Journal Watch Emergency Medicine
Substance use among emergency room patients: an exploratory analysis by ethnicity and acculturationCheryl J. Cherpitel INTRODUCTION
Substantial literature exists on the role of alcohol in injury occurrence and much of this research has been carried out in hospital emergency rooms (ERs) [reviewed in Ref. (1)]. Studies, using similar methodology of face-to-face interviews and an estimate of blood alcohol at the time of the ER visit have been carried out in a number of countries besides the U.S., including Mexico, Canada, Spain, Italy (1), and Australia (2). Over the last 15 years, these studies have documented the prevalence and role of alcohol consumption in injury occurrence and drinking patterns and problems among both injured and noninjured patients.
During the same period, research focused on substance use/abuse and ER attendance has been scarcer. A number of studies have reported estimates of the prevalence of substance use among patients at the time of the ER consultation (3), but the majority of these studies have not used representative samples of patients and/or have not examined substance use across a range of substances or of injury types and causes (4-11). Findings from these studies have, therefore, been limited, due to small samples of patients and/or selected groups with specific types of injury, and to prevalence estimates based on screening of blood or urine samples collected during the admission process for only a fraction of the patients, using inclusion criteria that do not guarantee representativeness of findings for all patients attending the given ER service.
Although a national surveillance system has been in place in a sample of ERs to provide estimates of drug abuse-related ER episodes since 1972 [the Drug Abuse Warning Network (DAWN) system] (12), it includes only those cases where the drug-related episode is identified as the primary reason for the ER visit, and when compared to toxicology reports from the same facility, has been found to under-report drug-related visits (13).
Research of alcohol and injury in ER studies have found injured patients, when compared to noninjured, more likely to be positive for estimated blood-alcohol level at the time of the ER visit, to report drinking prior to event, and to report heavy drinking (1). Some studies (14) but not all (15) have found injured patients more likely to be alcohol dependent or to report more alcohol-related consequences compared to the noninjured or to a control population. This research has also found that violence-related injuries are particularly more likely to be associated with alcohol use--both with reporting drinking prior to the event as well as with reporting more frequent heavy usual drinking (16). We do not know, however, whether findings from the alcohol literature are applicable to substance use; i.e., are injured patients more likely to use drugs than noninjured (either prior to the event or generally), or are patients injured in violence-related events more likely to use drugs compared to those injured from other causes?
The few studies of substance abuse among ER admissions, which have used probability samples of patients, have found prevalence rates for positive toxicology (excluding alcohol) ranging from 20% (17) to 45% (18,19). This research has also begun to document the role of substance use in both injuries and medical emergencies in the ER, but findings have not always been consistent. Borges et al. (14) found that any substance use in the last 12 months was a risk factor for both injuries and medical emergencies compared to the general population (in Mexico). In examining the role of drug use in the injury event, among those who reported drinking within 6 hr prior to the event that brought them to the ER, 18% of the injured--compared to 28% of the noninjured--reported drug use during this time, with those taking drugs only half as likely to be admitted to the ER with an injury compared to those who reported not taking drugs during this time (20). In a Canadian ER study, only 3% of the injured and 2% of the noninjured reported using drugs in the 6 hr prior to the event that brought them to the ER; however, 26% of the injured compared to 18% of the noninjured reported using drugs during the last year (41). Borges et al. (22) found that any substance or medication used 6 hr prior to the event was related to suicide attempts, but not to violence-related injuries (23), while the Canadian ER study found violence-related injuries more likely to test positive only for benzodiazepines compared to other injuries or to medical emergencies (24). Soderstrom et al. (18) found that intentional injuries were more likely to test positive on urine screen for drugs and for drugs in combination with alcohol than unintentional injuries, and that life-time and last-12-month drug dependence were both more common among intentional than unintentional injuries.
While research on alcohol in ER samples has found important differences across ethnic groups, with whites showing more alcohol involvement (based on self-reports of frequent heavy and problem drinking) than blacks or Hispanics (15), we do not know if this relationship holds for substance use, since data on substance use across ethnic groups are scarce. There is some evidence that nonwhites are more likely to test drug positive and to be drug dependent than whites (18). Additionally, we do not know how substance use among Hispanics varies across levels of acculturation, a factor that seems to be important in this ethnic group (25,26). Finally, since alcohol involvement appears to be a key variable associated with injury occurrence among ER patients, we need to explore how substance use varies with alcohol consumption in ER populations (18).
