Alice Cepeda

Risk Behaviors Among Young Mexican American Gang-Associated Females: Sexual Relations, Partying, Substance Use, and Crime.

This research focuses on young Mexican American girls who are not formal gang members yet participate in street-based activities of male gangs and engage in risk behaviors. These females comprise a larger proportion associated with male gangs in inner-city neighborhoods than actual female gang members. Using a qualitative design, the article presents a typology of Mexican American females that reveals a hierarchy based on exposure to four risk-related activities: sexual relations, partying, substance use, and crime. Findings illustrate how outcomes associated with these activities vary according to the girl’s relationship to the male gang and status within the community. Also, regardless of their relationship to the gang, participation in these activities resulted in different degrees of negative outcomes. The study concludes that problems associated with these females must go beyond being viewed as individual problems but rather seen within the social, cultural, and economic conditions of their environment.

Patterns of substance use among hurricane Katrina evacuees in Houston, Texas.

This paper focuses on changing patterns of substance use among low income, African American drug users evacuated from New Orleans, Louisiana, during Hurricane Katrina of August 2005. It examines the relationship between increases and decreases in alcohol and tobacco (AT) use and illicit drug (ID) use after Katrina and pre-disaster and within-disaster factors. Data from structured interviews with 200 Katrina evacuees currently living in Houston were collected 8-14 months after the disaster. Multivariate analysis revealed that rises in AT use were positively associated with education. Females and younger evacuees were more likely to have increased AT use. ID use increase was positively associated with resource loss and leaving the city before Katrina. Decreases in AT and ID use were found to be associated with disaster-related exposure. The paper discusses the specific consequences of disasters on disadvantaged minority substance users and the importance of developing public health disaster policies that target this population.

Disparities in completion of substance abuse treatment among Latino subgroups in Los Angeles County, CA.

RATIONALE A growing body of research has revealed disparities with respect to drug use patterns within Latino subgroups. However, the extent to which these potential disparities enable different Latino subgroups to respond favorably to treatment is unclear. METHODS This study analyzed a subset of multicross-sectional data (2006-2009) on Latinos collected from publicly funded facilities in Los Angeles County, CA (N=12,871). We used multilevel logistic regressions to examine individual and service-level factors associated with treatment completion among subgroups of first-time Latino treatment clients. RESULTS Univariate analysis showed that Cubans and Puerto Ricans were less likely to complete treatment than Mexicans and other Latinos. Cubans and Puerto Ricans entered treatment at an older age and with higher formal education than Mexicans, yet they were more likely to report mental health issues and use of cocaine and heroin as primary drugs of choice respectively. Multivariate analysis showed that age, having mental health issues, reporting high use of drugs at intake, and use of methamphetamines and marijuana were associated with decreased odds of completing treatment among all Latino subgroups. In contrast, age at first drug use, treatment duration, and referral monitoring by the criminal system increased the odds of completing treatment for all members. CONCLUSION These findings have implications for targeting interventions for members of different Latinos groups during their first treatment episode. Promising individual and service factors associated with treatment completion can inform the design of culturally specific recovery models that can be evaluated in small-scale randomized pilot studies.

Fumando La Piedra: Emerging Patterns of Crack Use Among Latino Immigrant Day Laborers in New Orleans

The devastating effects of Hurricane Katrina have contributed to a dynamic demographic shift in the Latino composition of New Orleans. This article focuses on a particularly deleterious pattern of crack cocaine smoking associated with numerous social and health consequences. Utilizing a rapid assessment methodology, in-depth qualitative interviews were conducted with 52 Latino immigrant day laborers in New Orleans. Findings reveal that the presence of a flourishing drug market has facilitated and maintained patterns of crack use including initiation and periods of daily use. Moreover, feelings of isolation and constant exposure to victimization due to day laborers’ marginal status are described as contributing to this use. This qualitative analysis reveals how social processes and contextual factors contribute to crack use among Latino day laborers in a post-disaster context. This study has important public health implications in the spread of HIV and other blood borne pathogens.

The Drugs-Violence Nexus Among Mexican-American Gang Members

Abstract This study examines hypotheses and builds models to help clarify the causal connections between drugs and violence outcomes among Mexican-American male gang members. The study uses cross-sectional data of 160 male gang members sampled from 26 gangs in a Southwestern city. A life-history /intensive interview using closed and open-ended questions and a violence risk psychometric test (PFAV) also employed 10 scenario questions to elicit self-produced accounts of the participants last fight. Gangmember participants ages ranged from 14 to 25 years with a mean age of 18.5 years. The study concludes that drug use interacts with an individual gang members risk for violence to affect violent behavior outcomes. Furthermore, an important situational variable explaining violent outcomes among respondents scoring high on the violence risk measure was whether the rival was using drugs that resulted in high intoxicatiion levels. The study concludes that drugs have a modulating and mediating influence on violence that is conditioned by situational and individual level variables among members of these adolescent street gangs.

