95

copy 2009 Springer Publishing CompanyHispanic Health Care International Vol 7 No 2 2009 DOI 1018911540ndash41537295

A Comparative Health Survey of Two Colonias Located on the

USMexico Border Robert L Anders DrPh FAAN

University of Texas at El Paso

Eduardo Peacuterez-Eguiacutea PhD Universidad Autoacutenoma de Ciudad Juaacuterez Chihuahua Meacutexico

Jorge Ibarra MD MPHCatherine Camilletti PhDNathaniel H Bean MS (c) University of Texas at El Paso

Luis Flores-Padilla PhD Instituto Mexican del Seguro Social Juaacuterez Chihuahua Meacutexico

Tom Olson PhDKris Robinson

John S Wiebe PhDRena DiGregorio PhD (c)Guillermina Solis PhD (c)

Justin Albrechtsen PhD (c) University of Texas at El Paso

Melchor Ortiz PhD University of Texas at El Paso Health Sciences Center

Little is known about how health disparities affect the health status and general health perceptions of Hispanics The purpose of this study was to conduct a health survey of participants living in two colonias one in El Paso Texas and the other in Cd Juarez Mexico Household sampling included 491 participants Instruments included a demographic questionnaire the SASH ISS CAGE and the SF36v2 Mean years of education was 8 years Average annual household income was $12440 and 259 of the sample admitted to smoking About 59 had a CAGE score greater than 2 The self-report rate of diabetes was around 138 24 were depressed and 169 were suffering from an anxiety disorder The SF36v2 composite functional health status scores mirrored the national norms with the Mexico scores slightly below the US averages SASH score for the Texas residents was 155 The average resident of the colonia has many health disadvantages when compared to other parts of the country beyond the USMexico border

Poco se sabe acerca de coacutemo las disparidades de salud afectan el estado de salud y las percepciones generales de salud en los Hispanos El propoacutesito de este estudio fue conducir una encuesta de salud de participantes residentes en dos Colonias de la Frontera una en El Paso Texas y otra en Ciudad Juaacuterez Meacutexico La muestra de hogares incluyoacute 491 participantes Los instrumentos incluyeron un cuestionario demograacutefico el SASH ISS CAGE y el SF-36 v2 El promedio de escolaridad fue de

Anders et al

96

8 antildeos El promedio anual de ingreso por hogar fue de $12440 y 259 individuos en la muestra admitieron ser fumadores Alrededor de 59 obtuvieron un puntaje del CAGE mayor de 2 La tasa auto-declarada de diabetes fue de 138 24 declararon estar deprimidos y 169 declararon padecer de un desorden de ansiedad Los puntajes del SF-36 v2 que midieron el estado funcional de salud fueron semejantes a las normas nacionales pero los puntajes de Meacutexico estuvieron ligera-mente por debajo de los puntajes de los Estados Unidos El puntaje del SASH para los participantes en Texas fue de 155 Los habitantes promedio de la Colonia fronteriza en Meacutexico tuvieron maacutes desventajas de salud comparados con habitantes de localidades maacutes allaacute de la Frontera MeacutexicoEstados Unidos

Keywords health disparities Hispanics minority poor underserved border health

Mexico and the United States share a 2000-mile-long border with one another (Barry 2000) While these two countries are distinct from

one another the area along the border is a blending of both cultures For example in El Paso Texas which is situated on the USMexico border there are 50 more cases of tuberculosis than in the rest of the country and the number of cases of Hepatitis A is five times the national average (Brennan 1997) There are 179 mil-lion people living near the USMexico border (Moya Torrex Solorzanoacute amp Huerta 2004) Of this population 637 live on the US side of the border while 363 live on the Mexico side of the border (Moya et al 2004) In 2004 it was estimated that 47 of those liv-ing on the border were under the age of 20 (Moya et al 2004) While the area along the border is a blending of cultures there can be great differences between the two countries in terms of life expectancy health and dis-ease prevalence In the border area the primary causes of mortality on the US side are heart disease malig-nant tumors diabetes cerebrovascular diseases chronic obstructive pulmonary disease accidents pneumonia and influenza Alzheimerrsquos disease liver disease and cir-rhosis and suicide (Moya et al 2004 The US-Mexico Border Diabetes Prevention and Control Project 2007) On the Mexico side of the border the primary causes of mortality are diabetes heart disease malignant tumors diabetes mellitus accidents cerebrovascular disease chronic liver disease and cirrhosis chronic obstructive pulmonary disease pneumonia and influenza disease originating in the prenatal period and homicide (Moya et al 2004 The US-Mexico Border Diabetes Prevention and Control Project 2007)

In 2005 the World Health Organization (WHO) determined that a male living in the United States was expected to live for 75 years but was only expected to have 67 years of healthy living (WHO 2002 2005) The WHO also determined that a female living in the United States could expect to live for 80 years but was only expected to have 71 years of healthy living Additionally the WHO determined that a male living

in Mexico was expected to live for 72 years but was only expected to have 63 years of healthy living a female liv-ing in Mexico was expected to live for 77 years but was only expected to have 68 years of healthy living (WHO 2002 2005)

The WHO also collects data on several health statistics of countries around the world In 2000 they determined that 311 of males over 15 years living in the United States were obese compared to 186 of males over 15 years living in Mexico while they determined that 332 of females over 15 years living in the United States were obese compared to 281 of females over 15 years living in Mexico (WHO 2000) In 2005 the WHO estimated that per 100000 people over 15 years in the United States 508 were living with HIVAIDS and 34 were living with tuberculosis while per 100000 people over 15 years in Mexico 244 were living with HIVAIDS and 269 were living with tuberculosis (WHO 2005)

Additionally the WHO collects data on how much a countryrsquos government spends on health care for its citizens every year In 2003 the WHO estimated that the United States spent 154 of its GDP on health care and that 189 of the US governmentrsquos total expenditures went toward health care During this same year the WHO estimated that Mexico spent 65 of its GDP on health care and that 129 of the Mexican governmentrsquos total expenditures went toward health care (WHO 2004)

Much of the health research on individuals of Mexican heritage is done with Mexican American immigrants Research with Mexicans living in Mexico is difficult to find Additionally very little is known about the functional health and health literacy of Mexicans and Mexican Americans living in unincorporated colonias along the USMexico border The specific aims of this descriptive study were to conduct a health survey of resi-dents living in a colonia located in El Paso County and those living across the USMexico border in a colonia located in Juarez Chihuahua Mexico to (a) assess the functional health status (b) assess the perceived impor-tance of local health problems and (c) compare the

A Comparative Health Survey

97

who had a PCS of 433 and an MCS of 521 (Cleary amp Howell 2006 ) Additionally these researchers found that males over 75 years had a PCS of 430 and an MCS of 513 compared to same-aged females who had a PCS of 438 and an MCS of 498 (Cleary amp Howell 2006) These researchers also looked at each of the different components of the scale for their entire sample of males and females 65 years and older This samplersquos overall PCS was 433 and their MCS was 511 The physical functioning score was 422 role limitation due to physical health score was also 422 social functioning score was 484 bodily pain score was 473 general mental health score was 516 role limitation due to emotional problems was 447 vitality was 503 and general health was 473 (Cleary amp Howell 2006) These scores can be compared to data on SF-36 from a Mexican sample presented later

MEXICO

USMBHC and PAHO determined that on the Mexico side of the USMexico border the primary causes of mortality were from heart disease malignant tumors diabetes mel-litus accidents cerebrovascular disease chronic liver dis-ease and cirrhosis chronic obstructive pulmonary disease pneumonia and influenza disease originating in the pre-natal period and homicide (Moya et al 2004) Several of the primary health concerns along the US-Mexico border are the same in both countries (USMBHC 2003) Cardiovascular disease cancer accidental injury diabetes mellitus cerebrovascular disease chronic obstructive pul-monary disease pneumonia and influenza and chronic liver disease and cirrhosis are prevalent on both sides of the border Additionally tuberculosis and hepatitis are primary health concerns in both Texas and Mexico (Brennan 1997 USMBHC 2003) There are other impor-tant health concerns on the USMexico border Of pri-mary concern is that individuals in this area have poor access to health care (USMBHC 2003) On the Mexico side of USMexico border the mortality rate is higher than in the rest of Mexico (USMBHC 2003) Additionally on the Mexico side of the border the rate of tuberculosis diabetes and hepatitis A are higher than in the rest of Mexico On the US side of the border there is a higher rate of gonorrhea salmonellosis shingellosis diabetes and hepatitis A (USMBHC 2003 The US-Mexico Border Diabetes Prevention and Control Project 2007)

While not pointed out as a primary health concern the infant mortality rate is higher in Mexico than it is in the United States In 2005 the WHO reported the infant mortal-ity rate in Mexico at 22 per 1000 live births (WHO 2005)

