Hotspots: Understanding Areas of Concentrated Alcohol and Drug Problems at the US-Mexico Border

摘要：热点：了解美国集中酒精和毒品问题的领域- 墨西哥边境 数以百万计的墨西哥裔美国人生活在美墨边境地区，这两个地区都处于极其不利的地位 区域和向内陆迁徙的中转区。因此，墨西哥人的健康和物质使用模式- 原籍边界居民是最令人关切的。尽管如此，尽管初步证据表明 在边境的贩运、毒品供应和药物使用问题上，人们对酒精知之甚少 以及这一地区的毒品问题。我们的团队最近启动了一项大型流行病学研究，美国-墨西哥 酒精及相关条件研究，或UMSARC(R01AA018365；Pi‘s CherPitel and Borges)，以解决 这个缺口。除了是仅有的两项大规模的边境流行病学研究之一 UMSARC是已知的唯一一项对美国和墨西哥居民进行调查的此类研究。数据 代表4796人与墨西哥人和墨西哥裔人的可能样本进行面谈 在2011-2013年间接受采访。基于UMSARC数据的新兴论文表明， 酒精和毒品问题，但在美国边境，物质使用治疗利用率大幅下降， 与内地相比。然而，初步证据也表明，即使在 边境地区，酒精和毒品问题集中在美国的一个热点：德克萨斯州的拉雷多。 未发表的初步分析还指出，拉雷多的姊妹城市新拉雷多是毒品的热点 有问题。这表明，当地环境可能在酒精和药物结果中发挥关键作用 边境--也许在整个拉美裔中也是如此。对环境的作用有更深的认识 边境热点问题明显集中的因素将有助于揭示核心流程 在药物滥用的流行病学中，以及与拉丁美洲有关的可能的干预点 边境地区和更广泛的地区。然而，还需要更多的研究来1)更好地描述和 将UMSARC站点在酒精和药物相关结果中的差异与背景联系起来；2)描述 解释这种变异的特定环境(和其他)因素；以及3)更好地理解 美国和墨西哥之间的影响，以及美墨互动可能如何促进 有问题。目前的项目建议解决这些差距。目标1将更好地描述分布 酒精使用和问题，药物使用和问题，以及药物使用治疗利用的研究 并与区域和国家估计数相比较。目标2和3将涉及对数据进行地理编码以测试角色 寻找关键的邻居变量来解释与酒精和毒品相关的结果的地理差异。目标 4将直接探索墨西哥和美国之间的潜在影响途径，使用现有的和地理编码 变量。分析将利用独特的丰富且功能强大的数据集来扩展非常有限的 关于酒精和毒品使用以及边境问题的知识库，以及提高对 环境对拉丁裔人口的这些结果的影响。

ABSTRACT: Hotspots: Understanding Areas of Concentrated Alcohol and Drug Problems at the US- Mexico Border Millions of Mexican Americans live in the US-Mexico border region, which is both an extremely disadvantaged area and a staging zone for migration to the interior. Thus, the health and substance use patterns of Mexican- origin border residents are of central concern. Nevertheless, despite preliminary evidence of high drug trafficking, drug availability, and substance use problems along the border, very little is known about alcohol and drug problems in this area. Our team recently initiated a large epidemiological study, the US-Mexico Study of Alcohol and Related Conditions, or UMSARC (R01AA018365; PI's Cherpitel and Borges), to address this gap. In addition to being one of only two large-scale epidemiological studies of the border addressing alcohol, UMSARC is the only known such study to survey residents of both the US and Mexico. Data represent 4,796 in-person interviews with a probability sample of Mexican and Mexican-origin individuals interviewed between 2011-2013. Emerging papers based on UMSARC data suggest a heightened risk for alcohol and drug problems, yet substantially lower substance use treatment utilization, at the US border, compared to the interior. Yet, preliminary evidence also suggests dramatic, unexplained variation even among border sites, with alcohol and drug problems being concentrated in a single US hotspot: Laredo, Texas. Preliminary, unpublished analyses also point to Nuevo Laredo, Laredo's sister city, as a hotspot for drug problems. This suggests that the local environment may play a critical role in alcohol and drug outcomes at the border—and perhaps among Latinos generally. A deeper understanding of the role of environmental factors in this apparent concentration of problems in border hotspots would help shed light on core processes in the epidemiology of substance abuse as well as possible points of intervention relevant to Latinos in the border region and more broadly. However, additional research is needed to 1) better characterize and contextualize variation across UMSARC sites in alcohol- and drug-related outcomes; 2) delineate the roles of specific environmental (and other) factors in explaining this variation; and 3) better understand pathways of influence between the US and Mexico, and how US-Mexico interactions may contribute to elevations of problems. The current project proposes to address these gaps. Aim 1 will better characterize the distribution of alcohol use and problems, drug use and problems, and substance use treatment utilization across study sites and relative to regional and national estimates. Aims 2 and 3 will involve geocoding the data to test roles for key neighborhood variables in explaining geographic variation in alcohol- and drug- related outcomes. Aim 4 will directly explore potential pathways of influence between Mexico and the US using existing and geocoded variables. Analyses will leverage a uniquely rich and well-powered dataset to extend the very limited knowledge base on alcohol and drug use and problems at the border, as well as improve understanding of environmental influences on these outcomes among Latino populations.