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We examine syndemic profiles of intimate partner violence, mental health, drug use, incarceration, and infectious diseases (HIV, HCV, and STIs) among a sample of adult Mexican American women who were affiliated with youth street gangs during adolescence through their relationships to boys and men. Latent class analysis included multiple factors along the following dimensions: intimate partner violence, drug use, mental illness, and incarceration. Five unique syndemic profiles were found with varying associations to HIV, HCV, and STI: (1) no syndemic, (2) intimate partner violence, no syndemic, (3) drug use, mental health, and incarceration syndemic, (4) intimate partner violence, drug use (without injection drug use), and mental health syndemic, and (5) intimate partner violence, drug use with injection drug use, mental health, and incarceration syndemic. To successfully prevent HIV, HCV, and STI among gang-involved girls and women, it is necessary to address syndemic factors.

Research on the role of incarceration history on the mental health of imprisoned mothers reveals contradictory findings. These inconsistencies are potentially attributable to the different incarceration histories across samples masked by the use of a dichotomized incarceration history measure. This study used incarceration trajectories over the life course to determine the nature and array of incarceration experiences detrimental to mental health. Using the Survey of Inmates in State and Federal Correctional Facilities dataset (N = 881), we conducted logistic regressions to examine the associations between imprisoned mothers’ incarceration trajectories and mental health problems. Findings suggested that incarceration trajectories were significantly associated with a post-traumatic stress disorder diagnosis and demonstrated a trend towards significance to be associated with anger symptoms and suicidal ideation. However, they were not significantly related to other mental health problems, such as depressive disorder and anxiety disorder. We concluded that mental health interventions need to be customized to the unique challenges encountered by subgroups of mothers with different incarceration experiences.

Knowledge about the motivations for crack cocaine use and the long-term effects among people who inject heroin is limited. This study aims to understand motivations associated with this co-use drug...

Despite growing research on women’s offending trajectories, knowledge on the imprisonment experiences of women who are mothers is limited. This study used a nationally representative dataset of state and federal prisoners to identify and characterize subgroups of mothers based on incarceration histories. Group-based trajectory modeling identified four groups with distinct incarceration trajectories: stable escalating group, moderate declining group, adolescence-peak group, and young-adulthood-peak group. Bivariate analyses then suggested that different incarceration trajectories were associated with adverse life experiences (i.e., foster care placement, sexual abuse experience) and confinement experiences (i.e., number of episodes of prison confinement). Discussed are the future research directions and implications for criminal justice policies and interventions targeting imprisoned mothers.

This analysis examined the role of impactful life events/stressful contextual factors and cannabis use in the patterns of illicit drug use. It utilized semi-structured qualitative interviews with 40 young adult medical cannabis patients and 22 non-patient users collected in Los Angeles during 2014–2015. Three patterns of illicit drug use emerged based on participants’ narratives: regular/problematic, recreational/occasional, and never users. Among regular/problematic users, a common theme was the lasting impact of traumatic life events or stressful contextual factors on transition to and away from problematic drug use, and using cannabis to cope with negative after effects of drug use. In contrast, most recreational/occasional and never users, who reported impactful life events or stressful contextual factors, used cannabis to cope with those experiences. Family history of addiction and acceptance of cannabis use within a family as protective factors against illicit drug use among some recreational/occasional and never users was an unexpected finding.

This qualitative study applied a life course framework to characterize the nature of interpersonal partner relationships of Mexican American young adult men affiliated with street gangs during their adolescence. Data come from a 15-year longitudinal mixed-method cohort study conducted in San Antonio, Texas. We analyzed semi-structured interviews conducted with a subsample (n = 40) during the course of three face-to-face sessions to explore the men’s motivations, aspirations, and goals to lead conventional lives, despite their criminal justice involvement. Specifically, we focus on the complex nature of maintaining ties to children, the navigation of complicated family structures, the processes of seeking partners with economic resources, and on partnerships with criminal and delinquent partners. We document the complex interpersonal nature of these relationships as men contend with serial incarceration and their desires and motivations to desist from criminal behavior.

Introduction Young adults have the highest rates of cannabis and other drug use, as compared to other age groups, and contribute a significant proportion to the total population of medical cannabis patients (MCP). However, little is known about the relationships between various cannabis practices and illicit drug use/prescription drug misuse among young adult cannabis users with and without legal access to medical cannabis. Methods 210 MCP and 156 non-patient cannabis users (NPU) aged 18–26 were recruited in Los Angeles in 2014–15 for a longitudinal study assessing the impact of medical cannabis on health and substance use among emerging adults. For the present analysis, only quantitative baseline survey data were used. Logistic regression was used to examine the associations between past 90-day cannabis practices and other drug use, including illicit drug use and prescription drug misuse. Results Illicit drug use was associated with being non-Hispanic white (AOR = 3.0, 95% CI 1.8–5.1), use of cannabis concentrates (AOR = 2.8, 95% CI 1.6–4.9), while self-reported medical cannabis use was associated with lower probability of illicit drug use (AOR = 0.5, 95% CI 0.3–0.9). The odds of prescription drug misuse were increased for participants who reported use of cannabis edibles (AOR = 2.0, 95% CI 1.1–3.5), and decreased with age (AOR = 0.9, 95% CI 0.8–1.0) and for those who used cannabis alone (AOR = 0.5, 95% CI 0.3–0.9). Conclusion Use of alternative cannabis forms, but not cannabis use frequency, were associated with greater odds of other drug use. Self-reported medical cannabis use, but not MCP status, decreased probability of illicit drug use.