As mentioned previously another important health indicator for an area is DALY scores Very little data was found on DALY scores for Mexico or the US-Mexico bor-der area specifically but there is some data from PAHO on DALY scores for Latin America and the Caribbean

findings found between the participants living in these two colonias

GENERAL HEALTH IN THE UNITED STATES

The United StatesndashMexico Border Health Commission (USMBHC) and the Pan American Health Organization (PAHO) determined that on the US side of the USMexico border the primary causes of mortality were from heart disease diabetes malignant tumors cerebrovascular diseases chronic obstructive pulmonary disease accidents pneumonia and influenza Alzheimerrsquos disease liver dis-ease and cirrhosis and suicide (Moya et al 2004 The US-Mexico Border Diabetes Prevention and Control Project 2007) Infant mortality does not seem to be a pri-mary concern in the United States In 2005 WHO reported that the US infant mortality rate was only 7 per 1000 live births (WHO 2005)

Another important health indicator is the disability adjusted life year (DALY) DALYs account for the amount of health burdens in an area that is not summarized by the arearsquos mortality rate DALYs also give an indication of how disabling certain diseases are (McKenna Michaud Murray amp Marks 2005) McKenna et al (2005) identified the primary health burden as indicated by DALY scores in the United States for both men and women as ischemic heart disease (McKenna et al 2005) Other diseases at the top of the list of health burdens in the United States are cerebrovascular disease cancer and dementia (McKenna et al 2005) These researchers also pointed out that there are differences in DALYs between men and women For men in the United States two primary causes of DALYs are road traffic injuries and violence while for women in the United States the primary causes of DALYs are osteoar-thritis unipolar depression and alcohol use (McKenna et al 2005) McKenna et al (2005) point out that while these health concerns may not affect the mortality rate for men and women in the United States they have a sig-nificant impact on their DALY scores Additionally HIVAIDS is also a significant contributor to DALY scores in the United States for both men and women

Additional health information from a group can be gleaned by examining scores from a multipurpose short-form health survey with only 36 questions (SF-36) The SF-36 generates an 8-scale profile of functional health and well-being scores physical and mental health sum-mary measures and a preference-based health utility index (Farivar Cunningham amp Hays 2007 ) Two summary measures result from this scale a physical component score (PCS) and a mental component score (MCS) Cleary and Howell discuss SF-36 scores for a group of elderly Americans (Cleary amp Howell 2006) The researchers found that males between 65 and 74 years had a PCS of 418 and an MCS of 533 compared to same-aged females

Anders et al

96

8 antildeos El promedio anual de ingreso por hogar fue de $12440 y 259 individuos en la muestra admitieron ser fumadores Alrededor de 59 obtuvieron un puntaje del CAGE mayor de 2 La tasa auto-declarada de diabetes fue de 138 24 declararon estar deprimidos y 169 declararon padecer de un desorden de ansiedad Los puntajes del SF-36 v2 que midieron el estado funcional de salud fueron semejantes a las normas nacionales pero los puntajes de Meacutexico estuvieron ligera-mente por debajo de los puntajes de los Estados Unidos El puntaje del SASH para los participantes en Texas fue de 155 Los habitantes promedio de la Colonia fronteriza en Meacutexico tuvieron maacutes desventajas de salud comparados con habitantes de localidades maacutes allaacute de la Frontera MeacutexicoEstados Unidos

Keywords health disparities Hispanics minority poor underserved border health

Mexico and the United States share a 2000-mile-long border with one another (Barry 2000) While these two countries are distinct from

one another the area along the border is a blending of both cultures For example in El Paso Texas which is situated on the USMexico border there are 50 more cases of tuberculosis than in the rest of the country and the number of cases of Hepatitis A is five times the national average (Brennan 1997) There are 179 mil-lion people living near the USMexico border (Moya Torrex Solorzanoacute amp Huerta 2004) Of this population 637 live on the US side of the border while 363 live on the Mexico side of the border (Moya et al 2004) In 2004 it was estimated that 47 of those liv-ing on the border were under the age of 20 (Moya et al 2004) While the area along the border is a blending of cultures there can be great differences between the two countries in terms of life expectancy health and dis-ease prevalence In the border area the primary causes of mortality on the US side are heart disease malig-nant tumors diabetes cerebrovascular diseases chronic obstructive pulmonary disease accidents pneumonia and influenza Alzheimerrsquos disease liver disease and cir-rhosis and suicide (Moya et al 2004 The US-Mexico Border Diabetes Prevention and Control Project 2007) On the Mexico side of the border the primary causes of mortality are diabetes heart disease malignant tumors diabetes mellitus accidents cerebrovascular disease chronic liver disease and cirrhosis chronic obstructive pulmonary disease pneumonia and influenza disease originating in the prenatal period and homicide (Moya et al 2004 The US-Mexico Border Diabetes Prevention and Control Project 2007)

In 2005 the World Health Organization (WHO) determined that a male living in the United States was expected to live for 75 years but was only expected to have 67 years of healthy living (WHO 2002 2005) The WHO also determined that a female living in the United States could expect to live for 80 years but was only expected to have 71 years of healthy living Additionally the WHO determined that a male living

in Mexico was expected to live for 72 years but was only expected to have 63 years of healthy living a female liv-ing in Mexico was expected to live for 77 years but was only expected to have 68 years of healthy living (WHO 2002 2005)

The WHO also collects data on several health statistics of countries around the world In 2000 they determined that 311 of males over 15 years living in the United States were obese compared to 186 of males over 15 years living in Mexico while they determined that 332 of females over 15 years living in the United States were obese compared to 281 of females over 15 years living in Mexico (WHO 2000) In 2005 the WHO estimated that per 100000 people over 15 years in the United States 508 were living with HIVAIDS and 34 were living with tuberculosis while per 100000 people over 15 years in Mexico 244 were living with HIVAIDS and 269 were living with tuberculosis (WHO 2005)

Additionally the WHO collects data on how much a countryrsquos government spends on health care for its citizens every year In 2003 the WHO estimated that the United States spent 154 of its GDP on health care and that 189 of the US governmentrsquos total expenditures went toward health care During this same year the WHO estimated that Mexico spent 65 of its GDP on health care and that 129 of the Mexican governmentrsquos total expenditures went toward health care (WHO 2004)

Much of the health research on individuals of Mexican heritage is done with Mexican American immigrants Research with Mexicans living in Mexico is difficult to find Additionally very little is known about the functional health and health literacy of Mexicans and Mexican Americans living in unincorporated colonias along the USMexico border The specific aims of this descriptive study were to conduct a health survey of resi-dents living in a colonia located in El Paso County and those living across the USMexico border in a colonia located in Juarez Chihuahua Mexico to (a) assess the functional health status (b) assess the perceived impor-tance of local health problems and (c) compare the

A Comparative Health Survey

97

who had a PCS of 433 and an MCS of 521 (Cleary amp Howell 2006 ) Additionally these researchers found that males over 75 years had a PCS of 430 and an MCS of 513 compared to same-aged females who had a PCS of 438 and an MCS of 498 (Cleary amp Howell 2006) These researchers also looked at each of the different components of the scale for their entire sample of males and females 65 years and older This samplersquos overall PCS was 433 and their MCS was 511 The physical functioning score was 422 role limitation due to physical health score was also 422 social functioning score was 484 bodily pain score was 473 general mental health score was 516 role limitation due to emotional problems was 447 vitality was 503 and general health was 473 (Cleary amp Howell 2006) These scores can be compared to data on SF-36 from a Mexican sample presented later

MEXICO

USMBHC and PAHO determined that on the Mexico side of the USMexico border the primary causes of mortality were from heart disease malignant tumors diabetes mel-litus accidents cerebrovascular disease chronic liver dis-ease and cirrhosis chronic obstructive pulmonary disease pneumonia and influenza disease originating in the pre-natal period and homicide (Moya et al 2004) Several of the primary health concerns along the US-Mexico border are the same in both countries (USMBHC 2003) Cardiovascular disease cancer accidental injury diabetes mellitus cerebrovascular disease chronic obstructive pul-monary disease pneumonia and influenza and chronic liver disease and cirrhosis are prevalent on both sides of the border Additionally tuberculosis and hepatitis are primary health concerns in both Texas and Mexico (Brennan 1997 USMBHC 2003) There are other impor-tant health concerns on the USMexico border Of pri-mary concern is that individuals in this area have poor access to health care (USMBHC 2003) On the Mexico side of USMexico border the mortality rate is higher than in the rest of Mexico (USMBHC 2003) Additionally on the Mexico side of the border the rate of tuberculosis diabetes and hepatitis A are higher than in the rest of Mexico On the US side of the border there is a higher rate of gonorrhea salmonellosis shingellosis diabetes and hepatitis A (USMBHC 2003 The US-Mexico Border Diabetes Prevention and Control Project 2007)

While not pointed out as a primary health concern the infant mortality rate is higher in Mexico than it is in the United States In 2005 the WHO reported the infant mortal-ity rate in Mexico at 22 per 1000 live births (WHO 2005)

As mentioned previously another important health indicator for an area is DALY scores Very little data was found on DALY scores for Mexico or the US-Mexico bor-der area specifically but there is some data from PAHO on DALY scores for Latin America and the Caribbean

findings found between the participants living in these two colonias

GENERAL HEALTH IN THE UNITED STATES

The United StatesndashMexico Border Health Commission (USMBHC) and the Pan American Health Organization (PAHO) determined that on the US side of the USMexico border the primary causes of mortality were from heart disease diabetes malignant tumors cerebrovascular diseases chronic obstructive pulmonary disease accidents pneumonia and influenza Alzheimerrsquos disease liver dis-ease and cirrhosis and suicide (Moya et al 2004 The US-Mexico Border Diabetes Prevention and Control Project 2007) Infant mortality does not seem to be a pri-mary concern in the United States In 2005 WHO reported that the US infant mortality rate was only 7 per 1000 live births (WHO 2005)

