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Ojeda VD, Parker T, Lyles M, Edwards TM, Jimenez C, Hiller-Venegas S, Berliant E, Lister Z. Access to Healthcare Among Young Adult Probationers Participating in a Pilot Health-Focused Reentry Program. Int J Offender Ther Comp Criminol 2024:306624X241240700. [PMID: 38528472 DOI: 10.1177/0306624x241240700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Justice-involved adults experience disparities in healthcare access. This pilot study examines healthcare access among young adult probationers (n = 66) receiving 6-months of Service Navigation and Health Coaching support implemented between 2017 and 2021. Data are from baseline, 6-month follow-up and satisfaction surveys. Between baseline and follow-up, the proportion of insured young adult participants (66%-88%; p < .001) and those using healthcare services (36%-71%; p < .001) increased significantly; report of unmet physical healthcare needs decreased significantly (44%-26%; p = .003). Satisfaction data revealed increased self-efficacy, motivation, focus, and improved organizational, goal setting, and communication skills. The program improved healthcare access by increasing health insurance and recent use of healthcare services. Longitudinal studies are needed to assess maintenance of these outcomes and potential impacts on disparities in health status and access to care indicators. Integrating navigation and coaching supports to advance the well-being of justice-involved young adults is a promising mechanism to facilitate healthcare access.
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Affiliation(s)
- Victoria D Ojeda
- University of California, San Diego, La Jolla, USA
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Tamara Parker
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Maurice Lyles
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Todd M Edwards
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Cielo Jimenez
- University of California, San Diego School of Medicine, La Jolla, USA
| | | | - Emily Berliant
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Zephon Lister
- University of California, San Diego School of Medicine, La Jolla, USA
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2
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Magana C, Gilmer TP, Munson MR, Jones N, Burgos JL, Ojeda VD. Programmatic Support for Peer Specialists that Serve Transition Age Youth Living with Serious Mental Illness: Perspectives of Program Managers from Two Southern California Counties. Community Ment Health J 2023; 59:1498-1507. [PMID: 37318670 PMCID: PMC10598154 DOI: 10.1007/s10597-023-01136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/06/2023] [Indexed: 06/16/2023]
Abstract
Peer Specialists (PS) often work in outpatient mental health programs serving transition age youth (TAY). This study examines program managers' perspectives on efforts to strengthen PS' professional development. In 2019, we interviewed program managers (n = 11) from two Southern California Counties employed by public outpatient mental health programs (n = 8) serving TAY and conducted thematic analyses. We present themes and illustrative quotes. PS' roles are highly flexible; thus, PM support PS to strengthen skills to address organization-facing and client-facing responsibilities. PM addressed time management, documentation, PS integration into the organization, and workplace relationships. Trainings to better support clients included addressing cultural competency to serve LGBTQ TAY and racial/ethnic subgroups. Diverse supervision modalities address PS' diverse needs. Supporting PS' technical and administrative skills (e.g., planning, interpersonal communication skills) may aid their implementation of a complex role. Longitudinal research can examine the impact of organizational supports on PS' job satisfaction, career trajectories, and TAY clients' engagement with services.
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Affiliation(s)
- Christopher Magana
- Herbert Wertheim School of Public Health, University of California San Diego , 9500 Gilman Drive MC 0725, La Jolla, California, 92093-0725, CA, USA
| | - Todd P Gilmer
- Herbert Wertheim School of Public Health, University of California San Diego , 9500 Gilman Drive MC 0725, La Jolla, California, 92093-0725, CA, USA
| | - Michelle R Munson
- Silver School of Social Work, New York University, New York, NY, USA
| | - Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jose Luis Burgos
- Herbert Wertheim School of Public Health, University of California San Diego , 9500 Gilman Drive MC 0725, La Jolla, California, 92093-0725, CA, USA
| | - Victoria D Ojeda
- Herbert Wertheim School of Public Health, University of California San Diego , 9500 Gilman Drive MC 0725, La Jolla, California, 92093-0725, CA, USA.
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Siantz E, Hiller S, Ojeda VD, Gilmer TP. Barriers to Accessing Mental Health Care Under the Mental Health Services Act: A Qualitative Case Study in Orange County, California. Community Ment Health J 2023; 59:381-390. [PMID: 36121527 DOI: 10.1007/s10597-022-01016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
Despite progress made under California's Mental Health Services Act, limited access to care for cultural and linguistic minority groups remains a serious issue in community mental health. In this qualitative study we report findings from a large-scale community-level assessment that explored barriers to accessing care from the perspectives of multiple stakeholders including county advisors, advocates, community members, and consumers representing a range of cultural and linguistic communities in Orange County, California. We conducted 14 focus groups with N = 112 participants. Qualitative analysis revealed that system fragmentation, limited availability of linguistically appropriate care, and stigma continue to undermine access to mental health care. Peer health navigation and culturally responsive peer support are potential ways to promote service engagement with persons from cultural and linguistic minority groups that encounter barriers when accessing mental health services.
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Affiliation(s)
- Elizabeth Siantz
- College of Social Work, University of Utah, Salt Lake City, UT, USA.
| | - Sarah Hiller
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
| | - Victoria D Ojeda
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
| | - Todd P Gilmer
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California San Diego, La Jolla, CA, USA
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Ojeda VD, Magana C, Hiller-Venegas S, Romero LS, Ortiz A. Motivations for Seeking Laser Tattoo Removal and Perceived Outcomes as Reported by Justice Involved Adults. Int J Offender Ther Comp Criminol 2023; 67:126-145. [PMID: 35674198 PMCID: PMC9669733 DOI: 10.1177/0306624x221102807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The goal of this study is to describe reasons for desiring removal of unwanted tattoos and self-reported outcomes among justice-involved adults (JIA) receiving free laser tattoo removal in Southern California. Between 2016 and 2021, JIA completed voluntary anonymous surveys at baseline (n = 53) and follow-up (n = 113) visits. Descriptive analyses were generated for quantitative items. Themes were identified from open-ended questions. Patients were predominantly male (74%) and most (81%) reported tattoo-related discrimination. Adjusted multivariate analyses showed that a higher number of domains in which patients reported tattoo-related discrimination was associated with having more tattoos to remove and citing reasons for removal related to employment and stigma by association (e.g., gang membership and police interactions). At follow-up, 48% of patients felt they were treated better in their community, and nearly a quarter of patients (25%) reported greater confidence and self-esteem. JIA seek tattoo removal due to stigma and discrimination. While JIA reported diverse benefits, tattoo removal should likely be considered as one element of comprehensive programing that addresses JIA's diverse emotional, social, and economic needs. Longitudinal research is needed to clarify the long-term effects of tattoo removal for JIA.
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Affiliation(s)
- Victoria D. Ojeda
- University of California, San Diego
Herbert Wertheim School of Public Health, La Jolla, USA
- University of California, San Diego
School of Medicine, La Jolla, USA
| | - Christopher Magana
- University of California, San Diego
Herbert Wertheim School of Public Health, La Jolla, USA
| | - Sarah Hiller-Venegas
- University of California, San Diego
Herbert Wertheim School of Public Health, La Jolla, USA
| | - Laura S. Romero
- University of California, San Diego
School of Medicine, La Jolla, USA
| | - Arisa Ortiz
- University of California, San Diego
School of Medicine, La Jolla, USA
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5
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Ojeda VD, Berliant E, Parker T, Lyles M, Edwards TM, Jimenez C, Linke S, Hiller-Venegas S, Lister Z. Overview of a Pilot Health-focused Reentry Program for Racial/Ethnic Minority Probationers ages 18 to 26 in Southern California. Int J Offender Ther Comp Criminol 2022; 66:1303-1326. [PMID: 33980068 DOI: 10.1177/0306624x211013739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There is a significant gap in reentry programming that is tailored to the needs of young adults ages 18 to 26 who are in a unique developmental life stage that involves ongoing maturity in their neurobiology, cognitive development, and social and financial transitions to adulthood and independence. This article describes the structure and approach of a 6-month health-focused reentry program designed for racial/ethnic minority young adult (YA) probationers in Southern California. The UCSD RELINK program includes service navigation and an optional psychoeducation health coaching program to build health literacy, problem-solving, and executive functioning skills relevant across multiple life domains. We describe participant characteristics and service needs at intake. Between 2017 and 2019, 122 YA probationers ages 18 to 26 responded to interviewer-administered baseline surveys. Participants needed basic services including housing, nutrition assistance, employment, and educational/vocational training. Depression and anxiety symptoms, Adverse Childhood Events, trauma, and unmet physical and mental health care needs were pervasive. Given the dearth of research on reentry programming for YA, this article documents the approaches taken in this multi-pronged health-focused reentry program to ensure that the program was tailored to YA reentrants' comprehensive needs. These data serve to concretely illustrate the range of needs and how YA reentrants view their own health and social needs in the context of multiple competing demands; such data may be useful for program planners and policymakers seeking to advance service delivery for YA minority reentrants.
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Affiliation(s)
- Victoria D Ojeda
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Emily Berliant
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Tamara Parker
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Maurice Lyles
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Todd M Edwards
- University of California, San Diego School of Medicine, La Jolla, USA
- University of San Diego, CA, USA
| | - Cielo Jimenez
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Sarah Linke
- University of California, San Diego School of Medicine, La Jolla, USA
| | | | - Zephon Lister
- University of California, San Diego School of Medicine, La Jolla, USA
- Loma Linda University, CA, USA
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6
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Ojeda VD, Magana C, Shalakhti O, Vargas-Ojeda AC, Burgos JL. Tattoo discrimination in Mexico motivates interest in tattoo removal among structurally vulnerable adults. Front Public Health 2022; 10:894486. [PMID: 36062106 PMCID: PMC9433543 DOI: 10.3389/fpubh.2022.894486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/11/2022] [Indexed: 01/22/2023] Open
Abstract
Tattoos are less prevalent in Mexico and tattooed persons are frequently stigmatized. We examine the prevalence and correlates of interest in receiving tattoo removal services among 278 tattooed Mexican adults living in Tijuana, Mexico who responded to interviewer-administered surveys, including open-ended questions. Overall, 69% of participants were interested in receiving free tattoo removal services, 31% reported facing employment barriers due to their tattoos, and 43% of respondents regretted or disliked some of their tattoos. Having a voter identification card, reporting moderate/severe depression symptoms and believing that tattoo removal would remove employment barriers were independently associated with interest in tattoo removal. Our findings suggest that there is substantial interest in tattoo removal services. Publicly financed tattoo removal services may help disadvantaged persons gain access to Mexico's labor market and it may positively impact other life domains such as mental well-being and interactions with law enforcement.
