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Initiation to Methamphetamine Use in a Binational Sample of Women at the US-Mexico Border

Javier Lopez-Zetinaa; Ricardo Sanchez-Huescab; Britt Rios-Ellisa; Robert Friisa; Isabel Torresc; Bridget Rogalaa a California State University, Long Beach, California b Centros de Integracin Juvenil, Mexico City, Mexico c MD Anderson Cancer Center, Houston, Texas Online publication date: 17 February 2010

To cite this Article Lopez-Zetina, Javier , Sanchez-Huesca, Ricardo , Rios-Ellis, Britt , Friis, Robert , Torres, Isabel and

Rogala, Bridget(2010) 'Initiation to Methamphetamine Use in a Binational Sample of Women at the US-Mexico Border', Journal of Ethnicity in Substance Abuse, 9: 1, 28 39 To link to this Article: DOI: 10.1080/15332640903539120 URL: http://dx.doi.org/10.1080/15332640903539120

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Journal of Ethnicity in Substance Abuse, 9:2839, 2010 Copyright # Taylor & Francis Group, LLC ISSN: 1533-2640 print=1533-2659 online DOI: 10.1080/15332640903539120

Initiation to Methamphetamine Use in a Binational Sample of Women at the USMexico Border

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JAVIER LOPEZ-ZETINA
California State University, Long Beach, California

RICARDO SANCHEZ-HUESCA
n Centros de Integracio Juvenil, Mexico City, Mexico

BRITT RIOS-ELLIS and ROBERT FRIIS

California State University, Long Beach, California

ISABEL TORRES
MD Anderson Cancer Center, Houston, Texas

BRIDGET ROGALA
California State University, Long Beach, California

This article examines comparative risk behaviors associated with methamphetamine use in a binational sample of women in the border cities of Tijuana, Mexico, and San Diego, California. Specifically, the study examined the differences and similarities in drug use and sexual risk behavior and the patterns of initiation to methamphetamine use. The binational pilot sample consisted of 70 adult women in Tijuana and 55 women in San Diego. Although there were important differences in the presentation of risk behavior and patterns of initiation between the two binational samples, women on both sides of the USMexico border also showed remarkable similarities in their risk profile. Results from this study suggest that despite significant cultural and socioeconomic differences between the study cities, certain specific substance abuse patterns (e.g., methamphetamine use) in border regions with an
Supported by grants from National Institute on Drug Abuse and the University AIDS Research Program in California. Address correspondence to Javier Lopez-Zetina, Ph.D., MA, California State University, Long Beach, Health Science Department, 1250 Bellflower Blvd., Long Beach, CA 908404902. E-mail: jlopezze@csulb.edu 28

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increasing demographic exchange and integration are emerging as an equalizer of risk, capable of dissolving context-based differentiating factors, and creating a more homogenous subpopulation of substance users. KEYWORDS methamphetamine, Mexico, sexual behavior, women

INTRODUCTION
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Use of methamphetamine among women has increased substantially in the United States over the past decades, particularly in regions with historically high prevalence of use such as the western United States. In California, methamphetamine has now surpassed alcohol and other drugs as the primary drug at admission in drug treatment facilities among both men and women (CA Department of Alcohol and Drug Programs, 2007a). The problem is singularly acute in the region encompassing the California region of the USMexico border. In 2000, 4 of the 10 Southern California counties within 200 miles of the USMexico border reported methamphetamine as the primary drug of abuse at admission into drug treatment; six years later, in 2005, all 10 counties were reporting methamphetamine as the primary drug of abuse (Jett, 2007). San Diego, Los Angeles, Orange, and San Bernardino counties, which are border or border-adjacent counties that have the largest urban population in the Western United States, are also the counties with the largest proportion of drug admissions with methamphetamine as the primary drug of abuse. In 2005, these four counties accounted for 38% of all methamphetamine-related admissions to treatment centers in the state of California (CA Department of Alcohol and Drug Programs, 2007a). In California in 2006, a larger proportion of women (41%) than men (30%) reported methamphetamine as their primary drug of abuse at admission to treatment (CA Department of Alcohol and Drug Programs, 2007a). In California, the proportion of drug treatment admissions overall with methamphetamine as the primary drug of abuse among women has increased from 31% in 2002 to 44% in 2006, with the top four counties with the highest proportion of methamphetamine-related admissions located in Southern California: Los Angeles, San Bernardino, Riverside, and San Diego (CA Department of Alcohol and Drug Programs, 2007b). Of particular concern is the spread of methamphetamine use among pregnant women. Among pregnant women admitted to treatment in 2006, the majority of cases (59%) reported methamphetamine as their primary drug of abuse (CA Department of Alcohol and Drug Programs, 2007b). Furthermore, the impact of methamphetamine use among women residing in California and border communities is particularly relevant in health care settings. Among non-pregnant and pregnant patients exposed to illicit drug use, amphetamines and methamphetamines are the most common drugs of choice (Catanzarite & Stein, 1995).

