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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. 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. [ABSTRACT FROM AUTHOR]

This paper determines the incidence and predictors of transitions to injecting drug use among a sample of noninjecting heroin users (NIUs). Three hundred street-recruited NIUs in San Antonio were interviewed in a prospective cohort study (three time periods: baseline, follow-up 1 and follow-up 2 at 6 month intervals). For the purpose of this analysis, a transition to injecting was identified as the first drug injection episode following baseline. Given the important distinction between former injectors and never injectors, hazards ratios are estimated by Cox proportional hazards regression, stratified by baseline injecting history. Analyses examine the rate of transitioning to injecting drug use, and the predictors of such transition rates with emphasis on the extent to which NIUs' interpersonal relationships (NIUs' personal social networks) with friends, kin and gang members, adherence to cultural values and norms, risk behaviors and personal susceptibility influence the relative risk for transitioning to injecting. Findings indicate the important role social networks play in influencing and facilitating transitioning to injecting among this population. These data will provide information that can be used to develop network-based interventions that can be conducted not only among couples and friendship groups, but also at the community-wide level through the diffusion of norms and practices among large numbers of NIUs to prevent the transition of injecting and other harmful health consequences of non-injecting heroin use. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Hurricane Katrina (August 29th 2005) is considered one of most devastating storms ever to occur in the United States (U.S.). A major consequences of this disaster was a dynamic demographic shift in the ethnic and racial composition of New Orleans (United States Congress, 2006). Although the New Orleans population is nearing 300,000, or about 65 percent of its pre-Hurricane Katrina size, the African American population has fallen substantially from 67 percent prior to the storm. Concomitantly, there has been a dramatic increase of the Latino population from 3% pre- Katrina to over 20 percent. These Latinos are mainly comprised of single, poor, undocumented immigrant men working in the demolition and construction trades. Despite this group's high immigration, and some initial research before Katrina (Sorenson, 2001), little is known about patterns of the adaptation and settlement in these new destinations for Hispanic immigrants. the Center for Drug and Social Policy Research (ODSPR) conducted two focus groups and 52 qualitative interviews with undocumented Latino day laborers in New Orleans. Focus groups were recruited by the NDRI fieldworkers who are involved in an ethnographic study of the Post- Katrina drug market. The qualitative interviews were in-depth face-to-face semi-structured interviews with 52 male immigrants living in New Orleans. Participants were recruited from 6 day labor sites in metropolitan New Orleans. Findings indicate new settlement patterns for Latinos resulted in increased high risk behavior related to issues of social isolation, depression and lack of social capital. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Drug treatment services for chronic adolescent drug users such as gang affiliated Mexican Americans residing in high risk and socially disadvantaged communities are sparse. A university-based drug research institute in collaboration with a community based treatment center adopted the Brief Strategic Family Therapy Model (BSFT) to the specific needs of the gang-affiliated Mexican American adolescents and their families in San Antonio. Using the research team's field study methodology, male and female adolescents were recruited along with at least one family member to participate in the intervention study. Two hundred participants were selected and randomly assigned to the treatment or comparison group. The treatment group received an 8 - 16 week family therapy that promotes change in family interactions and the cultural/contextual factors that influence youth behavior problems. In addition, they received education, STD/HIV reduction and gang diversion enhancements to the BSFT. Project findings indicate that the weekly sessions conducted with the treatment group participants resulted in reduced drug use and positive outcomes in family interactions and other risk domains that influence youth behavioral problems when compared to the control group. [ABSTRACT FROM AUTHOR]

This paper explores the processes by which some non-injecting heroin users (NIUs) initiate or re-initiate injecting drug use practices and others do not. More specifically, this analysis focuses on the influence of personal and behavioral susceptibility and community norms in the risk of transitioning to injecting drug use. The research is based on data currently being collected from a NIDA funded study examining Mexican American NIUs in San Antonio. For the purposes of this presentation, qualitative ethnographic data from 20 NIUs who reported transitioning to injecting at follow up will be compared with that of 20 NIUs who have not transitioned. Selected factors among this Mexican American population are examined including perceptions and attitudes towards "tecatos" (a term used by Mexican Americans to identify IDUs) as well as a perceived discomfort in using needles that reportedly invokes a "fear of needles." Findings reveal the importance in understanding the interaction between individual susceptibility factors and community (including culture) in explaining variations in the risk of transitioning to injecting. The growth of NIUs in this community has serious consequences for controlling increases in IDU and the spread of HIV, and other blood born pathogens associated with injectors. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

