Antonio L. Estrada

Breast and Cervical Cancer Screening Utilization Among Hispanic Women Living Near the United States-Mexico Border

OBJECTIVE Hispanic women who reside in low-resource settings are especially at risk for nonparticipation in cancer screening programs. The purpose of this study was to assess characteristics that influence breast and cervical cancer screening among older Hispanic women living along the United States-Mexico border. METHODS A cross-sectional study of women aged ≥50 years (n = 504) residing in Yuma County, Arizona, were randomly selected for interviews. Logistic regression analyses were conducted to identify determinants of compliance with mammography and Pap smear use. RESULTS Women who received a recommendation from a clinician to get both mammography and Pap smears were more likely to receive a mammogram within the past year (adjusted odds ratio [AOR] 5.1, 95% confidence interval [CI] 3.0-8.9) compared to women who received no recommendation. Likewise, women who received both recommendations were more likely to receive a Pap smear within the past 3 years (AOR 9.7, 95% CI 4.6-20.7) compared to women who received no recommendation. Other factors, such as current health insurance and a visit with their healthcare provider in the past year, were also associated with getting a mammogram within 1 year or Pap smear within 3 years. CONCLUSIONS Enabling characteristics were significantly associated with breast and cervical cancer screening use compared to predisposing and need characteristics among older Hispanic women residing near the U.S.-Mexico border. Clinician recommendation of both mammograms and Pap smears and opportunistic clinic visits to medical providers may increase breast and cervical cancer screening coverage and reduce the burden of these two cancers in this high-risk population.

A multisite study of sexual orientation and injection drug use as predictors of HIV serostatus in out-of-treatment male drug users

The risk groups of men who have sex with men and injection drug users (IDUs) together account for 90% of all male AIDS cases. The extent to which each risk behavior contributes to seroprevalence among IDUs has not been determined and is critical for intervention development. Analysis of data on sexual orientation, injection drug use, and HIV serostatus was undertaken in a multisite study of 3002 male drug injectors and crack smokers recruited for HIV prevention projects. Overall HIV seroprevalence was 8.4%; 57.1% for gay men, 25.4% for bisexual men, and 7.4% for heterosexuals (p = 0.001). Logistic regression analyses indicated being gay (OR = 24.08) and coming from an area where seroprevalence is high among IDUs (OR = 4.07) were the best predictors of serostatus. Ever having injected was significant only in interaction with moderate (OR = 3.09) or high (OR = 4.71) IDU seroprevalence areas. Among this multisite sample of drug users, being a gay drug user is the strongest predictor of serostatus. Drug injection is significant only in areas of moderate or high seroprevalence among injectors. This indicates the importance of targeted outreach and intervention efforts.

Cultural models of masculinity and drug use: “machismo,” heroin, and street survival on the U.S.-Mexico border:

This paper examines the interrelations between “machismo,” drug use, and aggression among injection drug users (IDUs) in a US-Mexico border community. Underscored is the directive force and social impact of “machismo” in the day-to-day life-worlds of Mexican male heroin addicts, or “tecatos.” This focus not only provides a broad description of the cultural model of “machismo” elucidated by this group of men, but also illuminates how ideas of masculinity are internalized and re-created through drug use and aggression in the context of life in the streets. Attention to these aspects of drug use invites consideration of several important issues, including the role structural factors play in the expression of masculinity as well as the social forces underpinning representations of Mexican men.

Mexican Americans and Historical Trauma Theory: A Theoretical Perspective

The observed intergenerational stress response to negative social and historical events is at the core of historical trauma theory, which has been applied to Native Americans, African Americans, and Pacific Islanders, among others. The historical and social experiences of the Mexican population living in the United States have many parallels that lend themselves to the application of historical trauma theory to macro-level and micro-level influences on access to health care, physical health status, and mental health status, including substance abuse among Mexican Americans. This article highlights the legacy of Spanish colonialism and Anglo–American neo-colonialism on Mexicans and Mexican Americans in the southwestern United States through a potential application of historical trauma theory.

Cocaine immunotoxicity : abnormal cytokine production in Hispanic drug users

Peripheral blood lymphocytes from 47 Hispanic poly-drug users with a history of cocaine abuse were analyzed for in vitro production of interleukin-1 (IL-1), interleukin-2 (IL-2), gamma-interferon (IFN) and plasma levels of soluble IL-2 receptor (SIL-2R). Cocaine use was confirmed and quantified by analysis of hair and urine samples, and subjects were grouped into 3 based on the extent of cocaine metabolites detected. No significant differences in IL-1 and IFN production were seen between the 3 groups. However, subjects with higher levels of cocaine in hair also showed higher levels of IL-2. In addition, a positive correlation was seen between cocaine concentrations and IL-2 levels. A corresponding negative correlation was seen between cocaine levels and levels of plasma SIL-2R. These findings suggest modulation of the IL-2 network by cocaine in poly-drug users.