Another important health indicator is the disability adjusted life year (DALY) DALYs account for the amount of health burdens in an area that is not summarized by the arearsquos mortality rate DALYs also give an indication of how disabling certain diseases are (McKenna Michaud Murray amp Marks 2005) McKenna et al (2005) identified the primary health burden as indicated by DALY scores in the United States for both men and women as ischemic heart disease (McKenna et al 2005) Other diseases at the top of the list of health burdens in the United States are cerebrovascular disease cancer and dementia (McKenna et al 2005) These researchers also pointed out that there are differences in DALYs between men and women For men in the United States two primary causes of DALYs are road traffic injuries and violence while for women in the United States the primary causes of DALYs are osteoar-thritis unipolar depression and alcohol use (McKenna et al 2005) McKenna et al (2005) point out that while these health concerns may not affect the mortality rate for men and women in the United States they have a sig-nificant impact on their DALY scores Additionally HIVAIDS is also a significant contributor to DALY scores in the United States for both men and women

Additional health information from a group can be gleaned by examining scores from a multipurpose short-form health survey with only 36 questions (SF-36) The SF-36 generates an 8-scale profile of functional health and well-being scores physical and mental health sum-mary measures and a preference-based health utility index (Farivar Cunningham amp Hays 2007 ) Two summary measures result from this scale a physical component score (PCS) and a mental component score (MCS) Cleary and Howell discuss SF-36 scores for a group of elderly Americans (Cleary amp Howell 2006) The researchers found that males between 65 and 74 years had a PCS of 418 and an MCS of 533 compared to same-aged females

A Comparative Health Survey

97

who had a PCS of 433 and an MCS of 521 (Cleary amp Howell 2006 ) Additionally these researchers found that males over 75 years had a PCS of 430 and an MCS of 513 compared to same-aged females who had a PCS of 438 and an MCS of 498 (Cleary amp Howell 2006) These researchers also looked at each of the different components of the scale for their entire sample of males and females 65 years and older This samplersquos overall PCS was 433 and their MCS was 511 The physical functioning score was 422 role limitation due to physical health score was also 422 social functioning score was 484 bodily pain score was 473 general mental health score was 516 role limitation due to emotional problems was 447 vitality was 503 and general health was 473 (Cleary amp Howell 2006) These scores can be compared to data on SF-36 from a Mexican sample presented later

MEXICO

USMBHC and PAHO determined that on the Mexico side of the USMexico border the primary causes of mortality were from heart disease malignant tumors diabetes mel-litus accidents cerebrovascular disease chronic liver dis-ease and cirrhosis chronic obstructive pulmonary disease pneumonia and influenza disease originating in the pre-natal period and homicide (Moya et al 2004) Several of the primary health concerns along the US-Mexico border are the same in both countries (USMBHC 2003) Cardiovascular disease cancer accidental injury diabetes mellitus cerebrovascular disease chronic obstructive pul-monary disease pneumonia and influenza and chronic liver disease and cirrhosis are prevalent on both sides of the border Additionally tuberculosis and hepatitis are primary health concerns in both Texas and Mexico (Brennan 1997 USMBHC 2003) There are other impor-tant health concerns on the USMexico border Of pri-mary concern is that individuals in this area have poor access to health care (USMBHC 2003) On the Mexico side of USMexico border the mortality rate is higher than in the rest of Mexico (USMBHC 2003) Additionally on the Mexico side of the border the rate of tuberculosis diabetes and hepatitis A are higher than in the rest of Mexico On the US side of the border there is a higher rate of gonorrhea salmonellosis shingellosis diabetes and hepatitis A (USMBHC 2003 The US-Mexico Border Diabetes Prevention and Control Project 2007)

While not pointed out as a primary health concern the infant mortality rate is higher in Mexico than it is in the United States In 2005 the WHO reported the infant mortal-ity rate in Mexico at 22 per 1000 live births (WHO 2005)

As mentioned previously another important health indicator for an area is DALY scores Very little data was found on DALY scores for Mexico or the US-Mexico bor-der area specifically but there is some data from PAHO on DALY scores for Latin America and the Caribbean

findings found between the participants living in these two colonias

GENERAL HEALTH IN THE UNITED STATES

The United StatesndashMexico Border Health Commission (USMBHC) and the Pan American Health Organization (PAHO) determined that on the US side of the USMexico border the primary causes of mortality were from heart disease diabetes malignant tumors cerebrovascular diseases chronic obstructive pulmonary disease accidents pneumonia and influenza Alzheimerrsquos disease liver dis-ease and cirrhosis and suicide (Moya et al 2004 The US-Mexico Border Diabetes Prevention and Control Project 2007) Infant mortality does not seem to be a pri-mary concern in the United States In 2005 WHO reported that the US infant mortality rate was only 7 per 1000 live births (WHO 2005)

Another important health indicator is the disability adjusted life year (DALY) DALYs account for the amount of health burdens in an area that is not summarized by the arearsquos mortality rate DALYs also give an indication of how disabling certain diseases are (McKenna Michaud Murray amp Marks 2005) McKenna et al (2005) identified the primary health burden as indicated by DALY scores in the United States for both men and women as ischemic heart disease (McKenna et al 2005) Other diseases at the top of the list of health burdens in the United States are cerebrovascular disease cancer and dementia (McKenna et al 2005) These researchers also pointed out that there are differences in DALYs between men and women For men in the United States two primary causes of DALYs are road traffic injuries and violence while for women in the United States the primary causes of DALYs are osteoar-thritis unipolar depression and alcohol use (McKenna et al 2005) McKenna et al (2005) point out that while these health concerns may not affect the mortality rate for men and women in the United States they have a sig-nificant impact on their DALY scores Additionally HIVAIDS is also a significant contributor to DALY scores in the United States for both men and women

Additional health information from a group can be gleaned by examining scores from a multipurpose short-form health survey with only 36 questions (SF-36) The SF-36 generates an 8-scale profile of functional health and well-being scores physical and mental health sum-mary measures and a preference-based health utility index (Farivar Cunningham amp Hays 2007 ) Two summary measures result from this scale a physical component score (PCS) and a mental component score (MCS) Cleary and Howell discuss SF-36 scores for a group of elderly Americans (Cleary amp Howell 2006) The researchers found that males between 65 and 74 years had a PCS of 418 and an MCS of 533 compared to same-aged females

Anders et al

98

every 2 years) In this study 211 of respondents reported drinking five or more alcoholic beverages in one or two instances in the past 30 days and 149 of respondents indicated that they had five or more alcoholic beverages on three or more occasions in the past 30 days These percent-ages are higher than the US national average of 161 of respondents who had five or more drinks one or two times in the past 30 days and 128 who reported having five or more drinks three or more times in the past 30 days Additionally 67 indicated that they had five or more drinks on more than five occasions in the past 30 days

There is also data on the prevalence of smoking and tobacco use provided by the WHO (WHO 2003) For 2003 WHO reported that in the United States 241 of males 15 years and older reported having used tobacco and 192 of females 15 years and older reported having used tobacco The American Lung Association (ALA) also has data on the rates of smoking for different ethnicities in the United States In 2002 they reported that 167 of Hispanics smoked com-pared to 236 for non-Hispanic Whites and 408 of American IndianAlaska Natives (ALA 2004) The ALA also reported that Hispanic women tend to have lower rates of smoking 108 in 2002 compared to 227 of Hispanic men

SUBSTANCE ABUSE AND SMOKING IN MEXICO

Slone et al (2006) investigated alcohol use and abuse in a sample of Mexicans and found that younger participants drank more than older participants regardless of sex These researchers determined that men reported consum-ing more alcoholic drinks than women Specifically men were more likely to consume three to five drinks per occa-sion and were particularly more likely to consume five or more drinks per occasion than were women Additionally these researchers found that 49 of the men in their sample demonstrated alcohol misuse compared to only 14 of the women included in their sample These researchers defined alcohol misuse as 12 or more drinks in the respondentrsquos lifetime and at least one indication of alcohol abuse or dependence

The use of illegal drugs among Mexicans is less widely reported than is alcohol use among Mexicans In Mexico illegal drug use is more prevalent in the northern areas along the US border compared to other parts of the country (Medina-Mora amp Rojas 2003 Secretariacutea de Salubridad y Asistencia [SSA] 1998) A 1998 report found that the Mexican national average of illicit drug use for the general population of 12- to 65-year-olds was 53 In comparison the average rate of illicit drug use for the gen-eral population of 12- to 65-year-olds in Ciudad Juarez was higher at 92 and in Tijuana it was much higher at 147 (SSA 1998)

(PAHO 1998) PAHO identified the top 10 contribu-tors to DALY scores as access to drinking water alcohol consumption malnutrition occupation high-risk sexual behavior hypertension drug abuse tobacco use physical inactivity and air pollution (PAHO 1998) PAHO did point out work-related factors were the second cause of DALYs in Mexico but were the seventh leading cause of mortality (PAHO 1998)

