Protective and risk influences of drug use among a multiethnic sample of adolescent boys.

A measurement model was analyzed to demonstrate a differential distribution and cumulative exposure to psychosocial risk and protective influences of adolescent drug use among ethnically-diverse adolescent samples. The sample included U.S.-born (US) Latino (N = 837), foreign-born (FB) Latino (N = 447), White (N = 632), and African American (N = 618) adolescent boys. Psychological Distress, Peer Drug Use, and Adolescent Drug Use were significantly positively correlated with Peer Drug Use and Adolescent Drug Use. In contrast, Family, School, law abidance, and guilt were significantly negatively correlated with Peer Drug Use and Adolescent Drug Use. Multiple group analyses indicated significant similarities and differences among US and FB Latinos, and Whites. Implications for early prevention, multi-level interventions, and suggestions for future research are discussed.

Patterns and predictors of treatment seeking after onset of a substance use disorder.

BACKGROUND: We studied survey respondents aged 18 through 54 years to determine consistent predictors of treatment seeking after onset of a DSM-III-R substance use disorder. METHODS: Survey populations included a regional sample in Ontario (n = 6261), a national sample in the United States (n = 5388), and local samples in Fresno, Calif (n = 2874) and Mexico City, Mexico (n = 1734). The analysis examined the effects of demographics, symptoms, and types of substances on treatment seeking. RESULTS: Between 50% (Ontario) and 85% (Fresno) of people with substance use disorders seek treatment but the time lag between onset and treatment seeking averages a decade or more. Consistent predictors of treatment seeking include: (1) late onset of disorder (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.6-5.6 for late [> or =30 years] vs early [1-15 years] age at first symptom of disorder); (2) recency of cohort (OR, 3.4; 95% CI, 2.3-5.0 for most recent [aged 15-24 years at interview] vs earliest [aged > or =45 years] cohorts); (3) 4 specific dependence symptoms (using larger amounts than intended, unsuccessful attempts to cut down use, tolerance, and withdrawal symptoms), with ORs ranging between 1.6 (95% CI, 1.3-2.0) and 2.7 (95% CI, 2.1-3.6) for people with vs without these symptoms; and (4) use vs nonuse of cocaine (OR, 2.1; 95% CI, 1.6-2.7) and heroin (OR, 2.6; 95% CI, 1.1-6.0). CONCLUSIONS: Although most people with substance use disorders eventually seek treatment, treatment seeking often occurs a decade or more after the onset of symptoms of disorder. While treatment seeking has increased in recent years, it is not clear whether this is because of increased access, increased demand, increased societal pressures, or other factors.

Alcohol abuse or dependence among Mexican American women who report violence.

BACKGROUND: Violence against women has been linked to alcohol disorders in various populations. Few studies have assessed alcohol disorders among assaulted women in a general population of Mexican Americans. This study examined alcohol disorders among Mexican American women who reported physical or sexual assault. METHODS: Participants were women (n = 1516, ages 18-59) living in Fresno County, California, who were enrolled in a population-based, randomized household survey of Mexican-origin men and women. Crude and adjusted odds ratios (ORs) were calculated for alcohol dependence/abuse (ADA) and physical or sexual assault by a current partner or someone other than a current partner. RESULTS: Women who reported lifetime physical or sexual assault were significantly more likely to meet criteria for ADA (OR = 8.2; 95% confidence interval [CI], 4.4-15.4). After we adjusted for birthplace, age, income, and parental problem drinking, assaulted women were still 4.7 times more likely to meet criteria for ADA (CI, 2.1-10.4). Physical or sexual assault by someone other than a partner was more strongly associated with ADA (OR = 8.7; CI, 4.5-16.9) than assault by a current partner (OR = 3.2; CI, 1.3-7.6). Both physical (OR = 9.0; CI, 4.7-17.0) and sexual assault (OR = 4.7; CI, 2.2-10.0) by either type of perpetrator were associated with ADA. CONCLUSION: There is a strong association between reporting violence and having a lifetime history of ADA. Although temporal order could not be established, these findings highlight the importance of screening for physical and sexual assault in settings that treat alcohol disorders as well as screening for alcohol disorders among women who seek services related to previous or current violence.

