Lynn Wallisch

Alcohol and Drug Use, Abuse, and Dependence in Urban Areas and Colonias of the Texas-Mexico Border

This study describes the prevalence of alcohol and drug use, abuse, and dependence among adults on the Texas-Mexico border in 2002-2003. The findings are based on survey responses from a random sample of 1,200 adults living in households in three communities: El Paso, a densely populated city in west Texas; the less dense urbanized areas of the lower Rio Grande Valley in south Texas; and rural or semirural colonias—unregulated settlements characterized by lack of basic public services—in south Texas. The findings revealed similarity in drug use across the three sites but higher rates of binge drinking and alcohol dependence in the colonias. Border alcohol and drug use appeared similar or lower than use among residents of Texas as a whole or Hispanics nationwide; however, problems of abuse and dependence appeared somewhat higher on the border.

Drug use and risk of HIV/AIDS on the Mexico-USA border: a comparison of treatment admissions in both countries

This study analyzes trends in treatment admissions and summarizes HIV/AIDS risk factors along the US-Mexican border. Data are presented at the national level and at the state level for states along the border. Client data also are compared for treatment programs located in sister cities on the Texas-Mexico border. These data show that methamphetamine admissions are increasing nationally and methamphetamine use is a major problem in the western states on both sides of the border. Use of Ice (smoked methamphetamine) has increased significantly. Use of crack (smoked cocaine) is a growing problem on the border, and injection is the primary route for using black tar heroin in this area. Each of these drugs is a risk factor, either from drug-influenced risky sexual behaviors or from sharing injection equipment. In addition, the availability of drugs on the border and patterns of risky behaviors among migrants mean that drug users on the border are at risk of HIV/AIDS, and this risk is expected to increase with the spreading methamphetamine epidemic and smoking of crack cocaine. Comparable data on HIV/AIDS are needed for further studies of the relationship of drug use and HIV/AIDS on the border.

Substance Use among Texas Hispanics and Non-Hispanics: Who's Using, Who's Not, and Why

The prevalence ofpast-yearand lifetime substance use, problem indicators, and the most important reasons for abstaining (among nonusers) were compared between Texas Hispanics and non-Hispanics, as well as among three subgroups of Hispanics who represented different levels of acculturation: Mexican born (i.e., least acculturated), U.S. born but relatively unacculturated, and U.S. born/highly acculturated. In general, prevalence rates among Hispanics increased as a function of U.S. acculturation, with the most acculturated groups rates more closely resembling non-Hispanics than Mexicanborn Hispanics. There were also significant variations by level of acculturation in the reasons given for abstinence. Whereas health was the most commonly cited reason for abstinence regardless of ethnicity, other important reasons (e.g., moral reasons versus influence of family and friends) varied significantly by ethnicity and acculturation. Results are interpreted with special regard to prevention.

Working Well – The Texas Demonstration to Maintain Independence and Employment: 18-month outcomes

Uninsured working adults with chronic mental, behavioral and physical health conditions may have greater difficulty in accessing needed health care due to health care costs and crowded public health systems. Untreated medical conditions can lead to poorer health, which is linked to loss of employment and eventual applications for and receipt of federal benefits such as Supplemental Security Income and Social Security Disability Insurance (SSI/SSDI). The Working Well study was designed to determine whether a coordinated set of health benefits and employment supports could help low-income, working adults maintain their employment and remain independent of publicly funded disability assistance. Patients from the Harris County Hospital District, a large public health system providing indigent care in the Houston metroplex, were recruited and randomized to the intervention (N = 904) and control (N = 712) groups. The Working Well case management intervention included health naviga- tion, employment/vocational supports, expedited appointments, free medications, and no co-pays for medical visits. Participant outcomes were measured through surveys, health claims data, and state agency employment data. Intervention group participants reported greater access to care, greater likelihood of outpatient medical visits and less likelihood of receiving SSI/SSDI benefits. These findings suggest that public health care systems can provide disability prevention programs, improve access to care and reduce reliance on publicly funded disability assistance.