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Affiliation(s)
- Victoria D. Ojeda
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, CA, United States,Department of Medicine, School of Medicine, University of California, San Diego, San Diego, CA, United States,*Correspondence: Victoria D. Ojeda
| | - Christopher Magana
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, CA, United States
| | - Omar Shalakhti
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, CA, United States
| | | | - Jose Luis Burgos
- Herbert Wertheim School of Public Health, University of California, San Diego, San Diego, CA, United States
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Ojeda VD, Munoz F, Burgos JL. Interest in Receiving HIV PrEP Among Biological Male Latinx Migrants at High-Risk of HIV Living in Mexico. J Health Care Poor Underserved 2022; 33:806-818. [DOI: 10.1353/hpu.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ojeda VD, Jones N, Munson MR, Berliant E, Gilmer TP. Roles of peer specialists and use of mental health services among youth with serious mental illness. Early Interv Psychiatry 2021; 15:914-921. [PMID: 32888260 PMCID: PMC9305632 DOI: 10.1111/eip.13036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/29/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To examine whether roles of peer specialists affect service use among Black, Latinx and White youth ages 16-24 with serious mental illness (SMI) in Los Angeles and San Diego Counties. METHODS Administrative data from 2015 to 2018 was used to summarize service use among 6329 transition age youth age 16-24 with SMI who received services from 76 outpatient public mental health programs with peer specialists on staff. Roles of peer specialists were assessed via a program survey. Generalized linear models were used to assess the relationship between peer specialist characteristics and service use outcomes (ie, outpatient and inpatient). RESULTS Having a transition age youth peer specialist on staff (vs older peer specialists) and having peer specialists that provide four or more services (vs fewer services) was associated with an increase in annual outpatient visits in both counties (P = <.001 each). In Los Angeles County, having three or more peer specialist trainings (vs fewer trainings) was associated with lower use of inpatient services (P < .001). In San Diego County, having a transition age youth peer specialist and peer specialists that provide four or more services was associated with lower use of inpatient services (P < .001 each). CONCLUSIONS Types of peer support and number of types of peer services were associated with mental health service utilization. Detailed examination of the roles of peer specialists is merited to identify the specific pathways that improve outcomes.
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Affiliation(s)
- Victoria D Ojeda
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA
| | - Nev Jones
- Department of Psychiatry & Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Michelle R Munson
- Silver School of Social Work, New York University, New York, New York, USA
| | - Emily Berliant
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA
| | - Todd P Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA
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Clermont D, Gilmer T, Burgos JL, Berliant E, Ojeda VD. HIV and Sexual Health Services Available to Sexual and Gender Minority Youth Seeking Care at Outpatient Public Mental Health Programs in Two California Counties. Health Equity 2020; 4:375-381. [PMID: 32923842 PMCID: PMC7484894 DOI: 10.1089/heq.2020.0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Sexual and gender minority youth (SGMY, ages 16-24 years) face disparities in sexually transmitted infections (STIs) and HIV, in part, due to exposure to settings and behaviors that may harm youth's physical and mental health. This study examines the scope of sexual health and HIV services available to youth living with serious mental illness (SMI), including SGMY, seeking care at publicly funded outpatient mental health programs. Methods: Between 2018 and 2019, we surveyed 183 managers of mental health programs serving youth living with SMI of ages 16-24 years, including SGMY, in San Diego and Los Angeles counties. Participants reported on programs' target populations, sexual health/HIV service provision, and the use of peer providers. Descriptive statistics and Pearson chi-square tests were used to describe sexual health/HIV services and identify programmatic characteristics associated with providing these services. Results: Overall, 46% of all programs surveyed provided sexual health/HIV services. Of these, 62% provided HIV education, 81% provided sexual/reproductive health education, and 69% provided sexual/reproductive health education tailored for lesbian, gay, bisexual, queer, intersex (LGBQI) youth. Peers often provided these services. Chi-squared tests showed that programs employing peer specialists (p=0.009) and targeting LGBQI youth (p=0.045) were significantly more likely to provide sexual health/HIV services. Conclusion: The use of peer providers may reduce stigma around sexual/HIV service utilization and promote SGMY's trust. Publicly funded outpatient mental health programs serving youth and especially those actively engaging SGMY may consider also offering onsite HIV, STI, and sexual health services, creating a one-stop-shop approach.
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Affiliation(s)
- Donald Clermont
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Todd Gilmer
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Jose Luis Burgos
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Emily Berliant
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Victoria D Ojeda
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA.,Department of Medicine, University of California, San Diego School of Medicine, La Jolla, California, USA
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10
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Ojeda VD, Magana C, Burgos JL, Vargas-Ojeda AC. Deported Men's and Father's Perspective: The Impacts of Family Separation on Children and Families in the U.S. Front Psychiatry 2020; 11:148. [PMID: 32256398 PMCID: PMC7092634 DOI: 10.3389/fpsyt.2020.00148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Family separation due to the deportation of a migrant is pervasive, yet less is known about its potential impacts on the social, economic and mental well-being of families remaining in the United States. Methods: We conducted a mixed-methods study. In 2013, 303 Mexican male nationals completed an interviewer-administered questionnaire at a free clinic in Tijuana, Mexico. For this analysis, participants were: (1) ≥18 years; (2) seeking services; (3) Spanish or English speakers and (4) reported a U.S. deportation. Participants answered migration history items and open-ended questions regarding the impact of their deportation on U.S.-based family members. We present descriptive statistics and illustrative quotes for themes identified in the qualitative text data. Using a grounded-theory approach, we considered all data to develop a conceptual framework that others may use to study the consequences of family separation due to deportation. Results: Nearly two-thirds of participants reported living in the U.S. for 11+ years, a similar proportion reported 2+ deportations, and 31% reported being banned from re-entering the U.S. for 11+ years. More than one-half of participants were separated from their nuclear families (spouse/partner and/or children). Deportees who were separated from any family members reported that their families lost income for basic needs (rent/utilities: 50%, food: 44%, clothing: 39%, daycare: 16%, health insurance: 15%); school participation was also negatively impacted (31%). Qualitative data revealed that children ≤18 years remaining in the U.S. experienced mental health symptoms post-parental deportation (i.e., persistent crying, depression, sadness, anger, resentment). Deported fathers consistently expressed frustration at being unable to provide love, care, support, mentorship for their children. Based on our mixed-methods approach, we propose a framework to systematically study the consequences of family separation due to the deportation of fathers. Conclusion: Findings are consistent with the extant research. Binational interventions to support families that experience forced-separation are needed to mitigate short and long-term adverse mental health outcomes, especially among youth in the U.S., and other unfavorable family and household-level outcomes. Funding to understand the implications of maternal deportation and for longitudinal qualitative and quantitative research on migrant-focused interventions and related outcomes is needed.
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Affiliation(s)
- Victoria D Ojeda
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States.,Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Christopher Magana
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States
| | - Jose Luis Burgos
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, United States
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Ojeda VD, Amico KR, Hughes JP, Wilson E, Li M, Holtz TH, Chitwarakorn A, Grant RM, Dye B, Bekker LG, Mannheimer S, Marzinke M, Hendrix CW. Low Disclosure of PrEP Nonadherence and HIV-Risk Behaviors Associated With Poor HIV PrEP Adherence in the HPTN 067/ADAPT Study. J Acquir Immune Defic Syndr 2019; 82:34-40. [PMID: 31169769 PMCID: PMC6698708 DOI: 10.1097/qai.0000000000002103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated the relationship between 2 types of social relationships, ie, (1) external support for use of HIV pre-exposure prophylaxis (PrEP) and related study supplies and (2) participants' disclosure of PrEP use and condom use and HIV PrEP adherence among daily-dosing regimen participants in HIV Prevention Trials Network (HPTN) 067, an open-label trial of oral tenofovir (TFV) disoproxil fumarate (TDF) 300 mg/emtricitabine (FTC) 200 mg. METHODS Using HPTN 067 survey data, we developed scales examining (1) Low Perceived External Support for PrEP: low perceived support by others for PrEP use or perceived negative reactions to the pill case (scoring ranges from 0 to 2) and (2) Participant-Staff Disclosure Challenges Scale, which identifies challenges to sharing nonuse of PrEP or condoms to study staff (scoring ranges from 0 to 4); these scales are the primary independent variables. Adherence, the dependent variable, was determined using log-transformed plasma TFV concentrations. generalized estimating equation (GEE) linear regression was used to assess the association between both scales and adherence. RESULTS Participants (n = 161) included HIV-uninfected women in South Africa, and men who have sex with men and transgender women, in Thailand and the United States. In multivariable analyses, higher scores in the Participant-Staff Disclosure Challenges Scale were significantly associated with lower PrEP adherence [exp(β) = 0.62, 95% CI: (0.46 to 0.84); P = 0.002] as were increased days since the last PrEP dose [exp(β) = 0.73, 95% CI: (0.65 to 0.83); P ≤ 0.001]. CONCLUSIONS Given the association with adherence, study staff-participant interactions and participants' disclosure of PrEP challenges may be worthwhile intervention targets for improving PrEP adherence in confirmatory studies.
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Affiliation(s)
- Victoria D. Ojeda
- Department of Medicine, UCSD School of Medicine, La Jolla,
California, United States
| | - K. Rivet Amico
- Department of Health Behavior and Health Education,
University of Michigan, Ann Arbor, Michigan, United States
| | - James P. Hughes
- Department of Biostatistics, University of Washington,
Seattle, Washington, United States
| | - Ethan Wilson
- Statistical Center for AIDS Research and Prevention, Fred
Hutchinson Cancer Research Center, Seattle, USA
| | - Maoji Li
- Statistical Center for AIDS Research and Prevention, Fred
Hutchinson Cancer Research Center, Seattle, USA
| | - Timothy H. Holtz
- Thailand Ministry of Public Health – U.S. Centers
for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease
Control and Prevention, Atlanta, Georgia, United States
| | | | - Robert M. Grant
- Gladstone Institutes, University of California, San
Francisco, California, United States
| | - Bonnie Dye
- HIV Prevention Trials Network, FHI 360, Durham, North
Carolina, United States
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town,
Cape Town, South Africa
| | - Sharon Mannheimer
- Department of Medicine, Harlem Hospital Center, New
York, New York, United States
- Department of Epidemiology, Columbia University Mailman
School of Public Health, New York, New York, United States
- ICAP, Columbia University Mailman School of Public
Health, New York, New York, United States
| | - Mark Marzinke
- Dept. of Pathology, Johns Hopkins University School of
Medicine, Baltimore, MD USA
- Department of Medicine (Clinical Pharmacology), Johns
Hopkins University, Baltimore, Maryland, USA
| | - Craig W. Hendrix
- Department of Medicine (Clinical Pharmacology), Johns
Hopkins University, Baltimore, Maryland, USA
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12
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Kremer P, Ulibarri M, Ferraiolo N, Pinedo M, Vargas-Ojeda AC, Burgos JL, Ojeda VD. Association of Adverse Childhood Experiences with Depression in Latino Migrants Residing in Tijuana, Mexico. Perm J 2019; 23:18-031. [PMID: 30589403 DOI: 10.7812/tpp/18-031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Physical, sexual, and emotional abuse in childhood-adverse childhood experiences (ACEs)-are associated with poor mental and physical health. OBJECTIVE To determine the prevalence of ACEs and their relationship to depression among Latino migrants in Mexico, which has not been previously examined. METHODS A total of 110 Latinos aged 18 years and older residing in Tijuana, Mexico, completed interviewer-administered questionnaires, including the ACE scale (range = 0 to 10 items), at baseline in 2015. We studied the prevalence of ACEs (score on the ACE scale) and the presence of depressive symptoms (Patient Health Questionnaire-9). Multivariate logistic regression models were used to estimate the association between the ACE score and depressive symptoms. RESULTS Overall, 82% of participants were men, and 82% reported being deported from the US. At least 1 ACE was reported by 64% of participants, and 33% reported 3 or more ACEs. Those who reported ever being incarcerated were significantly more likely to have 3 or more ACEs compared with no ACEs (56% vs 28%; p = 0.039). Symptoms of mild, moderate, or severe depression were identified in 14% of participants. In multivariate analyses, for each additional ACE item reported, participants were significantly more likely to meet criteria for depressive symptoms (adjusted odds ratio = 1.42; 95% confidence interval = 1.13-1.78; p = 0.002). CONCLUSION Among Latino migrants residing in the US-Mexico border region, ACEs were pervasive and associated with depression symptoms. Programs and policies targeting migrants in this region should consider addressing both ACEs and depression.