Intimate partner violence and health: self-assessed health, chronic health, and somatic symptoms among Mexican American women.

OBJECTIVE: In medical settings intimate partner violence (IPV) has been linked to a variety of health problems. However, few population-based studies have assessed the health of abused women, particularly women from low socioeconomic groups such as Mexican Americans. This study examined the association between recent physical or sexual IPV and self-rated health, chronic health conditions, and somatic symptoms among Mexican American women. METHODS: Participants were women (N = 1155) with current male partners enrolled in a household survey of 3012 Mexican-origin adults, ages 18 to 59 years, living in urban, town, and rural areas of Fresno County, California. Crude and adjusted odds ratios (ORs) were calculated for four self-assessed health measures, seven chronic diseases, and 32 somatic symptoms. RESULTS: In multivariate analyses, women reporting previous-year physical or sexual IPV were more likely to report 1) fair/poor overall health (OR, 1.9; confidence interval [CI], 1.0-3.7), physical health (OR, 2.1; CI, 1.2-3.9), and mental health (OR, 3.4; CI, 1.9-6.1), as well as worse comparative health (OR, 4.4; CI, 2.3-8.3); 2) a history of heart problems (OR, 17.0; CI, 4.3-66.7); 3) persistent health problems (OR, 3.3; CI, 1.5-7.0); and 4) numerous somatic symptoms. CONCLUSIONS: Physical or sexual IPV was associated with poorer self-assessed health and many health symptoms among this culturally distinctive Mexican American population.

Prevalence and predictors of physical partner abuse among Mexican American women.

OBJECTIVES: This study determined the lifetime prevalence of physical abuse by a current partner among women of Mexican origin and assessed factors associated with abuse. METHODS: Data are for a subsample of 1155 women with current partners from a larger population-based cross-sectional survey of US residents of Mexican origin. RESULTS: The self-reported prevalence of physical abuse by a current partner was 10.7%. In multivariate analysis, factors associated with physical abuse included US birthplace (odds ratio = 2.1; 95% confidence interval = 1.24, 3.56), young age, urban residence, and having 4 or more children. Social support and regular church attendance were protective. CONCLUSIONS: The self-reported prevalence of physical abuse among Mexican American women is high. US birth is associated with increased risk of abuse. Community-based prevention efforts should be aimed at this population.

Substance use during pregnancy in the state of California, USA.

Most analyses of prenatal substance use focus on individual level correlates and ignore community level variables and the effect of the dependency of respondents within communities. This analysis uses multilevel logistic regression models to more accurately assess the correlates of perinatal substance use in California. Statistical results indicate that a significant portion of substance use can be attributed to neighborhood heterogeneity, and that traditional models of substance use may inaccurately attribute this variation to individual level regression coefficients. Substantive results indicate that levels of neighborhood public assistance had an independent, significant effect on the prevalence of all substances tested for except alcohol. Black women had higher predicted prevalence risks for alcohol and cocaine while White women had higher predicted risks for tobacco, marijuana and amphetamines. Racial contrasts were non-significant for the overall illicit drug category and opiates, after controlling for neighborhood public assistance. Finally, individual level variables, with the exception of age, were not moderated by levels of neighborhood public assistance.

Help seeking for mental health problems among Mexican Americans.

