The US Border in Context: How Does Drug Use Compare? Lynn Wallisch and Richard Spence

1. The US Border in Context: How Does Drug Use Compare? Lynn Wallisch and Richard Spence University of Texas at Austin, School of Social Work, Addiction Research Institute Introduction Data from a representative sample of adults living on the Texas-Mexico border are compared with data from the state of Texas as a whole, from Hispanics in the US nationwide, and from adults living in northern Mexico, in order to put border substance use into a wider context. *p = .05 Data Sources Data for the border come from a 2002-2003 in-person survey of 1200 adults living in El Paso and in urban and colonia areas of the lower Rio Grande Valley of Texas. About 85% of the sample was Hispanic. The population of the counties sampled comprises 81% of the total Texas border population. Data were weighted to account for probabilities of selection and to conform the sample to the census age-sex-ethnic and site distribution. Standard errors were estimated in SUDAAN to adjust for the multistage cluster sampling design (see Wallisch & Spence, 2006, Hispanic Journal of Behavioral Sciences, 28, 286-307.). Data for the state of Texas come from Wright & Sathe (2005), State Estimates of Substance Use from the 2002-2003 National Surveys on Drug Use and Health (available online at http://oas.samhsa.gov.) Data for Hispanics in the United States (Mexican-Americans specifically, where available) are from the 2003 National Survey on Drug Use and Health: Detailed Tables (http://oas.samhsa.gov).Data for Mexico come from the 2002 Mexican National Survey on Addictions (Medina-Mora, Natera, & Borges, 2002 (www.conadic.gob.mx); Secretaría de Salud, 2002) (www.saludgob.mx)) and the 2001-2002 Mexican National Survey of Psychiatric Epidemiology (Medina-Mora et al., 2003, Salud Mental, 26, 1-16). Substate estimates for Texas regions are from the 1999-2001 National Surveys on Drug Use and Health: Substate Estimates (http://oas.samhsa.gov). Results Border adults were less likely than adults in Texas statewide to drink alcohol, binge drink, or use illicit drugs, but were more likely to report substance abuse/dependence. Hispanic border adults were less likely than Hispanics nationwide to drink in the past year (past month drinking was similar), to binge drink, or to use illicit drugs, but more likely to report substance abuse or dependence. Mexican survey data indicate that 8% of Mexicans aged 12-65 living in the urban areas of the northern (border) region of Mexico had ever used an illicit drug (compared with 33% of Texas border residents based on the Border Survey), and 11% of northern Mexicans were heavy drinkers (usuarios fuertes) as compared to 7% in the Border Survey. Some 5% of adults aged 18-65 in the northern region of Mexico had a past-year substance-related disorder, substantially lower than the rate of 13% substance abuse or dependence in the Border Survey. From a methodological standpoint, it is of interest to note that the substate estimates for Texas border areas recently made available by the NSDUH are roughly similar (i.e. within the confidence limits) to the use levels observed through the direct Border Survey. This enhances confidence in the accuracy of the estimation procedure for small areas. *p = .05 Methods and Measures Conclusions Drug and alcohol prevalence of use and problems (abuse/dependence) are compared, while recognizing that the data sources may have differed somewhat in exact question wording and other details of methodology. Where available, standard errors as reported in the data sources are used to assess the significance of differences with the border data. In both the Border Survey and the NSDUH, “alcohol problems” and “drug problems” in the charts for this poster refer to past-year dependence or abuse based on DSM-IV criteria, and binge drinking refers to the consumption of 5 or more drinks on one or more occasions during the past month. Results are presented for age groups 18-25 and 26+, where available. Although these comparisons are imperfect, due to differences in survey methodologies and samples and high standard errors for some estimates, the pattern of lowest drug use in Mexico and highest in the interior of the US appears to be consistent with other research, and belies the perception that drug use would be especially high on the border due to factors such as trafficking, unemployment, and the stresses of acculturation and poverty. However, the data do suggest that border residents may be relatively more likely to experience adverse consequences (abuse/dependence) from substance use. Given the financial, logistic, legal and possibly psychological barriers to accessing treatment services in the border region, this area should be a focus of attention in attempting to reduce health disparities. Presented at College on Problems of Drug Dependence 68th Annual Scientific Meeting, Scottsdale, AZ, June, 2006. This study was supported by NIDA grant R01DA14794.