Jorge Delva

The Epidemiology of Alcohol, Marijuana, and Cocaine Use Among Mexican American, Puerto Rican, Cuban American, and Other Latin American Eighth-Grade Students in the United States: 1991–2002

OBJECTIVES We compared trends in and correlates of marijuana use, cocaine use, and heavy alcohol use for adolescents of Mexican American, Puerto Rican, Cuban, and other Latin American heritage in the United States. METHODS We used/examined data from nationally representative samples of eighth-grade Hispanic students who participated in the Monitoring the Future study during the years 1991-2002 (n=24235). RESULTS Drug use was significantly higher among boys and adolescents of almost all Hispanic ethnicities who did not live with both parents. In addition, drug use differed considerably according to ethnic group on language first spoken, parental education, urbanicity, and region. CONCLUSIONS A better understanding of the homogeneity and heterogeneity of drug use patterns within and between Hispanic groups should assist in the development of prevention programs.

A Study of the Relationship Between Protective Behaviors and Drinking Consequences Among Undergraduate College Students

The authors identified the number, type, and frequency of protective behaviors that undergraduate college students who consume alcohol use to prevent alcohol-related consequences. Their hypothesis was that students who engage in more types of protective behaviors with greater frequency would be less likely to experience alcohol-related consequences. Participants consisted of a randomly selected sample of 1,355 undergraduates aged 18 years and older at a large public university. Students completed a mailed questionnaire on alcohol and health behaviors in spring 2002. The findings (after adjustment for covariates) indicated that self-protective behaviors are inversely associated with alcohol-related problems for women but not for men. The influences of gender and racial and ethnic differences are considered in relation to prevention and intervention programs aimed at reducing alcohol-related consequences on college campuses.

Race/Ethnicity and Gender Differences in Drug Use and Abuse Among College Students

SUMMARY This study examines race/ethnicity and gender differences in drug use and abuse for substances other than alcohol among undergraduate college students. A probability-based sample of 4,580 undergraduate students at a Midwestern research university completed a cross-sectional Web-based questionnaire that included demographic information and several substance use measures. Male students were generally more likely to report drug use and abuse than female students. Hispanic and White students were more likely to report drug use and abuse than Asian and African American students prior to coming to college and during college. The findings of the present study reveal several important racial/ethnic differences in drug use and abuse that need to be considered when developing collegiate drug prevention and intervention efforts.

Pervasive exposure to violence and posttraumatic stress disorder in a predominantly African American Urban Community: The Detroit neighborhood health study

Exposure to traumatic events is common, particularly among economically disadvantaged, urban African Americans. There is, however, scant data on the psychological consequences of exposure to traumatic events in this group. We assessed experience with traumatic events and posttraumatic stress disorder (PTSD) among 1,306 randomly selected, African American residents of Detroit. Lifetime prevalence of exposure to at least 1 traumatic event was 87.2% (assault = 51.0%). African Americans from Detroit have a relatively high burden of PTSD; 17.1% of those who experienced a traumatic event met criteria for probable lifetime PTSD. Assaultive violence is pervasive and is more likely to be associated with subsequent PTSD than other types of events. Further efforts to prevent violence and increase access to mental health treatment could reduce the mental health burden in economically disadvantaged urban areas.

Modifiable Risk and Protective Factors for Depressive Symptoms in Low-Income African American Mothers

Low-income African American mothers of young children experience high rates of depression, but many of the risk factors that have been identified provide little direction for intervention. The authors examined modifiable risk and protective factors for probable depression (Center for Epidemiological Studies Depression Scale >or= 23) in 824 African American mothers living in the 39 poorest census tracts in Detroit. Household food insufficiency and deteriorated housing significantly increased the odds of likely depression, whereas availability of a loan in a crisis, help with childcare, and transportation were protective. However, more frequent experiences of everyday discrimination greatly increased the odds of elevated depressive symptoms. These findings support the need for interventions that operate across individual and societal levels to address the fundamental causes of poor mental health.

Differences in service utilization and barriers among Blacks, Hispanics, and Whites with drug use disorders

BackgroundTreatment for drug use disorders (DUD) can be effective, but only a small proportion of people with DUD seek or receive treatment. Research on racial and ethnic treatment differences and disparities remains unclear. Understanding racial and ethnic differences and disparities in drug treatment is necessary in order to develop a more effective referral system and to improve the accessibility of treatment. The purpose of the current study was to explore the role of race and ethnicity in service utilization.MethodsUsing data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), this study examined racial and ethnic differences in use of 14 types of treatment services for DUD and 27 different treatment barriers among persons who met lifetime criteria for a DUD. Multivariate logistic regression analyses were used to examine service utilization and barriers among the racial and ethnic groups, while adjusting for other sociodemographic and clinical variables.Results and discussionAmong Blacks, Hispanics and Whites in the overall NESARC sample, approximately 10.5% met criteria for at least one lifetime drug use disorder. Approximately 16.2% of persons with a lifetime DUD received at least one type of service. Overall, this study indicated that Whites were less likely to report receiving help for drug-related problems than Blacks, Blacks used a greater number of different types of services, and no racial and ethnic differences were observed with respect to perceived barriers to drug treatment. However, by examining types of services separately, a complex picture of racial and ethnic differences emerges. Most notably, Whites were most likely to use professional services, whereas Blacks were most likely to use 12-step and clergy. The service use pattern of Hispanics most resembled that of Whites.ConclusionWhile structural barriers to accessing treatment were observed, broad-based educational programs and interventions that are appropriately targeted to racial and ethnic groups remains an important area for prevention and treatment.