To begin filling this gap in the literature, data are reported on the prevalence of self-reported substance use within 6 hr prior to ER attendance and during the last 12 months in a probability sample of 1429 ER patients in Santa Clara County, CA. Comparisons are made between injured and noninjured, and among injured, between those with and without violence-related injuries. Comparisons are also made across ethnicities and by level of acculturation (among Hispanics), controlling for reported alcohol use prior to the event and symptoms of alcohol dependence.
METHODS
Sample Selection
A probability sample of all patients (injured and noninjured) 18 years and older admitted to the ER of Santa Clara Valley Medical Center in San Jose, CA was selected for the study. The sample was drawn from ER admission forms, reflecting consecutive patient arrival in the ER during a 14-week period (November, 1995-February, 1996). Sampled shifts were rotated to provide equal representation of each shift for each day of the week throughout the study period. Black and Hispanic patients were over-sampled to provide adequate numbers for comparative analyses. Patients were approached with an informed consent to be interviewed for the study as soon as possible after admission to the ER. Patients who were too severely injured or ill to be interviewed in the ER were followed into the hospital and interviewed after their condition had stabilized.
Instruments
Data were collected using a questionnaire of about 25-min in length, administered by professionally trained interviewers who were supervised by the first author and by staff of the University of California, Berkeley, Survey Research Center. The interview obtained data, among other items, on the condition that brought the patient to the ER, use of prescription or nonprescription medications within the 6 hr prior to that event, use of illicit or nonprescription drugs or use of alcohol during that time, use of illicit drugs or nonprescription drugs during the last 12 months, alcohol consumption, and demographic characteristics, including level of acculturation among Hispanics.
Patients were asked about drug use in the 6 hr prior to the event and in the last 12 months in the following categories: (1) crank (Methamphetamine); (2) other types of speed or amphetamines (bennies, black beauties, whites, diet pills, Dexedrine); (3) crack or cocaine in any form; (4) sedatives, tranquilizers, or barbiturates, Quaaludes, Librium, or Valium; (5) methadone; (6) Heroin; (7) codeine and other opiates (opium, morphine, Demerol, Fentanyl, China White, Dilaudid, Darvon, Percodan); (8) PCP, angel dust, lysergic acid diethylamide (LSD), mescaline, psilocybin mushroom; (9) marijuana, Hash, or tetrahydrocannabinol (THC); (10) and any other drugs not including prescriptions and medications. Because of small numbers in some of these categories, these drugs were then grouped into four categories (27): (1) central nervous system stimulants (cocaine/amphetamines), (2) central nervous system depressants and opiates (tranquilizers/opium/heroine/methadone), (3) marijuana, (4) and hallucinogens/other substances.
Alcohol dependence was measured using an adaptation of the Alcohol Section of the Composite International Diagnostic Interview core (28), which measured both ICD-10 (International Classification of Diseases, 10th revision) (29) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision) criteria for current alcohol dependence (30). A patient was considered positive for alcohol dependence on meeting criteria in three of the six domains of ICD-10 and/or three of the seven domains of DSM-IV.
Acculturation was measured using a scale, which was developed by the Alcohol Research Group to measure the degree of adaptation to U.S. culture in the National Alcohol Survey (31) and which has also been used in a prior ER study (25). The reliability of this scale has been assessed with Cronbach's alpha (0.91) and Guttman's split-half method (0.87), and has been found to be negatively correlated with being foreign born and positively correlated with the number of years of living in the United States.
Using this measure, patients were asked whether they usually spoke English (scored 3), usually spoke Spanish (scored 1), or spoke both about the same (scored 2), separately for several categories of individuals. These items were combined and averaged to form a single scale for speaking. Patients were also asked about the proportion of time (also on a three-point scale of most of the time, scored 1; about half the time, scored 2; less than half the time or almost never, scored 3) they preferred reading in Spanish, listening to Hispanic music, listening to Hispanic radio stations, and listening to Hispanic TV channels. Responses to all items were summed with speaking given twice the weight as the other items (range of 6-18). If respondents could not answer certain items because the question was not applicable (e.g., do not watch TV), they were assigned their average score on all other items in the scale. The scale was divided into three groups representing low (scored 6-7), medium (scored >7- < 15) and high (scored 15-18) acculturation.
