Drug treatment, health, and social service utilization by substance abusing women from a community-based sample.

BACKGROUND: Substance abuse is an escalating problem among poor urban Latina women; little is known about their access to drug treatment and to needed social and health services. OBJECTIVE: Our objectives were to (1) examine the need and use of substance abuse treatment, health services, government entitlement programs, and social service programs among cocaine and heroin using Puerto Rican women and (2) identify whether service use predicts their prospective entry into drug treatment. RESEARCH DESIGN: This was a 3-wave longitudinal study of community substance abusing women evaluated on substance abuse and dependence using diagnostic measures, and hair and urine toxicological screens. Information was collected on self-reported need and receipt of substance abuse treatment, social services, general health services, and government entitlement programs. SUBJECTS: A community sample of cocaine-, crack-, and/or heroin-using women from copping areas in low-income urban centers of Puerto Rico were interviewed in 1997-1998 with 2 follow-up periods. RESULTS: Drug treatment, health, and social service utilization were low relative to need for services throughout all data waves. Social service utilization predicted prospective entry into drug treatment but not contacts with general health services or government entitlement programs. CONCLUSION: Drug-abusing women in low-income urban areas in Puerto Rico have substantial unmet substance abuse treatment, health, and social service needs. Mandated treatment by social service agencies may explain their clients' higher likelihood of entering drug treatment. Building linkages between service sectors to augment entry into drug treatment is essential for meeting the complex needs of this underserved population.

Understanding hard-core drug use among urban Puerto Rican women in high-risk neighborhoods.

The objectives of the current study were to determine the incidence and prevalence of hard-core drug (HCD) use and to explore the predictors of HCD use in a three-wave longitudinal study of women ages 18-35 living in urban areas of high drug traffic in Puerto Rico. Prevalence of HCD use was determined by positive self-report or positive toxicological tests for crack, cocaine, or heroine at baseline and follow-up periods. Incidence density was calculated using Poisson methods. Predictors of HCD use were identified using the generalized estimating equation (GEE) approach. Prevalence rates fluctuated between 16.3 at baseline and 12.6 and 14.6 at subsequent waves. Incidence of crack/cocaine or heroine ranged from 7.4 to 6.3 per 100 person years. Low education, unemployment, current alcohol use, and severe partner violence predict incident HCD use. Therefore, prevention programs for HCD use must consider strategies to promote social mobility and empowerment and to mitigate violence against women.

Understanding caregivers' help-seeking for Latino children's mental health care use.

BACKGROUND: Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why. OBJECTIVE: The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. SUBJECTS: Data were collected from a random Puerto Rican community sample of caregiver-child dyads. MEASURES: Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. STATISTICAL METHODS: The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care. RESULTS: The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis. CONCLUSION: : Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.