Crack cocaine use has increased rapidly throughout Mexico, coinciding with rising HIV and HCV infections among vulnerable groups. Due to the increased risk of infection among crack users, harm reduction approaches have been identified to reduce the spread of disease. However, Mexico has yet to adopt these techniques for crack users.To evaluate the impact of a pilot crack kit distribution program on risky smoking behaviors of active crack users in an impoverished colonia of Mexico City, Mexico.Fifty crack kits, containing safer smoking paraphernalia and related health items (i.e., condoms, alcohol wipes, etc.), were distributed to active crack users. A sample of 58 crack users were surveyed prior to the intervention and 35 were successfully relocated and surveyed three months after the intervention. Surveys assessed drug use, crack kit utilization, and smoking practices.Findings indicate that crack kit utilization was high throughout the sample. Use of risky or unsafe paraphernalia decreased, specifically the use of cans as pipes (Z = -2.653, p = .008). Similarly, Pyrex pipe use increased significantly (Z = -3.132, p = .002). Sharing of paraphernalia also decreased throughout the sample.These findings identify the potential benefits in reducing risky smoking behaviors of crack kit distribution programs in Mexico City. This evidence supports expansion of crack kit programs in Mexico and similar impoverished regions.

We use a risk environment framework to qualitatively examine pathways into substance use and abuse among Mexican female sex workers on the U.S.–Mexico border. Life history interviews and ethnographic observations were conducted with female sex workers to uncover how the border context shapes patterns of substance use. The findings illustrate that, for many women, initiation into sex work is contextualized within immigration, the global economy, and demands and desire for financial autonomy. Paradoxically, many find autonomy within sex work as they increase their ability to support their families and themselves. As women become more entrenched in sex work, however, they are put on a path toward substance abuse beginning with alcohol then cocaine and heroin. This identification of specific substance use pathways and trajectories has important implications for the development of prevention and intervention programs that can help curtail problematic drug use that can lead to negative health consequences.

A longitudinal study (15 years) investigates heroin use patterns following precocious transition experiences for gang-affiliated Mexican-American males (n=119) in San Antonio, Texas. Five precocious transitions are examined: cohabitation, early nest leaving, school dropout, teenage parenthood, and unemployment (while not in school). Half of these men used heroin over the follow-up period for an average of under 4 years. Findings from a zero-inflated Poisson model indicate that while these transitions do not have a significant effect on initiation of heroin use, they do have an important influence on individual's drug trajectories once they have initiated. Early-nest leaving and teenage parenthood are protective factors for continued heroin use while dropping out of high school and cohabiting during this same period are risk factors. Findings are discussed within the context of these disadvantaged and marginalized communities.

Research has found that among juveniles weak ties to informal social control entities such as parents, school, and conventional peers increase the probability of the initiation and continuation of deviant behaviors such as drug use and crime. Given the weak ties of formal social control mechanisms in highly disadvantaged communities, informal social control mechanisms are often an important deterrent that reduce or moderate engagement in deviant behaviors among serious and persistent offenders. This analysis examines the association between long-term gang membership and adolescent informal social control processes, drug use, and delinquency. This research is based on data from a study of 160 Mexican American male gang members between the ages of 16 and 20. Findings suggest that among gang members in this context, commonly studied informal control mechanisms such as the family and schools do not function to deter long-term gang membership that is associated with serious criminal and violent behavior and drug use. The implications for future research on desistance or continuation of antisocial behavior across the life course are discussed.

There has recently been growing attention and concern in the U.S. on the detrimental drug use and related health conditions impacting diverse sexual minority populations. While some evidence indicates that bisexual women are at increased risk of substance use, little attention has been given to disadvantaged and racial/ethnic minority bisexual women, who are particularly vulnerable to a complexity of stressors and risk. Using data from a 15-year longitudinal study in San Antonio, Texas, the current study examines drug use, incarceration histories, stressful life events, and infections among 206 young adult Mexican-American women who report engaging in sex with both men and women (WSWM) (n = 61) and those indicating having exclusively male sex partners (WSM) (n = 145). A bivariate analysis finds that WSWM experienced more frequent (p = 0.001) and longer total time incarcerated (p = 0.001), as well as exposure to more stressful life events (p = 0.003). WSWM also have higher rates of past 30 day injection drug use (p = 0.026) and related Hepatitis C Virus (HCV) infection (p = 0.001), as well as greater symptomatology associated with depression (p = 0.014), PTSD (p = 0.005), and suicidal ideation (p = 0.036). Findings indicate a significantly elevated risk profile for socio-economically marginalized WSWM. This knowledge is timely and central to policy discourse to develop interventions and health campaigns aimed at reducing and/or preventing further health disparities among this highly susceptible population of minority women.

