Luis R. Torres

Health Consequences of Long-Term Injection Heroin Use Among Aging Mexican American Men

Objectives: Research on the health consequences of long-term injection drug use (IDU) is limited. This article examines these consequences among aging, male Mexican American injecting heroin users. Concern for this group is crucial, given its health disparities and the association of IDU with disease transmission. Method: Aging, male Mexican American IDUs (N = 227) were recruited through intensive outreach. Participants self-reported health status, medical and substance use history, and completed behavioral and psychometric health scales. Results are compared to Hispanic national samples. Results: Participants had significantly poorer self-rated health and negative health conditions. Selected medical conditions not associated with the heroin-use lifestyle (i.e., hypertension, diabetes, arthritis) were lower relative to the comparison samples. Discussion: This population has a complex profile of health consequences linked to a heroin-using lifestyle. The study concludes that routine screening of infectious diseases and medical and behavioral conditions among aging substance using populations may contribute to reducing Hispanic health disparities.

A Cross-National Comparison of Adolescent Alcohol and Drug Use Behaviors: U. S. Hispanics and Youth in the Dominican Republic

The prevalence of substance use behaviors during adolescence is an important concern in the United States and internationally. Of particular importance to the U.S. is our ability to compare prevalence estimates and trends with those of neighboring countries, particularly those that feed our immigrant population and have a circulatory migration pattern with us. One of the fastest-growing Hispanic groups is Dominicans, who are also a young group, with a third of Dominicans in the United States under age 18. However, cross-national comparisons of the substance use rates of youth in the U. S. and the Dominican Republic have not been done. Our study represents, to our knowledge, the first such comparison. We conducted a secondary data analysis comparing data from the U.S. Center for Disease Control and Preventions (CDC) 1997 Youth Risk Behavior Survey (YRBS), a biennial survey in the U.S., to data from a survey conducted by the Ministry of Education of the Dominican Republic in 1997. The Dominican Republic survey used a similar sampling methodology and the Spanish version of the YRBS, piloted and modified to ensure linguistic and cultural appropriateness. Youth in the United States in general, and U.S. Hispanic youth in particular, consistently reported higher lifetime and recent use of alcohol, marijuana, and cocaine than youth in the Dominican Republic. Our study supports other cross-national comparisons that have found rates of substance use for youth in Latin America lower than those for youth in the United States. Cross-national comparisons of this nature help each individual country inform its social policies around prevention. They may also allow us to examine the impact of immigration, acculturation, and return migration processes on adolescent substance use in both countries.

Spatial accessibility of drug treatment facilities and the effects on locus of control, drug use, and service use among heroin-injecting Mexican American men

BACKGROUND This study explores the spatial accessibility of outpatient drug treatment facilities and the potential relationship with drug use-related outcomes among Mexican American heroin users. METHODS Secondary data on 219 current and former heroin-injecting Mexican American men aged 45 and older were drawn from a research study in Houston, Texas. We used geographic information systems (GIS) to derive two spatial accessibility measures: distance from ones place of residence to the closest drug treatment facility (in minutes); and the number of facilities within a 10-minute driving distance from ones place of residence. Exploratory logistic regression analyses examined the association between the spatial accessibility of drug treatment facilities and several drug use-related outcomes: internal locus of control (LOC); perceived chances and worries of injecting in the next six months; treatment utilization; and location of last heroin purchase. RESULTS Participants with greater spatial access to treatment programs were more likely to report a higher chance of injecting in the near future. However, while current heroin users were more worried about injecting in the next six months, greater spatial access to treatment programs seemed to have a buffering effect. Finally, those who lived closer to a treatment programs were more likely to have last purchased heroin inside the neighborhood versus outside the neighborhood. Spatial accessibility was not associated with internal LOC or treatment utilization. CONCLUSION The findings showed that the presence of outpatient treatment facilities-particularly services in Spanish-may influence perceived risk of future heroin use and purchasing behaviors among Mexican American men. Implications for future spatially-informed drug use research and the planning of culturally and linguistically responsive drug treatment programs are discussed.

From "Kickeando las malias" (Kicking the Withdrawals) to "Staying clean": The Impact of Cultural Values on Cessation of Injection Drug Use in Aging Mexican-American Men

Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users’ adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.

“El Lado Oscuro”: “The Dark Side” of Social Capital in Mexican American Heroin Using Men

This article describes social capital in a cohort of 227 Mexican American men who are long-term injection heroin users. Social capital scores for current and former users were similar, suggesting equal absolute values of capital, but associated with illicit activities in current users and with cessation efforts in former users. Stable drug-using relationships provided high negative capital, whereas conventional relationships provided positive capital. Thus, social capital functions dichotomously in positive and negative contextualized roles. This study provides an alternative understanding of the dynamic interactions between individuals, environment, and drug abuse and can inform prevention and treatment interventions for an important demographic group.