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Affiliation(s)
- Pedro Kremer
- University of California, San Diego School of Medicine, La Jolla
| | - Monica Ulibarri
- California School of Professional Psychology, Alliant International University, San Diego
| | | | - Miguel Pinedo
- Department of Kinesiology and Health Education, College of Education, University of Texas, Austin
| | | | - Jose Luis Burgos
- Department of Medicine at the University of California, San Diego School of Medicine, La Jolla
| | - Victoria D Ojeda
- Department of Medicine at the University of California, San Diego School of Medicine, La Jolla
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Abstract
Deported migrants face numerous challenges which may elevate their risk for drug use. We examined relationships between integration and drug use among deported migrants in Tijuana, Mexico. A cross-sectional survey conducted at a free health clinic included 255 deported Mexican-born migrants residing in Tijuana ≥6 months. Multivariable logistic regression examined associations between variables across four integration domains (public participation, social connections, macro-level facilitators and foundations) and recent (past 6-month) drug use. The prevalence of recent drug use was 46 %. Having sought work in Tijuana in the past 6 months, greater household affluence, lifetime history of incarceration in both US and Mexico, and lacking health insurance were independently associated with recent drug use. Policies that support access to employment, adequate housing and healthcare in Mexico, particularly for justice-involved deportees, may facilitate successful integration and reduce potential stressors that may contribute to drug use.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Centre for Population Health, Burnet Institute, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Miguel Pinedo
- Alcohol Research Group, University of California Berkeley, Emeryville, CA, 94608, USA
| | - Jose Luis Burgos
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Victoria D Ojeda
- Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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Burgos JL, Yee DC, Vargas-Ojeda AC, Ojeda VD. The Health Frontiers in Tijuana Undergraduate Internship Program: A Novel Global Health Experience in Mexico for Pre-medical/Pre-health Undergraduates. J Health Care Poor Underserved 2018; 27:947-53. [PMID: 27524743 DOI: 10.1353/hpu.2016.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe the creation of the Health Frontiers in Tijuana (HFiT) Undergraduate Internship Program (UIP), a novel global health experience for U.S. and Mexican undergraduate students based at the binational HFiT student-run free clinic. The UIP introduces students to a diverse underserved patient population, and U.S.-Mexico border public health.
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Abstract
This study describes the prevalence and factors of depressive symptoms among a sample of persons who inject drugs (PWID) with a history of deportation from the US in Tijuana, Mexico. In 2014, 132 deported PWID completed a structured questionnaire. Depressive symptoms were measured using the Center for Epidemiologic Studies Short Depression Scale (CESD-10) screening instrument. Eligible participants were ≥18 years old, injected drugs in the past month, spoke English or Spanish, and resided in Tijuana. Multivariate analyses identified factors associated with depressive symptoms. Among deported PWID, 45% reported current symptoms of depression. Deported PWID who were initially detained in the US for a crime-related reason before being deported (adjusted odds ratio (AOR): 5.27; 95% CI: 1.79-15.52) and who perceived needing help with their drug use (AOR: 2.15; 95% 1.01-4.61) had higher odds of reporting depressive symptoms. Our findings highlight the need for effective strategies targeting deported migrants who inject drugs to treat mental health and drug abuse in Tijuana. Investing in the mental health of deported PWID may also be a viable HIV prevention strategy.
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Affiliation(s)
- Miguel Pinedo
- Alcohol Research Group, 6475 Christie Avenue Suite 400, Emeryville, CA 94608
| | - José Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, Hepner Hall 203D, San Diego, CA 92182
| | - Ramona Perez
- Department of Anthropology, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-6022
| | - Caroline A. Macera
- School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162
| | - Victoria D. Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093
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Muñoz FA, Servin AE, Garfein RS, Ojeda VD, Rangel G, Zúñiga ML. Deportation history among HIV-positive Latinos in two US-Mexico border communities. J Immigr Minor Health 2016; 17:104-11. [PMID: 24136247 DOI: 10.1007/s10903-013-9929-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Health-related vulnerabilities associated with deportation are understudied. We conducted a cross-sectional study to identify factors associated with history of deportation from the US to Mexico among HIV-positive Latinos. From 2009 to 2010, we recruited a convenience sample from HIV clinics in San Diego, US and Tijuana, Mexico. Of 283 participants, 25% reported a prior deportation. Factors independently associated with increased odds of deportation history were being male [adjusted odds ratio (AOR) 2.77; 95% CI 1.18-6.48], having ≤high-school education (AOR 3.87; 95% CI 1.84-8.14), ever using cocaine (AOR 2.46; 95% CI 1.33-4.57), and reporting personalized HIV-stigma: "some have told me HIV is what I deserve for how I lived" (AOR 2.23; 95% CI 1.14-4.37). Lower self-reported antiretroviral medication adherence (AOR 0.35; 95% CI 0.12-0.96) and perceiving HIV-stigma: "most people believe a person who has HIV is dirty" (AOR 0.49; 95% CI 0.25-0.94) were associated with decreased odds of deportation history. Deportation is associated with specific socioeconomic indicators that are known to impact the health of individuals living with HIV.
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Affiliation(s)
- Fátima A Muñoz
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
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Ojeda VD, Hiller SP, Hurst S, Jones N, McMenamin S, Burgdorf J, Gilmer TP. Implementation of Age-Specific Services for Transition-Age Youths in California. Psychiatr Serv 2016; 67:970-6. [PMID: 27133720 DOI: 10.1176/appi.ps.201500084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examined the implementation of age-specific services for transition-age youths in California under the Mental Health Services Act (MHSA). METHODS This study employed a sequential, exploratory mixed-methods design. Qualitative interviews with 39 mental health service area administrators in California were analyzed to develop an understanding of how the MHSA has facilitated the development of youth-specific programs or services. A quantitative survey of 180 youth-focused programs was also used to describe the range of services that were implemented, the use of evidence-based and promising practices, and the role of youths in the design, planning, delivery, and evaluation of services. RESULTS Administrators described the MHSA as providing a programmatic focus and financial support for youth-specific services, outlining a stakeholder process to create buy-in and develop a vision for services, and emphasizing the role of youths in service delivery and planning. Youth-specific programs implemented a diverse array of services, including general medical care; employment and education support; housing placement and support; and family, mentoring, and social support. Programs described implementing evidence-based and promising practices and involving youths in service planning, implementation, or quality improvement activities. CONCLUSIONS The MHSA has had a substantial impact on the landscape of youth-specific services in California by expanding both the number of programs and the diversity in types of services and by promoting the engagement of youths in the planning and delivery of services. Additional efforts are necessary to determine the extent to which youth-specific services yield greater improvements in youths' outcomes compared with services designed for adults.
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Affiliation(s)
- Victoria D Ojeda
- Dr. Ojeda and Ms. Hiller are with the Department of Medicine, and Dr. Hurst, Dr. McMenamin, and Dr. Gilmer are with the Department of Family Medicine and Public Health, all at the University of California, San Diego, La Jolla (e-mail: ). Dr. Jones is with the Felton Institute, San Francisco. Dr. Burgdorf is with MedImpact, San Diego
| | - Sarah P Hiller
- Dr. Ojeda and Ms. Hiller are with the Department of Medicine, and Dr. Hurst, Dr. McMenamin, and Dr. Gilmer are with the Department of Family Medicine and Public Health, all at the University of California, San Diego, La Jolla (e-mail: ). Dr. Jones is with the Felton Institute, San Francisco. Dr. Burgdorf is with MedImpact, San Diego
| | - Samantha Hurst
- Dr. Ojeda and Ms. Hiller are with the Department of Medicine, and Dr. Hurst, Dr. McMenamin, and Dr. Gilmer are with the Department of Family Medicine and Public Health, all at the University of California, San Diego, La Jolla (e-mail: ). Dr. Jones is with the Felton Institute, San Francisco. Dr. Burgdorf is with MedImpact, San Diego
| | - Nev Jones
- Dr. Ojeda and Ms. Hiller are with the Department of Medicine, and Dr. Hurst, Dr. McMenamin, and Dr. Gilmer are with the Department of Family Medicine and Public Health, all at the University of California, San Diego, La Jolla (e-mail: ). Dr. Jones is with the Felton Institute, San Francisco. Dr. Burgdorf is with MedImpact, San Diego
| | - Sara McMenamin
- Dr. Ojeda and Ms. Hiller are with the Department of Medicine, and Dr. Hurst, Dr. McMenamin, and Dr. Gilmer are with the Department of Family Medicine and Public Health, all at the University of California, San Diego, La Jolla (e-mail: ). Dr. Jones is with the Felton Institute, San Francisco. Dr. Burgdorf is with MedImpact, San Diego
| | - James Burgdorf
- Dr. Ojeda and Ms. Hiller are with the Department of Medicine, and Dr. Hurst, Dr. McMenamin, and Dr. Gilmer are with the Department of Family Medicine and Public Health, all at the University of California, San Diego, La Jolla (e-mail: ). Dr. Jones is with the Felton Institute, San Francisco. Dr. Burgdorf is with MedImpact, San Diego
| | - Todd P Gilmer
- Dr. Ojeda and Ms. Hiller are with the Department of Medicine, and Dr. Hurst, Dr. McMenamin, and Dr. Gilmer are with the Department of Family Medicine and Public Health, all at the University of California, San Diego, La Jolla (e-mail: ). Dr. Jones is with the Felton Institute, San Francisco. Dr. Burgdorf is with MedImpact, San Diego
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Horyniak D, Melo JS, Farrell RM, Ojeda VD, Strathdee SA. Epidemiology of Substance Use among Forced Migrants: A Global Systematic Review. PLoS One 2016; 11:e0159134. [PMID: 27411086 PMCID: PMC4943736 DOI: 10.1371/journal.pone.0159134] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/28/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Forced migration is occurring at unprecedented levels. Forced migrants may be at risk for substance use for reasons including coping with traumatic experiences, co-morbid mental health disorders, acculturation challenges and social and economic inequality. This paper aimed to systematically review the literature examining substance use among forced migrants, and identify priority areas for intervention and future research. METHODS Seven medical, allied health and social science databases were searched from inception to September 2015 in accordance with PRISMA guidelines to identify original peer-reviewed articles describing any findings relating to alcohol and/or illicit drug use among refugees, internally displaced people (IDPs), asylum seekers, people displaced by disasters and deportees. A descriptive synthesis of evidence from quantitative studies was conducted, focusing primarily on studies which used validated measures of substance use. Synthesis of evidence from qualitative studies focused on identifying prominent themes relating to the contexts and consequences of substance use. Critical Appraisal Skills Programme (CASP) checklists were used to assess methodological quality of included studies. RESULTS Forty-four quantitative (82% cross-sectional), 16 qualitative and three mixed-methods studies were included. Ten studies were rated as high methodological quality (16%), 39 as moderate quality (62%) and 14 as low quality (22%). The majority of research was conducted among refugees, IDPs and asylum seekers (n = 55, 87%), predominantly in high-income settings. The highest-quality prevalence estimates of hazardous/harmful alcohol use ranged from 17%-36% in camp settings and 4%-7% in community settings. Few studies collected validated measures of illicit drug use. Seven studies compared substance use among forced migrants to other migrant or native-born samples. Among eight studies which conducted multivariable analysis, male sex, trauma exposure and symptoms of mental illness were commonly identified correlates of substance use. CONCLUSION Our understanding of substance use among forced migrants remains limited, particularly regarding persons displaced due to disasters, development and deportation. Despite a growing body of work among refugee-background populations, few studies include refugees in low and middle-income countries, where over 80% of the global refugee population resides. Findings suggest a need to integrate substance use prevention and treatment into services offered to forced migrants, particularly in camp settings. Efforts to develop and evaluate interventions to reduce substance use and related harms are needed.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
- Centre for Population Health, Burnet Institute, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Jason S. Melo
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Risa M. Farrell
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Victoria D. Ojeda
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Steffanie A. Strathdee
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
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19
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Smith LR, Patterson TL, Magis-Rodriguez C, Ojeda VD, Burgos JL, Rojas SA, Zúñiga ML, Strathdee SA. Engagement in the HIV Care Continuum among Key Populations in Tijuana, Mexico. AIDS Behav 2016; 20:1017-25. [PMID: 26354518 DOI: 10.1007/s10461-015-1186-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In Tijuana, Mexico, HIV is concentrated in sub-epidemics of key populations: persons who inject drugs (PWID), sex workers (SW), and men who have sex with men (MSM). To date, data on engagement in the HIV care continuum among these key populations, particularly in resource-constrained settings, are sparse. We pooled available epidemiological data from six studies (N = 3368) to examine HIV testing and treatment uptake in these key populations; finding an overall HIV prevalence of 5.7 %. Of the 191 identified HIV-positive persons, only 11.5 % knew their HIV-positive status and 3.7 % were on ART. Observed differences between these HIV-positive key populations suggest PWID (vs. non-PWID) were least likely to have previously tested or initiate HIV care. MSM (vs. non-MSM) were more likely to have previously tested but not more likely to know their HIV-positive status. Of persons aware of their HIV-positive status, SW (vs. non-SW) were more likely to initiate HIV care. Findings suggest engagement of key populations in HIV treatment is far below estimates observed for similarly resource-constrained generalized epidemics in sub-Saharan Africa. These data provide one of the first empirical-snapshots highlighting the extent of HIV treatment disparities in key populations.
