RESUMO
AIMS: This study assessed contributions of exposure to neighborhood stressors (violent victimization, witnessing crime, greater alcohol and drug availability) to variation in alcohol use disorder (AUD) symptoms among drinkers in three cities in Texas, USA. METHODS: We used data from interviews conducted from 2011 to 2013 with Mexican-origin adults (ages 16-65) in the US-Mexico Study of Alcohol and Related Conditions who were past-year drinkers (N = 1960; 55% male) living in two cities in the Texas-Mexico border region (Laredo, n = 751 and Brownsville/McAllen, n = 814) and one interior comparison site (San Antonio, n = 771). Analyses (conducted in 2018 and 2019) examined overall and gender-stratified multilevel mediated effects of each border site (versus San Antonio) on AUD symptoms through the neighborhood-level factors, adjusting for individual- and neighborhood-level covariates. RESULTS: Overall, drinkers in Laredo reported more AUD symptoms than drinkers in the other cities, and their neighborhoods had more witnessing of crime and greater perceived drug availability, as well as higher levels of disadvantage and a lower proportion non-Hispanic White residents, than neighborhoods in San Antonio. Witnessing neighborhood crime was associated with increased AUD symptoms, while neighborhood disadvantage and proportion non-Hispanic White residents each were negatively associated with AUD symptoms. Perceived neighborhood insecurity, crime victimization, perceived neighborhood drug availability and neighborhood alcohol availability (off- and on-premise) were not significantly associated with AUD symptoms. Stratified models suggested possible gender differences in indirect effects through witnessing neighborhood crime. CONCLUSION: Reducing witnessing of neighborhood crime may help reduce AUD symptoms among adults living in the US border region.
Assuntos
Alcoolismo , Americanos Mexicanos , Adulto , Masculino , Humanos , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Feminino , Alcoolismo/epidemiologia , México/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Características de Residência , EtanolRESUMO
PURPOSE: Receipt of alcohol-related care for alcohol use is particularly low among those residing in the U.S.-Mexico border region. One reason for this disparity may be limited treatment accessibility, making it difficult for those who need it to access needed treatment. The current study assesses whether differences in treatment utilization are mediated by differences in treatment accessibility in cities within and outside of the border region. METHODS: We used data from the U.S.-Mexico Study of Alcohol and Related Conditions involving a probability sample of Mexican-origin adults surveyed in three cities in Texas (2011-2013). We included only participants with a lifetime history of alcohol use disorder (AUD) (n = 792). We examined two lifetime measures of self-reported alcohol treatment utilization: considering getting help for an alcohol problem and receipt of treatment. We geocoded locations of facilities listed in the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities. We considered three types of facilities: any outpatient treatment, programs offering fee assistance, and programs offering Spanish-language services. We measured treatment accessibility by density of treatment (i.e., number of facilities within a 20-mile radius of participant's residence) and proximity to treatment (i.e., travel time to nearest facility). We assessed direct and indirect effects of two cities in the border region (versus one nonborder city) on the outcomes through treatment accessibility using generalized structural equation models that accounted for clustering of respondents in cities and in neighborhoods, weighted for sampling and nonresponse and adjusted for covariates. RESULTS: Of 792 respondents with lifetime AUD, 22% had considered getting help and 11% had received treatment, with consideration of getting help being less likely in cities in the border region. We observed no significant differences in treatment receipt across cities. Reduced densities of all three types of treatment programs were significant mediators for the effect of residing in a border region on considering getting help. Time to nearest Spanish-language program also mediated the effect of residing in a border region on considering getting help for one city. CONCLUSIONS: Border cities had lower density of treatment and because treatment density was positively associated with considering getting help, residence in a city in the border region was associated with lower odds of considering getting help, regardless of type of treatment. These findings suggest increasing the number of treatment locations available within cities along the U.S.-Mexico border may encourage those with AUD to consider getting help.