Among Hispanics, 48% of the interviews were conducted in Spanish. All instruments and questions had either previously been translated into Spanish for use in our prior ER studies or in the National Alcohol Surveys, or had translations readily available from the Mexican Institute of Psychiatry in Mexico City (for example, the Alcohol Section of the CIDI, including an adaptation of DSM-IV diagnostic criteria). Items were translated using a local translator. The Spanish version was then back translated into English by a second translator, who had no previous knowledge of the questions. The original version of the items and the English back-translated version were then compared for exactness of meaning, and differences were reconciled with the help of the translator, following the procedure described by Breslin (32).
Data Analysis
Data are analyzed comparing 6-hr and last-12-month drug use between injured and noninjured patients (Table 2), between those injured in violence-related events and those with injuries from other causes (Table 3), across the three ethnic groups (Table 4), and across levels of acculturation among Hispanics (Table 5). Six-hour and last-12-month drug use are also compared across groups (and level of acculturation among Hispanics) controlling for self-reported alcohol use within 6 hr prior to the event and for alcohol dependence (Table 6). Chi-squared and Fisher's exact tests (for cell sizes less than five) are used in determining statistical significance for these comparisons. Where the three ethnic groups are combined (Tables 2 and 3), the data are weighted to take into account the differential sampling fractions for white, black, and Hispanic patients.
Sample Characteristics
Of the 1952 patients sampled, completed interviews were obtained on 73% (n = 1429); 70% blacks, 80% Hispanics, and 69% whites (whites here also include 4% Asian and 5% primarily Filipino and Native American). Blacks were significantly more likely to refuse to participate in the study (13%) than Hispanics or whites (8%), while Hispanics were less likely to leave prior to completing the interview (6%) or to not participate due to their medical condition prohibiting the interview (6%). Those interviewed compared to noninterviewed were significantly more likely to be female among blacks and Hispanics, and to be under 30 among blacks and whites. Among Hispanics, 85% reported they were Mexican or Mexican American, 9% reported identification with Latin, Central, or South America, 3% with Cuba or Puerto Rico, and 3% reported other Hispanic identification. In the analyses reported here, 27 injury patients and 68 noninjury patients who were admitted to the ER for follow-up of a problem that had been treated previously (either in the ER or elsewhere) are excluded since they were not asked questions related to drug use or drinking prior to the event.
Table 1 shows demographic characteristics for the three ethnic groups. No difference was found (using comparisons of sample proportions) for gender or reporting use of an ER at least one other time during the last year. Blacks differed from whites only in a smaller proportion being over 50 and a larger proportion never being married. A number of differences were found for Hispanic patients, however, with these patients more likely to be under 30, to be less educated, and to be currently married or in a married-like relationship compared to whites and blacks. Hispanics were also more likely to not have health insurance than either whites or blacks.
RESULTS
As seen in Table 2, noninjured patients, not surprisingly, were more likely to report use of medicines in the 6 hr prior to the event than injured patients; however, no difference was found for substance use during the 6 hr prior to the event, with 4-5% reporting drug use during this time, and most reporting the use of only one drug. Injured, however, were significantly more likely to report drug use during the previous 12 months (primarily marijuana), and were also more likely to report the use of more than one drug compared to noninjured.
Table 3 shows differences in substance use among the injured for those with and without injuries related to violence. Those with violence-related injuries were more likely to report substance use in the 6 hr prior to injury, as well as in the last 12 months (primarily cocaine/amphetamines and marijuana in both time periods) compared to those with injuries from other causes. Those with injuries from other causes were more likely to report use of prescription or nonprescription medicines in the 6 hr prior to the event.
Table 4 shows these same data by ethnic group. A larger proportion of whites, followed by blacks and Hispanics were found to use both medicines and drugs in the 6 hr prior to the event, and also to use drugs during the last year. Hispanics appear notably less likely to use during the last year than either whites or blacks. Only the use of hallucinogens did not appear to differ significantly between Hispanics and whites or blacks for both 6-hr or last-12-month use. Whites also appear more likely to report the use of two or more substances during the last year than either blacks or Hispanics.