Supporting Healthy Alternatives through Patient Education: A Theoretically Driven HIV Prevention Intervention for Persons Living with HIV/AIDS

In the third decade of the HIV/AIDS epidemic, empirically based HIV transmission risk reduction interventions for HIV infected persons are still needed. As part of a Health Resources Services Administration/Special Projects of National Significance initiative to increase prevention services among HIV infected persons, we implemented SHAPE (Supporting Healthy Alternatives through Patient Education). SHAPE is a behavioral HIV prevention intervention delivered to HIV infected persons receiving primary medical care at El Rio Health Center in Tucson, Arizona. The SHAPE intervention is based on Kalichman’s “Healthy Relationships for Men and Women Living with HIV–AIDS.” The intervention is interactive and uses a video discussion intervention format where educational activities, movie clips, and discussions are used to provide participants with information and skills to increase their comfort in disclosing their HIV status and in reducing HIV transmission. This paper describes the intervention in sufficient detail to replicate it in other settings.

Are Hispana IDUs Tecatas?: Reconsidering Gender and Culture in Hispana Injection Drug Use

The roles of gender and culture remain elusive in the discussion of minority male vs. female Injecting Drug User (IDU) populations. A case in point is that of Hispano and Hispana IDUs. The commonly used street term for the Hispano (male) IDU, Tecato, is feminized through the use of the corresponding female noun Tecata. To do so however, minimizes the intricacies of gender and culture in the male vs. female roles of Hispano and Hispana IDUs (e.g., daughter/son, mother/father, partner, citizen). Hispano IDUs are also impacted by gender and culture in that Hispanos who embrace the Tecato way of life, must sacrifice and inure the consequences in how their male roles are minimized (e.g., the absent male figure in community, home, and family life). This article explores, through the analysis of qualitative interview data, the demands of gender and culture as they play themselves out in the lives of Hispana IDUs. Findings from this study suggest there are important gender and culture differences between Hispano and Hispana IDUs. Implications of this study include the need to reexamine the roles of gender and culture as they cause added pressure to Hispana IDUs (i.e., in demands to fulfill gender and culture stereotyped roles while also pursuing an IDU career).

Disparities in telephone CPR access and timing during out-of-hospital cardiac arrest

AIM Spanish-only speaking residents in the United States face barriers to receiving potentially life-saving 911 interventions such as Telephone -cardiopulmonary resuscitation (TCPR) instructions. Since 2015, 911 dispatchers have placed an increased emphasis on rapid identification of potential cardiac arrest. The purpose of this study was to describe the utilization and timing of the 911 system during suspected out-of-hospital cardiac arrest (OHCA) by Spanish-speaking callers in Metropolitan Phoenix, Arizona. METHODS The dataset consisted of suspected OHCA from 911 centers from October 10, 2010 through December 31, 2013. Review of audio TCPR process data included whether the need for CPR was recognized by telecommunicators, whether CPR instructions were provided, and the time elements from call receipt to initiation of compressions. RESULTS A total of 3398 calls were made to 911 for suspected OHCA where CPR was indicated. A total of 39 (1.2%) were determined to have a Spanish language barrier. This averages to 18 calls per year with a Spanish language barrier during the study period, compared with 286 OHCAs expected per year among this population. The average time until telecommunicators recognized CPR need was 87.4s for the no language barrier group compared to 160.6s for the Spanish-language barrier group (p<0.001).Time to CPR instructions started was significantly different between these groups (144.4s vs 231.3s, respectively) (p<0.001), as was time to first compression, (174.4s vs. 290.9s, respectively) (p<0.001). CONCLUSIONS Our study suggests that Hispanic callers under-utilize the 911 system, and when they do call 911, there are significant delays in initiating CPR.

Immunotoxicity of poly-drug use: abnormalities in the active and high-affinity CD2 antigen (E-rosette receptor) bearing T-lymphocytes

The E-rosetting profiles of T-cells were studied in 47 subjects with a history of poly-drug and alcohol abuse, and compared with 15 normal controls. No change was evident in numbers of total rosette-forming cells (TRFC). However, there was reduction in active and high-affinity rosette-forming cells (ARFC and HARFC). These two subsets of CD2-antigen-bearing T-cells are considered as immunocompetent surveillance cells. Thus the abnormality associated with them could be due to the combined immunotoxic effects of substance abuse, modulating the immune status of drug users.