1. Substance Use and Treatment Seeking in Colonias and Urban Areas of the Texas-Mexico Border
Principal Investigator: Dick Spence & Lynn Wallisch
School of Social Work, University of Texas at Austin
Supported by NIH/NIDA R01-DA14794

2. Purpose
To improve understanding of disparities in drug use and service utilization, and related attitudes, perceptions, and behaviors among border residents.

3. Texas Border Region
El Paso Urban
There are multiple definitions of “Border” depending on agency & purpose. In our study, we limited our potential generalizability to the 14 counties directly abutting the Rio Grande.

4. Sample 1200 respondents aged 18+ 400 - El Paso city
400 - Lower Rio Grande Valley – Urban (Brownsville, McAllen, Harlingen, Edinburg, San Benito, Mission, Pharr, Weslaco, and other small towns)
400 - Lower Rio Grande Valley – Colonias
- Represents 80% of the Border population
- Cooperation rate was 73%

5. Methods Face-to-face interviews – English or Spanish
Trained, bilingual, community residents
Post-stratification weights were calculated for probability of selection and demographics.
Sample involved multistage clustering and stratification.
SUDAAN was used to adjust for design effect.
In the colonias a slightly different sampling design was used. A first challenge in sampling in colonias is that there is no really good, up-do-date sampling frame that lists all colonias and their characteristics, and colonias are not identified as such in the census, so sampling census block groups in colonia locations would have lumped colonia and other rural residents together. We relied on the listing from the TWDB, which dates from 1996 and is significantly out of date, with colonias changing in size and density fairly rapidly, and some becoming incorporated as towns and losing their colonia designation. (868 colonias in H, 118 in C).
Since there is much variation in colonias and the question arises of how to sample them in a representative way, we based our sampling on a theory developed by Peter Ward, a geographer and professor of public affairs and sociology at UT, who has done extensive work in colonias. His theory is that colonias must reach a certain size and density in order to benefit from more social organization and cohesion. So we chose to sample colonias that were small and large, and sparse and dense, to see whether these factors were related to drug and alcohol use – perhaps through cohesion and informal social control and greater resources in terms of access to information about treatment.
So, colonias were sampled based on physical size (i.e. number of lots) and density (i.e. proportion of lots that are occupied). We had to do a “windshield” survey to supplement the TWDB info and get a true population of colonias by size and density that we could sample from. Very labor intensive, and very hard to find the smaller and less dense colonias, so the resulting sample was not 4 x 4.
The final sample included 19 colonias stratified by size and density. As in the metro areas the sample was also stratified by age and gender.
To increase participation rates, and because the surveys were long and intrusive, each participant was paid $20. The cooperation rates were 73 in EP, 69 in V and 83 in C. (C+SO/C+SO+RF). Data collected from March 2002 – July All IVers were bilingual and about 1/3 of the surveys were done using the Spanish version.

6. Respondent Characteristics
Some demographic characteristics of the sample: the sites are similar in gender and age structure (adults only; median age in V is slightly lower than in EP).
Largest % of non Hispanics in EP (21%) & almost none in C.
Educ is highest in EP, lowest in C. Income lowest in C. % employed similar in EP & C, lowest in V.
Data for Texas are from 2002 census; except data for health insurance coverage are from National Health Interview Survey for Jan-June 2003, and refer to adults nationally. Note that nationally, rates for Hispanics were about double rates for all people.

