Hispanics in the United States have traditionally been considered an "underserved population" in relation to their use of health and social services, including alcohol treatment. Yet this same population - particularly Mexican Americans - tends to self report more episodes of heavy drinking and alcohol-related problems, and have higher rates of driving under the influence (DUI), than other ethnic groups. A study in the January issue of Alcoholism: Clinical & Experimental Research examines what proportion of Mexican Americans arrested for DUI in one northern California county have severe alcohol problems, and what health and social services they have utilized.
"Despite higher rates of heavy drinking found among Mexican American DUI arrestees compared to whites," explained Cheryl J. Cherpitel, a senior scientist with the Alcohol Research Group and author of the study, "Mexican Americans (both those with and without an alcohol use disorder) were less likely to use health and social services. These differences between Mexican Americans and whites were primarily due to the low rate of any services utilization among those Mexican Americans born in Mexico."
Cherpitel explained that many Hispanics living in the United States, including Mexican Americans, have not had the opportunity to avail themselves of health care and social services. Lower utilization is also related to factors such as acculturation - including language barriers, low comfort with service providers, and an inability to negotiate the system - as well as a lack of insurance coverage. This "underutilization" of services has historically been most pronounced among migrant workers, who have not only lacked access to such services, but have also lacked access to standard housing and even proper sanitary services at the work site.
"Those born in Mexico may also have different expectations and perceptions regarding how to obtain services and relationships with providers," said Cherpitel. "They may also be socially isolated due to language barriers. Additionally, it might be expected that those who do not have legal resident status in the U.S. would likely avoid contact with health and social services systems for fear of identification and deportation." However, she noted, this latter point would not apply to her study’s findings, since any individual with an illegal status who was arrested for DUI would most likely be deported immediately, and never enter a DUI treatment program.
In contrast to their low usage of health and social services, Hispanics - particularly Hispanic men - tend to have high levels of alcohol-related problems. Several studies by other researchers at the Alcohol Research Group demonstrate a disturbing pattern. For example, those who reported frequent heavy drinking during the previous year (defined as drinking once a week or more often, and having five or more drinks at one sitting at least once a week): white males (12%) and females (2%) versus Hispanic males (18%) and females (3%). Those who reported three or more alcohol-related problems during the previous year (from a list of 29 social and dependence experiences): white males (11%) and females (4%) versus Hispanic males (16%) and females (5%). The mean number of drinks required to feel drunk: whites reported 6.3 while Hispanics reported 7.9. Comparable findings exist at some state levels. For example, a 1990 Department of Motor Vehicles study found that while Hispanics comprised 25 percent of the population in California, they accounted for 45 percent of DUI arrestees. According to Tom Greenfield, Center director at the Alcohol Research Group, this problem continues to challenge policy makers.
"Since there tend to be high levels of DUI among the Hispanic group in California," he said, "encountering DUI programs by this population may represent an important opportunity for intervention. Arrest for DUI, and mandatory referral to DUI programs, represent a crucial opportunity to address the higher-than-average alcohol-related problems seen in this group, treat their alcohol abuse and alcoholism, and perhaps help prevent later drunk driving offenses and other alcohol-related problems." In addition, he noted, "disparities in health insurance have also been implicated in the service disparities that have been found, emphasizing the need to move toward universal health coverage that includes parity for alcohol-related treatment."
Cherpitel reiterated that there were several caveats to her study’s findings.
"Mexican Americans should not be considered a homogeneous group with respect to drinking patterns and health and social services utilization," she said. "We found considerable differences between Mexican Americans born in Mexico and those born in the U.S., when compared to whites. Given this, future research on Mexican Americans should take into account the country of birth, which may be a more important variable to consider than acculturation in its various forms. Another few words of caution: these findings were obtained among those arrested, convicted and sent to a DUI treatment program. These individuals are not representative of the larger population of Mexican Americans or of whites in relation to demographic characteristics, drinking patterns and problems and, possibly, health and social services utilization. Nor will a DUI-treatment-program clientele include those most likely to be underutilizers, those born in Mexico who are here illegally. Accordingly, findings from this study are most likely conservative in relation to the under-utilization of health and social services by Mexican Americans compared to other whites. The disparity in utilization between Mexican Americans and whites is probably much greater than that reported here."
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Cherpitel, C.J. (2001, January). Differences in services utilization between White and Mexican American DUI arrestees. Alcoholism: Clinical and Experimental Research, 25(1), 122-127.
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