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Mexican border communities have been equally impacted by the spread of methamphetamine use; it is widely recognized that many of the northern border states in Mexico closely resemble epidemiologic patterns of metham phetamine use found in the United States (Direccion General de Epidemio loga, 2008). Similar to their U.S. counterparts, the majority of women at drug treatment centers on the Mexican side of the CaliforniaMexico border are now reporting methamphetamine as the primary drug used at admission. The Mexican western border state of Baja California Norte leads the Mexican nation in the majority of methamphetamine-related admissions. In 2006, 44.6% of all admissions reported methamphetamine as their primary drug n of abuse (Direccio General de Epidemiologa, 2008). In 2006, treatment data from Centros de Integracion Juvenil, one of the largest drug treatment providers in Mexico, indicate that 22.4% all women reported lifetime use of methamphetamine in border cities of Tijuana and Mexicali, Mexico. In Tijuana, previous studies have shown that the single, strongest independent predictor of HIV infection among pregnant women screened for HIV is methamphetamine use (Viani et al., 2006). The binational growing impact of methamphetamine use among women in the Western United States and Mexico is challenging previously accepted notions on substance use and women. Until recently, rates of abuse of illegal substances among women were much lower when compared to men; it was postulated that women respond more often with psychosomatic disorders to stress and other factors driving substance abuse (Uziel-Miller & Lyons, 2000). The spread of methamphetamine has substantially changed this pattern of initiation and maintenance of use among women. However, perhaps due to methamphetamines early association with the subpopulation of men who have sex with men in California, there is a paucity of research regarding methamphetamine use and women (Lorvick, Martinez, Gee, & Kral, 2006). Despite this limitation, preliminary research focusing on women and methamphetamine show that no one single factor can completely explain the spread of methamphetamine use among women. Motivation for methamphetamine use among women is multifactorial: as an appetite suppressant to lose weight, as an energy booster, as a sexual stimulant, or as an enhancer of subjectively perceived self-confidence (Semple, Patterson, & Grant, 2004). On a larger scale, contextual factors associated with the spread of methamphetamine use along communities of the Western US Mexico border include a culture of socially acceptable use of amphetamines as a light stimulant and weight control medication (Klee, 1997), the relatively ease of manufacturing methamphetamine with consequently low cost in the early years of the epidemic (Anglin, Burke, Perrochet, Stamper, & Dawud-Noursi, 2000), and the growing participation of women in the work market in the past few decades (Alwin, Braun, & Scott, 1992) among women in the United States. On the Mexican side, contextual factors include significant transborder drug trafficking of methamphetamine, particularly in