Child sexual abuse (CSA) is a pervasive problem that has been linked to numerous developmental, social, health, and substance use consequences. Nevertheless, the relationship between CSA and the consumption of psychoactive substances has not been adequately studied in Mexico. The present study aims to examine this association between history of CSA and illicit substance use and associated risk behaviors in a sample of young adult women in Mexico City.The present study uses a cross-sectional design to examine sexual abuse history among women who use illicit substances. Data collection consisted of a questionnaire administered through face-to-face interviews with 101 women who sought treatment for substance use in Mexico City. A bivariate analysis was used to examine women who experienced sexual abuse and those who did not. Odds ratio and relative risk were estimated.A total of 101 women were interviewed with an average age of 19.2 years. The average age of onset of drug use was 15.4 years. Among participants, 68% reported having been victims of sexual abuse and rape. The average age of reported sexual abuse was 12.2 years. Participants reported a high rate of polydrug use (32.7%), consuming more than two drugs. Sexual abuse was associated with detention by police for drugs, forced prostitution, and consumption of substances during pregnancy.This study found that sexual abuse and rape were highly associated with substance abuse outcomes and associated risk behaviors.

Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted infections in the United States. Despite this, there has been limited research on the correlates to HSV-2 among disadvantaged and marginalized women, particularly among Latinas. Data for the present analysis include 125 young adult Mexican-American women enrolled in a longitudinal study in a disadvantaged urban community in San Antonio, Texas. The current rate of tested HSV-2 infection is 56.8%. Our findings suggest strong comorbidity of genital herpes with injecting heroin use, Hepatitis C, sexual violence, incarceration, and mental illness. Contributing to this population's nexus of risk are the low rates of health service utilization among those infected with HSV-2. Integration between behavioral health and primary care, including access to preventative services, are essential for improving the health of Latinas living in disadvantaged neighborhoods.

Both injecting drug users (IDU) and sex workers are at great risk of contracting and transmitting HIV. Therefore, IDU sex workers could be at especially high risk. The recent increase of HIV infection in Mexico has caused increased attention to sex work. We identify the correlates of injecting drug use including socio-demographic, work history, and sexual and non-injecting drug use risk behaviors among Mexican female sex workers. There is a high risk profile for IDUs compared to never injectors including a high prevalence of lifetime STI infection (54.2%). Revealed is an environment composed of high-risk networks that may have serious binational public health implications.

Background While the comorbidity of mental health and injecting heroin has been documented, current research is limited by describing the mental health of people who inject drugs without a comparison group and by the lack of research on nontreatment samples in the United States, particularly among Hispanics. The purpose of this study was to examine the association of injecting history (never, former, occasional, and daily) and multiple outcomes of global and mental health using a sample of U.S.-based Latinos not currently in treatment. Methods Data are from a sample of street-recruited Mexican American young adult men (n = 275) in San Antonio, TX. Multiple logistic regression and structural equation modeling were used. Results Overall 54% of men reported lifetime injecting drug use (20.7% former users, 11.1% occasional users, and 21.9% daily users). We found varying prevalence rates of global and mental health status among different histories of injecting. After covariate adjustment, daily injecting remained strongly associated with all four outcomes: perceived poor health status (AOR = 4.39; p ≤ 0.001), psychological distress (AOR = 2.78; p ≤ 0.05), depression (AOR = 4.37; p ≤ 0.001), and suicidal ideation (OR = 4.75; p ≤ 0.001). Acculturation, gang membership, and incarceration history also emerged as important factors. Conclusion This study provides new information about the relationship between mental health and injecting heroin use. Findings Support the need to consider mental health states among people who inject drugs, and to examine varying histories of injecting with socially and culturally relevant factors.

Hispanics are disproportionately affected by substance use and related health harms yet remain underrepresented across scientific disciplines focused on researching and addressing these issues. An interdisciplinary network of scientists committed to fostering the development of social and biomedical researchers focused on Hispanic substance use and health disparities developed innovative mentoring and career development activities. We conducted a formative evaluation study using anonymous membership and conference feedback data to describe specific mentoring and career development activities developed within the national network. Successful mentoring initiatives and career development activities were infused with cultural and community values supportive of professional integration and persistence. Mentoring initially occurred within an annual national conference and was then sustained throughout the year through formal training programs and informal mentoring networks. Although rigorous evaluation is needed to determine the success of these strategies in fostering long-term career development among scientists conducting Hispanic health and substance use research, this innovative model may hold promise for other groups committed to promoting career development and professional integration and persistence for minority (and non-minority) scientists committed to addressing health disparities.