As seen in Table 5, acculturation appears to be an important variable in relation to substance use among Hispanics. Those high on acculturation were most likely to report substance use in the 6 hr prior to the event as well as during the last 12 months, with 50% reporting use during this latter time, and half of these reporting the use of two or more substances. The majority of those high on acculturation reported use of central nervous system depressants/opiates prior to the event, while for last year use, over a third reported use of marijuana, and 21% reporting use of stimulants cocaine/amphetamines) and depressants/opiates, each.
Table 6 shows both the 6-hr and last-year drug use in ethnic and acculturation subgroups controlling for drinking 6 hr prior to the event and for alcohol dependence. Among those reporting drinking 6 hr prior to the event and those meeting diagnostic criteria for alcohol dependence, significant differences are not found across ethnic and acculturation subgroups in the proportions reporting drug use in the 6 hr prior to injury. Ethnic differences were found, however, for substance use in the last 12 months among those reporting alcohol use in the 6 hr and also among those meeting diagnostic criteria for alcohol dependence, but this difference appears to be concentrated mainly among Hispanics in the medium acculturation group. When this group is removed from the analysis (not shown), differences across ethnic/acculturation groups are not significant among either those reporting drinking in the 6 hr (Fisher's = 0.424) or those meeting diagnostic criteria for alcohol dependence (Fisher's = 0.088). Those reporting alcohol use in the 6 hr and those with alcohol dependence appear more likely to report substance use, both prior to the event and during the last year, in all subgroups except Hispanics in the medium category of acculturation, compared to those not positive on these alcohol consumption variables. Hispanics at the high level of acculturation appear to be similar to or higher than whites in the proportions reporting 6-hr or 12-month drug use, controlling for alcohol consumption variables.
DISCUSSION
Findings from this descriptive study of the prevalence of substance use among patients attending the ER in Santa Clara, California, suggest that not all findings regarding alcohol use among ER patients are readily translated to other substances. For example, substance use 6 hr prior to the event was not found to be significantly different between injured and noninjured patients, although injured patients were more likely than the noninjured to report usual drug use during the last year. Those with violence-related injuries were more likely to report use of drugs both in the 6 hr prior to the event and during the last year compared to those with injuries from other causes. Alcohol studies have found those with injuries compared to noninjuries, and those with violence-related injuries compared to other injuries, more likely to report drinking in the 6 hr prior to the event and to report more frequent heavy drinking during the last year (1,16).
Findings for substance use in the 6 hr prior to the event for both injured and noninjured patients were similar to those in the Canadian ER study, where 3% of the injured and 2% of the noninjured reported drug use during this time (21). However, the proportion of those reporting drug use for the last year was much larger in the Santa Clara sample, where 46% of the injured and 31% of the noninjured reported use during this time, compared to 26 and 18%, respectively, in the Canadian study. Among the injured in the Canadian study, those with violence-related injuries were more likely to test positive only for benzodiazepines, while the Santa Clara study found those with violence-related injuries significantly more likely to report use of both marijuana and cocaine or amphetamines prior to the event compared to those with injuries from other causes.
Contrary to others (18), whites were found to report a higher prevalence of both 6-hr and 12-month substance use compared to blacks and Hispanics. These results across ethnicity are similar to those reported previously for alcohol consumption in this same ER sample (15). Acculturation among Hispanics also appears to be an important variable to consider in ER studies of substance abuse. Similar to what has been found for illicit drug use in the general Hispanic population of Fresno, California (26) and for alcohol use disorders among Hispanics in this same ER sample (21), the lower prevalence of substance use among Hispanics is primarily due to the lower prevalence among those who scored low on acculturation. Patients low on the acculturation scale presented prevalences of substance use (Table 5) similar to those found in a comparable study of ER patients in Pachuca, Mexico, where 1.2% reported substance use in the 6 hr prior to the event and 4.4% reported substance use in the last year (33).
A similar proportion of Hispanics in the high acculturation group as whites reported drug use in the 6 hr prior to the event (6%) and a higher proportion reported substance use during the last year (49 vs. 43%). The increased levels of substance use associated with increasing acculturation among U.S. Hispanics (primarily Mexican Americans in this study) may likely have a strong impact on health services utilization, including the use of ER services. A recent analysis of illicit drug use and ER utilization found that chronic drug use among both males and females increased the probability of ER use for medical treatment by more than 30% compared to casual use or nonuse (34). These authors suggest that policy makers and health services providers consider implementing intervention and prevention services in the ER where drug users are more likely to seek access to care.