The Process of Paradoxical Autonomy and Survival in the Heroin Careers of Mexican American Women

This study focuses on the process of paradoxical autonomy and survival in the heroin careers of Mexican American women. We explore how gender roles among Mexican American female heroin users influence the emergence of a paradoxical autonomy. Five key subprocesses of this autonomy were identified from 14 life history narratives: sustaining employment, working the welfare system, illegal activities, emotional aloofness, and loss of family and children. Dependency on drugs did not lead simply to the reproduction of traditional gender dependency but, paradoxically, seemed to contribute to a new type of gender autonomy. This autonomy did not necessarily make the survival less arduous, only more independent from gendered responsibilities associated with men and often with family and children. We discuss how this paradoxical autonomy is not acquired without ambiguity by some of these women, who place a value on maintaining relationships with men and family. Our study makes a contribution to a better understanding of the diverse processes by which Mexican American female heroin users struggle to survive. Although this struggle leads to a paradoxical autonomy from their traditional gender roles, it does little to change other barriers to self-development originating from poverty, ethnic discrimination, and the severity of their drug addiction.

An adapted brief strategic family therapy for gang-affiliated Mexican American adolescents

Objective: This study assessed the effectiveness of an adapted Brief Strategic Family Therapy (BSFT) intervention for gang-affiliated Mexican American adolescents and their parents. Methods: A total of 200 adolescents and their family caregivers were randomized to either a treatment or a control condition. Outcomes included adolescent substance use, conflict resolution, gang identification, parent substance use knowledge, gang awareness, family cohesion, child conduct problems and stress. Participants were assessed at baseline, treatment exit at 16 weeks, and 6 months follow-up. General linear mixed-effects and generalized estimating equations models were used to evaluate between-group differences in outcomes. Results: There were significant differences between the BFST and control groups on adolescent alcohol use at 6 months and parents’ reported conduct problems. No impact on marijuana use was found. Conclusions: Results provide emerging evidence supporting the adapted BSFT for gang-affiliated Mexican American adolescents and their families for alcohol and behavioral outcomes. Future adaptations may be needed to reduce drug use.

High rates of transitions to injecting drug use among Mexican American non-injecting heroin users in San Antonio, Texas (never and former injectors)

OBJECTIVE To assess the incidence and rate of transition to injecting among Mexican American noninjecting heroin users. METHODS In a prospective cohort study of street-recruited MA-NIU in San Antonio, Texas, 2002-2005, participants were administered structured interviews and tested for Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). The analysis sample comprised former injection drug users (last injected >6 months ago, n=47) and those who had never injected drugs and tested HCV negative (n=219). A transition to injecting was defined as the first injection of illicit drugs since baseline interview. Transition rates were based on person-years at-risk (PYAR). Proportional hazards regression was used to estimate crude and adjusted (for significant differences between former and never injectors) hazard ratios and 95% confidence intervals of injecting history on transitioning to injecting. RESULTS Sixty-three (24%) participants transitioned to injecting at a rate of 22.3/100 PYAR (95% CI: 17.2-28.2). Former-injectors were significantly more likely to transition than never injectors (43% or 20/47 vs. 20% or 43/219; p<0.001), and did so at a faster rate (40.4/100 PYAR, 95% CI: 24.6-60.0 vs. 18.5/100 PYAR, 95% CI: 13.4-24.4), with the crude HR=1.931 (95% CI: 1.116, 3.341) and adjusted HR=2.263 (95% CI: 1.192-4.294). CONCLUSIONS The rate of transitioning to injecting was high and greater among former injectors. Of particular concern is the high rate of injecting initiation among never injectors. Future analyses will examine factors associated with injecting initiation, including individual susceptibility and behaviors, social networks, and the cultural and drug market context.

Ethnographic Strategies in the Tracking and Retention of Street-Recruited Community-Based Samples of Substance Using Hidden Populations in Longitudinal Studies

The article presents practical and methodological strategies in the tracking and retention of a longitudinal community-based sample of 300 Mexican American noninjecting users of heroin. Presented are the ethnographic strategies the research team utilized to maintain high retention rates among this highly marginalized and hidden population. Findings indicate that these ethnographic strategies are the basis for a reliable method for subject retention among drug-using populations. Further, the strategies illustrate how qualitative methods can complement the collection of quantitative data. Discussed is how these strategies can be used to identify and engage similar populations in research studies.

The Relationship of Ecological Containment and Heroin Practices

In this chapter, we address how ecological and spatial factors contribute to behaviors that led to heroin use among Mexican-origin persons in the United States. Most of this contemporary drug using population is embedded in socio-economic environments that shape heroin use and other deviant behaviors. Using the experiences of San Antonio’s Mexican American population, the chapter illustrates how the dynamics and consequences of heroin use among this group can best be understood when considering the intersection of context and culture from both a historical and current framework. Specifically, it addresses how the constellation of social-historical patterns of inequality, ecological and deviance containment, and proximity to vice districts in San Antonio sustained and exacerbated heroin use among this population. What emerges from this analysis is how these historical precedents together with ecological and urban spatial processes provide a theoretical framework that helps to explain Mexican American heroin practices.