Female sex workers (FSW) represent a population confronted with an array of intersecting social problems. We explore the case of FSW in Nuevo Laredo and Ciudad Juarez to understand the everyday violence associated with sex work within the unique context of Mexico. Life history interviews were conducted with 109 FSW revealing violent acts by clients and other sex industry employees (bar owners, police, other FSW). The risk of violence by different types of persons associated with the sex work industry varied by venue and geographic area. Moreover, the violence was shaped by the social structural constraints of dominant gender ideologies.

This paper examines the association between childhood trauma and gang membership. Specifically, this study compares histories of potentially traumatic events as assessed by the Childhood Trauma Questionnaire among a street-recruited random sample of Mexican American male gang members and a matched comparison group of delinquent youth. The gang and delinquent youth samples are then compared to normative samples of adolescent male psychiatric inpatients and male undergraduates. The findings show that gang members generally report experiencing lower levels of childhood trauma compared to those in the sample of delinquent youth. In fact, gang members' levels of childhood trauma more closely resemble those of the undergraduate sample. However, this analysis suggests that gang membership, and delinquency in general, may be associated with physical neglect. Copyright © 2014 John Wiley & Sons, Ltd. 'Gang membership, and delinquency in general, may be associated with physical neglect' Key Practitioner Messages: * Childhood trauma prevalence and delinquent youth comparison groups are rare in gang research. * Childhood trauma rates (emotional, physical and sexual abuse) were found to be lower among a sample of gang-involved Mexican American males compared to non-gang delinquent youth. * Levels of physical neglect should be assessed for in youth regardless of gang membership. * Future research should focus on family-level sociocultural interventions that may be beneficial for gang-involved youth and trauma-informed interventions that may be particularly beneficial for delinquent youth in low-income communities. Language: en

Background Heroin use is a public health concern in the United States. Despite the unique etiology and patterns of heroin use among U.S. Latinos, long-term heroin trajectories and health consequences among Latinos are not well understood. This study aims to document the distinct heroin use trajectories for a group of street-recruited (non-treatment), young adult Mexican American men living in a disadvantaged community who were affiliated with gangs during their youth. Methods One-time interviews conducted between 2009–2012 in San Antonio, TX collected retrospective data from a sample of 212 Mexican American young adult men who reported using heroin at least once. Group-based trajectory modeling was applied to determine discrete developmental trajectories of heroin use. ANOVA, Chi square tests, and multinomial logistic regression examined current (past year) social and health indicators among each trajectory group. Results Five discrete heroin trajectories groups were identified: low use (n = 65); late accelerating (n = 31); early decelerating (n = 26); late decelerating (n = 38); and stably high (n = 52). Varying social and health consequences were found among the trajectory groups. Conclusion This study describes the unique heroin use trajectories and social and health outcomes among a high-risk subgroup of Mexican American men. The findings suggest that early intervention and intervention available in easy to access non-treatment spaces may be especially useful for groups of people who use relatively less heroin.

We used an intersectional minority stress perspective to examine the association between family/cultural stress and mental health among substance-using Mexican-Americans. Employing a unique longitudinal sample of 239 socioeconomically disadvantaged, non-injecting heroin-using Mexican-Americans from San Antonio, Texas, we examined how culturally relevant stressors are related to depression and suicidal ideation. First, we identified depression and suicidal ideation prevalence rates for this disadvantaged sample. Second, we determined how cultural stress is experienced over time using stress trajectories. Third, we evaluated how family/cultural stressors and stress trajectories are related to depression and suicidal ideation outcomes. Results showed high rates of baseline depression (24 %) and suicidal ideation (30 %). We used latent class growth analysis to identify three primary stress trajectories (stable, high but decreasing, and increasing) over three time points during 1 year. We found that the increasing stressors trajectory was associated with higher rates of depression and suicidal ideation, and that stress trajectories had unique relationships with mental illness. We also showed that baseline stressors, sum stressors, and high but decreasing stressors maintained positive associations with mental illness after controlling for baseline depression. Our results highlight the importance of focusing on within-group, culturally specific stressors and addressing both operant and cumulative stressors in the study of mental health for marginalized populations and suggest the importance of early intervention in minimizing stressors.

