUI deaths.

CONCLUSIONS

This study provides evidence that undocumented immigration has not increased the prevalence of drug or alcohol problems, but may be associated with reductions in these public health concerns.

The Anexo in Northern California: An Alcoholics Anonymous-Based Recovery Residence in Latino Communities

Our ethnographic study on help-seeking pathways of Latino immigrants in northern California reveals that they turn to anexos in their treatment and recovery quest. Anexos are linguistically- and culturally-specific recovery houses with origins in Mexico and Alcoholics Anonymous and a long history in Latino communities across the United States. Drawing on the findings of our study, we characterize the anexos and compare them to other recovery residences using National Alliance for Recovery Residences (NARR) criteria. The description and comparison reveal that anexos cannot be placed into a single NARR residence category. We discuss why this is the case.

The daily progress system: A proof of concept pilot study of a recovery support technology tool for outpatient substance abuse treatment

BACKGROUND

Illicit substance use remains highly prevalent in the US, and epidemiological surveillance surveys estimate that in 2015, over 27 million individuals (10.1% of the US population) 12 years of age or older used illicit drugs in the past 30 days.¹ Outpatient treatment delivered in community-based settings is the dominant modality for addiction treatment, typically involving weekly psychosocial counseling sessions in an individual and/or group format.^2,3 Unfortunately, relapse and premature treatment discontinuation are quite common in outpatient treatment.^3-5 Objectives: This is a pilot proof of concept feasibility study involving clients presenting for outpatient SUD treatment. This study sought to examine the feasibility and acceptability of the Daily Progress System (DPS), a telephone-based software program, using interactive voice response (IVR), designed to enhance quality care and improve client outcomes.

METHODS

Individuals who presented at the participating treatment clinic, who met study eligibility criteria, and who provided written informed consent to participate were included in the study (N = 15; 53.3% females). Incentives were paid to participants for calls completed.

RESULTS

Participants completed 65% of scheduled daily call-ins, representing 273 person-days of data on client cravings, mood, substance use, and involvement in recovery support activities. The average call duration was approximately 2 minutes and 42 seconds. There was a high degree of client and counselor acceptance and satisfaction using the system. Conclusions and Clinical Significance: Findings suggest that the DPS appears to be a feasible means of potentially addressing relapse and treatment engagement issues based on client and counselor engagement and satisfaction with the system.

The Influence of Relationship Power and Partner Communication on the Syndemic Factor among Hispanic Women

BACKGROUND

This study expands research on the substance abuse, intimate partner violence, human immunodeficiency virus (HIV), and depression syndemic theory for Hispanic women. We hypothesized relationship power and partner communication would be related to the syndemic.

METHODS

Data were used from the baseline assessment of an effectiveness trial of SEPA (Salud/Health, Educación/Education, Prevención/Prevention, and Autocuidado/Self-care), an HIV/sexually transmitted infection risk reduction program for Hispanic women. Hispanic adult women (n = 320) completed measures (in Spanish or English) of relationship power, partner communication about HIV, and acculturation. The syndemic was defined with a factor model of substance abuse, intimate partner violence, risk for HIV/sexually transmitted infection, and depression using structural equation modeling.

RESULTS

Controlling for acculturation and education, relationship power was inversely related to the syndemic factor (β = -0.49, p < .001), but partner communication was not (β = 0.14, p = .054). Acculturation and education were also related to the syndemic factor. These variables combined accounted for more than one-half (53%) of the variance in the syndemic factor.

CONCLUSIONS

Findings suggest the need to develop and test interventions that address the power dynamics of intimate relationships as a means of reducing health disparities among Hispanic women.

Factors Associated with Sexual Risk of HIV Transmission Among HIV-Positive Latino Men Who have Sex with Men on the U.S.-México Border

We present results from a cross-sectional, clinic-based survey of border-region Latino men who have sex with men (MSM) and who also are living with HIV in the El Paso-Ciudad Juárez area. Among the 66 participants who reported serodiscordant anal or vaginal intercourse, we examined levels of psychological distress and substance use and the association of these variables with condomless sex. Bivariate analyses indicated that MSM who reported condomless sex with a serodiscordant partner were more likely to report higher scores on measures of anxiety, depression, and trauma. These men were also more likely to report more days of alcohol use to the point of intoxication. In multivariate logistic regression, no variables were independently associated with sexual risk behavior, but symptoms of anxiety trended toward statistical significance. Our study is one of few reports aimed at understanding the HIV epidemic among Latino MSM living with HIV in the El Paso-Ciudad Juárez border region. Although we found no evidence of a relation between our measures of psychological distress and substance use and sexual risk behavior in multivariate analyses, psychological distress and problematic alcohol use were common in the sample and are important targets for intervention in their own right.