The nexus between substance use and prostitution has been widely established in existing literature. One assertion commonly argued has been that prostitution is a means by which a woman supports her addiction. This manuscript is based upon ethnographic observations and life history interviews with 109 female sex workers in Nuevo Laredo, Tamaulipas and Ciudad Juarez, Chihuahua, Mexico. Examined are the substance use patterns among the Mexican female sex workers. For this population of sex workers working on the U.S- Mexico border, substance use appears to initiate and progress (i.e. cocaine and heroin use) along with the women's involvement in the sex industry. Described is the alcohol and drug use trajectory these Mexican female prostitutes experience within the context of their careers. Findings reveal that this trajectory includes three phases: the first is related to the business demands associated with alcohol consumption, followed by the counteracting effect of cocaine use (negotiations) and culminating into an injecting drug use lifestyle that may lead to addiction. In conclusion, this analysis represents a significant contribution in understanding the binational public health implications associated with sex work within a context of a socially and economically marginalized region. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]

Elderly Hispanics in the United States represent one of the fastest growing cohorts of aging Americans. Using a life course drug use framework, this manuscript examines the applicability of the "maturing out" theory to a sample of ageing Mexican American long-term heroin injectors. The paper explores the trajectory of these men's heroin career phases that range from initiation to maintenance, yet paradoxically never reaching a maturing out phase. We examine the influence and relationships of family, peers, and community in creating a stable and supportive environment that contributes to these men's life course experience in maintaining their use. The findings of our qualitative study join a number of studies that challenge a simple linear conception of the maturing out hypothesis that as heroin addicts age the dysfunctions, stresses and strains of the heroin lifestyle become too much to manage for leading to an eventual cessation of heroin use. Rather our data support a more complex view of maturing out. In paradoxical maturing out, the dysfunctions that emerge in the heroin lifestyle lead not to cessation, but rather to a "maturing in" by which a specific process of social readjustment takes place that returns the heroin user to a stable maintenance pattern of use. This process of paradoxical maturing out can be attributed to the unconditional social support provided by the Mexican American heroin user by family, peers and the tecato subculture embedded in Mexican American communities in the Southwest. [ABSTRACT FROM AUTHOR]

Youth who associate with gangs are at risk for an array of problematic behaviors including high risk sex, drug use, incarceration, and criminal involvement. The health consequences of youth gang membership have also been previously examined in terms of HIV infection, STD prevalence, and violent victimization. The current longitudinal study follows up a cohort of adolescent Mexican American gang members originally interviewed in 1997-1998 in an impoverished neighborhood in San Antonio, TX as part of an ongoing NIDA funded study. We present preliminary (n = 127) self-report and tested (biological) data for 19 health outcomes including STDs and other biomarkers of health (i.e. hypertension, heart disease, obesity) as well as measures of behavioral health using standardized psychometric scales. Overall, findings show that this special population of former gang members continues to engage in high rates of drug use and has poor health with little access to healthcare. Discussed are the associations of health outcomes with types and patterns of substance use (i.e. alcohol, cocaine, heroin; daily vs. monthly user) and incarceration history. [ABSTRACT FROM AUTHOR]

Mexican Americans have consistently had the highest rates of injecting heroin use and AIDS risk behavior when compared to other groups in the United States. Previous research has focused on injecting drug use patterns as related to HIV and other infectious risks with no differentiation made between age cohorts even though injecting heroin use tends to be associated more often with relatively older drug users within this population of Mexican Americans. As these heroin users age, they are confronted by many of the same social and health problems as other aging groups, however, their problems are more severe given their heroin addiction, incarceration histories and marginal socio-economic status. Sixty ethnographic interviews were conducted with males who were 45 years of age and older and who were a current heroin user (20), receiving methadone treatment (20), or a former heroin user (20). This is part of a larger study which examines the life course development, social determinates and health consequences of aging male Mexican American heroin users. Findings indicate that long-term users of heroin are afflicted with multiple health problems associated with their deviant lifestyles. Discussed is how this population of aging Mexican American heroin users manage the transition to old age, a process which is shaped by the social and cultural context of a disadvantaged urban Mexican American community. This analysis contributes to our understanding of the aging processes among deviant groups. [ABSTRACT FROM AUTHOR]