Additional health information on Mexico is available through SF-36 scores Peek and her colleagues discuss SF-36 scores for a Mexican sample (Peek Ray Patel Stoebner-May amp Ottenbacher 2004) They report scores for males and females between 65 and 74 years and for males and females over 75 years on each component of the SF-36 However they do not report overall PCS or MCS scores For males and females between 65 and 74 years the physical functioning score was 6542 role limitation due to physical health score was 7057 social functioning score was 8262 bodily pain score was 7221 general mental health score was 8101 role limitation due to emotional problems was 8255 vitality was 6706 and general health was 6250 These were compared to males and females 75 years and older whose physical function-ing score was 5892 role limitation due to physical health score was also 6577 social functioning score was 8122 bodily pain score was 6819 general mental health score was 8074 role limitation due to emotional problems was 8076 vitality was 6423 and general health was 5936 While the older age grouprsquos scores were generally lower than the younger age grouprsquos scores the Mexican sample had higher scores than the American sample in each com-ponent of the SF-36

SUBSTANCE ABUSE AND SMOKING IN MEXICAN AMERICANS

Vega Alderate Kolody and Aguilar-Gaxiola (1998) exam-ined the effects of gender and acculturation on illicit drug use among adults of Mexican origin between the ages of 18 and 59 living in Fresno County California These research-ers reported that males had higher rates of using illicit drugs than did females Specifically the researchers found higher rates of marijuana cocaine hallucinogens heroin and inhalants in Mexican American males than in Mexican American females Additionally the researchers found that respondents with higher acculturation scores and who had been born in the United States were more likely to use illicit drugs than respondents with lower acculturation scores and who had not been born in the US

A 2002 Behavioral Risk Factor Surveillance System (BRFSS) conducted in El Paso County determined that there is some cause for concern regarding binge drinking statistics (Paso del Norte Health Foundation [PDNHF] 2005) (The BRFSS is a nationwide survey conducted by the Centers for Disease Control and Prevention [CDC]

A Comparative Health Survey

99

a current map of the area was used to gain a random selec-tion of blocks In the third stage three to five households per block were selected to obtain a sample size of 303 Only one individual 18 years or older from each house was asked to respond The response rate was near 90 and the final sample consisted of 274 respondents

Instruments

Data was collected on demographic variables acculturation socioeconomic status CAGE (Cutting down Annoyance by criticism Guilty feeling and Eye-openers) dealing with alcohol abuse selected BRFSS questions health history and medication adherence

Acculturation was measured using the Short Acculturation Scale for Hispanics (SASH) (Mariacuten Sabogal Mariacuten Otero-Sabogal amp Perez-Stable 1987) The SASH consists of 12 items that tap language use media prefer-ences and ethnic social relations Possible scores on the SASH range from 12 to 60 with higher scores suggesting greater acculturation to US culture The internal consis-tency of the scale is strong (α = 92) and validity has been demonstrated (Mariacuten et al 1987)

Socioeconomic status was measured using Hollings-headrsquos two-factor Index of Social Status (ISS) (Hollingshead amp Redlich 1958) This index requires only two factorsmdasheducation and occupationmdashto determine socioeconomic status A strong correlation exists between judged class and education and occupation ( r = 91) (Miller 1991) In local research the interrater reliability achieved with Hispanic medical patients ranged from 97 to 99 (Longoria Wiebe amp Meza 2003) The ISS shows strong evidence of criterion validity when correlated with other indices of socioeconomic status (Longoria et al 2003)

The CAGE Questionnaire (Ewing 1984) is a four-item self-report measure used to assess problem drinking It is commonly used in both clinical and research contexts because of its brevity and straightforward dichotomous (yesno) response format Studies have shown sensitivity ranging from 43 to 94 for the detection of alcohol abuse and alcoholism (Fiellin Reid amp OrsquoConnor 2000) There have been multiple translations of the instrument into Spanish Although there is limited psychometric data available on most of the translations Saitz Lepore Sullivan Amaro and Samet (1999) have validated their translation of the CAGE with a sample of 210 Hispanics living in the United States The CAGE was shown to have adequate psychometric properties and greater sensitiv-ity than a longer screening instrument the Alcohol Use Disorders Identification Test (AUDIT) instrument

The SF36 version 2 (S36vr2) was used to assess func-tional (physical and emotional) health status It is a self-administered 36-item questionnaire that takes approx-imately 7 to 10 minutes to complete The scale consists of eight separate subscales measuring physical health physical and emotional role function bodily pain social

There is also data on the prevalence of smoking and tobacco use provided by the WHO (2003) For 2003 the WHO reported that in Mexico 359 of males 15 years and older reported having used tobacco and 15 of females 15 years and older reported having used tobacco

METHODS

Setting Participants

El Paso Texas and Ciudad Juarez Chihuahua (Mexico) are situated on the USMexico border Along the border are pockets of underdeveloped areas known as colonias that lack sewer and water utilities The US Department of Housing and Urban Development (US Department of Health and Human Services [USDHHS] 1999) defines a colonia as a community within 150 miles of the USMexico border that lacks one or more of the following a potable water supply adequate sewage system paved roads andor decent safe and sanitary housing Data was collected from two colonias one on the US side of the border located in San Elizario in El Paso County Texas and the other on the Mexico side of the border in Felipe Angeles located in Ciudad Juarez Chihuahua The majority of the population in San Elizario is Mexican American while the majority of the population in Felipe Angeles is Mexican

Sample Design

In San Elizario a four-stage cluster sample design was used Given the census tract (CT) and population distribu-tion of San Elizario (United States Census Bureau [USCB] 2000) two strata were constructed Stratum 1 (CT 10403) where 72 of the households and the adult population over 18 years of age reside and stratum 2 (a combination of adjacent CT)

During the first stage a proportionate-to-size selection of households was performed Thus 72 of the house-holds were randomly selected from CT 10403 In the second stage a proportionate number of blocks in each stratum were randomly selected (33 blocks for CT 10403) In the third stage four to five households were selected per block to complete the 217 needed households In the final stage only one adult over 17 years old was randomly selected in each household for the interview

A 95 confidence level was used to ensure that the results obtained from our sample were similar to the tar-get population allowing for a plusmn 10 margin of error This design has the capacity to select a probability sample of adults in the selected sample frame and to infer results to all adults living within the selected area

In Felipe Angeles a three-stage cluster sample design was used First a list of potential colonias was identified The colonias had to have a population near 10000 be located in the immediate USMexico border area and be socially and economically deprived Once the colonia was selected

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At the interviews interviewers verified that the respon-dent had the most recent birthday in the household If the respondent did not have the most recent birthday in the household that person was identified and the interview was conducted with the appropriate individual

Confidentiality was stressed with all interviewers All interviewers were instructed to request the participant read and sign the informed consent form before begin-ning the survey Any questions or concerns regarding the content of the survey or the information being requested were to be addressed to ensure the comfort of all partici-pants in the survey In the event a participant was illiterate interviewers were directed to read the informed consent to the participant and allow them to indicate consent by drawing their mark on the informed consent In these cases interviewers were to sign the informed consent as a witness Once the participant provided informed consent interviewers were instructed to keep all documentation containing identifying information separate from sur-veys In addition interviewers were instructed to secure all completed surveys in a safe place and avoid taking completed informed consents or surveys into another household with them

After obtaining informed consent the interviewer pro-ceeded to conduct the survey Interviewers were directed to attempt to conduct the survey in a private setting away from others in the household Answers provided by other people in the household were not to be accepted unless the participant was physically unable to respond Skip patterns within the survey were reviewed during training and interviewers were advised to follow them closely All interviewers were trained to ask each question exactly as it was written in the survey providing the respondent with enough time to answer each question All responses were to be recorded immediately and were required to be selected from the options provided in the questionnaire Interviewers were not to suggest or answer questions for the respondent Finally before concluding the interview the interviewers were instructed to review the survey and verify answers provided by the participant as necessary

Data collection in Felipe Angeles was similar to that used in San Elizario In Felipe Angeles 10 trained bilingual students from UTEP went door-to-door to recruit respon-dents Two epidemiologists supervised data collection and assured completeness of the data The same standardized questionnaire was used in Felipe Angeles as was used in San Elizario

STATISTICAL ANALYSIS

There was no statistical comparison of the San Elizario and Felipe Angeles SF36v2 results to the national data However the SF36vr2 software produced the US national average for each SF-36 sub-area If the national mean for a sub-area was within two standard errors (calculated from

functioning mental health vitality and general health perceptions Response possibilities range from six-point scores to yesno ratings The instrument includes a score for each of the eight subscales as well as summary mental health and physical scales

The reliability of the SF36vr2 has been estimated using internal consistency test-retest and alternative forms (mental health scale only) methods Coefficients have exceeded 070 with some items measuring 080 Coefficients for the mental health and physical summary scores exceed 090 (Ware 2000) Reliability validity and feasibility of the SF36vr2 for general hospital psychiatric patients have been established (Adler Bungay Cynn amp Kosinski 2000) and when used with schizophrenic patients the SF36v2 has also been found valid and reli-able (Russo et al 1998) The SF36v2 has been found to be valid for use with Spanish-speaking patients (Bennett amp Reigel 2003 ) and a recent study demonstrated validity in assessing health-related quality of life in a sample of older Mexican Americans (Peek et al 2004) This instrument is widely used in the assessment of functional health status and is referenced to a US normative group to facilitate comparisons (Ware Kosinski amp Dewey 2000)