Reports indicate that the criminal victimization of Latino immigrants in the United States has been increasing yet is often underreported. This may be especially true in new immigrant settlement cities that lack an established Latino community to provide support and feelings of security. New Orleans is an important context to investigate criminal victimization as it has experienced a large demographic shift in Latino composition post–Hurricane Katrina. This ethnographic study elucidates the social processes and structural factors that contribute to the criminal victimization of Latino day laborers (LDLs) in New Orleans. Three emergent social processes associated to criminal victimization are discussed, including: (1) distinct settlement process; (2) chaos of the setting and lifestyle; and (3) high-risk exposure. LDLs’ experiences of crime victimization are also explored. Findings reveal distinct structural factors associated to new immigrant settlement cities that contribute to the heightened vulnerability of LDLs.

Objective: This study assessed the effectiveness of an adapted Brief Strategic Family Therapy (BSFT) intervention for gang-affiliated Mexican American adolescents and their parents. Methods: A total of 200 adolescents and their family caregivers were randomized to either a treatment or a control condition. Outcomes included adolescent substance use, conflict resolution, gang identification, parent substance use knowledge, gang awareness, family cohesion, child conduct problems and stress. Participants were assessed at baseline, treatment exit at 16 weeks, and 6 months follow-up. General linear mixed-effects and generalized estimating equations models were used to evaluate between-group differences in outcomes. Results: There were significant differences between the BFST and control groups on adolescent alcohol use at 6 months and parents’ reported conduct problems. No impact on marijuana use was found. Conclusions: Results provide emerging evidence supporting the adapted BSFT for gang-affiliated Mexican American adolescents and their families for alcohol and behavioral outcomes. Future adaptations may be needed to reduce drug use.

Recent research has documented crack cocaine's increasing spread in Mexico, which is likely to contribute to the rapid transmission of HIV and other sexually transmitted infections (STIs). In Mexico, crack use is increasing most rapidly in vulnerable, hard-to-reach populations, where little is known about risk behaviors. This report aims to present baseline data regarding HIV and STI knowledge and testing prevalence from an innovative projection mapping HIV intervention, in which 3-D illusions, animation, and visual text graphics and sound are projected onto buildings with health messages that were designed to disrupt everyday life and connect with the target population. Fifty-eight men and women who used crack in the past month without receiving drug treatment were recruited and interviewed before the projection mapping intervention took place. Testing instruments included a sociodemographic assessment, drug use and treatment profile, HIV and STI knowledge questionnaires, and a sex and drug risk assessment. The mean scores for respondents on the HIV Knowledge Questionnaire (10.5 out of 18, 58.3%) and STD Knowledge Questionnaire (9.5 out of 27, 35.2%) were both low. Respondents also reported high rates of sexual risk behaviors, with 73% reporting never using a condom and 64% never being tested for HIV. This report provides a portrait of STI and HIV risk among a vulnerable population in Mexico City and the need for urgent interventions to prevent the spread of STIs and HIV. The associated projection mapping intervention will seek to increase HIV and STI knowledge and reduce risk in this hard-to-reach population.

This chapter examines how gender dynamics shape violent acts among Mexican American young adult males with a history of adolescent gang membership. We use the concept of hegemonic masculinity to examine the various ways that gender is performed in acts of violence (Connell, 1995). Masculinity is not a fixed entity or individual personality traits, masculinities are “configurations of practice that are accomplished in social action and, therefore, can differ according to the gender relations in a particular setting” (Connell & Messerschmidt, 2005:836). In other words, “gender identity is never a completed project, but always a developmental process which unfolds within a social context” (Messner, 1990:209). Nevertheless, the tendencies for aggression and violence are central to what it means to be masculine (Messerschmidt, 2000; Crowley, Foley et al., 2008) because “real men” must show others that they are not afraid (Kimmel, 2010). We examine the unfolding of masculine identity among disadvantaged Mexican American men in two different yet related contexts: violent acts with other men and the retelling of these violent acts. Among disadvantaged men, in general, social class is central to masculinity because these men are likely to have limited options in accomplishing their masculinity compared to men with more advantages (Britton, 2011; Messerschmidt, 1993; Stretesky & Pogrebin, 2007). The type of masculinity expressed by Mexican American males, more specifically, varies depending on a constellation of variables related to social class including income, generational status, education, and association with the criminal justice system (Rios, 2011; Valdez, 2007).

Mexican American youth represent one of the fastest growing subpopulations with persons of Mexican origin comprising approximately 65 % of the Hispanic population in the United States (U.S. Census Bureau 2008). Mexican Americans also represent a disproportionate percentage of both substance using and gang populations (Valdez and Sifaneck 2004). In part, this may be due to both a young Mexican American age composition that reflects immigration patterns and an age-graded proclivity towards adolescent substance use and gang membership. In addition, due to socioeconomic disadvantages, Mexican American youth may be at an elevated risk for compromised social bonds and subsequent delinquent behaviors. This chapter employs a life course perspective to examine the extent that adolescent informal social control processes mediate the relationship between gang memberships and adolescent delinquent behavior in a population of young Mexican Americans.