7. Colonias
Rural or peri-urban communities with inadequate infrastructure (running water, sewers, electricity, paved roads, police & other social services)
About 400,000 people live in 1800 colonias on the Texas border
Offers the possibility of affordable land ownership, but contracts and financing are often exploitative.
In the colonias a slightly different sampling design was used. A first challenge in sampling in colonias is that there is no really good, up-do-date sampling frame that lists all colonias and their characteristics, and colonias are not identified as such in the census, so sampling census block groups in colonia locations would have lumped colonia and other rural residents together. We relied on the listing from the TWDB, which dates from 1996 and is significantly out of date, with colonias changing in size and density fairly rapidly, and some becoming incorporated as towns and losing their colonia designation. (868 colonias in H, 118 in C).
Since there is much variation in colonias and the question arises of how to sample them in a representative way, we based our sampling on a theory developed by Peter Ward, a geographer and professor of public affairs and sociology at UT, who has done extensive work in colonias. His theory is that colonias must reach a certain size and density in order to benefit from more social organization and cohesion. So we chose to sample colonias that were small and large, and sparse and dense, to see whether these factors were related to drug and alcohol use – perhaps through cohesion and informal social control and greater resources in terms of access to information about treatment.
So, colonias were sampled based on physical size (i.e. number of lots) and density (i.e. proportion of lots that are occupied). We had to do a “windshield” survey to supplement the TWDB info and get a true population of colonias by size and density that we could sample from. Very labor intensive, and very hard to find the smaller and less dense colonias, so the resulting sample was not 4 x 4.
The final sample included 19 colonias stratified by size and density. As in the metro areas the sample was also stratified by age and gender.
To increase participation rates, and because the surveys were long and intrusive, each participant was paid $20. The cooperation rates were 73 in EP, 69 in V and 83 in C. (C+SO/C+SO+RF). Data collected from March 2002 – July All IVers were bilingual and about 1/3 of the surveys were done using the Spanish version.

14. Alcohol and Drug Use: Changes Since 1996

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16. ** *

17. Social and Neighborhood Conditions and Attitudes

18. Drug Availability and Visibility in Neighborhood, by Site
IF TIME Couple of other interesting topics
20. Drug Availability and Drug Use Visibility in Neighborhood. This slide shows that about 56% of respondents – with nsd across sites – said it would be easy or very easy for them to acquire MJ if they wanted to get some, and 45% said it would be easy to get other drugs like cocaine, crack or heroin. Here, residents of colonias were more likely (55%) than residents of the two urban sites (49 EP & 42V – diff V-C sig) to say that drugs other than MJ were easy to obtain.
In response to the Q: how much evidence of alcohol or drug use among children under age 14 do you see in your neighborhood? % said they saw some or a lot – slightly more in colonias. There was a bigger difference across sites in the percentage who said they saw some or a lot of alcohol or drug abuse among adults in their communities: 18-19% of respondents in the two urban areas and more than double or 46% of respondents in colonias.

19. Drug Trafficking Attitudes, by Site
Drug trafficking. About 80% of all respondents agreed or strongly agreed with the statement, “There is a lot of drug trafficking in this area” WELL DUH. (nsd across sites) and most agreed that it was associated with corruption, violence and crime. However, about 20% also agreed that drug trafficking might have some positive economic benefits for the area and that drug dealing can be a good way for people to raise themselves out of poverty (the latter statement was endorsed by 29 % of colonia residents vs 20% of urban residents).

20. Service Utilization

21. What would you do if you had a drinking or drug problem that interfered with your daily activities?
Other = treat self, visit curandero, DK.
Notable differences: Colonias more likely than other sites to say medical/professional treatment. EP more likely than other sites to say self-help group.

22. Treatment Experience, among those potentially in need.
This is the previous treatment experience among those who would have been potentially “eligible” for seeking treatment, meaning they had a self-acknowledged problem (3 Q: was there ever a time in your life you thought you might have a problem with drinking or with drugs or have you ever talked with anyone about a drug or alcohol problem you yourself had), or they scored as having symptoms of abuse or dependence on the DSM questions).
Among them, about 18% had ever attended a self help group, 8% had ever gotten formal treatment, and another 6% had wanted treatment but failed to get it. You can see that the percentage who had ever had treatment was lowest in the Valley; yet the percentage who had wanted but failed to get treatment was highest there.
The barriers cited by those who had wanted but failed to get treatment were cost (55%), didn’t know where to go (54%), no place nearby (27%), thought it wouldn’t help or nobody would understand their problem (41%), embarrassment/didn’t want anyone to know (39%), or logistics, such as child care, transportation, not enough help at home (34%).
Although it has been suggested that culture and language can represent barriers to medical care in the border region, worry about not finding anyone who spoke their language or who was from the same ethnic background was not reported as a barrier.
Note: Potentially in need of treatment was defined as alcohol or drug abuse or dependence in past year, or ever having thought one had a problem with alcohol or drugs.

23. Perceived Barriers as Percentage of Persons Who Wanted but Failed to Receive Care