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Tijuana (Case et al., 2008), increasing sex trade on both side of the border (Patterson et al., 2006), and the establishment of maquiladora industry, which has become a strong magnet for unemployed, impoverished women from economically depressed regions in Mexico (La Botz, 1994). The current research aims at describing characteristics and risk factors associated with initiation to methamphetamine use in a binational sample of women in the United StatesMexico border near California.
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METHODS
Results in this study are from analyses conducted with baseline data collected during the period of the summer of 2005 to December 2007. A survey instrument specifically developed for a binational, bilingual population was administered to 55 women in San Diego and 70 women in Tijuana. All participants were recruited into the study at drug treatment facilities for methamphetamine users. The survey questionnaire was conceived as a hybrid instrument, with standardized question items and in-depth probes designed to further explore the dynamics of methamphetamine use among women. The survey instrument contains detailed information on demographics, patterns of substance use, initiation to methamphetamine, self-reported health status, and sexual risk behavior during the past 12 months prior to admission to current treatment. All data ascertained with this instrument are self-reported. The survey instrument was first developed in English, translated into Spanish, and retranslated into English. Linguistic equivalence of the survey questionnaire was evaluated by the principal author and two study collaborators with significant experience in bilingual EnglishSpanish survey design and administration. Given the relatively small sample size of the study, only bivariate comparisons of drug use and other risk behaviors are presented in this report. In San Diego, face-to-face interviews were conducted by trained graduate students from the Masters of Public Health program at California State University, Long Beach. Interviews in Tijuana, conducted by locally trained field workers, were all administered with the Spanish survey instrument. Passive recruitment of participants was implemented at both binational recruitment sites. Study participants were offered monetary incentive for their participation. The study protocol was reviewed and approved by Institutional Review Board at California State University, Long Beach.

RESULTS
The sample size for this pilot study consisted of 55 women recruited from San Diego and 70 from Tijuana. By demographic characteristics, the samples were statistically different by age and self-reported sources of income during the 12-month period prior to admission into treatment and transborder

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long-term residency (Table 1). Women in San Diego were substantially older than their counterparts in Tijuana. The mean age was 36 years for the participants in San Diego and 25 years for those in Tijuana (t 6.6; P  .01). A greater proportion of women in Tijuana reported illegal sources of income. The sample in San Diego showed a greater educational attainment than that in Tijuana. Forty-one percent and 27% of women in Tijuana and San Diego, respectively, reported an educational level of less than high school. By marital status, 60% and 50% of the Tijuana and San Diego participants reported never having been married, respectively. Race=ethnicity data were only ascertained from the participants from San Diego. The race=ethnicity breakdown was 18% white, 20% African American, 35% Latinas, and 27% who identified themselves as other. Women in Tijuana began using methamphetamine at a slightly younger age than women in San Diego (Table 2). Eighty percent of women in Tijuana reported smoking as the main route of methamphetamine administration versus 63% of women in San Diego. Nearly two-thirds of the women in each sample reported a peak use of daily use in the 12 months preceding their admission to drug treatment. Although all participants reported methamphetamine use during the 12-month period preceding their enrollment in current treatment, substantial polydrug use was common in both samples. Essentially, the same level of polydrug use (by specific substance) was found among both samples (P < .5). Interestingly, the mean age of first use of legal and illegal substances (alcohol, marijuana, crack, cocaine, and tranquilizers) was statistically similar in the binational samples. There was greater social use of
TABLE 1 Demographic Characteristics Variable Age (y, mean) Education Less than high school Marital status Never been married Race=ethnicity (San Diego site only) Caucasian Latina African American Other Sources of incomea Regular employment Illegal source of income Transborder residency Ever lived on other side of the border Ever visited the other side of the border San Diego (n 55) 36 years 27% 50% 18% 35% 20% 27% 44% 20% 22% 82% 29% 40% 49% 74% Tijuana (n 70) 25 years 41% 60% P .01 NS NS

NA .05 .05 .01 NS

a Categories are not mutually exclusive. Illegal sources of income include stealing, survival sex, and drug dealing. NS not significant (P value greater than .05).