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Pinedo M, Burgos JL, Zuniga ML, Perez R, Macera CA, Ojeda VD. Police Victimization Among Persons Who Inject Drugs Along the U.S.-Mexico Border. J Stud Alcohol Drugs 2016; 76:758-63. [PMID: 26402356 DOI: 10.15288/jsad.2015.76.758] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.-Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. METHOD From 2011 to 2013, 733 PWID (62% male) were recruited in Tijuana and completed a structured questionnaire. Eligible participants were age 18 years or older, injected illicit drugs within the past month, and spoke Spanish or English. Multivariable logistic regression analyses identified correlates of recent experiences of police victimization (e.g., bribes, unlawful confiscation, physical and sexual violence). RESULTS Overall, 56% of PWID reported a recent police victimization experience in Tijuana. In multivariable logistic regression analyses, factors independently associated with recent police victimization included recent injection of methamphetamine (adjusted odds ratio [AOR] = 1.62; 95% CI [1.18, 2.21]) and recently received injection assistance by a "hit doctor" (AOR = 1.56; 95% CI [1.03, 2.36]). Increased years lived in Tijuana (AOR = 0.98 per year; 95% CI [0.97, 0.99]) and initiating drug use at a later age (AOR = 0.96 per year; 95% CI [0.92, 0.99]) were inversely associated with recent police victimization. CONCLUSIONS Physical drugusing markers may increase PWID susceptibility to police targeting and contribute to experiences of victimization. Interventions aimed at reducing police victimization events in the U.S.-Mexico border region should consider PWID's drug-using behaviors. Reducing problematic policing practices may be a crucial public health strategy to reduce HIV risk among PWID in this region.
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Affiliation(s)
- Miguel Pinedo
- Alcohol Research Group, University of California, Berkeley, California
| | - Jose Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego, California
| | - Maria Luisa Zuniga
- School of Social Work, San Diego State University, San Diego, California
| | - Ramona Perez
- Department of Anthropology, San Diego State University, San Diego, California
| | - Caroline A Macera
- School of Public Health, San Diego State University, San Diego, California
| | - Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego, California
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21
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Ferraiolo N, Pinedo M, McCurley J, Burgos JL, Vargas-Ojeda AC, Rodriguez MA, Ojeda VD. Depressive symptoms among patients at a clinic in the Red Light District of Tijuana, Mexico. ACTA ACUST UNITED AC 2016; 9:151-163. [PMID: 28042307 DOI: 10.1080/17542863.2016.1144776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Little is known about depression among structurally vulnerable groups living in Tijuana (e.g., migrants, deportees, substance users, sex workers, homeless) who may be at high risk for poor mental health. This study investigates the prevalence and correlates of depressive symptoms among vulnerable patients receiving services at a free clinic in Tijuana, Mexico. A convenience sample of 584 adult Mexican patients completed an interviewer-administered questionnaire in English or Spanish that included the 8-item NIH PROMIS depression short form and measures of individual, social, and structural factors affecting health. The prevalence of clinically significant depressive symptoms in our sample was 55%. In the multivariate analysis, female gender, poor/fair self-rated health, recent illicit drug use (past six months), feeling rejected (past six months), history of forced sex, and history of violence were independently associated with increased odds of experiencing depressive symptoms. When stratified by gender, we found important differences in significant factors, including recent illicit drug use in men and deportation in women. Among study participants, prevalence of depressive symptoms exceeds prevalence rates reported elsewhere in the U.S.-Mexico border region. These findings suggest that public health efforts to support mental health services in the border region are needed.
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Affiliation(s)
- Natalie Ferraiolo
- University of California, San Diego School of Medicine, La Jolla CA, USA
| | - Miguel Pinedo
- Alcohol Research Group, University of California, Berkeley, Emeryville CA, USA
| | - Jessica McCurley
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Jose Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla CA, USA
| | - Adriana Carolina Vargas-Ojeda
- Postgraduate Studies and Research Department, School of Medicine and Psychology, Autonomous University of Baja California, Tijuana, Baja California, México
| | - Michael A Rodriguez
- Department of Family Medicine/UCLA Blum Center on Poverty and Health in Latin America, University of California, Los Angeles, Los Angeles CA, USA
| | - Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, La Jolla CA, USA
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22
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Ojeda VD, Eppstein A, Lozada R, Vargas-Ojeda AC, Strathdee SA, Goodman D, Burgos JL. Establishing a binational student-run free-clinic in Tijuana, Mexico: a model for US-Mexico border states. J Immigr Minor Health 2015; 16:546-8. [PMID: 23371839 DOI: 10.1007/s10903-012-9769-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In 2011, a bi-national student-run free clinic for the underserved, known as "Health Frontiers in Tijuana" (HFiT), was created in Tijuana, Mexico. Students and faculty from one Mexican and one US medical school staff the clinic and attend patients on Saturdays. Students from both medical schools enroll in a didactic course during the quarter/semester that they attend the free clinic. The course addresses clinical, ethical, cultural, population-specific issues and the structure, financing and delivery of medical care in Mexico. The clinic implements an electronic medical record and is developing telemedicine for consulting on complex cases. Despite challenges related to sustaining adequate funding, this program may be replicated in other border communities.
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Affiliation(s)
- Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, Institute of the Americas, San Diego School of Medicine, University of California, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA, 92093, USA,
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Matthews CE, Wooten W, Gomez MGR, Kozo J, Fernandez A, Ojeda VD. The California Border Health Collaborative: A Strategy for Leading the Border to Better Health. Front Public Health 2015; 3:141. [PMID: 26075195 PMCID: PMC4443723 DOI: 10.3389/fpubh.2015.00141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/02/2015] [Indexed: 11/16/2022] Open
Abstract
There are hundreds of people and organizations working on border health issues in the California–Baja California border region trying to protect and improve health. These efforts are being conducted without a collaborative structure that integrates jurisdictions and organizations. Thus, there is a need to coordinate these organizations to work together and benefit from their collective effort and each other’s best practices. The outcome of such an effort could effectively improve the health in the border region. The newly developed “California Border Health Collaborative” unites organizations and provides the leadership and collaborative culture to positively improve the health of the border region; it is referred to as the “Collaborative.” This article describes the developmental process of this Collaborative, including partner engagement, governance, strategic planning, key elements for success, the roles of multi-level jurisdictions, and policy implications. This paper focuses on describing the preparation and processes that created the U.S./California side of this binational collaborative effort and is a strong reflection of the theory of border collaboration as described by Denman and De Sonora (1) in “Working beyond Borders: A Handbook for Transborder Projects in Health.”
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Affiliation(s)
- Charles Edwards Matthews
- Health and Human Services Agency, County of San Diego , San Diego, CA , USA ; Joint Doctoral Program, Global Health, San Diego State/University of California San Diego , San Diego, CA , USA
| | - Wilma Wooten
- Public Health, Health and Human Services Agency, County of San Diego , San Diego, CA , USA
| | | | - Justine Kozo
- Public Health, Health and Human Services Agency, County of San Diego , San Diego, CA , USA
| | - April Fernandez
- California Department of Public Health, Office of Binational Border Health , San Diego, CA , USA
| | - Victoria D Ojeda
- School of Medicine, University of California San Diego , San Diego, CA , USA
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Sarkin A, Lale R, Sklar M, Center KC, Gilmer T, Fowler C, Heller R, Ojeda VD. Stigma experienced by people using mental health services in San Diego County. Soc Psychiatry Psychiatr Epidemiol 2015; 50:747-56. [PMID: 25406401 DOI: 10.1007/s00127-014-0979-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 11/10/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This paper describes how individuals struggling with severe mental illness experience stigma along multiple dimensions including their experiences of discrimination by others, their unwillingness to disclose information about their mental health, and their internalization or rejection of the negative and positive aspects of having mental health problems. METHODS This cross-sectional study employs descriptive analyses and linear regression to assess the relationship between demographics, mental health diagnoses and self-reported stigma among people receiving mental health services in a large and ethnically diverse county public mental health system (n = 1,237) in 2009. We used the King Stigma Scale to measure three factors related to stigma: discrimination, disclosure, and positive aspects of mental illness. RESULTS Most people (89.7 %) reported experiencing some discrimination from having mental health problems. Regression analyses revealed that younger people in treatment experienced more stigma related to mental health problems. Women reported experiencing more stigma than men, but men were less likely to endorse the potentially positive aspects of facing mental health challenges than women. Although people with mood disorders reported more discomfort with disclosing mental illness than people with schizophrenia, they did not report experiencing more discrimination than people with schizophrenia. CONCLUSIONS Study findings suggest that the multidimensional experiences of stigma differ as a function of age, gender, and diagnosis. Importantly, these findings should inform anti-stigma efforts by describing different potential treatment barriers due to experiences of stigma among people using mental health services, especially among younger people and women who may be more susceptible to stigma.