Finally, when substance use (both 6-hr and last-12-month use) was examined across ethnic and cultural subgroups, controlling for self-reported alcohol consumption within 6 hr prior to the event and for alcohol dependence (Table 6), a much higher prevalence of substance use was apparent among alcohol positive cases, a finding that is similar to that reported previously by Soderstrom, et al. (18), and observed differences in substance use across ethnic/ acculturation subgroups appear relatively minor, suggesting that among those heavily involved with alcohol, substance use may become secondary. These results must be viewed with caution, however, due to the small size of subgroups analyzed. Larger sample sizes and temporal sequences of alcohol and substance use involvement are clearly needed to explore this important topic further. The higher prevalence of substance use among those reporting drinking within 6 hr prior to the event also suggests that future research focused on the interaction of alcohol and other substances on injury occurrence, including violence, is important.
Neither pharmacologically nor sociologically is there a reason to believe that drug use (licit or illicit) should have the same relationship with ER visits, especially for injuries, as those found for alcohol consumption. Moreover, there is no reason to expect that specific classes of drugs would have the same relationship as other classes, with injury occurrence and/or medical emergencies. For instance, it has been postulated that alcohol has a direct effect on violent behavior, but that illicit substances, such as cocaine, are related to violence in a more complex way (35) and may be related more to the economics of drug trafficking and the environment in which drugs are consumed than to the physiological effects of a substance (36). A special point of inquiry is related to prescription and over-the-counter medications, which, according to data reported here, not only have a very high prevalence of use prior to the event among the noninjured, but also have a substantial prevalence among the injured as well. Further research, which documents the effect of these drugs (and their interactions with alcohol) on injury occurrence, is needed.
Limitations of our results are related mainly to the lack of a biological specimen for toxicology testing in the ER sample. Thus, we are not able to discard the possibility of a bias in the self-reported prevalence of substance use prior to the injury or medical emergency. While the validity of self-reported drug use has been found to be as high as for reports of nonchemical use items such as ER visits, arrests, or hospitalizations (37), validity has been found to vary by population subgroup, and little is known about under-reporting of substance use by ethnicity (38). While positive results from toxicology screens are not truly comparable in time frame with self-reported substance use within 6hr prior the event, at least for alcohol consumption, self-reported use prior to the event has been found to be a more accurate indicator of use than biological specimens obtained at the time of the ER visit (39), and some data suggest this may also be true of drug use (40). The ER studies have found relatively large proportions (20-40%) of patients who register negative for estimated blood alcohol at the time of the ER visit report drinking prior to the event, which is most likely due to the time lapsed between the event and arrival in the ER, especially for those with less serious conditions.
Additionally, data on substance use disorders were not obtained; therefore, the level of substance use dependence in this sample, as reported by others (18), could not be obtained. This is an important topic that should be covered in future research. Finally, the number of Hispanics within acculturation categories was small, affecting the precision and stability of prevalence estimates reported here. Additional research is also needed by gender, ethnicity, and acculturation to determine the burden that substance use (both acute and chronic use) places on the ER, and those substances that have the greatest impact on health services utilization.
Table 1. Demographic Characteristics by Ethnicity (%)
White Black Hispanic
Gender (452) (332) (550)
Male 52 48 46
Female 48 52 54
Age (years)
18-29 30 31 39 (b,c)
30-49 49 55 39 (b,c)
50+ 21 14 (a) 22 (b
Education
<High school 18 16 59 (b,c)
High school grad 34 34 22 (b,c)
Some college 35 41 15 (b,c)
College grad 13 9 4 (b,c)
Marital status
Married/married like relationship 36 30 44 (b,c)
Sep/div/widowed 32 29 27
Never married 32 41 (a) 29 (c)
No health insurance 58 51 62 (b)
Other ER visits last year 48 50 44
(a) p < 0.05 Comparison of proportions between blacks and whites.
(b) p < 0.05 Comparison of proportions between Hispanics and whites.
(c) p < 0.05 Comparison of proportions between blacks and Hispanics.