Methamphetamine Use of Women at the USMexico Border TABLE 2 Drug Use Risk Behavior Variable Mean age of first use of methamphetamine Most common route of methamphetamine administration Smoking Peak use (past 12 months) Every day weekly Polydrug use (most commonly reported substance) Proportion reporting: Alcohol Marijuana Crack Cocaine Tranquilizers Other Polydrug use Mean age (years) of first use of: Alcohol Marijuana Crack Cocaine Tranquilizers Other Place of most often use Transient venue (vs. own place) Methamphetamine social use Always use methamphetamine with other people Methamphetamine social use With sex partner
NS not significant (P value greater than .05).

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San Diego (n 55) 22.5 (years) 63% 75% 97% 87% 58% 38% 37% 13% 13.7 15.2 22.6 21.8 19.3 20.2 27% 47% 41%

Tijuana (n 70) 19.4 (years) 80% 65% 100% 84% 28% 50% 33% 21% 14.8 16.8 22.3 19.6 17.6 18.9 24% 63% 37%

P .05 .05 NS NS NS .01 NS NS NS NS

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NS .05 NS

methamphetamine among women in Tijuana, but the proportion of methamphetamine use with sex partners was similar in both samples (Table 2). Substantial use of legal and illegal substances at initiation to methamphetamine use was common in both samples (Table 3). Use of alcohol, marijuana, and cocaine followed by other stimulants during initiation to methamphetamine use were reported in approximately similar proportions of women in both study sites. Although most participants began using methamphetamine in stable settings (their own or relatives places) as opposed to transient venues, the large majority of participants did not plan on beginning to use methamphetamine when it initiated and, in fact, approximately 50% of each binational sample reported that they previously rejected use of methamphetamine prior to initiation. Additionally, the majority of all respondents watched other people take methamphetamine prior to initiation. Statistically significant differences between sites were found in the proportion of women who reported being under the influence of alcohol or drugs at initiation. Forty-eight percent and 26% of the women in Tijuana and San Diego reported

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TABLE 3 Initiation to Methamphetamine Use Variable Mean age at first use of methamphetamine Used alcohol and=or illicit drugs at initiation Methamphetamine use=first time venue At home or a friends home Ever watched other people take methamphetamine Yes Ever rejected methamphetamine before first time Yes Mean number of persons at first time of use Condition the first time of methamphetamine use Sober High on alcohol=drugs Time elapsed until second use One day to one week Longer than one week Mean number of months elapsed from date of peak use to current treatment (interview date)
NS not significant (P value greater than .05).

San Diego (n 55) 22.5 (years) 69% 71% 70% 56% 3.5 52% 48% 56% 44% 41

Tijuana (n 70) 19.4 (years) 56% 57% 64% 49% 3.4 74% 26% 47% 53% 19

P .05 NS NS NS NS NS .01 NS .01

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being intoxicated with alcohol or drugs during methamphetamine initiation. The number of people present during methamphetamine initiation was similar in San Diego and Tijuana at 3.5 and 3.4, respectively. The largest proportion of women from both samples reported relatively immediate repeated use of methamphetamine after initiation (the next day or within one week). The largest proportion of repeat users within this time period was observed among women in San Diego. Moreover, women in San Diego reported a significantly greater period of time between peak methamphetamine use and entering current treatment.
TABLE 4 Sexual Risk Behavior Variables Mean age at sexual initiation Mean number of sexual partners past 12 months Sexual partner used methamphetamine in the past 12 months Sexual partner used other drugs in the past 12 months Sexual partner injected drugs in the past 12 months Sexual partner ever used methamphetamine How often used condoms with non-steady sexual partner Not always (versus always) Exchanged money=drugs for sex Sexual preference Non-heterosexual
NS not significant (P value greater than .05).

San Diego (n 55) 15 3.4 73% 62% 9% 85% 68% 16% 22%

Tijuana (n 70) 15 2.8 77% 60% 21% 73% 72% 20% 23%

P NS NS NS NS .05 NS NS .05 NS

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FIGURE 1 Intersection of drug use by sexual partners of women using MA in Tijuana and San Diego: Number of women reporting sexual partners drug use behavior.