PROCEDURES

This study received approval from the institutional review board at the University of Texas at El Paso (UTEP) and from the Bioethics Committee of the Universidad Autoacutenoma de Ciudad Juarez (UACJ)

For data collected in San Elizario the principal investi-gator (PI) and coprincipal investigators (Co-PIs) employed the help of promotoras (community health workers) Eight promotora interviewers and seven screeners were trained to carry out the interview and survey process Screeners con-tacted households and recruited appropriate respondents for participation Once screeners secured an appointment with a respondent the information was provided to an interviewer who contacted the respondent conducted the survey and returned the completed surveys to project supervisors

Screening was conducted by phone and in person and all screeners were given a script to follow when making the first contact At least five attempts to contact were made at each household and screeners were instructed to schedule attempts at contact on varying days and times When a screener successfully scheduled an interview a reminder was left with the participant indicating the agreed upon date and time of the interview All interviews were sched-uled within the same week of contact by the screener

Screeners informed project managers of scheduled appointments the day they were made Additionally screeners provided pertinent identifying information to the project manager about the respondent so that they were easily located

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the sample) of the sample mean then the sample popula-tion mean would not be considered as different from the national mean A t test was used to compare the accultura-tion means between single yesno variables such as the depression question or the violence questions

RESULTS

A total of 523 San Elizario household contacts were made by screeners to schedule interviews Out of the 523 total contacts 79 ( n = 413) of contacts were face to face Out of the 413 face-to-face attempts at contact 523 ( n = 217) led to a completed survey In Felipe Angeles 303 participants enrolled in the study by face-to-face household attempts of

which 913 ( n = 274) led to a completed survey Thus in all there were 491 total respondents

Demographics

As shown in Table 1 there were a total of 321 female participants and 170 male participants Of the female par-ticipants 132 were from San Elizario and 189 were from Felipe Angeles Of the male participants 85 were from San Elizario and 85 were from Felipe Angeles The mean age for the total sample was about 40 years The mean age of San Elizario participants was about 425 years and for Felipe Angeles participants it was about 386 years This difference was statistically significant ( df = 489 p lt 01) For the total sample about 813 ( n = 399) were born in

TABLE 1 Summary of Demographic Questionnaire Items

Total San Elizario Felipe Angeles Significancee

Total 491 217 274 df = 1 p lt 04

Female 321 132 189

Male 170 85 85

Age (mean) 4036 4252 3865 df = 489 p lt 01

Relationship status (n = 491)a (n = 217) (n = 274)

Married 361 (735)b 159 (733) 202 (737)

Divorced 23 (47) 14 (65) 9 (33)

Single 107 (218) 44 (203) 63 (230)

Where did you go to school

Mexico 361 (735) 103 (475) 258 (942)

United States 87 (177) 86 (396) 1 (04)

Both 30 (61) 26 (120) 4 (15)

Highest grade (mean) 802 959 675 df = 481 p lt 01

How long in the colonia (n = 491) (n = 217) (n = 274)

lt1 year 24 (49) 12 (55) 12 (44)

1 to 5 years 39 (79) 12 (55) 27 (99)

6 to 10 years 62 (126) 33 (152) 29 (106)

More than 10 years 366 (745) 160 (326) 206 (752)

Where Born (n = 491) (n = 217) (n = 274) df = 489 p lt 01

Mexico 399 (813) 145 (668) 254 (925)

United States 75 (153) 71 (327) 4 (15)

State 16 (33) 1 (05) 15 (55)

Other 1 (02) 1 (04)

Work outside the home 252 (513) (n = 491)

109 (502) (n = 217)

143 (522) (n = 274)

Household income (mean) $12440cd $19044cd

(n = 167)$5536cd

(n = 217)df = 382 p lt 01

aN size is noted when different from the original sample size bAll percentages are rounded up to the next tenth of a percent cTrimmed sample (950) dUS dollars eOnly significant findings are reported

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Mexico while 153 ( n = 75) were born in the United States and 35 ( n = 17) reported being born somewhere else Of participants in San Elizario 668 ( n = 145) were born in Mexico 327 ( n = 71) were born in the United States and 05 ( n = 1) reported being born elsewhere Of participants in Felipe Angeles 925 ( n = 254) were born in Mexico 15 ( n = 4) were born in the United States 59 ( n = 16) reported being born somewhere else As might be expected this difference was also statistically significant ( df = 498 p lt 01) Additionally most respon-dents reported living in their communities for more than 10 years (total sample = 745 n = 366 San Elizario = 326 n = 160 Felipe Angeles = 752 n = 206)

Most respondents were married (total sample = 735 n = 361 San Elizario = 733 n = 159 Felipe Angeles = 737 n = 202) with a smaller percentage who were sin-gle (total sample = 218 n = 107 San Elizario = 203 n = 44 Felipe Angeles = 230 n = 63) There were sig-nificant differences between San Elizario ( M = 959) and Felipe Angeles ( M = 675) participants for the highest grade in school they had attended ( df = 481 p lt 01)

In both communities 80 ( n = 136) of men reported working outside the home while 369 ( n = 116) of women reported working outside the home In Felipe Angeles 859 ( n = 73) of men reported working outside the home while 383 ( n = 70) of women reported work-ing outside the home In San Elizario 741 ( n = 63) of the men reported working outside the home while 351 ( n = 46) of the women reported working outside the home

The mean household income of those who reported it was $11283 ( SD = $13754 n = 277) There were sig-nificant differences between the mean household income in San Elizario ( M = $19044 SD = $17322 n = 167) and Felipe Angeles ( M = $5836 SD = $5650 n = 217mdashconverted to US dollars) Please see Table 1 for further demographic information

Participants ( n = 32) reported having five or more drinks at one sitting an average of 308 times in the past 30 days Participants in San Elizario ( n = 29) reported doing this an average of 345 times in the past 30 days while participants in Felipe Angeles ( n = 23) reported doing this an average of 261 times in the past 30 days Additionally participants ( n = 15) reported having been drunk driving an average of 247 times in the past 30 days San Elizario residents ( n = 9) reported drinking and driv-ing an average of 222 times in the past 30 days compared to Felipe Angeles ( n = 6) residents who reported drinking and driving an average of 283 times in the past 30 days When asked if they had considered cutting down on their drinking about 21 ( n = 104) of the entire group said yes with 147 ( n = 32) of San Elizario residents and 264 ( n = 72) of Felipe Angeles residents reporting that they had considered cutting down on their drinking Approximately 59 ( n = 29) of the entire sample had CAGE scores greater than 2 Of these participants the average CAGE score for San Elizario residents was 317 ( n = 12) compared to 335 ( n = 17) for Felipe Angeles residents

Smoking

About 259 ( n = 127) of the entire sample reported smoking cigarettes while 332 ( n = 163) of the entire sample reported having smoked more than 100 cigarettes in their lifetime Broken down by site about 23 ( n = 50) of San Elizario participants reported using cigarettes com-pared to 281 ( n = 77) of Felipe Angeles participants 346 ( n = 75) of San Elizario and 321 ( n = 88) of Felipe Angeles respondents reported having smoked more than 100 cigarettes in their lifetime

Health History

Participants were also asked a number of health history questions For the entire sample 138 reported a history of diabetes 248 reported a history of hypertension 171 reported a history of elevated cholesterol 240 reported a history of depression and 169 reported a history of anxiety Comparing participantsrsquo health his-tory by site 152 of San Elizario residents compared to 128 of Felipe Angeles residents reported a history of diabetes 240 of San Elizario residents compared to 255 of Felipe Angeles residents reported a history of hypertension 203 of San Elizario residents compared to 146 of Felipe Angeles residents reported a history of elevated cholesterol 203 of San Elizario residents compared to 270 of Felipe Angeles residents reported a history of depression and 166 of San Elizario residents compared to 172 of Felipe Angeles residents reported a history of anxiety Please see Table 2 for further informa-tion about participantsrsquo reported health histories

About 356 of the entire sample reported currently using prescribed medications with 406 of San Elizario and 318 of Felipe Angeles representatives currently using prescribed medication Additionally 625 of the entire sample reported taking an herb or drinking an herbal tea when they were not feeling well with 700 of San Elizario residents and 566 of Felipe Angeles resi-dents reporting this behavior

General Health and Community Concerns

The SF36v2 functional health scores for both the physical and mental profiles mostly mirrored the national US norms For the entire sample the physical health score was 5061 compared to a normative sample of 500 while the mental health score was 4918 compared to a normative sample of 500 (Soden 2006) There was no significant difference between the physical and mental health scores of San Elizario and Felipe Angeles residents San Elizario residents had a physical health score of 5111 compared to Felipe Angeles residentsrsquo physical health score of 5019 San Elizario residents had a mental health score of 5007 compared to Felipe Angeles residentsrsquo mental health score of 4843

The participants were asked what they perceived as the most important health problems in their respective

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TABLE 2 Summary of Health Questionnaire Items