This study uses data from a household survey (Mexican American Prevalence and Services Study; MAPSS) of 3,000 respondents in Fresno County, California, to 1) contrast use across multiple sectors of care among immigrant and U.S. born Mexican Americans with recent psychiatric disorders, 2) contrast multiple provider utilization patterns, and 3) identify specific factors associated with the use of mental health specialty and general medical sectors. Immigrants and U.S. born disproportionately used the general medical sector for treating mental health problems. The U.S. born were more likely to use family physicians and counselors than were immigrants, and neither relied heavily upon informal network providers to treat psychiatric disorders. A comparison of patterns showed that most people with a recent disorder used a combination of providers. The logistic regression analyses showed that knowing where to find a provider increased the likelihood of specialty mental health use by an odds ratio (O.R.) of 4.68. Private insurance increased use of mental health providers, O.R. = 3.76. Public insurance availability did not increase mental health provider use, suggesting that other factors were linked to use of mental health specialty care. Public insurance did increase medical sector care for psychiatric problems, O.R. = 2.57. Poor self-rated mental health status was primarily associated with use of physicians by U.S. born (O.R. = 5.39). Severe mental health impairment increased use of both general medical (O.R. = 5.54) and specialty mental health (O.R. = 5.1) providers. These results point out that eligibility for public insurance is a necessary but not sufficient status to increase mental health sector care among immigrants, and education and more effective referral from other sectors are needed to encourage use of these services.

Priority issues in Latino mental health services research.

This paper identifies issues and trends affecting the quality and comprehensiveness of Latino mental health research and services. These issues include current patterns of need and services use, rapid expansion of the Latino population, extraordinary rates of uninsured, social and language barriers to care, transformation in treatment science and technology, and the sheer complexity and rapid changes in the delivery system. Progress in the field requires coordination and investments from both public and private sectors. Scientific journals should provide assistance for creating a high quality knowledge base and rapidly disseminating this information to students, practitioners, and policy makers. Vigorous activity is needed to (1) augment the supply of people entering the "pipeline" for researcher and practitioner training, and (2) support research in priority areas such as outcome studies for diverse treatments and different sectors of care, cultural competence, treatment models for youth and aging populations, quality of care, and barriers to mental health care.

Perceived discrimination and depression among Mexican-origin adults in California.

We contend that perceived discrimination has an independent effect on depression outcomes among adults of Mexican origin. Using a sample of 3,012 Mexican-origin respondents in Fresno, California in 1995/96 (ages 18-59) we investigate the direct and moderating connections between perceived discrimination, acculturative stress, and mental health (CES-D). We also investigate the social patterning of perceived discrimination. While more highly acculturated immigrant respondents were more likely to experience discrimination than their less acculturated counterparts, more highly acculturated U.S. born respondents were less likely to experience discrimination. Discrimination was directly related to depression, but this effect was moderated through nativity/country of residence, English-language acculturation, sex, and country of education variables. Moderate levels of legal status acculturative stress were especially depressive for native-born U.S. residents.

Effects of time in the United States and Indian ethnicity on DSM-III-R psychiatric disorders among Mexican Americans in California.

The study examines the effects of time in the United States and Indian ethnicity on prevalence of 12 DSM-III-R psychiatric disorders among Mexican Americans in California. In Fresno County, primarily an agricultural area, 3012 participants of Mexican origin (18 to 59 years) were selected under a cluster sampling design and interviewed using a version of the World Health Organization's Composite International Diagnostic Instrument (WHO-CIDI). Lifetime prevalence of any psychiatric disorder was 46.4% for Indians and 32.9% for non-Indians. Alcohol dependence was the most prevalent disorder (Indians = 17.4%, non-Indians = 10.7%). Indians had significantly higher risk of affective disorders (adjusted OR = 2.9) and drug abuse/dependence (adjusted OR = 2.6) compared with non-Indians. Time in the United States was associated with higher risk of lifetime affective disorders and drug abuse/dependence. This effect was more pronounced among Indians. Mexican immigrants are ethnically heterogenous and Indians appear to be more vulnerable to negative effects of exposure to U.S. society.

Lifetime prevalence of and risk factors for psychiatric disorders among Mexican migrant farmworkers in California.