Diagnostic, Symptom, and Functional Assessments of Hispanic Outpatients in Community Mental Health Practice

With increased US Hispanic diversity come diagnostic challenges associated with culture, language, and expression of mental disorders. In a community-based clinic, we compared diagnostic agreement between Hispanic and non-Hispanic clinicians, and a structured diagnostic instrument, in live and videotaped interviews with Hispanic adults. Percentage agreement and kappas show low diagnostic reliability between clinicians, and between clinicians and instrument. Significant differences appeared in rates of various diagnoses. Non-Hispanic clinicians rated patients’ functional capacity and symptom-severity as significantly worse than Hispanic clinicians. Findings match past research with Hispanic patients and raise questions about diagnostic reliability in multi-cultural community mental health practice.

Assessing Psychosocial Stressors Among Hispanic Outpatients: Does Clinician Ethnicity Matter?

OBJECTIVE Psychosocial and environmental stressors are a well-documented factor in the etiology, progression, and maintenance of psychiatric disorders. Clear guidelines on identifying them are lacking. When the patient and provider are of different cultures, the clinician may not properly understand and identify stressors. This study explored clinician ethnicity and identification of stressors. METHODS A total of 88 adult Hispanic outpatients in a community clinic were separately evaluated by pairs of clinicians (Hispanic and non-Hispanic) drawn from a pool of 47, as part of a larger study. Axis IV data are reported here. RESULTS Clinicians identified few psychosocial stressors. Non-Hispanic clinicians identified significantly more problems related to the primary support group and educational problems than Hispanic clinicians. CONCLUSIONS Clinician ethnicity played a role in identification of psychosocial and environmental problems. Because stressors often affect the presenting problem and course of treatment, failure to properly identify and address them in treatment may influence service outcomes.

The Perceived Role of Family in Heroin Use Behaviors of Mexican–American Men

The influence of the family is not well understood as it relates to drug use behaviors of Hispanic male adults. We examined the family’s influence on drug use behavior, as perceived by Hispanic men who use heroin. One-time qualitative interviews were conducted with 21 current and former heroin users who participated in a larger study on long-term heroin use in Mexican–American men. Data were analyzed using a thematic analysis approach. Three main themes emerged: family as a supportive environment for heroin use; heroin as a family legacy; and, the family’s strategies for helping to stop using heroin. A sub-theme emerged on the paradox of family involvement, which spanned the three main themes. This research lays a foundation for future work to disentangle the risks and benefits of family involvement to inform culturally-centered therapies and cultural adaptations to traditional therapeutic approaches with Mexican–American men who abuse drugs.

Hispanic Perspectives on Recovery High Schools: If We Build Them, Will They Come?

ABSTRACT Recovery high schools (RHSs) have been among the continuum of care for adolescents experiencing addiction since 1979 (Moberg & Finch, 2008). Outcome studies for RHSs are limited, and even less is known about RHS engagement of Hispanics. RHS students are overwhelmingly middle-class non-Hispanic White students with prior formal treatment (Moberg & Finch, 2008). Hispanic youth are more likely to live in discordant low-income ethnic enclaves, placing them at high risk for addictive disorders (Torres, Kaplan, & Valdez, 2011). The individualized approach of RHSs could make them a culturally relevant continuing care intervention. This article reviews the literature to explore the use of RHSs by Hispanics.

Stress, Depression, and Drug Use Among Aging Mexican American Men Living in the Barrio

Residing in Mexican American barrios might place individuals at heightened risk for chronic financial and acute stress, which are associated with adverse mental health outcomes. Stressors could be exacerbated for substance users. This research explores relations between chronic financial stress, acute stress, and depressive symptomatology among aging Mexican American heroin and other drug-using men. A prospective cohort study and field-intensive outreach methodology were used to recruit 227 men for in-depth interviews. Participants were categorized into depressed and nondepressed groups based on symptomatology measured by the Center for Epidemiological Studies Depression Scale. Chronic financial stress (i.e., poverty) and acute stress (i.e., Life Events Questionnaire) associated with depressive symptomatology were tested using logistic regression. Findings suggest scores of depressive symptoms among substance users are highly related to chronic financial stress. Community-level interventions targeting chronic stressors present in the barrio could be especially salient in improving the mental health of Latino drug users.