Total San Elizario Felipe Angeles Significancec

of times in past 30 days had 5 gt drinks at one sitting 308 (n = 52)a 345 (n = 29) 261 (n = 23)

Have thought about cutting down on drinking (212)b (n = 104) (147) (n = 32) (264) (n = 72) df = 1 p lt 01

of times have drunk and drove during past 30 days 247 (n = 15) 222 (n = 9) 283 (n = 6)

CAGE score gt2 328 (n = 29) 317 (n = 12) 335 (n = 17)

Smokes cigarettes (259) (n = 127) (230) (n = 50) (281) (n = 77)

Have smoked at least 100 cigarettes over lifetime (332) (n = 163) (346) (n = 75) (321) (n = 88)

Been told by health care provider you have

Diabetes (138) (n = 68) (152) (n = 33) (128) (n = 35)

Hypertension (248) (n = 122) (240) (n = 52) (255) (n = 70)

Elevated cholesterol (171) (n = 84) (203) (n = 44) (146) (n = 40)

Depression (240) (n = 118) (203) (n = 44) (270) (n = 74)

Anxiety (169) (n = 83) (166) (n = 36) (172) (n = 47)

Currently takes prescribed medications (356) (n = 175) (406) (n = 88) (318) (n = 87) df = 489 p lt 05

Have taken herb or tea when not feeling well (625) (n = 307) (700) (n = 152) (566) (n = 155) df = 488 p lt 01

SASH score (mean) 1893 2373 1547 df = 468 p lt 01

SF-36v2

Physical health score (mean) 5061 5111 5019

Mental health score (mean) 4918 5007 4843

aN size is noted when different from the original sample size bAll percentages are rounded up to the next tenth of a percent cOnly significant findings are reported

communities the responses were coded and then grouped into categories (see Tables 3 and 4) There was a signifi-cant difference between the first and second ranked most important health problems in both communities (F (468) = 2218 p lt 05) For participants in both San Elizario (147 n = 32) and Felipe Angeles (162 n = 41) access to care was ranked number two Diabetes was number one in San Elizario (369 n = 80) and in Felipe Angeles (162 n = 62)

Acculturation

The average score on SASH for the entire sample was 1893 (highest possible score = 60 lowest possible score = 12) Participants living in San Elizario ( M = 2373) had significantly higher ( df = 468 p lt 01) levels of accul-turation than did participants living in Felipe Angeles ( M = 1547)

DISCUSSION

This investigation is one of the first to compare functional health status and general health perceptions between one group of individuals living in two colonias one located in El Paso Texas and the second directly across the Rio Grande River located in Cd Juarez Chihuahua Mexico

The gender composition of our sample in which women comprised 690 (see Table 1) is markedly dif-ferent than the estimated population of El Paso (Soden 2006) This sample consisted of 310 men and 690 women The sampling method may be responsible for this discrepancy in the amount of women in El Paso versus the amount of women in our sample However because households were randomly selected it is pos-sible that there are significantly more women than men living in the colonia It is also possible that women were

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Mexico while 153 ( n = 75) were born in the United States and 35 ( n = 17) reported being born somewhere else Of participants in San Elizario 668 ( n = 145) were born in Mexico 327 ( n = 71) were born in the United States and 05 ( n = 1) reported being born elsewhere Of participants in Felipe Angeles 925 ( n = 254) were born in Mexico 15 ( n = 4) were born in the United States 59 ( n = 16) reported being born somewhere else As might be expected this difference was also statistically significant ( df = 498 p lt 01) Additionally most respon-dents reported living in their communities for more than 10 years (total sample = 745 n = 366 San Elizario = 326 n = 160 Felipe Angeles = 752 n = 206)

Most respondents were married (total sample = 735 n = 361 San Elizario = 733 n = 159 Felipe Angeles = 737 n = 202) with a smaller percentage who were sin-gle (total sample = 218 n = 107 San Elizario = 203 n = 44 Felipe Angeles = 230 n = 63) There were sig-nificant differences between San Elizario ( M = 959) and Felipe Angeles ( M = 675) participants for the highest grade in school they had attended ( df = 481 p lt 01)

In both communities 80 ( n = 136) of men reported working outside the home while 369 ( n = 116) of women reported working outside the home In Felipe Angeles 859 ( n = 73) of men reported working outside the home while 383 ( n = 70) of women reported work-ing outside the home In San Elizario 741 ( n = 63) of the men reported working outside the home while 351 ( n = 46) of the women reported working outside the home

The mean household income of those who reported it was $11283 ( SD = $13754 n = 277) There were sig-nificant differences between the mean household income in San Elizario ( M = $19044 SD = $17322 n = 167) and Felipe Angeles ( M = $5836 SD = $5650 n = 217mdashconverted to US dollars) Please see Table 1 for further demographic information

Participants ( n = 32) reported having five or more drinks at one sitting an average of 308 times in the past 30 days Participants in San Elizario ( n = 29) reported doing this an average of 345 times in the past 30 days while participants in Felipe Angeles ( n = 23) reported doing this an average of 261 times in the past 30 days Additionally participants ( n = 15) reported having been drunk driving an average of 247 times in the past 30 days San Elizario residents ( n = 9) reported drinking and driv-ing an average of 222 times in the past 30 days compared to Felipe Angeles ( n = 6) residents who reported drinking and driving an average of 283 times in the past 30 days When asked if they had considered cutting down on their drinking about 21 ( n = 104) of the entire group said yes with 147 ( n = 32) of San Elizario residents and 264 ( n = 72) of Felipe Angeles residents reporting that they had considered cutting down on their drinking Approximately 59 ( n = 29) of the entire sample had CAGE scores greater than 2 Of these participants the average CAGE score for San Elizario residents was 317 ( n = 12) compared to 335 ( n = 17) for Felipe Angeles residents

Smoking

About 259 ( n = 127) of the entire sample reported smoking cigarettes while 332 ( n = 163) of the entire sample reported having smoked more than 100 cigarettes in their lifetime Broken down by site about 23 ( n = 50) of San Elizario participants reported using cigarettes com-pared to 281 ( n = 77) of Felipe Angeles participants 346 ( n = 75) of San Elizario and 321 ( n = 88) of Felipe Angeles respondents reported having smoked more than 100 cigarettes in their lifetime

Health History

Participants were also asked a number of health history questions For the entire sample 138 reported a history of diabetes 248 reported a history of hypertension 171 reported a history of elevated cholesterol 240 reported a history of depression and 169 reported a history of anxiety Comparing participantsrsquo health his-tory by site 152 of San Elizario residents compared to 128 of Felipe Angeles residents reported a history of diabetes 240 of San Elizario residents compared to 255 of Felipe Angeles residents reported a history of hypertension 203 of San Elizario residents compared to 146 of Felipe Angeles residents reported a history of elevated cholesterol 203 of San Elizario residents compared to 270 of Felipe Angeles residents reported a history of depression and 166 of San Elizario residents compared to 172 of Felipe Angeles residents reported a history of anxiety Please see Table 2 for further informa-tion about participantsrsquo reported health histories

About 356 of the entire sample reported currently using prescribed medications with 406 of San Elizario and 318 of Felipe Angeles representatives currently using prescribed medication Additionally 625 of the entire sample reported taking an herb or drinking an herbal tea when they were not feeling well with 700 of San Elizario residents and 566 of Felipe Angeles resi-dents reporting this behavior

General Health and Community Concerns

The SF36v2 functional health scores for both the physical and mental profiles mostly mirrored the national US norms For the entire sample the physical health score was 5061 compared to a normative sample of 500 while the mental health score was 4918 compared to a normative sample of 500 (Soden 2006) There was no significant difference between the physical and mental health scores of San Elizario and Felipe Angeles residents San Elizario residents had a physical health score of 5111 compared to Felipe Angeles residentsrsquo physical health score of 5019 San Elizario residents had a mental health score of 5007 compared to Felipe Angeles residentsrsquo mental health score of 4843

The participants were asked what they perceived as the most important health problems in their respective

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TABLE 2 Summary of Health Questionnaire Items

Total San Elizario Felipe Angeles Significancec

of times in past 30 days had 5 gt drinks at one sitting 308 (n = 52)a 345 (n = 29) 261 (n = 23)

Have thought about cutting down on drinking (212)b (n = 104) (147) (n = 32) (264) (n = 72) df = 1 p lt 01

of times have drunk and drove during past 30 days 247 (n = 15) 222 (n = 9) 283 (n = 6)

CAGE score gt2 328 (n = 29) 317 (n = 12) 335 (n = 17)

Smokes cigarettes (259) (n = 127) (230) (n = 50) (281) (n = 77)

Have smoked at least 100 cigarettes over lifetime (332) (n = 163) (346) (n = 75) (321) (n = 88)

Been told by health care provider you have

Diabetes (138) (n = 68) (152) (n = 33) (128) (n = 35)

Hypertension (248) (n = 122) (240) (n = 52) (255) (n = 70)

Elevated cholesterol (171) (n = 84) (203) (n = 44) (146) (n = 40)

Depression (240) (n = 118) (203) (n = 44) (270) (n = 74)

Anxiety (169) (n = 83) (166) (n = 36) (172) (n = 47)

Currently takes prescribed medications (356) (n = 175) (406) (n = 88) (318) (n = 87) df = 489 p lt 05