OBJECTIVES: In this study, the prevalence of and risk factors for 12 psychiatric disorders were examined by sex and ethnicity (Indian vs non-Indian) among Mexican migrant farm-workers working in Fresno County, California. METHODS: Subjects aged 18 through 59 years were selected under a cluster sampling design (n = 1001). A modified version of the Composite International Diagnostic Interview was used for case ascertainment. The effects of sociodemographic and acculturation factors on lifetime psychiatric disorders were tested. RESULTS: Lifetime rates of any psychiatric disorder were as follows: men, 26.7% (SE = 1.9); women, 16.8% (SE = 1.7); Indians, 26.0% (SE = 4.5); non-Indians, 20.1% (SE = 1.3). Total lifetime rates were as follows: affective disorders, 5.7%; anxiety disorders, 12.5%; any substance abuse or dependence, 8.7%; antisocial personality, 0.2%. Lifetime prevalence of any psychiatric disorder was lower for migrants than for Mexican Americans and for the US population as a whole. High acculturation and primary US residence increased the likelihood of lifetime psychiatric disorders. CONCLUSIONS: The results underscore the risk posed by cultural adjustment problems, the potential for progressive deterioration of this population's mental health, and the need for culturally appropriate mental health services.

Gaps in service utilization by Mexican Americans with mental health problems.

OBJECTIVE: The purpose of this study was to ascertain the degree of underutilization of services for mental health problems among urban and rural Mexican American adults. METHOD: A probability sample (N = 3,012) was used to represent the Mexican American population of Fresno County, California, and face-to-face interviews were conducted with the use of the Composite International Diagnostic Interview. Bivariate and multivariate analyses were used to analyze the data on diagnosis and service utilization. RESULTS: Among the respondents with DSM-III-R-defined disorders, only about one-fourth had used a single service or a combination of services in the past 12 months, and Mexican immigrants had a utilization rate which was only two-fifths of that of Mexican Americans born in the United States. Overall use of mental health care providers by persons with diagnosed mental disorders was 8.8%, use of providers in the general medical sector was 18.4%, use of other professionals was 12.7%, and use of informal providers was only 3.1%. According to logistic regression analyses, factors associated with utilization of mental health services included female sex, higher educational attainment, unemployment, and comorbidity. CONCLUSIONS: Immigrants are unlikely to use mental health services, even when they have a recent disorder, but may use general practitioners, which raises questions about the appropriateness, accessibility, and cost-effectiveness of mental health care for this population. Several competing hypotheses about the reasons for low utilization of services need to be examined in future research.

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology.

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.

Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California.

BACKGROUND: The Mexican American Prevalence and Services Survey presents lifetime prevalence rates for 12 DSM-III-R psychiatric disorders in a sample of 3012 adults of Mexican origin by place of residence and nativity, and compares these results with those of population surveys conducted in the United States and Mexico. METHODS: The stratified random sample included non-institutionalized persons aged 18 to 59 years of Mexican origin, who were residents of Fresno County, California. Psychiatric disorders were assessed using a modified version of the World Health Organization Composite International Diagnostic Interview in face-to-face interviews. RESULTS: Mexican immigrants had lifetime rates similar to those of Mexican citizens, while rates for Mexican Americans were similar to those of the national population of the United States. This difference is attributable to a prevalence rate for any disorder among immigrants of 24.9%, compared with 48.1% among US-born respondents. A higher prevalence for any disorder was reported in urban (35.7%) compared with town (32.1%) or rural (29.8%) areas. Multivariate analyses showed an adjusted effect of country of birth, but not of urban residence. CONCLUSIONS: Despite very low education and income levels, Mexican Americans had lower rates of lifetime psychiatric disorders compared with rates reported for the US population by the National Comorbidity Survey. Psychiatric morbidity among Mexican Americans is primarily influenced by cultural variance rather than socioeconomic status or urban vs rural residence.

Illicit drug use among Mexicans and Mexican Americans in California: the effects of gender and acculturation.