Table 2. Substance Use Among Injured and Noninjured Patients (%)
Noninjured Injured
(1025) (297)
Medicines 6 hr prior 44.1 17.8
Substance use 6 hr prior 5.2 3.7
Type of substance:
Cocaine/amphetamine 1.2 1.0
Tranquilizers/opium/heroine/methadone 3.4 1.7
Marijuana 1.3 1.7
Hallucinogens/other 0.6 --
Number of substances 6 hr prior
Only one 3.7 2.7
Two or more 1.5 0.3
Substance use, last 12 months 30.8 46.0
Type of substance:
Cocaine/amphetamine 13.4 17.0
Tranquilizers/opium/heroine/methadone 14.9 11.5
Marijuana 17.7 39.7
Hallucinogens/other 3.7 5.2
Number of substances, last 12 months
Only one 15.5 27.9
Two or more 15.2 18.1
[X.sup.2](df) P
Medicines 6 hr prior 67.2 (1) <0.000
Substance use 6 hr prior 1.0 (1) 0.311
Type of substance:
Cocaine/amphetamine (a) 1.000
Tranquilizers/opium/heroine/methadone 2.3 (1) 0.130
Marijuana 0.3 (1) 0.574
Hallucinogens/other (a) 0.348
Number of substances 6 hr prior (a) 0.240
Only one (a) 0.475
Two or more (a) 0.142
Substance use, last 12 months 23.0 (1) <0.000
Type of substance:
Cocaine/amphetamine 2.4 (1) 0.120
Tranquilizers/opium/heroine/methadone 2.1 (1) 0.145
Marijuana 61.7 (1) <0.000
Hallucinogens/other 1.4 (1) 0.233
Number of substances, last 12 months 27.6 (2) <0.000
Only one (a) <0.000
Two or more (a) 0.024
(a) Fisher's exact test used.
Table 3. Substance Use Among Violent-Related Injuries (%)
No Violence (251)
Medicines 6 hr prior 19.9
Substance use 6 hr prior 2.0
Type of substance:
Cocaine/amphetamine --
Tranquilizers/opium/heroine/methadone 1.2
Marijuana --
Hallucinogens/other --
Number of substances 6 hr prior
Only one 1.6
Two or more --
Substance use, last 12 months 43.3
Type of substance:
Cocaine/amphetamine 15.4
Tranquilizers/opium/heroine/methadone 11.3
Marijuana 37.0
Hallucinogens/other 4.9
Number of substances, last 12 months
Only one 26.3
Two or more 17.0
Violence (45) [X.sup.2](df)
Medicines 6 hr prior 4.4 6.3 (1)
Substance use 6 hr prior 11.4 (a)
Type of substance:
Cocaine/amphetamine 4.5 (a)
Tranquilizers/opium/heroine/methadone 2.3 (a)
Marijuana 9.1 (a)
Hallucinogens/other --
Number of substances 6 hr prior (a)
Only one 9.1 (a)
Two or more 2.3 (a)
Substance use, last 12 months 61.0 4.4 (1)
Type of substance:
Cocaine/amphetamine 26.8 3.3 (1)
Tranquilizers/opium/heroine/methadone 14.6 0.4 (1)
Marijuana 56.1 5.4 (1)
Hallucinogens/other 7.7 (a)
Number of substances, last 12 months 4.4 (1)
Only one 36.6 (a)
Two or more 24.4 (a)
P
Medicines 6 hr prior 0.012
Substance use 6 hr prior 0.009
Type of substance:
Cocaine/amphetamine 0.022
Tranquilizers/opium/heroine/methadone 0.482
Marijuana 0.000
Hallucinogens/other
Number of substances 6 hr prior 0.005
Only one 0.018
Two or more 0.140
Substance use, last 12 months 0.036
Type of substance:
Cocaine/amphetamine 0.071
Tranquilizers/opium/heroine/methadone 0.544
Marijuana 0.021
Hallucinogens/other 0.440
Number of substances, last 12 months 0.110
Only one 0.102
Two or more 0.096
(a) Fisher's exact test used.
