1. Diversity in Drinking and Associated Problems Among U.S. Hispanics Supported by grants RO1 AA 013642, R01-AA016827 and RO1-AA020542 from the National Institute on Alcohol Abuse and Alcoholism to the University of Texas School of Public Health and the Pacific Institute for Research and Evaluation. Raul Caetano, MD, PhD Senior Research Scientist Prevention Research Center, Pacific Institute for Research and Evaluation (PIRE)

2. Three Research Projects Hispanic Americans Baseline Alcohol Survey (HABLAS): Focuses on drinking and related problems among Hispanic national groups. Border Project: Examines drinking by Mexican Americans on and off U.S./Mexico border areas. Alcohol and Other Substances Use Among Puerto Ricans: Describes substance use in Puerto Rico. A planned comparison with Puerto Ricans in the U.S. is under review. All projects recognize diversity across Hispanic national groups and assess how this diversity influences drinking and alcohol-related problems.

3. Epidemiological Studies of Hispanics and Alcohol

4. HABLAS Sample and Data Collection Participants (N=5,224) were selected at random from the household population in Miami, New York, Philadelphia, Houston and Los Angeles using probability methods. Face to face one-hour CAPI were conducted in respondents homes by trained interviewers. Subjects were at least 18 years of age. 76% response rate. Fieldwork conducted by the Institute for Survey Research, Temple University.

5. Overall consumption and binge drinking

6. Mean Number of Drinks Per Week: Males (current drinkers only) Age group a b, c a T-test significant between 40-49 yrs and 50+ yrs; b T-test significant between 18-29 yrs and 50+ yrs c T-test significant between 30-39 yrs and 50+ yrs

7. Mean number of drinks per week: Females (current drinkers only) Age group a a T-test significant between 18-29 yrs and 30-39 yrs.

8. Proportion Who Binge One or More Times a Month: Males Age group * p< 0.05

9. Proportion Who Binge One or More Times a Month by Age: Females Age group ** p< 0.01

10. Alcohol Abuse and Dependence

11. Prevalence of DSM-IV Alcohol Abuse US females US males Abuse only in the “YES” category and includes those with Dependence in the “NO” category. Overall Chi square for Abuse: Male χ2 = 10.01, p-value= 0.02 Female χ2 = 4.4181, p-value= 0.222

12. Prevalence of DSM-IV Alcohol Dependence US males US females Overall Chi square for Dependence: Male χ2 = 26.56, p-value= 0.000 Female χ2 = 13.26, p-value= 0.005

13. Prevalence of DSM-IV Alcohol Dependence by Age: Males * P<.01 Age group

14. Prevalence of DSM-IV Alcohol Dependence by Age: Females * P<.03 Age group

15. Prevalence of DSM-IV Alcohol Abuse by Place of Birth * p< 0.05

16. Prevalence of DSM-IV Alcohol Dependence by Place of Birth ** p< 0.01; *** p< 0.001

17. Prevalence of DSM-IV Alcohol Abuse by Acculturation Level *** p< 0.001 Acculturation Level

18. Prevalence of DSM-IV Alcohol Dependence by Acculturation Level Acculturation Level

19. Drinking and Alcohol Problems among Border and non-Border Mexican Americans

20. Border Population About 7.3 million people live in the 24 U.S. counties that border Mexico, and nearly 4 million are Hispanic (Census 2010). In 2010, there were about 39.9 million pedestrian crossings in the main ports of entry along the border. Drug trafficking; increased alcohol availability in Mexico.

21. Border drinking and problems Binge drinking once a month or more among Hispanic men on the border is 36%, compared to 6 to 7% among Hispanics outside the border (Caetano et al., 2008). The rate of alcohol abuse on the border is 7%, compared to 3.9% in the US (Grant et al., 2004). Likewise, the rate of alcohol dependence among Hispanic men on the border is 14.5%, compared to 3.9% in the United States (Grant et al., 2004).

26. http://abcnews.go.com/Blotter/drug-smugglers-suv-stuck-atop-border- fence/story?id=17618147http://abcnews.go.com/Blotter/drug-smugglers-suv-stuck-atop-border- fence/story?id=17618147, accessed on 11/2/2012

27. Objectives The main objective was to understand more about the unique influences of the border area on drinking among Mexican Americans. Legal drinking age in Mexico is 18. Research has documented border crossing into Mexico during weekends by youth. Drinking in Mexico by American youth is mainly done in bars.

28. Methods A random sample of Mexican Americans (N=1307) was interviewed face to face in the four border states. This sample was compared to Mexican Americans interviewed in non-border areas in the HABLAS (most from Houston and Los Angeles; N=1288). Weighted response rates for the border and HABLAS were 67% and 76%, respectively.

