Treatment seeking in populations in urban and rural settings on the border.
BACKGROUND
Only a small proportion of persons with alcohol or drug problems seek help in the form of treatment for these problems. To examine service disparities among Hispanics living in urban and rural border areas, an improved understanding of factors associated with service seeking is needed for this population.


METHODS
In-person interviews were conducted with a sample of 1,200 colonia residents and urban residents living along the Texas border with Mexico. For the present study, the dataset was limited to Hispanic respondents (85% of the sample) and those who reported any indicator of need for treatment (38% of the sample). There were 380 respondents who met these criteria. Treatment seeking was measured by any past attempt, successful or unsuccessful, to obtain treatment or by their present stated desire for treatment. Factors influencing treatment seeking were compared across 3 sites.


RESULTS
Path analyses indicated that, after taking demographics into account, severity of need (the total number of drug-related and alcohol-related problems experienced by an individual) was a strong influence on treatment seeking, but income-related variables were more influential than severity of need in 1 site. Generation of immigration was positively related to treatment seeking in 2 sites, and in colonias, high religiosity was related to treatment seeking. In 2 sites, need severity was related to neighborhood variables. In colonias, need severity was related to low income and low religiosity.


CONCLUSIONS
This framework for understanding treatment seeking in border communities suggests that pathways to treatment seeking vary by locality in ways that may reflect variations in local environments and service systems. Design of outreach efforts should be tailored to the unique social and service system challenges of each local community. Although service seeking is low overall, findings are suggestive of an inequitable service access structure in 1 site where need is not the predominant factor for treatment seeking.
Spence
Richard
R
Addiction Research Institute, University of Texas at Austin, Austin, Texas 78703, USA. utattc@mail.utexas.edu
Wallisch
Lynn
L
Smith
Shanna
S
D000069:Acculturation; D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D017058:Mexican Americans / Q000208:ethnology* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000208:ethnology* / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000628:therapy*; D013781:Texas / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data