Table 4. Substance Use Among Three Ethnic Groups (%)
White (447) Black (330)
Medicines 6 hr prior 42.5 38.2
Substance use 6 hr prior 6.3 4.0
Type of substance:
Cocaine/amphetamine .9 2.2
Tranquilizers/opium/heroine/methadone 4.0 0.9
Marijuana 2.0 1.9
Hallucinogens/other 0.5 --
Number of substances 6 hr prior
Only one 4.7 3.4
Two or more 1.6 0.6
Substance use, last 12 months 43.1 38.7
Type of substance:
Cocaine/amphetamine 18.2 16.5
Tranquilizers/opium/heroine/methadone 18.5 14.8
Marijuana 27.2 27.6
Hallucinogens/other 5.1 2.5
Number of substances, last 12 months
Only one 22.1 22.0
Two or more 21.0 16.8
Hispanic (545) [X.sup.2](df)
Medicines 6 hr prior 33.0 9.5 (2)
Substance use 6 hr prior 3.1 6.0 (2)
Type of substance:
Cocaine/amphetamine 1.1 (a)
Tranquilizers/opium/heroine/methadone 2.2 7.7 (2)
Marijuana 0.4 (a)
Hallucinogens/other 0.6 (a)
Number of substances 6 hr prior (a)
Only one 2.0 (a)
Two or more 0.9 (a)
Substance use, last 12 months 22.4 51.7 (2)
Type of substance:
Cocaine/amphetamine 8.8 20.4 (2)
Tranquilizers/opium/heroine/methadone 9.0 19.0 (2)
Marijuana 15.9 23.7 (2)
Hallucinogens/other 3.0 4.6 (2)
Number of substances, last 12 months 53.2 (4)
Only one 12.9 (a)
Two or more 9.5 (a)
P
Medicines 6 hr prior 0.008
Substance use 6 hr prior 0.050
Type of substance:
Cocaine/amphetamine 0.315
Tranquilizers/opium/heroine/methadone 0.021
Marijuana 0.028
Hallucinogens/other 0.541
Number of substances 6 hr prior 0.110
Only one 0.055
Two or more 0.425
Substance use, last 12 months <0.000
Type of substance:
Cocaine/amphetamine <0.000
Tranquilizers/opium/heroine/methadone <0.000
Marijuana 0.000
Hallucinogens/other 0.100
Number of substances, last 12 months <0.000
Only one <0.000
Two or more <0.000
(a) Fisher's exact test used.
Table 5. Substance Use Among Hispanics by Acculturation(%)
Hisp/Low (177)
Medicines 6 hr prior 24.3
Substance use 6 hr prior 1.1
Type of substance:
Cocaine/amphetamine 0.6
Tranquilizers/opium/heroine/methadone --
Marijuana 0.6
Hallucinogens/other 0.6
Number of substances 6 hr prior
Only one --
Two or more 0.6
Substance use, last 12 months 3.9
Type of substance:
Cocaine/amphetamine 2.8
Tranquilizers/opium/heroine/methadone/ 0.6
Marijuana 2.2
Hallucinogens/other 0.6
Number of substances, last 12 months
Only one 2.2
Two or more 1.7
Hisp/Med (175)
Medicines 6 hr prior 38.9
Substance use 6 hr prior 1.7
Type of substance:
Cocaine/amphetamine --
Tranquilizers/opium/heroine/methadone 1.1
Marijuana 0.6
Hallucinogens/other --
Number of substances 6 hr prior
Only one 1.7
Two or more --
Substance use, last 12 months 12.1
Type of substance:
Cocaine/amphetamine 1.7
Tranquilizers/opium/heroine/methadone/ 5.2
Marijuana 8.1
Hallucinogens/other 1.2
Number of substances, last 12 months
Only one 9.2
Two or more 2.9
Hisp/High (180)
Medicines 6 hr prior 35.0
Substance use 6 hr prior 6.1
Type of substance:
Cocaine/amphetamine 2.2
Tranquilizers/opium/heroine/methadone 5.0
Marijuana --
Hallucinogens/other 1.1
Number of substances 6 hr prior
Only one 4.5
Two or more 1.7
Substance use, last 12 months 49.2
Type of substance:
Cocaine/amphetamine 21.0
Tranquilizers/opium/heroine/methadone/ 20.4
Marijuana 35.9
Hallucinogens/other 7.2
Number of substances, last 12 months
Only one 26.0
Two or more 23.2
[X.sup.2](df) P
Medicines 6 hr prior 9.1 (2) 0.010
Substance use 6 hr prior 9.2 (2) 0.010
Type of substance:
Cocaine/amphetamine (a) 0.134
Tranquilizers/opium/heroine/methadone (a) 0.002
Marijuana (a) 0.552
Hallucinogens/other (a) 0.777
Number of substances 6 hr prior (a) 0.005
Only one (a) 0.009
Two or more (a) 0.179
Substance use, last 12 months 121.6 (2) 0.000
Type of substance:
Cocaine/amphetamine 53.1 (2) <0.000
Tranquilizers/opium/heroine/methadone/ 48.2 (2) <0.000
Marijuana 88.2 (2) <0.000
Hallucinogens/other 16.5 (2) <0.000
Number of substances, last 12 months 124.9 (4) <0.000
Only one 68.5 (2) <0.000
Two or more 83.3 (2) <0.000
(a) Fisher's exact test used.