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Affiliation(s)
- Andrew Sarkin
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, 92093, USA,
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Burgos JL, Yee D, Csordas T, Vargas-Ojeda AC, Segovia LA, Strathdee SA, Olivares-Nevarez JA, Ojeda VD. Supporting the minority physician pipeline: providing global health experiences to undergraduate students in the United States-Mexico border region. Med Educ Online 2015; 20:27260. [PMID: 26088189 PMCID: PMC4472552 DOI: 10.3402/meo.v20.27260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND The sizeable US Latino population calls for increasing the pipeline of minority and bilingual physicians who can provide culturally competent care. Currently, only 5.5% of US providers are Hispanic/Latino, compared with 16% of the US population (i.e., >50.5 million persons). By 2060, it is predicted that about one-third of all US residents will be of Latino ethnicity. ACTIVITIES AND OUTCOMES This article describes the Health Frontiers in Tijuana Undergraduate Internship Program (HFiT-UIP), a new quarterly undergraduate internship program based at a US-Mexico binational student-run free clinic and sponsored by the University of California, San Diego School of Medicine and the Universidad Autónoma de Baja California in Tijuana, Mexico. The HFiT-UIP provides learning opportunities for students and underrepresented minorities interested in medical careers, specifically Latino health. DISCUSSION The HFiT-UIP might serve as a model for other educational partnerships across the US-Mexico border region and may help minority and other undergraduates seeking academic and community-based enrichment experiences. The HFiT-UIP can also support students' desires to learn about Latino, border, and global health within resource-limited settings.
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Affiliation(s)
- Jose L Burgos
- Division of Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA;
| | - Daniel Yee
- Division of Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Thomas Csordas
- Department of Anthropology, University of California San Diego, La Jolla, CA, USA
| | - Adriana C Vargas-Ojeda
- Facultad de Medicina y Psicología, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | | | - Steffanie A Strathdee
- Division of Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Jose A Olivares-Nevarez
- Division of Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Victoria D Ojeda
- Division of Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
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Irvin VL, Nichols JF, Hofstetter CR, Ojeda VD, Song YJ, Kang S, Hovell MF. Osteoporosis and milk intake among Korean women in California: relationship with acculturation to U.S. lifestyle. J Immigr Minor Health 2014; 15:1119-24. [PMID: 23338905 DOI: 10.1007/s10903-013-9774-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Korean population in the US increased by a third between 2000 and 2010. Korean women in the US report low calcium intake and relatively high rate of fractures. However, little is known about the prevalence of osteoporosis among Korean American women. This paper examined the relationship between prevalence of osteoporosis and milk consumption, and their relationship with acculturation among a representative sample of immigrant California women of Korean descent. Bilingual telephone surveys were conducted from a probability sample (N = 590) in 2007. Lower acculturation significantly related to lower milk consumption for women during the age periods of 12-18 and 19-34 years. Acculturation was related to higher prevalence of osteoporosis among post-menopausal, but not pre-menopausal Korean women in California. Future research should include larger cohorts, objective measures of osteoporosis, other sources of calcium specific to Korean cuisine, and assessment of bone-loading physical activity.
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Affiliation(s)
- Veronica L Irvin
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA, 92123, USA,
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Pinedo M, Burgos JL, Robertson AM, Vera A, Lozada R, Ojeda VD. Perceived risk of HIV infection among deported male injection drug users in Tijuana, Mexico. Glob Public Health 2014; 9:436-54. [PMID: 24650124 DOI: 10.1080/17441692.2014.893367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Deported injection drug users (IDUs) in Mexico may be vulnerable to HIV infection following expulsion from the USA. We examined factors associated with HIV risk perception among a sample of deportees in Tijuana. From January to April 2010, 313 male IDUs who reported ever being deported from the USA completed a questionnaire. Overall, 35% (N=110) of deportees perceived HIV risk. In multivariate logistic regression analyses, factors independently associated with HIV risk perception included ever having a steady female partner in Tijuana post-deportation (adjusted odds ratio [AOR]: 2.26; 95% confidence interval [CI]: 1.01-5.07) and years spent in a US prison (AOR: 1.29 per year; 95% CI: 1.13-1.48). Conversely, years of drug injection use (AOR: 0.95 per year; 95% CI: 0.91-0.99), ever witnessing family members use drugs prior to first migration trip (AOR: 0.24; 95% CI: 0.09-0.65), years of residence in the USA (AOR: 0.91 per year; 95% CI: 0.84-0.98) and being a Tijuana native (AOR: 0.40; 95% CI: 0.16-0.99) were negatively associated with HIV risk perception. US-Mexico border cities that receive deported migrants should target HIV prevention interventions to specific subgroups, including drug-using male deportees. Interventions should consider migrant's time in the USA, the role of their social networks, and reducing missed opportunities for HIV testing/education.
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Affiliation(s)
- Miguel Pinedo
- a Division of Global Public Health, Department of Medicine , University of California , San Diego , CA , USA
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Pinedo M, Burgos JL, Ojeda VD. A critical review of social and structural conditions that influence HIV risk among Mexican deportees. Microbes Infect 2014; 16:379-90. [PMID: 24583278 DOI: 10.1016/j.micinf.2014.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/17/2014] [Indexed: 11/27/2022]
Abstract
Mexican migrants who are deported from the US may be at elevated risk for HIV infection. Deportations of Mexican migrants by the US have reached record numbers. We critically reviewed existing literature to assess how social and structural conditions in post-deportation settings can influence Mexican deported migrants' HIV risk. We also identify critical research gaps and make research recommendations.
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Affiliation(s)
- Miguel Pinedo
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093, USA; Joint Doctoral Program in Public Health, San Diego State University and University of California San Diego (SDSU/UCSD), San Diego, CA, USA
| | - José Luis Burgos
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093, USA
| | - Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093, USA.
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Gilmer TP, Ojeda VD, Hiller S, Stefancic A, Tsemberis S, Palinkas LA. Variations in Full Service Partnerships and Fidelity to the Housing First Model. American Journal of Psychiatric Rehabilitation 2013. [DOI: 10.1080/15487768.2013.847769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ulibarri MD, Hiller SP, Lozada R, Rangel MG, Stockman JK, Silverman JG, Ojeda VD. Prevalence and characteristics of abuse experiences and depression symptoms among injection drug-using female sex workers in Mexico. J Environ Public Health 2013; 2013:631479. [PMID: 23737808 PMCID: PMC3666207 DOI: 10.1155/2013/631479] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/08/2013] [Accepted: 04/11/2013] [Indexed: 11/29/2022]
Abstract
This mixed methods study examined the prevalence and characteristics of physical and sexual abuse and depression symptoms among 624 injection drug-using female sex workers (FSW-IDUs) in Tijuana and Ciudad Juarez, Mexico; a subset of 47 from Tijuana also underwent qualitative interviews. Linear regressions identified correlates of current depression symptoms. In the interviews, FSW-IDUs identified drug use as a method of coping with the trauma they experienced from abuse that occurred before and after age 18 and during the course of sex work. In a multivariate linear regression model, two factors-ever experiencing forced sex and forced sex in the context of sex work-were significantly associated with higher levels of depression symptoms. Our findings suggest the need for integrated mental health and drug abuse services for FSW-IDUs addressing history of trauma as well as for further research on violence revictimization in the context of sex work in Mexico.
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Affiliation(s)
- Monica D. Ulibarri
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0849, USA
| | - Sarah P. Hiller
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 10111 N. Torrey Pines Road, La Jolla, CA 92093-0507, USA
| | - Remedios Lozada
- Prevencasa, Avenida Baja California 7580, Zona Norte, 22000 Tijuana, BC, Mexico
| | - M. Gudelia Rangel
- El Colegio de La Frontera Norte-Secretaria de Salud, Carretera Escenica Tijuana-Ensenada, Km. 18.5, San Antonio del Mar, 22560 Tijuana, BC, Mexico
| | - Jamila K. Stockman
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 10111 N. Torrey Pines Road, La Jolla, CA 92093-0507, USA
| | - Jay G. Silverman
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 10111 N. Torrey Pines Road, La Jolla, CA 92093-0507, USA
| | - Victoria D. Ojeda
- Division of Global Public Health, Department of Medicine, University of California, San Diego, 10111 N. Torrey Pines Road, La Jolla, CA 92093-0507, USA
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Hiller SP, Syvertsen JL, Lozada R, Ojeda VD. Social support and recovery among Mexican female sex workers who inject drugs. J Subst Abuse Treat 2013; 45:44-54. [PMID: 23375570 DOI: 10.1016/j.jsat.2012.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 12/07/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
This qualitative study describes social support that female sex workers who inject drugs (FSW-IDUs) receive and recovery efforts in the context of relationships with family and intimate partners. We conducted thematic analysis of in-depth interviews with 47 FSW-IDUs enrolled in an intervention study to reduce injection/sexual risk behaviors in Tijuana, Mexico. FSW-IDUs received instrumental and emotional social support, which positively and negatively influenced recovery efforts. Participants reported how some intimate partners provided conflicting positive and negative support during recovery attempts. Problematic support (i.e., well-intended support with unintended consequences) occurred in strained family relationships, limiting the positive effects of support. Mexican drug treatment programs should consider addressing social support in recovery curricula through evidence-based interventions that engage intimate partners, children and family to better reflect socio-cultural and contextual determinants of substance abuse.
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Affiliation(s)
- Sarah P Hiller
- Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, Institute of the Americas, La Jolla, CA 92093-0507, USA
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Ojeda VD, Burgos JL, Rangel AG, Lozada R, Vera A. U.S. drug use and migration experiences of Mexican female sex workers who are injection drug users. J Health Care Poor Underserved 2012; 23:1733-49. [PMID: 23698687 PMCID: PMC4232365 DOI: 10.1353/hpu.2012.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe U.S.-based drug/sex behaviors and correlates of lifetime U.S. drug use by Mexican female sex workers who inject drugs (FSW-IDUs). METHODS Between 2008-2010, 315 migrant FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires. RESULTS Twenty-seven percent (n=85) of FSW-IDUs were U.S. migrants; of these, 46% (n=39) were deportees. One-half of U.S.-migrant FSW-IDUs consumed illicit drugs in the U.S., and two-thirds of these injected drugs in the U.S. Among U.S. injectors, over 75% ever received or shared used injection equipment. The majority (92%) of U.S.-migrant FSW-IDUs never obtained U.S. drug treatment services. HIV prevalence was 4% among U.S.-migrant and 5% among non-U.S. migrant FSW-IDUs; 100% of U.S.-migrant and 75% of non-U.S. migrant FSW-IDUs were unaware of their HIV status. CONCLUSIONS Binational coordination to improve access to substance use treatment and HIV testing services in Mexico and the U.S. among marginalized binational migrants may be critical to containing HIV transmission.
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Affiliation(s)
- Victoria D Ojeda
- Division of Global Public Health, Department of Medicine, UCSD School of Medicine, University of California, San Diego, 10111 N. Torrey Pines Road, La Jolla, CA 92093-0507, USA.
