Deportation along the U.S.-Mexico border: its relation to drug use patterns and accessing care.

Since migration has been linked to new drug trends and risky behaviors, and deported individuals face unique economic and social stressors, we investigated behaviors of injection drug users (IDUs) from Tijuana, Mexico in relation to deportation history. In 2005, IDUs > or =18 years old who injected within the prior month were recruited by respondent-driven sampling, administered a questionnaire, and underwent antibody testing for HIV, HCV, and syphilis. Logistic regression compared IDUs who reported coming to Tijuana due to deportation from the U.S. versus others in the study. Of 219 participants, 16% were deportees. Prevalence of HIV, HCV and syphilis was 3, 95 and 13%, respectively. Deportees had lived in Tijuana for a shorter time (median: 2 vs. 16 years), were more likely to inject multiple times/day (OR: 5.52; 95%CI: 1.62-18.8), but less likely to have smoked/inhaled methamphetamine (OR: 0.17; 95%CI: 0.17-0.86). Deportation history was inversely associated with receiving drug treatment (OR: 0.41; 95%CI: 0.19-0.89), recent medical care (OR: 0.37; 95%CI: 0.13-1.00), or HIV testing (OR: 0.44; 95%CI: 0.19-1.02). Deportees had different drug use patterns and less interaction with public health services than other study participants. Our study is an indication that migration history might relate to current risk behaviors and access to health care. More in-depth studies to determine factors driving such behaviors are needed.

Exposure to immunization media messages among African American parents.

BACKGROUND: African Americans have low immunization rates, yet little is known about their immunization knowledge, attitudes, and practices or about the effect of outreach to this audience. In Spring 1997, the California Department of Health Services (CDHS) launched a statewide culturally sensitive and ethnically specific media campaign directed toward African Americans. This campaign was preceded by a major Los Angeles County Department of Health Services media campaign. OBJECTIVES: The objectives of this study were to (a) estimate exposure to immunization media messages among African Americans; (b) determine sources of immunization information; and (c) assess various immunization attitudes and beliefs in order to refine future outreach efforts. METHODS: Following the CDHS media campaign, a random digit dial survey was conducted with 801 African American families with children under age 10. The sample was drawn from the four California regions with the highest African American birth rates. It included all zip codes in these regions with greater than 150 African American births per year. Lower bound response rates ranged from 62.5 to 76.1%. Higher income and education levels were overrepresented. Results were weighted to adjust for this. RESULTS: Over 88% remembered seeing or hearing some form of immunization information. Exposure to television ads was reported by 63% followed by billboards (51%) and radio (42%). Sixty-two percent thought mild disease was possible after shots; 27% feared HIV from needles and 19% thought pain was a barrier. Respondents who cited money as a barrier (26%) were less likely to believe that shots were available for free (P = 0.02). CONCLUSIONS: Media advertising is an effective tool for reaching African Americans. Addressing specific concerns (e.g., clarification of the circumstances and likelihood of getting a mild case of the disease following an immunization, availability of free shots, and risk of HIV) may contribute to increased immunization rates for this population.

The presence of total quality management and continuous quality improvement processes in California public health clinics.

Total quality management (TQM) and continuous quality improvement (CQI) processes have not been fully integrated into public health practice. Current levels of participation and interest in TQM/CQI were assessed in California's 62 county departments of health services. Survey results indicated that only 18.5 percent of the 54 respondents were using TQM/CQI. Of those not using TQM/CQI, 75 percent were interested in these activities. Improvement of public health clinic ability to compete and to survive in a rapidly changing health care environment requires fostering this interest through public health decision-maker support, increased TQM/CQI training opportunities, and demonstration of TQM/CQI cost-effectiveness in public health.