AIMS: To examine the effects of gender and acculturation on illicit drug use among the Mexican-origin population in California. DESIGN: The 3012 subjects between 18 and 59 years of age were selected under a stratified, multi-stage cluster sampling method. SETTING: Fresno County in California is primarily agricultural, with only one metropolitan area. Over 30% of the total population of 764,800, are Hispanics, of Mexican origin. MEASUREMENTS: A modified version of the World Health Organization's Composite International Diagnostic Instrument (WHO-CIDI) was used to ascertain drug use. Respondents were considered drug users if they had ever used marijuana, cocaine, hallucinogens, heroin or inhalants. Acculturation was measured with a Likert scale, assessing English vs. Spanish language preference. Other covariates of interest were nativity and place of residence. FINDINGS: Men had higher rates of use than women for every drug (men = 46.3%, women = 23.2%). Urban rates were higher than rural rates, for both women (urban = 32.8% vs. rural = 16.6%) and men (urban = 57.0% vs. rural = 36.8%). In logistic regression models, men were more likely than women to have ever used illicit drugs or inhalants (adjusted OR = 4.8), cocaine (adjusted OR = 5.3) or marijuana (OR = 4.3). However, the combined effect of United States nativity and acculturation, on drug use, was greater among women (adjusted OR = 29.3) than among men (adjusted OR = 7.4). The effect of acculturation was stronger among urban, than among town or rural residents. CONCLUSIONS: Acculturation and United States nativity are risk factors for illicit drug use among Mexican origin men and women. However, women have increased vulnerability compared with men. Findings reinforce the need for culturally based public health interventions.

Effects of age on perinatal substance abuse among whites and African Americans.

This descriptive study assessed age effects on perinatal use of alcohol, marijuana, and cocaine among African-American and white women. Data were derived from the California Perinatal Exposure Study, relying on a statistical probability sample n = 29,494) of women who underwent anonymous urine toxicology screening in birthing hospitals. The central hypothesis was that there would be no difference in age effects on drug use among white and African-American women. Marital status and payment source were used as risk factors in order to create detailed age-risk profiles for both racial-ethnic groups. Logistic regression analyses were used and findings indicated that cocaine use peaked in early adulthood for whites and in mid-adulthood for African-Americans who had higher prevalence levels with the same or fewer risk factors as whites. Over one third of African-American women in their mid-thirties who were not married and who had publicly assisted births tested positive for cocaine. In contrast, high risk whites had higher marijuana prevalence levels than African-American women, and prevalence increased with age. Alcohol prevalence increased with age for African-American and white women who were publicly assisted, but decreased with age for all others. Findings for alcohol and marijuana generally followed the same risk-adjusted patterns for African American and white women but with different prevalence levels; however, cocaine use had a unique pattern with higher prevalence among African-American women in mid-adulthood regardless of risk level.

Perinatal drug use among immigrant and native-born Latinas.

Perinatal drug exposures pose a significant health hazard for women and imperil normal fetal and neonatal development. Little is known about patterns of drug exposure among pregnant immigrant and native-born Latinas in the United States. We present multivariate risk factor analyses for alcohol and illicit drug use from the California Perinatal Substance Exposure Study using a statistical probability sample (N = 11,002) of Latinas who were tested anonymously using urine toxicology screening techniques. Alcohol use during pregnancy was pervasive among both immigrant and United States-born Latinas (7%) with little variation on risk factors. Illicit drug use was found primarily in a high risk group of United States-born Latinas between 25 and 34 years of age who received no prenatal care (prevalence 50%, odds ratio of 185). Increased general awareness of perinatal alcohol risk by medical providers and public health practitioners serving this population is needed. The potential isolation of United States-born Latinas who are at risk using illicit drugs during pregnancy requires effective communication and outreach.

Prenatal substance abuse in California: findings from the Perinatal Substance Exposure Study.

This article reports the overall statewide findings of an epidemiological study that included 29,494 pregnant women who had been admitted for delivery in more than 200 hospitals in California and who were tested for alcohol and other drugs via blind urine toxicology screens. Results were matched to demographic data. The article includes analysis and discussion of four major variables: race/ethnic group differences, acculturation, source of payment for birth, and prenatal care status. Regional results are also discussed. The authors emphasize the high rate of alcohol use and self-reported tobacco use in comparison to relatively low rates of illicit drug use. Alcohol use rates were fairly stable, while use of illicit drugs and tobacco tended to vary according to social and demographic variables. The findings establish the need for both broad-based and targeted prevention and intervention programs to better disseminate the risks involved in drinking alcohol, smoking tobacco, and using drugs during pregnancy.