School Physical Activity Environment Related to Student Obesity and Activity: A National Study of Schools and Students

PURPOSE To explore whether characteristics of the U.S. secondary school physical activity environment are associated with student body mass index (BMI) and physical activity. METHODS This report uses data from two studies: Monitoring the Future (MTF; an annual nationally representative survey of 8th-, 10th-, and 12th-grade public and private school students) and Youth, Education, and Society (a survey of administrators in schools that have completed their 2-year participation in the MTF study). School policies and programs related to various health issues, including physical education (PE) and sports activity, were examined for relationships with student self-reported height, weight, being active in sports, exercising vigorously, and participating in school athletics. RESULTS The results show that in 2004-2007, the percentage of students who attended schools that required PE in their grade differed sharply by grade level: 88% of 8th graders, 48% of 10th graders, and 20% of 12th graders. There were few statistically significant associations between school PE requirements and student BMI. The average percentage of students who participated in interscholastic or varsity sports was associated at the bivariate level with a lower percentage of students being overweight in all three grades. Other measures of PE and sports activity showed varying associations with BMI and physical activity measures. CONCLUSIONS Relationships between the school physical activity environment and student BMI and physical activity were not uniformly strong. We conclude that, as currently practiced in schools, existing variations in physical activity policies may not be sufficient to produce discernible school-wide differences; thus, there is a need for more vigorous PE programming than is typically provided.

Prevalence of Substance Use Disorders Among African Americans and Caribbean Blacks in the National Survey of American Life

OBJECTIVES We sought to estimate the prevalence of substance disorders for African Americans and Caribbean Blacks in the United States using data from the National Survey of American Life. METHODS A national household probability sample of noninstitutionalized African Americans (n=3570) and Caribbean Blacks (n=1621) was obtained between February 2001 and June 2003 using a slightly modified version of the Composite International Diagnostic Interview. RESULTS Overall differences in prevalence of substance disorders between the ethnic groups were not significant. Prevalence rates of substance disorders among African Americans exceeded that of Caribbean Blacks among women, those aged 45 to 59 years, and those who were divorced. African Americans in major metropolitan areas had higher prevalence rates, and those in the South had lower ones, compared with those living in other areas. Overall, first-generation Caribbean Blacks were significantly less likely, but second-generation more likely, than were African Americans to meet criteria for overall substance disorders. CONCLUSIONS Failure to distinguish between African Americans and Caribbean Blacks masks important differences in substance use patterns among the Black population in the United States.

A Systematic Review of Mammography Educational Interventions for Low-income Women

Objective. We conducted a systematic review to examine the effectiveness of educational interventions in increasing mammography screening among low-income women. Data Sources. Bibliographic databases, including MEDLINE, The Cochrane Central Register of Controlled Trials, The Cochrane Database of Systematic Reviews, and the ISI Web of Science, were searched for relevant articles. Study Inclusion and Exclusion Criteria. Randomized, community-based trials targeting low-income women and published between January 1980 and March 2003 were included. Data Extraction. The search yielded 242 studies; 24 met all inclusion criteria. Data Synthesis. Three studies used mammography vans, three used low-cost vouchers or provided free mammograms, three used home visits, one used community education alone, one provided referrals, five incorporated multiple intervention strategies, two used phone calls, one used videos and print material, and five used primarily print material. Results. Of nine studies that reduced barriers to care via mammography vans, cost vouchers, or home visits, eight showed statistically significant increases in mammography screening. Seven of the eight studies that used peer educators had significant increases in screening, as did four of the five studies that used multiple (intervention) components. Conclusions. Interventions that used peer educators, incorporated multiple intervention strategies, or provided easy access via vans, cost vouchers, or home visits were effective in increasing screenings. Mailed letter or telephone reminders were not effective in trials involving low-income women, which is contrary to findings from middle/upper-income studies.

First Opportunities to Try Drugs and the Transition to First Drug Use: Evidence from a National School Survey in Panama

In recent evidence from the United States, there generally are no male-female differences in the probability of drug use among persons who report an opportunity to try the drugs. This is an important observation that might help us understand male-female differences in later drug use and dependence, but the observation needs to be replicated elsewhere. We begin this replication process using data from a 1996 national school survey of drug involvement among 6,477 students age 12-18 in Panama. We first examine the occurrence of an opportunity to use drugs by grade. We then follow these analyses with an examination of male-female differences in drug opportunity patterns. We found opportunities to use drugs and actual drug use to be greater at higher grade levels. Also, we found the probability of making a transition to use, given an opportunity, to be more likely among upper-grade students. Consistent with results observed in the United States, we found males in Panama to be more likely to have an opportunity to use marijuana, crack-cocaine, and other forms of cocaine, but not more likely than females to make a transition into drug use once an opportunity had occurred to try each drug. These findings are discussed in relation to the epidemiology and prevention of drug use in Panama and elsewhere, and future research on male-female differences in drug involvement.