The transition among non-injecting heroin users (NIUs) to injecting presents a formidable public health risk for the spread of HIV, HBV and HCV. Transition rates from NIUs to injecting use have been shown to vary considerably among cities. For never injectors the rates reported in a New York prospective cohort study were lower than those reported in similarly designed studies in Montreal and Amsterdam. The overarching conclusion that can be drawn from these unique prospective open cohort studies in three nationally and geographically diverse cities is the critical importance of culture and the context of city-specific risk environments in conditioning transitioning behavior. We present the results of an open prospective cohort study of transitions to injecting among non-injecting heroin users that builds on the New York, Amsterdam and Montreal research extending it to a culturally homogeneous population of Mexican Americans in a high injecting risk environment in San Antonio that also, paradoxically, has a notably low HIV rate although the prevalence of hepatitis C is considerable among injecting drug users (IDUs). Our study finds high transition rates for both former-injectors and never-injectors in San Antonio. Furthermore, the study provides additional evidence from our baseline analysis to formulate the hypothesis that Mexican American culture has certain aspects that can influence high rates of transition. [ABSTRACT FROM AUTHOR]

This presentation examines substance use patterns among low-income, African American drug using Hurricane Katrina evacuees living in Houston. Specifically, building upon a Multivariate Risk Factor Model, we focus on the relationship between pre-, within-, and post-disaster experiences, mental health status and substance use outcomes among a sample of 345 Hurricane Katrina evacuees currently living in Houston. A Latent Class Analysis (LCA) was used to determine post-Katrina substance use pattern groups. Multinominal models were utilized to explain the relative risks of substance use pattern groups. Findings indicate specific substance use increases in this population, in particular for "new users" whom appear to use at similar rates to established users. Analyses also revealed high levels of resource loss, disaster exposure distress and anxiety associated with significant levels of increased or new substance use. Discussed are the specific substance use consequences of disasters on disadvantaged minority users and the importance of understanding both internal and external resources in developing social health disaster policies that target this population. [ABSTRACT FROM AUTHOR]

This paper explores the marijuana scene in an disadvantaged Mexican American inner- city community. This research is primarily based on qualitative data from a CDC and two NIDA funded studies on 500 Mexican American male gang members, gang associated females and non-injecting heroin users between the ages of 16 ? 30 years old. The paper focuses on four general areas in order to provide a contextual overview of marijuana use among this population. Quantitative data examines the patterns of marijuana use including age of onset, lifetime and current use, and frequency of use. Next, qualitative data is presented on the ?social occasion? of marijuana use focusing on factors associated with excess leisure time (high unemployment, school dropout rates), context of use (i.e. social gatherings vs. conventional gatherings) and ?smoking buddies? (family, friends, intimates). The use of marijuana with other drugs is examined, specifically as it relates to patterns (i.e. before or after using heroin, cocaine) and psychopharmacological experiences. Finally, emerging trends among marijuana users in this population are identified including new smoking paraphernalia, blunts and marketing strategies. Findings reveal important contextual factors associated with continual marijuana use despite the use of other drugs (heroin and cocaine) that occur over the life course. Findings indicate that while this population is characterized as chronic marijuana users there is a certain degree of regulation associated with specific social circumstances that emerge over time. These data may have important drug policy implications such as the prevention and control of adverse consequences and self-regulation of use. [ABSTRACT FROM AUTHOR]

This paper examines selected contextual factors specific to Mexican Americans that may be related to the risk of non-injecting heroin users transitioning to injecting use. This research is based on data gathered from a NIDA funded study examining 300 Mexican American non-injecting drug users in San Antonio. In the Southwest, Mexican Americans have been consistently characterized by high rates of drug injecting and AIDS cases. This paper will initially focus on a contextual domain by describing the current heroin market and the changing social perception of heroin use among this population of NIUs. Qualitative data regarding the nature and dynamics of the drug retail markets including the recent availability of powdered heroin as opposed to black tar will be addressed. Findings reveal the importance in examining contextual variations in the risk of transitioning to injecting. As well, this growth in NIUs in this community has serious consequences for controlling increases in IDU and the spread of HIV, and other blood born pathogens associated with injectors. [ABSTRACT FROM AUTHOR]