Level of sexual risk behavior was comparable in the two samples. Statistically, the age of sexual initiation with penetrative sex was similar as was the average number of sexual partners reported in the past 12 months (Table 4). More than one-third of participants in both samples reported inconsistent use of a condom during sexual activity with partners. The intersection of methamphetamine or other drug use and sexual activity had a high frequency in both samples. Essentially, more than half of the participants reported that their sexual partners had used methamphetamine and other drugs within the past 12 months. The Figure illustrates the intersecting proportion of women who reported knowledge of their sexual partners use of methamphetamines, having used methamphetamine in the past 12 months, or having used other drugs during the same period.

DISCUSSION
Despite substantial differences in treatment protocols, language, and the cultural, social, and legal framework of the two study cities, methamphetamine use appears to be an important equalizer of risk among women in this binational sample. Statistically, few differences were found between women using methamphetamine in San Diego and Tijuana. High frequency of drugusing, sexual, and other risk behaviors were found equally in both samples. Similarly, patterns of drug and sexual risk behavior exhibiting low frequency

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were correspondingly alike in the two samples. These findings suggest that methamphetamine use is becoming an equalizer of high risk, capable of dissolving macro level, sociodemographic, and international differences, creating a more homogenous subpopulation of substance users and contributing to the development of an equalized universe of specific high risk behaviors. Multiple drug use is common among women using methamphetamine. At initiation to methamphetamine use, women are often already intoxicated with alcohol or other drugs and the use of methamphetamine may play an important role as an upper substance, neutralizing the effect of so-called downers such as alcohol or marijuana. However, the transition to routine methamphetamine use is not necessarily a simple one. In the current study, many participants reported having rejected methamphetamine when it was offered in previous drug exposure episodes. However, the majority of survey participants reported steady use of methamphetamine within one week of initiation. This pattern of rejection-steady use after initiation suggests that methamphetamine, unlike other illegal substances used by women, may have a greater capacity to elicit a faster psychological and physical dependence response among new users. Conceivably, this shorter time to routine drug use may be grounded on subcultural factors such as the perceived notion that methamphetamine use is relatively harmless because its use of so widespread. In the current studys survey, although the majority of participants responded that use of methamphetamine was triggered by psychological factors, such as feelings of loneliness and sadness as well as curiosity, a significant proportion of respondents in both cities reported that they began using methamphetamine because everybody is doing it or it helped them to stay up at work. A high level of drug use by the study participants sexual partners was reported in both samples. However, low frequency of trading money or drugs for sex and a relatively low number of sexual partners was also observed in this study. Unlike other high-risk populations of women using drugs, methamphetamine users in this study appear to have a somewhat more stable sexual behavior. However, employment instability reflected in the large proportion of women who reported illegal sources of income, including survival sex, may better represent the contextual domain of sexual risk behavior. Particularly in Tijuana, sex work is extensive. In Mexico, prostitution is semi-legal or tolerated and attracts sex tourists from the United States and elsewhere, suggesting that border cities such as Tijuana have been feminized in marginalizing and stigmatized manner whereby U.S. men cross the border to obtain sex from Mexican woman and Mexican men cross the border to labor in the U.S. agricultural industry, thus creating a growing subpopulation of vulnerable women (Castillo, Gomez, & Delgado, 1999). Recent data suggests that female sex workers in Tijuana are often single mothers and enter the sex trade at a young age due to financial necessity (Bucardo, Semple, Fraga-Vallejo, Davila, & Patterson, 2004). In Tijuana and Ciudad

