RESUMO
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.
Assuntos
Infecções por HIV , Hepatite C , Violência por Parceiro Íntimo , Infecções Sexualmente Transmissíveis , Transtornos Relacionados ao Uso de Substâncias , Adulto , Masculino , Humanos , Feminino , Adolescente , Infecções por HIV/epidemiologia , Americanos Mexicanos , Infecções Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Hepatite C/epidemiologia , HepacivirusRESUMO
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 (nâ¯=â¯65); late accelerating (nâ¯=â¯31); early decelerating (nâ¯=â¯26); late decelerating (nâ¯=â¯38); and stably high (nâ¯=â¯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.
Assuntos
Dependência de Heroína/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , Grupo Associado , Adolescente , Adulto , Dependência de Heroína/etnologia , Dependência de Heroína/psicologia , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Americanos Mexicanos/psicologia , Estudos Retrospectivos , Texas/epidemiologia , Adulto JovemRESUMO
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.
Assuntos
Herpes Genital/psicologia , Herpes Simples/psicologia , Hispânico ou Latino/psicologia , Adulto , Comorbidade , Estudos Transversais , Feminino , Identidade de Gênero , Herpesvirus Humano 2/patogenicidade , Humanos , Estudos Longitudinais , Americanos Mexicanos/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Prevalência , Fatores de Risco , Comportamento Sexual/psicologia , Infecções Sexualmente Transmissíveis/psicologia , Texas/epidemiologia , Estados Unidos , Populações Vulneráveis/psicologia , Adulto JovemRESUMO
OBJECTIVES: Little research has examined the long-term health consequences of gang affiliation among Mexican Americans. The objectives of this study were to (1) measure biological indicators of cardiovascular and metabolic risk, as well as prevalence of sexually transmitted infections (STIs), in a sample of Mexican American men aged 25-40 who were affiliated with gangs as adolescents and (2) compare those indicators with a comparable national sample of Latino men. METHODS: Using bivariate analyses, we compared blood pressure, body mass index, 4 metabolic and cardiovascular indicators, and 4 infections for 179 Mexican American formerly gang-affiliated men in San Antonio, Texas, and 155 Mexican American men from the National Health and Nutrition Examination Survey. We used multivariate models to estimate adjusted risk scores for each sample controlling for age, marital status, and education. RESULTS: Compared with men in the national sample, the unadjusted results showed that men in the gang-affiliated sample had significantly higher mean systolic blood pressure (125.6 vs 120.0 mm Hg, P = .001), diastolic blood pressure (81.4 vs 71.1 mm Hg, P < .001), and C-reactive protein (5.9 vs 3.6 mg/L, P = .04), and a significantly lower mean total cholesterol (164.2 vs 205.5 mg/dL, P < .001) and low-density lipoprotein cholesterol (91.1 vs 120.1 mg/dL, P < .001). Compared with men in the national sample, more men in the gang-affiliated sample had herpes simplex virus type 2 (64/174 [36.8%] vs 18/147 [12.2%], P < .001), chlamydia (10/176 [5.7%] vs 1/135 [0.7%], P = .02), and hepatitis C virus (85/173 [49.1%] vs 0, P < .001). The gang-affiliated sample had a significantly higher adjusted risk score than the national sample (1.5 vs 1.1, P = .003). CONCLUSIONS: Gang-affiliated Mexican American men had significant disparities in biological risk indicators and STIs, which can lead to long-term health implications and highlight the need for tailored prevention strategies. Long-term exposure to psychosocial stressors and subsequent systemic inflammation may also increase the risk for physiological and psychological dysregulation and detrimental chronic health conditions in this population.
Assuntos
Doenças Cardiovasculares/epidemiologia , Americanos Mexicanos , Influência dos Pares , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Biomarcadores/análise , Ensaio de Imunoadsorção Enzimática , Humanos , Lipídeos/sangue , Estudos Longitudinais , Masculino , Inquéritos Nutricionais , Medição de Risco , Fatores de Risco , Texas/epidemiologiaRESUMO
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.
Assuntos
Depressão/epidemiologia , Dependência de Heroína/epidemiologia , Americanos Mexicanos/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Ideação Suicida , Adolescente , Comorbidade , Humanos , Estudos Longitudinais , Masculino , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Adulto JovemRESUMO
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.
Assuntos
Cocaína Crack , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Relacionados ao Uso de Opioides , Aceitação pelo Paciente de Cuidados de Saúde , Infecções Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Idoso , Cidades , Preservativos/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Prevalência , Assunção de Riscos , Comportamento Sexual , Inquéritos e Questionários , Adulto JovemRESUMO
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.
RESUMO
During the past decade, crack smoking has increased in Mexico among poor urban populations. Despite this increasing prevalence, little is known about the types of paraphernalia used and related sharing practices and physical harms. Data come from in-depth semi-structured interviews and observations with 156 current crack smokers in Mexico City. Findings reveal a complex, crack-smoking process in Mexico City that represents an interconnected structure of paraphernalia items and pipes that could contribute to detrimental health consequences. Specifically, we identify essential paraphernalia items that make the smoking of crack possible; describe the homemade construction of two categories of pipes; and detail the sharing practices and physical harms associated with these paraphernalia. Results point towards a smoking process that is embedded in impoverished urban neighborhoods sustained by an accessible street-level crack market. Discussed are the policy and intervention implications associated with reducing crack-related health consequences in Mexico and other Latin American countries.
Assuntos
Fumar Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack , Adulto , Fumar Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Feminino , Política de Saúde , Humanos , Entrevistas como Assunto , Masculino , México/epidemiologia , Áreas de Pobreza , Assunção de Riscos , População Urbana , Adulto JovemRESUMO
A longitudinal study (15years) 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 4years. 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.
Assuntos
Escolaridade , Características da Família , Dependência de Heroína/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , Pais/psicologia , Grupo Associado , Adolescente , Adulto , Seguimentos , Dependência de Heroína/psicologia , Humanos , Estudos Longitudinais , Masculino , Americanos Mexicanos/psicologia , Texas/epidemiologia , Tempo , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
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.
Assuntos
Delinquência Juvenil , Americanos Mexicanos , Grupo Associado , Controles Informais da Sociedade , Absenteísmo , Adolescente , Comportamento do Adolescente/psicologia , Relações Familiares , Humanos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Texas/epidemiologia , Adulto JovemRESUMO
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.
Assuntos
Envelhecimento/etnologia , Dependência de Heroína/etnologia , Americanos Mexicanos/psicologia , Teoria Psicológica , Abuso de Substâncias por Via Intravenosa/etnologia , Idoso , Estudos Transversais , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
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.
Assuntos
Infecções por HIV/epidemiologia , Trabalho Sexual/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Feminino , Humanos , México/epidemiologia , Prevalência , Infecções Sexualmente Transmissíveis/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
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.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack/toxicidade , Adulto , Transtornos Relacionados ao Uso de Cocaína/psicologia , Feminino , Humanos , Masculino , México/epidemiologiaRESUMO
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.