We examined drug-scene familiarity and exposure to gang violence among residents of a migrant farming community in rural Baja California, Mexico. In October 2010, 164 members of a single colonia (community) underwent an interviewer-administered survey to assess 'exposure to gang violence' and 'drug-scene familiarity', as well as other health indicators. Logistic regression was used to identify correlates of exposure to gang violence. Overall, 20% of participants were male, the median age was 27 years, 24% spoke an indigenous language, 42% reported exposure to gang violence and 39% reported drug-scene familiarity. Factors independently associated with exposure to gang violence included being younger (adjusted odds ratio [AOR] =0.80 per 5-year increase, 95% confidence interval [CI]=0.67-0.96), living in the community longer (AOR=1.47 per 5-year increase, 95% CI=1.11-1.72), higher educational attainment (AOR=1.70 per 5-year increase, 95% CI=1.07-1.12) and drug-scene familiarity (AOR=5.10, 95% CI=2.39-10.89). Exposure to gang violence was very common in this community and was associated with drug-scene familiarity, suggesting a close relationship between drugs and gang violence in this rural community. In a region characterised by mass migration from poorer parts of Mexico, where drugs and gangs have not been previously reported, emerging social harms may affect these communities unless interventions are implemented.

Introduction Existing research has documented high comorbid rates for injecting drug use (IDU) and social and health consequences including HIV infection, a condition that disproportionately affects U.S. Hispanic populations. Few studies have examined the specific associations between injecting transition risk among non-injecting heroin using (NIU) populations and mental health conditions. This study hypothesizes that injecting transition risk will be strongly associated with depression symptomatology controlling for age and gender among Mexican American NIUs. Methods Street-recruited NIUs ( n = 300) were administered structured interviews. The Mexican American sample was predominantly male (66%), unemployed (75%) with more than half experiencing incarceration in their lifetimes (58%). Depression was measured using the CES-D scale. Univariate and multivariate logistic regression analysis were employed to determine the associations between the dependent variable of heroin injecting transition risk and the key independent variables of depression symptomatology and other independent variables. Results Depression symptomatology was the strongest independent correlate of injecting transition risk. Those NIUs with high levels of depression symptomatology had more than three times the heroin injecting transition risk than those NIUs with low levels. Heroin use network influence was also found to be a strong correlate. Acculturation level was significantly associated with injecting transition risk. Conclusion The comorbid condition of depression symptomatology and heroin use places Mexican American NIUs at elevated risk of contracting blood-borne pathogens such as HIV. Development of prevention and treatment strategies that target Hispanic non-injecting heroin users in socially disadvantaged communities should consider depression symptoms and develop interventions that build new social networks.

The purpose of this study is to examine the prevalence of childhood trauma in a sample of female sex workers in Mexico. One hundred and nine female sex workers were recruited from Nuevo Laredo and Ciudad Juarez and administered the Childhood Trauma Questionnaire. Findings reveal a high prevalence rate of childhood trauma among the total sample (94%). Nuevo Laredo sex workers had significantly higher total mean and subscale scores and levels of severity compared to Ciudad Juarez sex workers. This research is important because it examines the extent of childhood trauma among sex workers in a developing country. Moreover, it contributes to the few existing studies on sex workers that have documented the circumstances and factors unique to rural and urban environments. These results underline the importance of early identification of childhood trauma and implementation of appropriate prevention, intervention, and policies that might reduce these females' trajectory into sex work.

This paper focuses on changing patterns of substance use among low income, African American drug users evacuated from New Orleans, Louisiana, during Hurricane Katrina of August 2005. It examines the relationship between increases and decreases in alcohol and tobacco (AT) use and illicit drug (ID) use after Katrina and pre-disaster and within-disaster factors. Data from structured interviews with 200 Katrina evacuees currently living in Houston were collected 8–14 months after the disaster. Multivariate analysis revealed that rises in AT use were positively associated with education. Females and younger evacuees were more likely to have increased AT use. ID use increase was positively associated with resource loss and leaving the city before Katrina. Decreases in AT and ID use were found to be associated with disaster-related exposure. The paper discusses the specific consequences of disasters on disadvantaged minority substance users and the importance of developing public health disaster policies that target this population.

The article presents practical and methodological strategies in the tracking and retention of a longitudinal community-based sample of 300 Mexican American noninjecting users of heroin. Presented are the ethnographic strategies the research team utilized to maintain high retention rates among this highly marginalized and hidden population. Findings indicate that these ethnographic strategies are the basis for a reliable method for subject retention among drug-using populations. Further, the strategies illustrate how qualitative methods can complement the collection of quantitative data. Discussed is how these strategies can be used to identify and engage similar populations in research studies.