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Juarez, another border town that shares similar characteristics with Tijuana, female sex workers with U.S. clients report higher risk behavior, such as drug use before and during sex, drug injection within the last month, clients who used drugs, and that their fellow sex workers used drugs with their clients, than those without U.S. clients (Strathdee et al., 2007). In another study comparing sexual and drug use behaviors between female sex workers in Tijuana and Ciudad Juarez, methamphetamine use was more common in Tijuana and highly associated with syphilis (Patterson et al., 2006). Higher risk of HIV or other sexually transmitted diseases among female sex workers in Mexico is exacerbated by a lack of safe sex knowledge and an inability to negotiate condom use because clients often prefer and will pay more for unprotected sex acts (Bucardo et al., 2004). Women in asymmetric sexual dynamics (powerless gender dynamics with sex partners) are more likely than men to be initiated by and maintain access to methamphetamine through a spouse or sex partner (Brecht, OBrien, von Mayrhauser, & Anglin, 2004). As is the case of methamphetamine as a sexual enhancer among men who have sex with men, methamphetamine use among women is often introduced by men in heterosexual sexual dynamics with their female partners. In the current study, among the major reasons reported for using methamphetamine the first time, idiosyncratic statements such as because husband wanted, to please my partner, and to keep my boyfriend around points to a highly sexualized context of methamphetamine initiation and regular use. In ethnographic probing about reasons for using methamphetamine for the first time, a participant reported: What happened is that my husband could only have sex when he was on meth. He said he felt less inhibited. Then he started to invite me to take meth and to help him feel relaxed and uninhibited I accepted and began to use meth regularly before sex. Despite the emergence of methamphetamine as an ingredient of sexual activity (either as stimulant for the male partner or a mechanism for psychosexual bonding between men and women), respondents in this study reported a wide range of factors driving methamphetamine initiation and steady use. The high versatility of methamphetamine as an appetite suppressant, stimulant, or club drug, the relative invisibility of its use in the workplace, school, and family settings, and its affordability are among the many desirable properties driving the spread of methamphetamine among women. Differential gradient of risk and the stage in the drug career of the users may explain the inconsistent pattern of relatively low prevalence of certain sexual risk behaviors and high prevalence of survival sex found in the binational samples. Furthermore, participants from Tijuana may not recognize survival sex as prostitution unless they have already joined the large segment of women who regularly earn their main income as street sex workers. This study addresses an area of research poorly documented. Although methamphetamine use is now highly common among women in drug treatment, little is known about the sexual and drug using risk dynamics

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associated with this substance in this population. The current study offers a preliminary examination of binational patterns of methamphetamine use among women in the highly integrated region of the Western USMexico border. However, important study limitations preclude definitive assessments based on these data. First, the study is based on a fairly small sample which prevents generalization to the entire population. Second, participants in San Diego were recruited by convenience sampling from outpatient treatment settings, whereas their Tijuana counterparts were interviewed in residential treatment facilities. Hence, it may be inappropriate to apply statistical methods of analysis to non-randomly selected samples from two considerably different recruitment venues. Furthermore, given the limited sample size, it was not possible to examine patterns of drug use likely influenced by betweencity differences. However, despite these and other minor limitations, this study offers a systematic narrative of a growing USMexico binational public health problem in which limited research has been conducted. Methamphetamines properties to elicit a uniform high risk behavioral response among women should be of the greatest concern for the public health sector in the United States and Mexico. Methamphetamine is now the primary substance reported by women entering drug treatment on both sides of the Western USMexico border. The potential for further spread of methamphetamine use in Mexico and its stable but high prevalence in the United States will require ongoing international collaboration in designing and implementing binational prevention and treatment strategies.

REFERENCES
Alwin, D. F., Braun, M., & Scott, J. (1992). The separation of work and the family: Attitudes towards womens labour-force participation in Germany, Great Britain, and the United States. European Sociological Review, 8, 1337. Anglin, M. D., Burke, C., Perrochet, B., Stamper, E., & Dawud-Noursi, S. (2000). History of the methamphetamine problem. Journal of Psychoactive Drugs, 32, 137141. Brecht, M.-L., OBrien, A., von Mayrhauser, C., & Anglin, M. D. (2004). Methamphetamine use behaviors and gender differences. Addictive Behaviors, 29, 89106. doi: 10.1016=S0306-4603(03)00082-0. Bucardo, J., Semple, S., Fraga-Vallejo, M., Davila, W., & Patterson, T. (2004). A qualitative exploration of female sex work in Tijuana, Mexico. Archives of Sexual Behavior, 33, 343351. doi: 10.1023=B:ASEB.0000028887.96873.f3. CA Department of Alcohol and Drug Programs. (2007a). Methamphetamine users in treatment. Sacramento, CA: Office of Applied Research and Analysis. CA Department of Alcohol and Drug Programs. (2007b). Women in treatment. Sacramento, CA: Office of Applied Research and Analysis. Case, P., Ramos, R., Brouwer, K. C., Firestone-Cruz, M., Pollini, R. A., Strathdee, S. A., et al. (2008). At the borders, on the edge: Use of injected methamphetamine in