Excludes 14 Hispanics with missing data on acculturation.
Table 6. Substance Use in Ethnic-Acculturation Groups According to
Selected Variables (%)
White Black
Alcohol 6 hr prior self report No (382) (297)
Drugs 6 hr prior 5.0 1.3
Drugs last 12months 39.9 36.1
Yes (63) (26)
Drugs 6 hr prior 14.3 34.6
Drugs last 12 months 62.3 69.2
Alcohol dependence syndrome No (365) (278)
Drugs 6 hr prior 4.9 2.5
Drugs last 12 months 37.4 32.2
Yes (70) (40)
Drugs 6 hr prior 12.9 15.0
Drugs last 12 months 72.5 87.5
Hisp/Low Hisp/Med
Alcohol 6 hr prior self report No (167) (164)
Drugs 6 hr prior 0.6 1.8
Drugs last 12months 1.8 11.7
Yes (10) (11)
Drugs 6 hr prior 10.0 --
Drugs last 12 months 40.0 18.2
Alcohol dependence syndrome No (171) (160)
Drugs 6 hr prior 0.6 1.9
Drugs last 12 months 2.3 11.9
Yes (6) (13)
Drugs 6 hr prior 16.7 --
Drugs last 12 months 50.0 15.0
Hisp/High
Alcohol 6 hr prior self report No (156)
Drugs 6 hr prior 3.2
Drugs last 12months 46.5
Yes (23)
Drugs 6 hr prior 26.1
Drugs last 12 months 66.7
Alcohol dependence syndrome No (147)
Drugs 6 hr prior 4.1
Drugs last 12 months 44.0
Yes (31)
Drugs 6 hr prior 16.1
Drugs last 12 months 71.0
[X.sup.2](df)
Alcohol 6 hr prior self report No
Drugs 6 hr prior (a)
Drugs last 12months 131.7 (4)
Yes
Drugs 6 hr prior (a)
Drugs last 12 months (a)
Alcohol dependence syndrome No
Drugs 6 hr prior (a)
Drugs last 12 months 114.7 (4)
Yes
Drugs 6 hr prior (a)
Drugs last 12 months (a)
P
Alcohol 6 hr prior self report No
Drugs 6 hr prior 0.014
Drugs last 12months <0.000
Yes
Drugs 6 hr prior 0.067
Drugs last 12 months 0.028
Alcohol dependence syndrome No
Drugs 6 hr prior 0.050
Drugs last 12 months <0.000
Yes
Drugs 6 hr prior 0.624
Drugs last 12 months <0.000
(a) Fisher's exact test use.
ACKNOWLEDGMENTS
This study was supported by National Institute on Alcohol Abuse and Alcoholism grant R21 AA11503.
* Presented at the American Public Health Association Annual Meeting, Atlanta, GA, October 22-25, 2001.
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Cheryl J. Cherpitel (1), ([dagger]) and Guilherme Borges (2)
(1) Public Health Institute, Alcohol Research Group, 2000 Hearst Avenue, Berkeley, California
(2) National Institute of Psychiatry and UAM-Xochimilco, Calzada Mexico-Xochimilco 101, Mexico D.F., C.P. 14370, Mexico
([dagger]) Corresponding author. E-mail: ccherpitel@argo.org
COPYRIGHT 2002 Marcel Dekker, Inc.
COPYRIGHT 2003 Gale Group
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