Substance Use and Cumulative Exposure to American Society: Findings From Both Sides of the US-Mexico Border Region

OBJECTIVES We investigated whether Mexican immigration to the United States exerts transnational effects on substance use in Mexico and the United States. METHODS We performed a cross-sectional survey of 2336 Mexican Americans and 2460 Mexicans in 3 Texas border metropolitan areas and their sister cities in Mexico (the US-Mexico Study on Alcohol and Related Conditions, 2011-2013). We collected prevalence and risk factors for alcohol and drug use; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol-use disorders; and 2 symptoms (hazardous use and quit or control) of drug use disorder across a continuum of migration experiences in the Mexican and Mexican American populations. RESULTS Compared with Mexicans with no migrant experience, the adjusted odds ratios for this continuum of migration experiences ranged from 1.10 to 8.85 for 12-month drug use, 1.09 to 5.07 for 12-month alcohol use disorder, and 1.13 to 9.95 for 12-month drug-use disorder. Odds ratios increased with longer exposure to US society. These findings are consistent with those of 3 previous studies. CONCLUSIONS People of Mexican origin have increased prevalence of substance use and disorders with cumulative exposure to US society.

A model for assessing primary prevention needs and resources

This article describes an Integrated Needs Estimation model which assesses needs for prevention services by combining measures of risk and resiliency for local areas. These estimates, based on data from surveys and social statistics, are used to design programs which foster resiliency and reduce risk, and to allocate resources based on local needs.

Wanting and Getting Help for Substance Problems on Both Sides of the US-Mexico Border

The US-Mexico border presents potential cultural and logistic barriers to obtaining substance abuse treatment. We compare the prevalence and correlates of wanting and getting help between border and non-border residents in both the US and Mexico. Data come from the 2011 to 2012 US-Mexico Study on Alcohol and Related Conditions which surveyed 3214 border and 1582 non-border residents in the US and Mexico. Multivariate logistic regressions estimate the effect of border residence on desire for and receipt of help. In both countries, border substance users were about half as likely as nonborder substance users to have wanted or obtained any kind of help, independent of predisposing, need and enabling factors, including migration status. Among those desiring help, however, about half had obtained it, both on and off the border in both countries. While substantial proportions of those who need help do not get it either on or off the border, lower motivation for treatment may be more important than access in explaining border/non-border differences. Future research should investigate whether there are border-specific barriers to wanting help, and how to minimize them.

Drug use on both sides of the US-Mexico border

OBJECTIVE To compare drug use for cities along the USMexico border. MATERIALS AND METHODS Data are from the US-Mexico Study on Alcohol and Related Conditions (UMSARC, 2011-2013), a survey of 4 796 randomly selected BMexican and of Mexican origin individuals on both sides of the border. RESULTS Higher rates of any past-year drug use and symptoms of drug use disorders were found only in the border city of Laredo, when compared to the non-border city of San Antonio. Nuevo Laredo and Reynosa/Matamoros showed higher rates of drug use than the non-border city of Monterrey. Much higher rates (ORs in the range of 4-11) were found in the US cities when compared to their acrossthe-border Mexican counterparts. CONCLUSIONS Drug use is high on the border for the selected Mexican cities. Misuse of prescription drugs is nevertheless a concern in the south Texas border cities in our study.

Prevalence and correlates of arrests or stops for drunk driving on both sides of the U.S.-Mexico border

ABSTRACT Risk for driving under the influence of alcohol (DUI) may be higher in U.S. and Mexico border cities as compared to nonborder cities in each country. We examine rates and correlates of self-reported DUI arrests or stops on both sides of the border, drawing on a large-scale survey of 4,796 Mexicans and Mexican Americans in border and nonborder cities of Texas and two states in Mexico. Findings varied by site and country and did not consistently show higher rates on the border. DUI prevention efforts should consider the heterogeneity of local conditions and needs.