Substance use and treatment outcomes among Spanish-speaking Latino/as from four acculturation types

The purpose of this study was to examine the association of acculturation with substance use treatment outcomes in a sample of treatment-seeking Latino/as (N = 405). The study used data from a multisite randomized controlled trial of a culturally adapted version of Motivational Enhancement Therapy delivered in Spanish. Berry, Kim, Minde, and Mok's (1987) acculturation model was used to divide the sample into 4 types (integrated, assimilated, separated, marginalized), based on Bicultural Involvement Questionnaire scores. One-way analyses of variance, chi-squared tests, and repeated-measures regression were used to examine baseline acculturation, posttreatment outcomes, and follow-up outcomes. All participants were of Latino/a background, and 88.4% of the sample was male. Participants with greater acculturation to American culture (i.e., integrated and assimilated acculturation types) reported more substance use and associated problems at baseline, χ²(3) = 20.5, p < .001, with the integrated type reporting the highest percentage of substance use disorder symptoms and problems (67.6%). No significant differences in substance use were detected among acculturation types posttreatment or at follow-up. Although the integrated and assimilated acculturation types were associated at baseline with more substance use and associated problems, all acculturation types seemed to benefit at posttreatment from an evidence-based culturally adapted treatment. (PsycINFO Database Record

Interrelationship between family history of alcoholism and generational status in the prediction of alcohol dependence in US Hispanics

BACKGROUND

Both a family history of alcoholism and migration-related factors like US v. foreign nativity increase the risk for developing alcohol use disorders in Hispanic Americans. For this study, we integrated these two lines of research to test whether the relationship between familial alcoholism and alcohol dependence changes with successive generations in the United States.

METHOD

Data were from the waves 1 and 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Subjects self-identified Hispanic ethnicity (N = 4122; n = 1784 first, n = 1169 second, and n = 1169 third or later generation) and reported ever consuming ⩾12 drinks in a 1-year period. A family history of alcoholism was assessed in first- and second-degree relatives. Analyses predicting the number of alcohol dependence symptoms were path models.

RESULTS

Alcohol dependence symptoms were associated with a stronger family history of alcoholism and later generational status. There was a significant interaction effect between familial alcoholism and generational status; the relationship of familial alcoholism with alcohol dependence symptoms increased significantly with successive generations in the United States, more strongly in women than men. Acculturation partially mediated the interaction effect between familial alcoholism and generational status on alcohol dependence, although not in the expected direction.

CONCLUSIONS

Familial alcoholism interacted with generational status in predicting alcohol dependence symptoms in US Hispanic drinkers. This relationship suggests that heritability for alcoholism is influenced by a higher-order environmental factor, likely characterized by a relaxing of social restrictions on drinking.

Psychosocial Factors Associated with Substance Abuse and Anxiety on Immigrant and U.S. Born Latinos

Latinos are exposed to adverse psychosocial factors that impact their health outcomes. Given the heterogeneity and rapid growth of this population, there is an urgent need to understand the mechanisms through which psychosocial factors impact substance abuse and anxiety between immigrant and U.S. born Latino adults. The present study employs a multi-group path analysis using Mplus 7.2 to examine generational differences in the paths between affiliation culture, years of formal education, contact with important people, and length of full-time employment to substance abuse and anxiety in immigrant and U.S. born Latino adults who completed substance abuse treatment. A total of 131 participants (Mage= 36.3, SD ± 10.5, 86.3% males, 48.1% non-U.S. born with a mean length of stay of 19 years in the U.S. (SD ± 13.71) in recovery from substance abuse completed self-report measures. Results from the multi-group path analysis suggest that being more affiliated to the U.S. culture is associated with substance abuse, whereas years of formal education and longer full-time employment is associated with reduced anxiety in the immigrant group. Conversely, frequent contact with important people and affiliation to the U.S. culture are associated with fewer years of substance abuse, whereas longer full-time employment is associated with substance abuse in the U.S. born group. Anxiety and substance abuse was correlated only in the U.S. born group. The implications of these findings are discussed.