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Robertson AM, Ojeda VD, Nguyen L, Lozada R, Martínez GA, Strathdee SA, Patterson TL. Reducing harm from HIV/AIDS misconceptions among female sex workers in Tijuana and Ciudad Juarez, Mexico: A cross sectional analysis. Harm Reduct J 2012; 9:35. [PMID: 22867427 PMCID: PMC3477120 DOI: 10.1186/1477-7517-9-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 07/13/2012] [Indexed: 11/10/2022] Open
Abstract
Background HIV prevalence is increasing among female sex workers (FSWs) in Mexico’s Northern border region, who experience multiple occupational risks. Improving vulnerable populations’ education, empowerment, and access to preventive services are important components of harm reduction strategies. Given the increasing interest in adapting harm reduction principles from drug use to sex work and other public health responses to the HIV epidemic, we used a sex work harm reduction framework to guide our investigation of FSWs’ HIV knowledge. Methods From 2004–2006, FSWs aged ≥18 years in Tijuana and Ciudad Juarez participated in a behavioral intervention study and completed structured interviews. Measures included HIV knowledge assessment and factors within each domain of our theoretical framework for sex work harms: (1) socio-demographic factors that may lead to sex work, (2) sex work characteristics and behaviors that may lead to harm, and (3) mutually reinforcing harms that lead to sex work and result from it (e.g., drug abuse). Negative binomial regression identified factors independently associated with suboptimal HIV knowledge (i.e., incorrect responses during the HIV knowledge assessment). Results Among 924 FSWs, the median proportion of incorrect responses was nearly one third (28% incorrect). Examination of item responses revealed misconceptions regarding specific transmission and prevention mechanisms, including prevention of mother to child transmission. Suboptimal HIV knowledge was independently associated with older age, lower education, living in Tijuana (vs. Ciudad Juarez), inconsistent condom use for vaginal sex with male clients, and lacking prior HIV testing. Conclusions Our application of a sex work harm reduction framework to the study of FSWs’ HIV knowledge is an important first step in enhancing HIV prevention efforts in Northern Mexican border cities. Our findings imply that interventions should identify and discredit local HIV misconceptions to improve knowledge of specific HIV transmission routes and self-protective strategies (e.g., condom negotiation). Interventions will require materials appropriate for women from diverse socio-economic backgrounds and may benefit from innovative harm reduction approaches such as peer education and outreach.
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Affiliation(s)
- Angela M Robertson
- Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Drive, Mail Code 0680, La Jolla, CA, USA.
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Robertson AM, Lozada R, Pollini RA, Rangel G, Ojeda VD. Correlates and contexts of US injection drug initiation among undocumented Mexican migrant men who were deported from the United States. AIDS Behav 2012; 16:1670-80. [PMID: 22246511 DOI: 10.1007/s10461-011-0111-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Preventing the onset of injection drug use is important in controlling the spread of HIV and other blood borne infections. Undocumented migrants in the United States face social, economic, and legal stressors that may contribute to substance abuse. Little is known about undocumented migrants' drug abuse trajectories including injection initiation. To examine the correlates and contexts of US injection initiation among undocumented migrants, we administered quantitative surveys (N = 309) and qualitative interviews (N = 23) on migration and drug abuse experiences to deported male injection drug users in Tijuana, Mexico. US injection initiation was independently associated with ever using drugs in Mexico pre-migration, younger age at first US migration, and US incarceration. Participants' qualitative interviews contextualized quantitative findings and demonstrated the significance of social contexts surrounding US injection initiation experiences. HIV prevention programs may prevent/delay US injection initiation by addressing socio-economic and migration-related stressors experienced by undocumented migrants.
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Gilmer TP, Ojeda VD, Fawley-King K, Larson B, Garcia P. Change in mental health service use after offering youth-specific versus adult programs to transition-age youths. Psychiatr Serv 2012; 63:592-6. [PMID: 22422015 DOI: 10.1176/appi.ps.201100226] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examined changes in service use associated with providing age-specific services for youths in their transitional years, ages 18–24. METHODS A quasi-experimental, difference-in-difference design with propensity score weighting was used to compare mental health service utilization (use of outpatient, inpatient, emergency, and justice system services) among 931 youths enrolled in outpatient programs specifically for transition-age youths and 1,574 youths enrolled in standard adult outpatient programs in San Diego County, California, from July 2004 through December 2009. RESULTS Among youths enrolled in outpatient programs geared toward youths of transitional age, the mean number of annual outpatient mental health visits increased by 12.2 (p<.001) compared with youths enrolled in standard adult outpatient programs. CONCLUSIONS Compared with traditional adult outpatient mental health programs, age-specific programs were associated with an increased use of outpatient mental health services. Future research is needed to assess the effectiveness of age-specific programs for transition-age youths and how use of these programs relates to improved clinical, educational, and vocational outcomes over time.
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Affiliation(s)
- Todd P Gilmer
- Division of Health Policy in the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622, USA.
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Gilmer TP, Ojeda VD, Leich J, Heller R, Garcia P, Palinkas LA. Assessing needs for mental health and other services among transition-age youths, parents, and providers. Psychiatr Serv 2012; 63:338-42. [PMID: 22337004 DOI: 10.1176/appi.ps.201000545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This qualitative study assessed the needs for mental health and other services among transition-age youths who were receiving services in youth-specific programs. METHODS Thirteen focus groups were conducted between June 2008 and January 2009. The purposefully sampled participants included transition-age youths age 18 to 24 who were receiving services in youth-specific programs (N=75, eight groups), parents of transition-age youths (N=14, two groups), and providers in the youth-specific programs (N=14, three groups). The qualitative analysis used an inductive approach in which investigators focused on generating themes and identifying relationships between themes. Through a process of repeated comparisons, the categories were further condensed into broad themes illustrating service needs. RESULTS Youths expressed needs for improved scheduling of services, stronger patient-provider relationships, and group therapies that address past experiences of violence, loss, and sexual abuse and that provide skills for developing and nurturing healthy relationships. Parents and providers expressed needs for increased community-based and peer-led services. Youths, parents, and providers all expressed needs for more housing options and for mentors with similar life experiences who could serve as role models, information brokers, and sources of social support for youths who were pursuing education and employment goals. CONCLUSIONS Findings from the focus groups suggest that there is room for improvement in the provision of services that are relevant to the current needs and life experiences of transition-age youths. Even within age-specific programs, improvements in services are needed to foster transitions to independence.
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Affiliation(s)
- Todd P Gilmer
- Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093-0622, USA.
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Robertson AM, Lozada R, Vera A, Palinkas LA, Burgos JL, Magis-Rodriguez C, Rangel G, Ojeda VD. Deportation experiences of women who inject drugs in Tijuana, Mexico. Qual Health Res 2012; 22:499-510. [PMID: 21917563 PMCID: PMC3556510 DOI: 10.1177/1049732311422238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Deportation from the United States for drug offenses is common, yet the consequences of deportation for women drug users are poorly documented. In 2008, in Tijuana, Mexico, we conducted an exploratory qualitative study of migration, deportation, and drug abuse by interviewing 12 Mexican injection-drug-using women reporting U.S. deportation. Women reported heavy drug use before and after deportation, but greater financial instability and physical danger following deportation than when in the United States. We identified an unmet need for health and social services among deported drug-using women, including HIV prevention, drug treatment, physical and mental health services, and vocational training. Binational coordination is needed to help deported women resettle in Mexico.
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Affiliation(s)
| | | | - Alicia Vera
- University of California–San Diego, La Jolla, California, USA
| | | | | | - Carlos Magis-Rodriguez
- Research Center for Sexually Transmitted Infections, HIV/AIDS Program of Mexico City, Mexico
| | - Gudelia Rangel
- College of the Northern Border, Tijuana, Baja California, Mexico
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Robertson AM, Rangel MG, Lozada R, Vera A, Ojeda VD. Male injection drug users try new drugs following U.S. deportation to Tijuana, Mexico. Drug Alcohol Depend 2012; 120:142-8. [PMID: 21835559 PMCID: PMC3245754 DOI: 10.1016/j.drugalcdep.2011.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/30/2011] [Accepted: 07/16/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Among male injection drug users (IDUs) in Tijuana, Mexico, U.S. deportation is associated with HIV transmission. Changing drug use behaviors following deportation, including the use of new drugs, may increase HIV risk but are understudied. We identify correlates of trying new drugs following male IDUs' most recent U.S. deportation to Mexico. METHODS In 2010, we recruited 328 deported male IDUs in Tijuana, Mexico. Questionnaires collected retrospective data on drug use and other HIV risk behaviors throughout migratory events. Logistic regression identified correlates of trying new drugs/combinations following their most recent deportations. Informed consent was obtained from all participants. RESULTS Nearly one in six men (n=52, 16%) tried new drugs following their most recent deportation, including heroin (n=31), methamphetamine (n=5), and heroin/methamphetamine combined (n=17). Trying new drugs following deportation was independently associated with U.S. incarceration (adjusted odds ratio [AOR]=3.96; 95% confidence interval [C.I.] 1.78, 8.84), increasing numbers of U.S. deportations (AOR=1.11 per deportation; C.I. 1.03, 1.20), feeling sad following deportation (AOR 2.69; C.I. 1.41, 5.14), and perceiving that one's current lifestyle increases HIV/AIDS risk (AOR 3.91; C.I. 2.05, 7.44). CONCLUSIONS Trying new drugs following U.S. deportation may be related to the unique contexts and stressors experienced by drug-abusing migrants as they attempt to reestablish their lives in Mexico. Findings imply an unmet need for health and social programs to alleviate pre- and post-deportation stressors faced by undocumented and return migrants in the U.S.-Mexico context.
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Affiliation(s)
- Angela M. Robertson
- San Diego State University/University of California, San Diego; Institute of the Americas, 10111 N. Torrey Pines Road, Mail Code 0507, La Jolla, CA 92093-0507
| | - M. Gudelia Rangel
- El Colegio de la Frontera Norte; Carretera Escénica Tijuana - Ensenada, Km. 18.5, San Antonio del Mar, Tijuana, Mexico; y Secretaría de Salud de México, Distrito Federal, México
| | - Remedios Lozada
- Patronato Pro-COMUSIDA; Ave. Baja California 7580, Zona Norte, Tijuana, Mexico
| | - Alicia Vera
- University of California, San Diego; Institute of the Americas, 10111 N. Torrey Pines Rd., Mail Code 0507, La Jolla, CA 92093-0507
| | - Victoria D. Ojeda
- University of California, San Diego; Institute of the Americas, 10111 N. Torrey Pines Rd., Mail Code 0507, La Jolla, CA 92093-0507
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Ojeda VD, Robertson AM, Hiller SP, Lozada R, Cornelius W, Palinkas LA, Magis-Rodriguez C, Strathdee SA. A qualitative view of drug use behaviors of Mexican male injection drug users deported from the United States. J Urban Health 2011; 88:104-17. [PMID: 21246301 PMCID: PMC3042081 DOI: 10.1007/s11524-010-9508-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Deportees are a hidden yet highly vulnerable and numerous population. Significantly, little data exists about the substance use and deportation experiences of Mexicans deported from the United States. This pilot qualitative study describes illicit drug use behaviors among 24 Mexico-born male injection drug users (IDUs), ≥ 18 years old, residing in Tijuana, Mexico who self-identified as deportees from the United States. In-person interviews were conducted in Tijuana, Mexico in 2008. Content analysis of interview transcripts identified major themes in participants' experiences. Few participants had personal or family exposures to illicit drugs prior to their first U.S. migration. Participants reported numerous deportations. Social (i.e., friends/family, post-migration stressors) and environmental factors (e.g., drug availability) were perceived to contribute to substance use initiation in the U.S. Drugs consumed in the United States included marijuana, heroin, cocaine, methamphetamine, and crack. More than half of men were IDUs prior to deportation. Addiction and justice system experiences reportedly contributed to deportation. After deportation, several men injected new drugs, primarily heroin or methamphetamine, or a combination of both drugs. Many men perceived an increase in their substance use after deportation and reported shame and loss of familial social and economic support. Early intervention is needed to stem illicit drug use in Mexican migrant youths. Binational cooperation around migrant health issues is warranted. Migrant-oriented programs may expand components that address mental health and drug use behaviors in an effort to reduce transmission of blood-borne infections. Special considerations are merited for substance users in correctional systems in the United States and Mexico, as well as substance users in United States immigration detention centers. The health status and health behaviors of deportees are likely to impact receiving Mexican communities. Programs that address health, social, and economic issues may aid deportees in resettling in Mexico.