Have taken herb or tea when not feeling well (625) (n = 307) (700) (n = 152) (566) (n = 155) df = 488 p lt 01

SASH score (mean) 1893 2373 1547 df = 468 p lt 01

SF-36v2

Physical health score (mean) 5061 5111 5019

Mental health score (mean) 4918 5007 4843

aN size is noted when different from the original sample size bAll percentages are rounded up to the next tenth of a percent cOnly significant findings are reported

communities the responses were coded and then grouped into categories (see Tables 3 and 4) There was a signifi-cant difference between the first and second ranked most important health problems in both communities (F (468) = 2218 p lt 05) For participants in both San Elizario (147 n = 32) and Felipe Angeles (162 n = 41) access to care was ranked number two Diabetes was number one in San Elizario (369 n = 80) and in Felipe Angeles (162 n = 62)

Acculturation

The average score on SASH for the entire sample was 1893 (highest possible score = 60 lowest possible score = 12) Participants living in San Elizario ( M = 2373) had significantly higher ( df = 468 p lt 01) levels of accul-turation than did participants living in Felipe Angeles ( M = 1547)

DISCUSSION

This investigation is one of the first to compare functional health status and general health perceptions between one group of individuals living in two colonias one located in El Paso Texas and the second directly across the Rio Grande River located in Cd Juarez Chihuahua Mexico

The gender composition of our sample in which women comprised 690 (see Table 1) is markedly dif-ferent than the estimated population of El Paso (Soden 2006) This sample consisted of 310 men and 690 women The sampling method may be responsible for this discrepancy in the amount of women in El Paso versus the amount of women in our sample However because households were randomly selected it is pos-sible that there are significantly more women than men living in the colonia It is also possible that women were

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TABLE 2 Summary of Health Questionnaire Items

Total San Elizario Felipe Angeles Significancec

of times in past 30 days had 5 gt drinks at one sitting 308 (n = 52)a 345 (n = 29) 261 (n = 23)

Have thought about cutting down on drinking (212)b (n = 104) (147) (n = 32) (264) (n = 72) df = 1 p lt 01

of times have drunk and drove during past 30 days 247 (n = 15) 222 (n = 9) 283 (n = 6)

CAGE score gt2 328 (n = 29) 317 (n = 12) 335 (n = 17)

Smokes cigarettes (259) (n = 127) (230) (n = 50) (281) (n = 77)

Have smoked at least 100 cigarettes over lifetime (332) (n = 163) (346) (n = 75) (321) (n = 88)

Been told by health care provider you have

Diabetes (138) (n = 68) (152) (n = 33) (128) (n = 35)

Hypertension (248) (n = 122) (240) (n = 52) (255) (n = 70)

Elevated cholesterol (171) (n = 84) (203) (n = 44) (146) (n = 40)

Depression (240) (n = 118) (203) (n = 44) (270) (n = 74)

Anxiety (169) (n = 83) (166) (n = 36) (172) (n = 47)

Currently takes prescribed medications (356) (n = 175) (406) (n = 88) (318) (n = 87) df = 489 p lt 05

Have taken herb or tea when not feeling well (625) (n = 307) (700) (n = 152) (566) (n = 155) df = 488 p lt 01

SASH score (mean) 1893 2373 1547 df = 468 p lt 01

SF-36v2

Physical health score (mean) 5061 5111 5019

Mental health score (mean) 4918 5007 4843

aN size is noted when different from the original sample size bAll percentages are rounded up to the next tenth of a percent cOnly significant findings are reported

communities the responses were coded and then grouped into categories (see Tables 3 and 4) There was a signifi-cant difference between the first and second ranked most important health problems in both communities (F (468) = 2218 p lt 05) For participants in both San Elizario (147 n = 32) and Felipe Angeles (162 n = 41) access to care was ranked number two Diabetes was number one in San Elizario (369 n = 80) and in Felipe Angeles (162 n = 62)

Acculturation

The average score on SASH for the entire sample was 1893 (highest possible score = 60 lowest possible score = 12) Participants living in San Elizario ( M = 2373) had significantly higher ( df = 468 p lt 01) levels of accul-turation than did participants living in Felipe Angeles ( M = 1547)

DISCUSSION

This investigation is one of the first to compare functional health status and general health perceptions between one group of individuals living in two colonias one located in El Paso Texas and the second directly across the Rio Grande River located in Cd Juarez Chihuahua Mexico

The gender composition of our sample in which women comprised 690 (see Table 1) is markedly dif-ferent than the estimated population of El Paso (Soden 2006) This sample consisted of 310 men and 690 women The sampling method may be responsible for this discrepancy in the amount of women in El Paso versus the amount of women in our sample However because households were randomly selected it is pos-sible that there are significantly more women than men living in the colonia It is also possible that women were

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104

by the 2002 Paso del Norte Health Report (PDNHF 2005) which indicated that 212 had one to three incidences of binge drinking and 149 had three or more incidences The CAGE scores reflect that 59 of the sample or 29 respondents had scores greater than 2 which means they may potentially be at risk for alcoholism (see Table 2) Thus the CAGE scores report a lower potential problem with alcohol than the self-reported incidences of binge drinking (this is not true in the Felipe Angeles data) About 30 of the sample had driven while drunk during the past 30 days See Table 2 for more information

Around 332 of the sample had smoked more than 100 cigarettes in their lifetime and 259 reported that they currently smoke (see Table 2) This is similar to the 229 reported by the 2002 Paso del Norte Health Report (PDNHF 2005) The WHO (2007) reports a smoking prevalence in Mexico of individuals who are 15 years and older of 359 for men and 150 for women While the Mexico data is less than the reported national figures clearly there is more work to be done to assist the populations in both countries in reducing their inci-dences of smoking

The incidence of diabetes in the study population is 138 (see Table 2) This is almost twice the rate of diabetes reported by the 2002 and 2005 Paso del

more likely to be available and at home to respond to the surveys This seems likely considering that only 369 ( n = 116) of the women in the sample reported that they worked outside the home while 80 ( n = 136) of men reported working outside the home

The average Felipe Angeles resident has received 675 years of schooling with 930 not having completed high school (see Table 1) In the San Elizario group the average years of schooling was only 959 years This is a lower level of education than El Paso County where 342 of residents do not have a high school education and USMexico border states where 224 have not completed high school (Soden 2006)

The El Paso County household average income in 2003 was $29831 and for Texas as a whole was $40063 (Rivera et al 2005) In our San Elizario sample the household income (US dollars) was an average of $19044 and in Felipe Angeles $5836 This is not surpris-ing considering that the educational level of the Felipe Angeles participants was lower than that of the average resident of El Paso County

Fifty-two respondents 105 of those that answered the question reported binge drinking (ie number of times in the past 30 days that they had five or more alcoholic drinks at one sitting) This is a marked dif-ference from the El Paso County findings reported

TABLE 3 Perceived Important Health Problems in the San Elizario Community

Identified health problem Frequency Percent () Cumulative frequency Cumulative percent ()

Diabetes 80 369a 80 369

Access to care 32 147 112 516

Acute ailments 27 124 139 64

Other chronic ailments 24 111 163 751

Other 24 111 187 862

Note When asked ldquoWhat is the most serious health problem in their communityrdquo the top five responses were diabetes access to care acute ailments other chronic ailments and a general grouping of otheraAll percentages are rounded up to the next tenth of a percent

TABLE 4 Perceived Important Health Problems in the Felipe Angeles Community

Identified health problem Frequency Percent () Cumulative frequency Cumulative percent ()

Chronic diseases 62 245a 62 245

Access to care 41 162 103 407

Acute diseases 40 158 143 565

Drug addiction 29 116 172 681

Environment 23 90 195 771

Note When asked ldquoWhat is the most serious health problem in your communityrdquo the top five responses were chronic diseases access to care acute diseases drug addiction and environmentaAll percentages are rounded up to the next tenth of a percent

A Comparative Health Survey

105

LIMITATIONS

As with any international comparisons there is clearly potential for cultural differences not accounted for in procedures Our Mexican co-investigators assisted us in assuring such differences were kept to a minimum This study is the first to the best of the researchersrsquo knowledge addressing the functional and general status of colonia residents residing on both sides of the USMexico bor-der The information will hopefully provide some insight into the multinational issues facing border residents in El Paso and Juarez However given the small sample size the results cannot be generalized to other border regions Perhaps as a result of the household survey method used women were overrepresented and thus the ability to generalize the findings to both men and women may be limited

CONCLUSIONS

The average resident living in the studied colonias located in El Paso County and in Cd Juarez Mexico along the USMexico border has substantially less income and has a poorer health status compared to national norms There are many disadvantages related to health when compared to his or her counterpart not living along the USMexico border The prevalence of depression and anxiety disor-ders is greater The probability of having diabetes is twice as large The residents were less likely to abuse alcohol and to drink and drive The health of this population will most likely be impaired as they age because of high rates of diabetes comorbid health conditions such as hyper-tension and elevated cholesterol levels and a high rate of smoking The residents on both sides of the border rank access to health care as their number two health concern and without access to health care these health disparities will only become more prevalent