Objective: This study examines patterns of multimorbidity among elderly male inmates across four domains of health (chronic medical conditions, drug- and alcohol-related diseases, impairments, and mental and behavioral health) to understand the complex health care needs of this growing population. Method: We use the 2004 Survey of Inmates in State Correctional Facilities and Latent Class Regression Analysis to examine 22 health problems among 1,026 men aged 50 and older. Results: There are four groups of elderly male inmates: (a) relatively healthy (45.1%), (b) substance users with behavioral health issues (23.4%), (c) chronic unhealthy with impairments and violence/injury (23.6%), and (d) very unhealthy across all domains (7.9%). These groups have unique sociodemographic background and incarceration history characteristics. Conclusion: This study demonstrates the complexity of health for elderly inmates. Prison health should continue to be monitored to aid correctional and community health programs in understanding clinical risks, exposures, and health care needs for this population.

Objective: To examine the applicability of the “maturing out” theory to a sample of aging Mexican American men who are long-term heroin injectors. Method: Ethnographic data were collected as part of a cross-sectional study of aging Mexican American heroin users in Houston with 20 current heroin users. Results: Findings indicate that dysfunctions that emerge in the heroin lifestyle lead not to cessation but rather to “maturing in,” a specific process of social readjustment that returns the heroin user to a stable maintenance pattern of use instead of a recovery phase. This process of paradoxical maturing out can be attributed to the unconditional social support provided to the heroin user by family, peers, and the tecato subculture embedded in Mexican American communities. Discussion: Results highlight the implications for the intersection of heroin-related conditions, natural age-related impairments, and cognitive functioning that make this population increasingly susceptible to adverse health consequences.

Background Recent studies in Mexico have documented a significant increase in crack cocaine use, indicating the potential for an emerging drug epidemic. Methods Ethnographic observations and interviews were used describe the profiles and patterns of use among street-recruited crack users in Mexico City. The data came from an international research collaboration funded by the National Institutes of Health. Results A polythetic typology was developed based on five dimensions central to categorizing patterns of crack use behavior: frequency of use, duration of use, context, social networks, and social contracts. Four types of users were discovered applying these dimensions: dabblers, stable users, crack heads, and old heads. Although several similarities were documented between patterns of crack use in Mexico and those in the United States and Western Europe, several key aspects distinguished crack users in this population: (1) self-regulated use; (2) non-linear progression of crack; and (3) the influence of the dimensions pertaining to setting, social networks, and social contract as contributing to understanding of the previous two. Further, we provide a discussion of how specific contextual factors in Mexico may be giving rise to these emerging patterns. Conclusion Compared to the U.S. and Europe, this study finds that the majority of crack users were able to self-regulate their use without major disruption to daily social functioning. As crack use spreads in Mexico and other Latin American countries, we need to recognize the importance of social context in developing more tailored health and social responses that are specific to these developing countries.

Hispanic adolescent females are the largest group of minority adolescents in the nation and appear to be at great risk for substance use. This research is based on data generated from a cross-sectional study of 150 Mexican American gang-affiliated adolescent females to predict substance-use recurrence. Findings reveal that positive family relationships, and in particular, mother-daughter relationships are protective factors for alcohol- and tobacco-use recurrence. Furthermore, the ability of the immediate family to cope with difficulties, stress, and conflicts were significant in averting illicit drug recurrence. This research provides evidence of the role of the family as a protective factor among these adolescents, despite their gang affiliation and street orientation. Discussed is how these findings contribute to formulating effective intervention, prevention, and treatment responses aimed at this “beyond risk” population.

This study focuses on the process of paradoxical autonomy and survival in the heroin careers of Mexican American women. We explore how gender roles among Mexican American female heroin users influence the emergence of a paradoxical autonomy. Five key subprocesses of this autonomy were identified from 14 life history narratives: sustaining employment, working the welfare system, illegal activities, emotional aloofness, and loss of family and children. Dependency on drugs did not lead simply to the reproduction of traditional gender dependency but, paradoxically, seemed to contribute to a new type of gender autonomy. This autonomy did not necessarily make the survival less arduous, only more independent from gendered responsibilities associated with men and often with family and children. We discuss how this paradoxical autonomy is not acquired without ambiguity by some of these women, who place a value on maintaining relationships with men and family. Our study makes a contribution to a better understanding of the diverse processes by which Mexican American female heroin users struggle to survive. Although this struggle leads to a paradoxical autonomy from their traditional gender roles, it does little to change other barriers to self-development originating from poverty, ethnic discrimination, and the severity of their drug addiction.

Gang youth have been a perennial issue with criminologists for nearly a century. Much evidence suggests that something about participation within a gang leads youth to commit more crime when compared to non-gang youth. Gang youth are at an increased risk of arrest and incarceration for serious offences in comparison to other delinquent youth. Gang youth also are more likely to report participation in what are described as ‘health risk behaviors’, which include substance use, violence, and unsafe sexual practices. Consequently, gang youth are at an elevated risk of exposure to the negative health outcomes related to such behaviors, including addiction, overdose, infection, injury, disability, and death. This chapter offers data gathered in three cities over a 20-year period to provide a descriptive epidemiology of substance use, violence and unsafe sexual practices among gang-identified youth. We conclude with a discussion on how public health approaches towards other high-risk categories of youth could compliment current criminal justice efforts aimed at curbing the influence or impact of youth gangs.