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Affiliation(s)
- Victoria D Ojeda
- Division of Global Public Health, UCSD School of Medicine, University of California, San Diego, 10111 N. Torrey Pines Road, La Jolla, CA 92093-0507, USA.
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Loza O, Strathdee SA, Martinez GA, Lozada R, Ojeda VD, Staines-Orozco H, Patterson TL. Risk factors associated with chlamydia and gonorrhoea infection among female sex workers in two Mexico-USA border cities. Int J STD AIDS 2011; 21:460-5. [PMID: 20852194 DOI: 10.1258/ijsa.2010.010018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Female sex workers (FSWs) aged ≥18 years without known HIV infection living in Tijuana and Ciudad Juarez, Mexico who had recent unprotected sex with clients underwent interviews and testing for chlamydia and gonorrhoea using nucleic acid amplification. Correlates of each infection were identified with logistic regression. Among 798 FSWs, prevalence of chlamydia and gonorrhoea was 13.0% and 6.4%, respectively. Factors independently associated with chlamydia were younger age, working in Tijuana versus Ciudad Juarez and recent methamphetamine injection. Factors independently associated with gonorrhoea were working in Tijuana versus Ciudad Juarez, using illegal drugs before or during sex, and having a recent male partner who injects drugs. Chlamydia and gonorrhoea infection were more closely associated with FSWs' drug use behaviours and that of their sexual partners than with sexual behaviours. Prevention should focus on subgroups of FSWs and their partners who use methamphetamine and who inject drugs.
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Affiliation(s)
- O Loza
- College of Health Sciences, University of Texas at El Paso, El Paso, TX, USA
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Wagner KD, Pollini RA, Patterson TL, Lozada R, Ojeda VD, Brouwer KC, Vera A, Volkmann TA, Strathdee SA. Cross-border drug injection relationships among injection drug users in Tijuana, Mexico. Drug Alcohol Depend 2011; 113:236-41. [PMID: 20889270 PMCID: PMC3025041 DOI: 10.1016/j.drugalcdep.2010.08.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 08/19/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND International borders are unique social and environmental contexts characterized by high levels of mobility. Among drug users, mobility increases risk for human immunodeficiency virus (HIV) in part through its effects on the social environment. However, the social dynamics of drug users living in border regions are understudied. METHODS 1056 injection drug users (IDUs) residing in Tijuana, Mexico were recruited using respondent-driven sampling (RDS) from 2006 to 2007, and underwent surveys and testing for HIV, syphilis, and tuberculosis (TB). Using logistic regression on baseline data, we identified correlates of having ever injected drugs with someone from the US. RESULTS Almost half (48%) reported ever injecting drugs with someone from the US. In RDS-adjusted logistic regression, factors independently associated with having ever injected with someone from the US included: having greater than middle school education (Adjusted Odds Ratio [AOR] 2.91; 95% confidence interval [C.I.] 1.52, 5.91), speaking English (AOR 3.24, 95% C.I. 1.96, 5.36), age (AOR 1.10 per year; 95% C.I. 1.07, 1.14), age at initiation of injection drug use (AOR 0.90 per year; 95% C.I. 0.86, 0.94), homelessness (AOR 2.61; 95% C.I. 1.27, 5.39), and having ever been incarcerated (AOR 11.82; 95% C.I., 5.22, 26.77). No associations with HIV, syphilis, TB, drug use, or injection risk behavior were detected. CONCLUSION Findings suggest that IDU networks in Mexico and the US may transcend international borders, with implications for cross-border transmission of infectious disease. Binational programs and policies need to consider the structure and geographic distribution of drug using networks.
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Affiliation(s)
- Karla D. Wagner
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Robin A. Pollini
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Thomas L. Patterson
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive MC 0680; La Jolla, California, 92093-0680, USA
| | - Remedios Lozada
- Pro-COMUSIDA, Niños héroes 697, Oficina 1 y 6, Zona Norte, Tijuana 22000-Baja California; Mexico
| | - Victoria D. Ojeda
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Kimberly C. Brouwer
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Alicia Vera
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Tyson A. Volkmann
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
| | - Steffanie A. Strathdee
- Division of Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive MC 0507; La Jolla, California, 92093-0507, USA
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Ojeda VD, Strathdee SA. Sex work and the city: The social geography of health and safety in Tijuana, Mexico. Glob Public Health 2010. [DOI: 10.1080/17441690903468931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
We analyzed the impacts of nativity and mental health (MH) on work by gender for non-elderly adults using the 2002 National Survey on Drug Use and Health. We employed two indicators of MH - the K6 scale of Mental Illness (MI) and an indicator for symptoms of Mania or Delusions (M/D). Instrumental variable (IV) models used measures of social support as instruments for MI. Unadjusted work rates were higher for immigrants (vs US-born adults). Regressions show that MI is associated with lower rates of work among US-born males but not immigrant males and females; M/D is associated lower rates of work among US-born males and females, and among immigrant males. Results did not change using IV models for MI. Most persons with MI work, yet symptom severity reduces labor supply among natives especially. Immigrants' labor supply is less affected by MI.
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Affiliation(s)
- Victoria D Ojeda
- Division of Global Public Health, School of Medicine, University of California-San Diego, Institute of the Americas, 10111 N. Torrey Pines Rd., La Jolla, CA 92093-0507, USA.
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Loza O, Strathdee SA, Lozada R, Staines H, Ojeda VD, Martínez GA, Amaro H, Patterson TL. Correlates of early versus later initiation into sex work in two Mexico-U.S. border cities. J Adolesc Health 2010; 46:37-44. [PMID: 20123256 PMCID: PMC2818024 DOI: 10.1016/j.jadohealth.2009.06.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 06/01/2009] [Accepted: 06/04/2009] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine correlates of early initiation into sex work in two Mexico-U.S. border cities. METHODS Female sex workers (FSWs) >/=18 years without known HIV infection living in Tijuana and Ciudad Juarez who had recent unprotected sex with clients underwent baseline interviews. Correlates of initiation into sex work before age 18 were identified with logistic regression. RESULTS Of 920 FSWs interviewed in Tijuana (N=474) and Ciudad Juarez (N=446), 9.8% (N=90) were early initiators (<18 years) into sex work. Median age of entry into sex work was 26 years (range: 6-58). After adjusting for age, compared to older initiators, early initiators were more likely to use inhalants (21.1% vs. 9.6%, p=.002), initiate sex work to pay for alcohol (36.7% vs. 18.4%, p < .001), report abuse as a child (42.2% vs. 18.7%, p<.0001), and they were less likely to be migrants (47.8% vs. 62.3%, p=.02). Factors independently associated with early initiation included inhalant use (adjOR=2.39), initiating sex work to pay for alcohol (adjOR=1.88) and history of child abuse (adjOR=2.92). Factors associated with later initiation included less education (adjOR=0.43 per 5-year increase), migration (adjOR=0.47), and initiating sex work for better pay (adjOR=0.44) or to support children (adjOR=0.03). CONCLUSIONS Different pathways for entering sex work are apparent among younger versus older females in the Mexico-U.S. border region. Among girls, interventions are needed to prevent inhalant use and child abuse and to offer coping skills; among older initiators, income-generating strategies, childcare, and services for migrants may help to delay or prevent entry into sex work.
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Affiliation(s)
- Oralia Loza
- Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | | | - Remedios Lozada
- Patronato Pro-COMUSIDA, Zona Norte, Tijuana, Baja California, México
| | - Hugo Staines
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Cuidad Juárez, Cuidad Juárez, Chihuahua, México
| | - Victoria D. Ojeda
- Department of Medicine, University of California at San Diego, La Jolla, CA, USA
| | - Gustavo A. Martínez
- Salud y Desarrollo Comunitario de Ciudad Juárez, A.C.; Federación Mexicana de Asociaciones Privadas, Ciudad Juárez, Chihuahua, México
| | - Hortensia Amaro
- Institute on Urban Health Research, Northeastern University, Boston, MA, USA
| | - Thomas L. Patterson
- Department of Psychiatry, University of California at San Diego, La Jolla, CA, USA
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Deiss R, Garfein RS, Lozada R, Burgos JL, Brouwer KC, Moser KS, Zuniga ML, Rodwell TC, Ojeda VD, Strathdee SA. Influences of cross-border mobility on tuberculosis diagnoses and treatment interruption among injection drug users in Tijuana, Mexico. Am J Public Health 2009; 99:1491-5. [PMID: 19542040 PMCID: PMC2707467 DOI: 10.2105/ajph.2008.142166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to identify correlates of reported lifetime diagnoses of TB among injection drug users in the border city of Tijuana, Mexico. METHODS Injection drug users in Tijuana were recruited into a prospective cohort study during 2006 and 2007. We used weighted multivariate logistic regression to identify correlates of TB diagnoses. RESULTS Of the 1056 participants, 103 (9.8%) reported a history of TB, among whom 93% received anti-TB medication and 80% were diagnosed in the United States. Treatment was prematurely halted among 8% of patients; deportation from the United States was the cause of half of these treatment interruptions. History of travel to (odds ratio [OR] = 6.44; 95% confidence interval [CI] = 1.53, 27.20) or deportation from (OR = 1.83; 95% CI = 1.07, 3.12) the United States and incarceration (OR = 2.20; 95% CI = 1.06, 4.58) were independently associated with a reported lifetime diagnosis of TB. CONCLUSIONS Mobility and migration are important factors in identifying and treating TB patients diagnosed in the US-Mexico border region. Strengthening capacity on both sides of the border to identify, monitor, and treat TB is a priority.
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Affiliation(s)
- Robert Deiss
- Department of Family and Preventive Medicine, Division of International Health and Cross-Cultural Medicine, School of Medicine, University of California, San Diego, USA
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Gilmer TP, Ojeda VD, Fuentes D, Criado V, Garcia P. Access to public mental health services among older adults with severe mental illness. Int J Geriatr Psychiatry 2009; 24:313-8. [PMID: 18759380 PMCID: PMC2645478 DOI: 10.1002/gps.2123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Limited data are available on how older adults access public mental health systems. This study examines how uninsured or publicly insured older adults with severe mental illness in San Diego County initially accessed the public mental health system, as well as their subsequent use of public mental health services, as compared to younger adults. METHODS Data from San Diego County, 2002-2006, were used to examine how older adults initially accessed the public mental health system, and their utilization over the subsequent 90 days. Multivariate regression models were used to control for demographic and clinical characteristics. RESULTS Older adults (age 60 +) were more likely to access the public mental health system through the Psychiatric Emergency Response Team (PERT), a combined law-enforcement and psychiatric service that responds to psychiatric related 911 calls. Older adults were also less likely to receive follow-up care. This lower rate of follow-up was due to both the initial site of service--and an associated lower rate of follow-up among PERT clients--as well as a lower rate of follow-up among older adult clients initiating services in other sectors. CONCLUSIONS This paper suggests two areas for intervention that would improve access to care for older adults: improving linkages and referrals between PERT and outpatient providers; and additional efforts to retain older adults at outpatient programs.