29. Drinking

30. Volume (Drinks/Week)

31. 5+ Drinks at least Once per Year: Men

32. 5+ Drinks at least Once per Year: Women

33. Attended a bar in last year

34. Bars were most frequent drinking location

35. Association between bar attendance, drinking and problems

36. Drinks per week, binge drinking, alcohol abuse and dependence, and social problems among drinkers who drank only in the U.S. versus those who drank in the U.S. and Mexico Drank only in U.S.Drank in U.S. and MexicoSig. Average number of drinks per week, mean ± SD8.7 ± 1.1 (503)12.8 ± 1.4 (188)* Binged 1+ times in past 12 months35%58%*** Alcohol abuse6%4.5%ns Alcohol dependence13.5%21.7%ns Alcohol-related problems (1+)19.5%35.5%** Notes: Weighted percentages, unweighted n's; Sig. = significance; SD = standard deviation; N/A = not applicable; ns = not significant; * p < 0.05; ** p < 0.01; *** p < 0.001. Drinking in the U.S. and in Mexico and the U.S.

37. Characteristics of drinking in Mexico MenWomenTotalSig. Went to Mexico at least once in past 12 months, %47.825.934.5*** Current drinkers who went to Mexico, %63.154.359.2ns Current drinkers who went to Mexico and drank, %38.932.036.1ns Average N of drinks on a single day among those who drank in Mexico, mean ± SD6.2 ± 0.54.0 ± 0.45.4 ± 0.4*** Drank in Mexico and binged 1+ times in past 12m, %61.634.751.8ns Drinking companions Drank alone/with date/spouse or significant other/co-worker, %8.116.211.0 Family member, %63.253.759.7 Friend, %28.730.129.2 ns Drinking places Bar/tavern/club/hotel/motel/restaurant, %27.836.531.0 Friend, relative house/party/wedding, %54.8 Your home, %14.76.111.5 Other, %2.72.6 ns Notes: Weighted percentages, unweighted n's; Sig. = significance; ns = not significant; SD = standard deviation; *** p < 0.001. Drinking in Mexico

38. Social Problems (%)

39. Alcohol Abuse & Dependence

40. Alcohol Dependence: Men

41. Alcohol Dependence: Women

42. Substance Use in Puerto Rico Random household population survey of San Juan, Puerto Rico. Respondents are 18-64 years of age. Computer Assisted Personal Interviews (CAPI) 2013-2014 data collection completed with 1510 interviews and a 83% response rate.

43. Preliminary data: Selected Drinking Indicators in Different Puerto Rican Groups Table 1: Mean Number of Drinks per Week by birthplace and location MenWomen Island Puerto Rican Immigrant Puerto Rican U.S.-born Puerto Rican Island Puerto Rican Immigrant Puerto Rican U.S.-born Puerto Rican Mean N. drks/week 12 (7-10.7) 13 (9.6-14.2)15 (10.6-18.6)6 (5-7)7 (4-9.8)9 (2.8-15.7) Immigrant and U.S.-born Puerto Ricans from 2006 HABLAS

44. Prevalence of Binge Drinking Past year by Place of Residence and Birth

45. Prevalence of DSM-5 Alcohol Use Disorder Past Year by Place of Residence and Birth NESARC III DSM-5 AUD prevalence: Men, 17.6%; women, 10.4 (Grant et al., 2015 U.S. men U.S. women

46. Prevalence of Social/Health Problems Past Year by Place of Residence and Birth

47. Other Analyses in the Puerto Rican Data Employment status not associated with binge drinking, social/health problems and DSM-5 AUD. Unemployed and part-time employed males 3 and 4 times more likely to be depressed than employed females (ref. group). DSM-5 unidimensionality confirmed in Puerto Rico. There are 15% orphans (1 criterion+) among men and 16% among women.

48. Conclusions Diversity in drinking and alcohol problems across Hispanic national groups. Mexican Americans and Puerto Ricans are at more risk than others. The same is true for U.S.-born Hispanics compared to Hispanics born abroad. Along the U.S./Mexico border, bars seem to be a special factor of risk for younger Mexican Americans. Drinking in Mexico seems to be particularly heavy. Increased drinking among Puerto Ricans in the U.S. appears to happen among those who are U.S. born, not among the immigrant.