Rationale A growing body of research has revealed disparities with respect to drug use patterns within Latino subgroups. However, the extent to which these potential disparities enable different Latino subgroups to respond favorably to treatment is unclear. Methods This study analyzed a subset of multicross-sectional data (2006–2009) on Latinos collected from publicly funded facilities in Los Angeles County, CA ( N = 12,871). We used multilevel logistic regressions to examine individual and service-level factors associated with treatment completion among subgroups of first-time Latino treatment clients. Results Univariate analysis showed that Cubans and Puerto Ricans were less likely to complete treatment than Mexicans and other Latinos. Cubans and Puerto Ricans entered treatment at an older age and with higher formal education than Mexicans, yet they were more likely to report mental health issues and use of cocaine and heroin as primary drugs of choice respectively. Multivariate analysis showed that age, having mental health issues, reporting high use of drugs at intake, and use of methamphetamines and marijuana were associated with decreased odds of completing treatment among all Latino subgroups. In contrast, age at first drug use, treatment duration, and referral monitoring by the criminal system increased the odds of completing treatment for all members. Conclusion These findings have implications for targeting interventions for members of different Latinos groups during their first treatment episode. Promising individual and service factors associated with treatment completion can inform the design of culturally specific recovery models that can be evaluated in small-scale randomized pilot studies.

The devastating effects of Hurricane Katrina have contributed to a dynamic demographic shift in the Latino composition of New Orleans. This article focuses on a particularly deleterious pattern of crack cocaine smoking associated with numerous social and health consequences. Utilizing a rapid assessment methodology, in-depth qualitative interviews were conducted with 52 Latino immigrant day laborers in New Orleans. Findings reveal that the presence of a flourishing drug market has facilitated and maintained patterns of crack use including initiation and periods of daily use. Moreover, feelings of isolation and constant exposure to victimization due to day laborers’ marginal status are described as contributing to this use. This qualitative analysis reveals how social processes and contextual factors contribute to crack use among Latino day laborers in a post-disaster context. This study has important public health implications in the spread of HIV and other blood borne pathogens.

To assess the incidence and rate of transition to injecting among Mexican American noninjecting heroin users.In a prospective cohort study of street-recruited MA-NIU in San Antonio, Texas, 2002-2005, participants were administered structured interviews and tested for Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). The analysis sample comprised former injection drug users (last injected6 months ago, n=47) and those who had never injected drugs and tested HCV negative (n=219). A transition to injecting was defined as the first injection of illicit drugs since baseline interview. Transition rates were based on person-years at-risk (PYAR). Proportional hazards regression was used to estimate crude and adjusted (for significant differences between former and never injectors) hazard ratios and 95% confidence intervals of injecting history on transitioning to injecting.Sixty-three (24%) participants transitioned to injecting at a rate of 22.3/100 PYAR (95% CI: 17.2-28.2). Former-injectors were significantly more likely to transition than never injectors (43% or 20/47 vs. 20% or 43/219; p0.001), and did so at a faster rate (40.4/100 PYAR, 95% CI: 24.6-60.0 vs. 18.5/100 PYAR, 95% CI: 13.4-24.4), with the crude HR=1.931 (95% CI: 1.116, 3.341) and adjusted HR=2.263 (95% CI: 1.192-4.294).The rate of transitioning to injecting was high and greater among former injectors. Of particular concern is the high rate of injecting initiation among never injectors. Future analyses will examine factors associated with injecting initiation, including individual susceptibility and behaviors, social networks, and the cultural and drug market context.

This article provides a detailed examination of the relationship between disaster-related experiences and mental health outcomes among a sample of drug using African American Hurricane Katrina evacuees. Face-to-face structured interviews were administered to Hurricane Katrina evacuees (n = 350) residing in voucher assisted apartment complexes in Houston, Texas (2006-2007). We use Ordinary Least Squares and logistic regression models to examine both the relevance of disaster-related experiences and the interactive relationships between disaster-related experiences and post-disaster mental health outcomes including psychological distress, severe depression, somatic symptoms, and posttraumatic stress disorder. Results indicate that disaster-related experiences including negative life changes, disaster exposure, post-disaster stressors, and resource loss, have unique, inverse relationships with mental health. While resource loss has the strongest inverse relationship with mental health, disaster exposure has a negative interactive effect on psychological distress and anxiety. Although highly vulnerable populations report low levels of mental health nearly 2 years following a disaster experience, there is a convergence in mental health outcomes with high levels of disaster experiences and disaster exposure that suggests mental resiliency.