Methamphetamine Use of Women at the USMexico Border

39

Downloaded By: [EBSCOHost EJS Content Distribution - Superceded by 916427733] At: 15:31 10 September 2010

Tijuana and Ciudad Juarez, Mexico. Journal of Immigrant and Minority Health, 10, 2333. doi: 10.1007=s10903-007-9051-0. Castillo, D. A., Gomez, M. G. R., & Delgado, B. (1999). Border lives: Prostitute women in Tijuana. Signs, 24, 387422. doi: 10.1086=495345. Catanzarite, V. A., & Stein, D. A. (1995). Crystal and pregnancy: Methamphetamineassociated maternal deaths. Western Journal of Medicine, 162, 454457. n Direccio General de Epidemiologa. (2008). Informe del sistema de vigilancia gica de las adicciones (SISVEA). Mexico 2006. Mexico City: Subseepidemiolo n n cretara de Prevencio y Promocio de la Salud. Retrieved February 28, 2008, from http://www.dgepi.salud.gob.mx/sis/sis2006/sisvea2006.pdf. Jett, K. (2007). Methamphetamine: Treatment demographics in California. Sacramento, CA: Office of Applied Research and Analysis; California State Department of Alcohol and Drug Programs. Klee, H. (1997). Amphetamine misuse: International perspectives on current trends (1st ed.). The Netherlands: Harwood Academic Publishers. La Botz, D. (1994). Manufacturing poverty: The maquiladorization of Mexico. International Journal of Health Services, 24, 403408. Lorvick, J., Martinez, A., Gee, L., & Kral, A. (2006). Sexual and injection risk among women who inject methamphetamine in San Francisco. Journal of Urban Health, 83, 497505. doi: 10.1007=s11524-006-9039-4. Patterson, T. L., Semple, S. J., Fraga, M., Bucardo, J., de la Torre, A., Salazar, J., et al. (2006). Comparison of sexual and drug use behaviors between female sex workers in Tijuana and Ciudad Juarez, Mexico. Subst Use Misuse, 41, 15351549. doi: 10.1080=10826080600847852. Semple, S. J., Patterson, T. L., & Grant, I. (2004). The context of sexual risk behavior among heterosexual methamphetamine users. Addictive Behaviors, 29, 807 810. doi: 10.1016=j.addbeh.2004.02.013. Strathdee, S. A., Lozada, R., Semple, S. J., Orozovich, P., Pu, M., Staines-Orozco, H., et al. (2007). Characteristics of female sex workers with US clients in two Mexico-US border cities. Sexually Transmitted Diseases, 35(3), 263268. doi: 10.1097=OLQ.0b013e31815b0. Uziel-Miller, N. D., & Lyons, J. S. (2000). Specialized substance abuse treatment for women and their children: An analysis of program design. Journal of Substance Abuse Treatment, 19, 355367. doi: 10.1016=S0740-5472(00)00123-9. Viani, R. M., Araneta, M. R., Ruiz-Calderon, J., Hubbard, P., Lopez, G., Chacon-Cruz, E., et al. (2006). Perinatal HIV counseling and rapid testing in Tijuana, Baja California, Mexico: Seroprevalence and correlates of HIV infection. Journal of Acquired Immune Deficiency Syndromes, 41, 8792.