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Affiliation(s)
- Todd P. Gilmer
- University of California, San Diego, Department of Family and Preventive Medicine, CA, USA, Correspondence to: T. Gilmer, University of California, San Diego, Department of Family and Preventive Medicine, 9500 Gilman Drive, la Jolla, CA 92093-0622, USA.
| | - Victoria D. Ojeda
- University of California, San Diego, Department of Family and Preventive Medicine, CA, USA
| | - Dahlia Fuentes
- University of Southern California, School of Social Work, Los Angeles, CA, USA
| | - Viviana Criado
- San Diego County Adult and Older Adult Mental Health Services, San Diego, CA, USA
| | - Piedad Garcia
- San Diego County Adult and Older Adult Mental Health Services, San Diego, CA, USA
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Ojeda VD, Strathdee SA, Lozada R, Rusch MLA, Fraga M, Orozovich P, Magis-Rodriguez C, De La Torre A, Amaro H, Cornelius W, Patterson TL. Associations between migrant status and sexually transmitted infections among female sex workers in Tijuana, Mexico. Sex Transm Infect 2009; 85:420-6. [PMID: 19188211 DOI: 10.1136/sti.2008.032979] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine associations between migration and sexually transmitted infection (STI) prevalence among Mexican female sex workers (FSW). METHODS FSW aged 18 years and older in Tijuana, Baja California (BC) underwent interviews and testing for HIV, syphilis, gonorrhoea and chlamydia. Multivariate logistic regressions identified correlates of STI. RESULTS Of 471 FSW, 79% were migrants to BC. Among migrant FSW, prevalence of HIV, syphilis, gonorrhoea, chlamydia and any STI was 6.6%, 13.2%, 7.8%, 16.3% and 31.1% compared with 10.9%, 18.2%, 13.0%, 19.0% and 42.4% among FSW born in BC. A greater proportion of migrant FSW were registered with local health services and were ever tested for HIV. Migrant status was protective for any STI in unadjusted models (unadjusted odds ratio 0.61, 95% CI 0.39 to 0.97). In multivariate models controlling for confounders, migrant status was not associated with an elevated odds of STI acquisition and trended towards a protective association. CONCLUSIONS Unexpectedly, migrant status (vs native-born status) appeared protective for any STI acquisition. It is unclear which social or economic conditions may protect against STI and whether these erode over time in migrants. Additional research is needed to inform our understanding of whether or how geography, variations in health capital, or social network composition and information-sharing attributes can contribute to health protective behaviours in migrant FSW. By capitalising on such mechanisms, efforts to preserve protective health behaviours in migrant FSW will help control STI in the population and may lead to the identification of strategies that are generalisable to other FSW.
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Affiliation(s)
- V D Ojeda
- Department of Psychiatry (0680), University of California San Diego, La Jolla, CA 92093-0680, USA
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Gilmer TP, Ojeda VD, Barrio C, Fuentes D, Garcia P, Lanouette NM, Lee KC. Adherence to antipsychotics among Latinos and Asians with schizophrenia and limited English proficiency. Psychiatr Serv 2009; 60:175-82. [PMID: 19176410 PMCID: PMC3235435 DOI: 10.1176/appi.ps.60.2.175] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The authors examined data for 7,784 Latino, Asian, and non-Latino white Medi-Cal beneficiaries with schizophrenia to determine the relationship between patients' preferred language for mental health services--English, Spanish, or an Asian language--and their adherence to treatment with antipsychotic medications. METHODS Data reflected 31,560 person-years from 1999 to 2004. Pharmacy records were analyzed to assess medication adherence by use of the medication possession ratio (MPR). Clients were defined as nonadherent (MPR<.5), partially adherent (MPR=.5-<.8), or adherent (MPR=.8-1.1) or as an excess filler of prescriptions (MPR<1.1). Regression models were used to examine adherence, hospitalization, and costs by race-ethnicity and language status. RESULTS Latinos with limited English proficiency were more likely than English-proficient Latinos to be medication adherent (41% versus 36%; p<.001) and less likely to be excess fillers (15% versus 20%; p<.001). Asians with limited English proficiency were less likely than English-proficient Asians to be adherent (40% versus 45%; p=.034), more likely to be nonadherent (29% versus 22%; p<.001), and less likely to be excess fillers (13% versus 17%; p=.004). When analyses controlled for adherence and comorbidities, clients with limited English proficiency had lower rates of hospitalization and lower health care costs than English-proficient and white clients. CONCLUSIONS Adherence to antipsychotic medications varied by English proficiency among and within ethnic groups. Policies supporting the training of bilingual and multicultural providers from ethnic minority groups and interventions that capitalize on patients' existing social support networks may improve adherence to treatment in linguistically diverse populations.
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Affiliation(s)
- Todd P. Gilmer
- Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622 (e-mail: ). Dr. Barrio and Ms. Fuentes are with the School of Social Work, University of Southern California, Los Angeles. Dr. Garcia is with San Diego County Adult and Older Adult Mental Health Services. Dr. Lanouette is with the Department of Psychiatry and Dr. Lee is with the Skaggs School of Pharmacy and Pharmaceutical Sciences, both at UCSD
| | - Victoria D. Ojeda
- Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622 (e-mail: ). Dr. Barrio and Ms. Fuentes are with the School of Social Work, University of Southern California, Los Angeles. Dr. Garcia is with San Diego County Adult and Older Adult Mental Health Services. Dr. Lanouette is with the Department of Psychiatry and Dr. Lee is with the Skaggs School of Pharmacy and Pharmaceutical Sciences, both at UCSD
| | - Concepcion Barrio
- Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622 (e-mail: ). Dr. Barrio and Ms. Fuentes are with the School of Social Work, University of Southern California, Los Angeles. Dr. Garcia is with San Diego County Adult and Older Adult Mental Health Services. Dr. Lanouette is with the Department of Psychiatry and Dr. Lee is with the Skaggs School of Pharmacy and Pharmaceutical Sciences, both at UCSD
| | - Dahlia Fuentes
- Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622 (e-mail: ). Dr. Barrio and Ms. Fuentes are with the School of Social Work, University of Southern California, Los Angeles. Dr. Garcia is with San Diego County Adult and Older Adult Mental Health Services. Dr. Lanouette is with the Department of Psychiatry and Dr. Lee is with the Skaggs School of Pharmacy and Pharmaceutical Sciences, both at UCSD
| | - Piedad Garcia
- Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622 (e-mail: ). Dr. Barrio and Ms. Fuentes are with the School of Social Work, University of Southern California, Los Angeles. Dr. Garcia is with San Diego County Adult and Older Adult Mental Health Services. Dr. Lanouette is with the Department of Psychiatry and Dr. Lee is with the Skaggs School of Pharmacy and Pharmaceutical Sciences, both at UCSD
| | - Nicole M. Lanouette
- Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622 (e-mail: ). Dr. Barrio and Ms. Fuentes are with the School of Social Work, University of Southern California, Los Angeles. Dr. Garcia is with San Diego County Adult and Older Adult Mental Health Services. Dr. Lanouette is with the Department of Psychiatry and Dr. Lee is with the Skaggs School of Pharmacy and Pharmaceutical Sciences, both at UCSD
| | - Kelly C. Lee
- Dr. Gilmer and Dr. Ojeda are affiliated with the Department of Family and Preventive Medicine, University of California, San Diego (UCSD), 9500 Gilman Dr., La Jolla, CA 92093-0622 (e-mail: ). Dr. Barrio and Ms. Fuentes are with the School of Social Work, University of Southern California, Los Angeles. Dr. Garcia is with San Diego County Adult and Older Adult Mental Health Services. Dr. Lanouette is with the Department of Psychiatry and Dr. Lee is with the Skaggs School of Pharmacy and Pharmaceutical Sciences, both at UCSD
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Depp C, Ojeda VD, Mastin W, Unützer J, Gilmer TP. Trends in use of antipsychotics and mood stabilizers among Medicaid beneficiaries with bipolar disorder, 2001-2004. Psychiatr Serv 2008; 59:1169-74. [PMID: 18832503 DOI: 10.1176/ps.2008.59.10.1169] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined longitudinal trends in the use of mood stabilizers and antipsychotics for treatment of bipolar disorder in a large public mental health system and whether trends differed by age, gender, and race-ethnicity. METHODS Data were from Medicaid beneficiaries with bipolar disorder receiving services in the San Diego County public mental health system from 2001 to 2004. For each year the proportion of clients receiving any pharmacotherapy and the proportion receiving antipsychotics alone, mood stabilizers alone, or antipsychotics plus mood stabilizers were determined. Pharmacotherapy use was examined by age, gender, and race-ethnicity. RESULTS A total of 1,473 clients were identified who were continuously enrolled in Medicaid during the four years. Seventy-five percent received mood stabilizers or antipsychotics. Of this group, 33% received antipsychotics alone, 23% mood stabilizers alone, and 44% both antipsychotics and mood stabilizers. The percentage receiving mood stabilizers or antipsychotics increased significantly, from 71% in 2001 to 77% in 2004, primarily because of increased use among women. Use of mood stabilizers alone declined from 25% to 20%, and use of antipsychotics alone increased from 32% to 36%. African Americans and Latinos were less likely than non-Latino whites to receive mood stabilizers or antipsychotics; this pattern was stable over time. CONCLUSIONS Antipsychotics were prescribed for a larger percentage of clients than mood stabilizers. Persons from ethnic minority groups were less likely to receive either medication type. Research is needed to examine factors affecting pharmacotherapy in bipolar disorder and mechanisms underlying racial-ethnic disparities in pharmacotherapy, including their persistence over time.
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Affiliation(s)
- Colin Depp
- Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA 92093-0622, USA
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Ojeda VD, Bergstresser SM. Gender, race-ethnicity, and psychosocial barriers to mental health care: an examination of perceptions and attitudes among adults reporting unmet need. J Health Soc Behav 2008; 49:317-334. [PMID: 18771066 DOI: 10.1177/002214650804900306] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Though researchers have described psychosocial barriers to mental health care-seeking, limited research has examined ways in which gender and race-ethnicity are associated with individuals' perceptions and attitudes. This study investigates correlates of psychosocial barriers to mental health care in a population of adults reporting unmet need for mental health care, focusing on gender and race-ethnicity. Data are from the 2002 National Survey on Drug Use and Health. Multivariate analyses show that non-Latino white male status is positively associated with stigma avoidance and mistrust/fear of the mental health care system. Persons of lower income or educational status are less likely to report negative attitudes towards care. Findings imply a need to reconsider the roles of gender race-ethnicity, and socioeconomic status within investigations of psychosocial barriers to care. Future research should examine the relationships among social status, help-seeking behaviors, and attitudes toward mental health care.
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Affiliation(s)
- Victoria D Ojeda
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093-0622, USA.
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