REFERENCES

Adler D A Bungay K M Cynn D J amp Kosinski M (2000) Patient-based health status assessments in an outpatient psychiatry setting Psychiatric Services 51 341ndash348

American Lung Association (2004) Smoking and Hispanic fact sheet Retrieved July 26 2005 from httpwwwlungusaorgsiteppaspc=dvLUK9O0Eampb=36002

Barry J (2000) USndashMexican border Can good fences make bad neighbors Retrieved September 25 2007 from httpspeak outcomactivismissue_briefs1370b-1html

Bennett J A amp Riegel B (2003) United States Spanish short-form health survey Scaling assumptions and reliability in elderly community-dwelling Mexican-Americans Nursing Research 52 262ndash269

Brennan B (1997) Land of the third culture Perspectives in Health 2 Retrieved September 20 2007 from httpwwwpahoorgEnglishDPINumber2_article3htm

Norte Health Report (PDNHF 2002 2005) This report revealed that 248 had hypertension and 171 had elevated cholesterol This certainly places these individu-als at high risk for diabetic complications as they age and the disease progresses As previously mentioned a 2007 report released by the PAHO revealed a diabetes preva-lence rate of 161 on the US side of the border and a rate of 151 on the Mexico side of the border ( The US-Mexico Border Diabetes Prevention and Control Project 2007)

A high percentage of the sample (625) reported taking herbs when not feeling well (see Table 2) Seventy percent of the San Elizario participants reported using herbs while 566 of the Felipe Angeles groups reported such use ( df = 488 p lt 001) A study conducted in El Paso in 2005 reported that from a sample of 439 non-HIV patients 79 reported using herbal products (Rivera et al 2005) This is slightly higher than the rate of use reported by our sample It appears that the use of herbal products is common within this Mexican American popu-lation This is a concern considering certain herbal medi-cines particularly when used in combination with other medications may pose serious health risks

As discussed in the results section the SF36v2 scores did not reveal any marked difference between the study sample and the normative population The mental health subscale score for the Felipe Angeles participants was 4843 compared to 4918 in San Elizario The rate of reported depression was also different between the two groups 203 in San Elizario and 27 in Felipe Angeles While not statistically significant there appears to be more mental health issues presence in the Felipe Angeles group In the San Elizario colonia we observed higher incidences of diabetes smoking and alcohol use in this population than indicated in the 2002 and 2005 Paso del Norte Health Report (PDNHF 2002 2005) As this pop-ulation ages ( M = 4036 years) and the effects of these behaviors affect health we anticipate seeing a change in the SF36v2 profiles

Given the length of time the San Elizario participants have lived in the United States their acculturation scores as measured by the SASH revealed low levels of integra-tion The impact of a low acculturation score on this populationrsquos health is not known The low education and income levels of our sample may be related to their low acculturation scores Our analysis however did not reveal any significant relationship between the participantsrsquo functional and general health status This may be because the acculturation instrument used was not sensitive enough to adequately detect such changes

The participantsrsquo concern about health issues in their communities mirrored to a great extent the same con-cerns Chronic diseases (diabetes) access to care and acute diseases were all ranked as significant concerns Thus it appears that the border has no protective boundar-ies related to perceived health concerns

Anders et al

106

from httpwwwsaludgobmxunidadesconadicepidem htm

Slone L B Norris F H Rodriguez F G Rodriguez J J G Murphy A M amp Perilla J L (2006) Alcohol use and mis-use in urban Mexican men and women An epidemiologic perspective Drug and Alcohol Dependence 85 163ndash170

Soden D (2006) At the cross roads USMexico border counties in transition El Paso TX University of Texas at El Paso Institute for Policy and Economic Development

United States Census Bureau (2000) Ethnic background of popu-lation the state of Texas-2000-census Washington DC US Government Printing Office

United States-Mexico Border Health Commission (2003) Healthy border 2010 An agenda for improving health on the United States-Mexico border Retrieved September 20 2007 from httpwwwborderhealthorgfilesres_63pdf

US Department of Health and Human Services (1999) Fact sheet LatinosHispanics Retrieved May 2 2005 from httpwwwschsstatencusSCHSpdfHL-factspdf

The US-Mexico border diabetes prevention and control project (2007) Retrieved November 4 2007 from httpwwwfeppahoorgenglishpublicacionesDiabetesDiabetes20first20report20of20Resultspdf

Vega W A Alderate E Kolody B amp Aguilar-Gaxiola S (1998) Illicit drug use among Mexicans and Mexican-Americans in California The effects of gender and acculturation Addiction 93 1839ndash1850

Ware J E (2000) SF36 health survey update Spine 25 3130ndash3139 Ware J E Kosinski M amp Dewey J E (2000) How to score ver-

sion two of the SF36 health survey Lincoln RI QualityMetric Incorporated

World Health Organization (2000) Core health indicators Re -trieved September 18 2007 from httpwwwwhointwhosisdata basecorecore_select_processcfm

World Health Organization (2002) Core health indicators Re -trieved September 18 2007 from httpwwwwhointwhosisdata basecorecore_select_processcfm

World Health Organization (2003) Core health indicators Re -trieved September 18 2007 from httpwwwwhointwhosisdata basecorecore_select_processcfm

World Health Organization (2004) Core health indicators Re -trieved September 18 2007 from httpwwwwhointwhosisdata basecorecore_select_processcfm

World Health Organization (2005) Core health indicators Re -trieved September 18 2007 from httpwwwwhointwhosisdata basecorecore_select_processcfm

World Health Organization (2007) Core health indicators Re -trieved February 27 2008 from httpwwwwhoint whosisdata basecorecore_select_processcfmcountries=mexampindicators=AlcoholConsumptionampindicators=TobaccoUseAdultMaleampindicators=TobaccoUseAdultFemale

ACKNOWLEDGMENTS A portion of the funding for this investigation was provided by the National Institutes of Health National Center on Minority Health and Health Disparities (Grant Nos P20MD000548 and T37 MD001376-01) as well as the School of Nursing University of Texas at El Paso

Correspondence regarding this article should be directed to Robert L Anders DrPh School of Nursing University of Texas at El Paso El Paso TX 79902 E-mail rlandersutepedu

Cleary K K amp Howell D M (2006) Using the SF-36 to deter-mine perceived health-related quality of life in rural Idaho seniors Journal of Allied Health 35 (3) 156ndash161

Ewing J A (1984) Detecting alcoholism The CAGE question-naire The Journal of the American Medical Association 252 1905ndash1907

Farivar S S Cunningham W E amp Hays R D (2007) Correlated physical and mental summary scores for the SF-36 and SF-12 health survey v1 Health and Quality of Life Outcomes 54 Retrieved on September 25 2007 from httpwwwhqlocomcontents5154

Fiellin D A Reid M C amp OrsquoConnor P G (2000) Screening for alcohol problems in primary care Systematic review Archives of Internal Medicine 160 1977ndash1989

Hollingshead A B amp Redlich F C (1958) Social class and men-tal illness New York Wiley

Longoria V Wiebe J amp Meza A (2003 April) The develop-ment and validation of a bilingual measure of HIV and AIDS-related knowledge in people living with HIV Paper presented at annual meeting for the Society of Behavioral Medicine Salt Lake City UT

Mariacuten G Sabogal F Mariacuten B V Otero-Sabogal R amp Perez-Stable E J (1987) Development of a short acculturation scale for Hispanics Hispanic Journal of Behavioral Science 9 183ndash205

McKenna M T Michaud C M Murray C J L amp Marks J S (2005) Assessing the burden of disease in the United States using disability-adjusted life years American Journal of Preventive Medicine 28 415ndash423

Medina-Mora M E amp Rojas G E (2003) Demand of drugs Mexico in the international perspective Salud Mental 26 1ndash11

Miller D C (1991) Selected sociometric scales and indices Newbury Park CA Sage

Moya E M Torres C Solorzanoacute E M amp Huerta P (2004) USndashMexico border Retrieved September 20 2007 from httpwwwpahoorgEnglishDDPINsv_borderpdf

Pan American Health Organization (1998) Health in the Americas Washington DC Pan American Health Organization Scientific Publications

Paso del Norte Health Foundation (2002) Paso del Norte Health Report El Paso TX Author

Paso del Norte Health Foundation (2005) Paso del Norte Health Report El Paso TX Author

Peek M K Ray L Patel K Stoebner-May D amp Ottenbacher K J (2004) Reliability and validity of the SF-36 among older Mexican Americans The Gerontologist 44 (3) 418ndash425

Rivera J O Gonzales-Stuart A Ortiz M Rodriguez J C Anaya J P amp Meza A (2005) Herbal produce use in non-HIV and HIV-positive Hispanic patients Journal of National Medical Association 97 1686ndash1691

Russo J Trujillo C A Wingerson D Decker K Ries R Wetzler H et al (1998) The MOS 36 item short form health survey Reliability validity and preliminary findings in schizophrenic outpatients Medical Care 36 752ndash756

Saitz R Lepore M F Sullivan L M Amaro H amp Samet J H (1999) Alcohol abuse and dependence in Latinos living in the United States Validation of the CAGE (4M) questions Archives of Internal Medicine 159 718ndash724

Secretariacutea de Salubridad y Asistencia (1998) National survey of addictions Epidemiologic data Retrieved February 14 2004