Testing a Multidimensional Acculturation Model on Latinos who Completed Substance Abuse Treatment

Disparities in substance abuse treatment (SAT) utilization and completion suggest that traditional substance abuse models may fall short of addressing the complex needs of Latinos, increasing the odds of relapsing. The need for substance use models that integrate multiple acculturation domains in relation to substance abuse is warranted. The goal of the present study is twofold: a) test a multidimensional acculturation model on Latinos who completed SAT; and b) examine the association between the proposed multidimensional acculturation and days consuming alcohol and illicit drugs in the past six months. A total of 131 participants (Mage=36.15, SD ± 10.5, 86.3% males, 48.1% non-U.S. born with a mean length of stay of 19 years in the U.S. (SD ± 13.71) were interviewed upon completion of SAT. Results from the SEM indicated adequate model fit to the population under study, supporting the use of a multidimensional acculturation approach for this population. Subsequent results from the structured regression analysis suggest that multidimensional acculturation is negatively associated with days using alcohol in the past 6 months. The implications of these findings are discussed.

Sociodemographic characteristics associated with alcohol use among low-income Mexican older adults

BACKGROUND

Despite increasing concern about the quality of life of older adults, little is known about characteristics associated with health risk behaviors among older adults in middle-income countries. This study relied on unique longitudinal data to examine the relationship between sociodemographic characteristics and alcohol use among low-income older adults, one of the fastest-growing populations worldwide.

METHODS

This multilevel longitudinal analysis involved three waves of data (2008-2010) from 2,351 adults aged 70 or older in Yucatán, Mexico. Multilevel regressions models were used to test interactions among gender, speaking Mayan (indigenous language), and socioeconomic status to understand conditions associated with the odds of current alcohol use and the frequency and amount of alcohol use.

RESULTS

Half of the participants in this study report consuming alcohol in their lifetime, 21.58 % of whom were current alcohol users. Older adults reported consuming alcohol 1.15 days a week and 1.60 drinks per day. Speaking Mayan was associated with lower odds of current alcohol use. However, men who spoke Mayan reported higher odds of drinking alcohol compared to women and non-Mayan (Spanish) speakers. The positive relationship between socioeconomic status and alcohol use was also moderated by gender (male).

CONCLUSIONS

Findings show that older and Mayan populations had lower odds of drinking in Yucatán, Mexico, whereas men were at highest risk of drinking alcohol, after adjusting for ethnic culture and socioeconomic status. Implications for health policy and epidemiological studies on substance use among older adults residing in low-income settings are discussed.

Collectivism and individualism in Latino recovery homes

Research indicates that Latinos underutilize substance abuse interventions; cultural variables may contribute to difficulties accessing and completing treatment for this group. As a result, there is a need to understand the role of cultural constructs in treatment outcomes. The purpose of this study was to investigate how levels of collectivism (COL) and individualism (IND) relate to length of stay and relapse outcomes in self-run recovery homes. We compared Latinos in several culturally modified recovery Oxford Houses to Latinos in traditional recovery Oxford Houses. By examining COL and IND in the OH model, we explored whether aspects of COL and IND led to longer lengths of stay and better substance use outcomes. We hypothesized that higher levels of COL would predict longer stays in an Oxford House and less relapse. COL did not have a main effect on length of stay. However, COL had a significant interaction effect with house type such that COL was positively correlated with length of stay in traditional houses and negatively correlated with length of stay in the culturally modified condition; that is, those with higher collectivism tended to stay longer in traditional houses. When we investigated COL, length of stay, and substance use, COL was negatively correlated with relapse in the culturally modified houses and positively correlated with relapse in the traditional houses. In other words, those with higher COL spent less time and had less relapse in the culturally modified compared to the traditional Oxford Houses. The implications of these findings are discussed.