49. Collaborators Jonali Baruah, PhD Craig Field, PhD, MPH Robert Harris, PhD Christy McKinney, PhD, MPH Susie Mikler, PhD, MPH Bahman Roudsari, MD, PhD Patrice Vaeth, MPH, Dr.PH Lori Rodriguez, MPH Malembe Ebama, MPH Kierste Miller, MPH Karen Chartier, PhD Britain Mills, PhD

50. THE END

51. DSM-5 Orphans compared to DSM-5 AUD Positive Lifetime Prevalence DSM-5 Age 1 st drinkFamily HistoryMean weekly volume Binge Drinking Social/health problems Men 1 Criterion +14.5%16.341.5%11.935.3%.22 2+ Criteria44.3%15.757.1%14.941.9%.68 Women 1 Criterion+16.0%17.054.3%5.427.3%.20 2+ Criteria24.8%16.564.4%12.544.9%.71

52. Table 1: Mean age at first drink by birth place among U.S. Hispanic national groups Foreign-bornU.S.-born mean ± SE (N) MalesMexican Americans Non-Border*17.92 ± 0.29 (346)16.80 ± 0.40 (122) Border*18.25 ± 0.45 (203)17.22 ± 0.26 (222) Puerto Ricans17.19 ± 0.39 (231)16.90 ± 0.35 (243) Cuban Americans***19.35 ± 0.45 (405)16.84 ± 0.47 (39) South/Central Americans***18.49 ± 0.21 (405)17.03 ± 0.32 (67) FemalesMexican Americans Non-Border 19.94 ± 0.71 (149)18.75 ± 0.45 (115) Border*** 22.62 ± 0.92 (162)19.98 ± 0.48 (193) Puerto Ricans***21.51 ± 0.65 (171)18.60 ± 0.37 (169) Cuban Americans***21.49 ± 0.54 (227)18.36 ± 0.47 (37) South/Central Americans20.54 ± 0.42 (299)20.07 ± 0.98 (37) Notes: Sample includes current and ex-drinkers; Weighted means, N’s are unweighted sample sizes for each group; SE = Standard error; * p < 0.05; *** p < 0.001.

53. Table 2: Proportion binge drinking by age at first drink among U.S. Hispanic national groups. ≤ 14 years (N)15-17 years (N)18-20 years (N)21+ years (N) Males Mexican Americans Non-Border*34.40 (62)28.46 (182)29.17 (136)25.53 (76) Border10.65 (72)9.03 (156)5.58 (134)2.72 (57) Puerto Ricans** 48.73 (101)24.31 (174)23.01 (107)24.50 (77) Cuban Americans*** 44.00 (43)16.07 (130)25.87 (154)11.42 (98) South/Central Americans 37.77 (41)29.16 (166)19.38 (159)16.67 (86) Females Mexican Americans Non-Border*13.22 (26)12.92 (58)3.52 (78)7.62 (91) Border*7.45 (27)3.46 (73)0.91 (101)0.49 (148) Puerto Ricans** 53.86 (35)36.98 (79)17.18 (95)9.81 (114) Cuban Americans 10.00 (14)13.92 (50)7.49 (85)2.98 (105) South/Central Americans 37.23 (23)12.89 (62)11.48 (110)9.57 (128) Notes: Sample includes current and ex-drinkers; Weighted means, parentheses are unweighted sample sizes for each group; * p < 0.05; ** p < 0.01; *** p < 0.001. In logistic analysis, 0-14 compared to 21+ is a factor of risk in all groups, with OR varying from 2.5 to 3. Group 15-17 is also a factor of risk for non-border Mex. Americans (OR=2.6) and Cuban Americans (OR=2.5

54. Table 3: Prevalence of DSM-5 alcohol use disorder by age at first drink among U.S. Hispanic national groups ≤ 14 years % (N) 15-17 years % (N) 18-20 years % (N) 21+ years % (N) Males Mexican Americans Non-Border38.76 (58)40.39 (179)30.40 (129)29.70 (69) Border **63.46 (68)44.43 (149)27.41 (127)25.57 (50) Puerto Ricans **56.28 (98)50.15 (162)28.56 (103)25.40 (76) Cuban Americans **35.93 (43)19.41 (128)10.47 (147)6.80 (96) South/Central Americans29.79 (39)34.02 (157)20.14 (149)21.05 (86) Female s Mexican Americans Non-Border27.64 (25)23.57 (50)5.89 (64)8.69 (76) Border ***39.94 (24)34.03 (68)8.11 (92)10.75 (109) Puerto Ricans **69.34 (33)22.46 (63)21.11 (83)15.65 (87) Cuban Americans24.04 (13)13.60 (45)5.26 (80)2.01 (92) South/Central Americans16.68 (21)16.53 (60)8.97 (86)3.37 (109) Notes: Sample includes current drinkers; Weighted percentages, N’s are unweighted sample sizes for each group; ** p < 0.01; *** p < 0.001. In logistic analysis 0-14 and 15-17 compared to 21+ are factors of risk with ORs varying from 2 to 8.