Deportation of Family Members of US-Citizen Latinos and Misuse of Prescription Drugs: United States, 2019 Miguel Pinedo, PhD Objectives. To investigate how personally knowing a deported migrant relates to infections and mortality stemming from an past-year prescription drug misuse among US-citizen Latinos. overdose. These health consequences and Methods. Between April and May 2019, a national sample (n = 3446) was recruited implications are notably evident by the cur- to complete an online survey. Multivariate and multinomial logistic regression models rent opioid epidemic in the United States, examined the role of (1) personally knowing a deported migrant and (2) the relationship which claimed the lives of more than 47 000 to the deportee (e.g., family, friend) on (1) any past-year prescription drug misuse and Americans through overdoses in 2017 alone." (2) the frequency of prescription drug misuse. I limited analyses to US citizens only It is not surprising that opioids are the most (n = 3282). commonly misused prescription drug. 9,10 Results. Overall, 19% of all participants reported any past-year prescription drug Furthermore, although opioid overdoses misuse. Latinos who had a family member who was deported reported significantly are highest among Whites, recent data have documented that opioid overdoses among higher odds of past-year prescription drug misuse and were exceedingly at higher risk Latinos are increasing at an exceedingly faster for misusing prescription drugs 3 or more days in the past year as compared with Whites rate relative to Whites. For example, opioid and Latinos who did not personally know a deported migrant. overdose deaths among Latinos in Massa- Conclusions. Public health prevention strategies and deportation policies need to chusetts doubled from 2014 to 2017." This consider and address how the deportation of an individual will affect the health of that trend has also been observed nationwide. individual's US-citizen family members. (Am J Public Health. 2020; 110:560-566. doi: According to data from the Centers for 10.2105/AJPH.2019.305516) Disease Control and Prevention, fatalities resulting from opioid overdose increased by 53% between 2014 and 2016 among Latinos. 12 Prescription drug misuse has emerged as a prevalence compared with the general pop- However, why opioid overdose fatalities are critical public health concern in the past ulation. For instance, a study among Latinos increasing among Latinos is poorly understood. decade. Prescription drugs refer to opioids in Texas border communities found that Much research has focused on under- (i.e., pain relievers), tranquilizers, stimulants, past-year prescription drug misuse ranged standing factors associated with prescription or sedatives and do not include over-the- from 7% to 26% among Latinos, depending drug misuse, including sociodemographic counter drugs. The misuse of prescription on gender and border community. Similarly, characteristics, mental and substance use drugs is characterized as their use without a national study among adults aged 65 years or disorders, social factors (e.g., social norms, having a prescription, recreationally (i.e., "just older found that Latinos had 3 times the odds peer pressure, low social support), and con- for the feeling"), or in greater amounts, more of misusing prescription drugs in the past year textual factors (e.g., physicians' prescribing often, or longer than prescribed. According to compared with Whites.' practices).25,13-15 However, the role of national estimates, in 2017, approximately 7% Prescription drug misuse carries numerous structural-level factors and their influence of the total adult US population reported adverse health implications. The misuse of on prescription drug misuse have received past-year misuse of prescription drugs. This prescription drugs can lead to the develop- almost no attention. Specifically, within prevalence is significantly higher among ment of prescription drug dependence, in- the context of Latinos in the United States, young adults: 14% of those aged 18 to 25 years crease susceptibility to alcohol and other emerging findings from my research team reported misusing prescription drugs in 2017. drugs, transition into injection drug use, and have underscored the importance of depor- Importantly, this prevalence varies by race/ increase risk of HIV and other blood-borne tations as a structural determinant of the ethnicity. Among those aged 18 to 25 years in 2017, 18% of Whites, 10% of Blacks, and ABOUT THE AUTHOR 12% of Latinos reported past-year misuse of Miguel Pinedo is with the Department of Kinesiology and Health Education, College of Education, University of Texas, Austin prescription drugs. Although Latinos tend Correspondence should be sent to Miguel Pinedo, PhD, 2109 San Jacinto Blud, Stop D3700, Austin, TX 78712-1415 (e-mail: o report less misuse of prescription drugs, npinedo@austin. utexas.edu). Reprints can be ordered at http:/ /www.ajph.org by clicking the "Reprints" link. This article was accepted December 7, 2019. other studies have documented an elevated doi: 10.2105/AJPH.2019.305516 560 Research Peer Reviewed Pinedo AJPH April 2020, Vol 110, No. 4AJPH OPEN-THEMED RESEARCH AJPH OPEN-THEMED RESEARCH substance-using behaviors of US-citizen La- - Participants were recruited by using contact misuse is defined as engaging in prescription depression or hopelessness. Participants Finally, to assess for US citizenship, partici- analyses with Stata version 15 software tinos. With use of current nationally repre- information (i.e., e-mail addresses) from the drug misuse at least 1 day in the past year self-reported the frequency of these sentiments pants were first asked if they were born in the (StataCorp LP, College Station, TX). Given sented data (2019), findings from this work national voter registration database and Web (vs never). Frequency of prescription drug in the past 2 weeks: not at all, several days, United States. Participants who answered "no" the study's objective, I restricted all analyses suggest that US-citizen adult Latinos who panels from Pure Spectrum and Cint, 2 misuse was a 3-category variable based on more than half the days, or nearly every day. were asked they were a naturalized US citizen, to US citizens and excluded non-US citizens have had a family member deported have market research firms. Briefly, Web panels the original question (i.e., never, 1 or 2 days, A point is assigned to each response option have applied for citizenship, were a legal per- (n = 164). I first employed descriptive char- significantly higher odds of reporting symp- entail registries of individuals who have 3 or more days). (ranging from 0 to 3 points) and summed manent resident, were a visa holder, or other. acteristics for our sample, stratifying by race/ toms of a drug use disorder as compared with agreed to partake in online surveys. Web The primary independent variable of in- (total possible points: 12). A score of 3 or more Participants who reported being US-born or ethnicity. Next, I conducted multivariate Whites. " The present study extends this panels are constructed through targeted in- terest was Latinos' relationship to a deported is characterized as having psychological dis- naturalized US citizens were characterized as analyses to evaluate how race/ethnicity and previous work and is distinct in that this study vitations that are meant to reflect the general migrant if they reported personally knowing ress.2 Important sociodemographic charac- being US citizens. Latinos' relationship to deported migrants exclusively examined the relationship be- population. Web panels were used to reach someone who has been deported. Participants teristics included age, biological sex, marital related to each outcome variable. For the tween the deportation of family members and nonregistered voters, including non-US were first asked if they personally know tatus, being US-born, highest educational dichotomous dependent variable, any pre- prescription drug misuse among US-citizen citizens, to reduce bias. Next, participants someone who was deported. Those who attainment, employment status (full- or part- Statistical Analysis scription drug misuse, I estimated a logistic Latinos. The deportation of a family member were randomly selected and invited to par- answered yes were then asked to self-report if time vs unemployed), annual household in- I weighted all statistical analyses to adjust regression model. For the categorical de- is a traumatic experience that has an impact ticipate via e-mail. While participants were this was a family member, a friend, or a co- come, and voter registration status (yes vs no). for the sampling methods. I conducted pendent variable, frequency of prescription on the whole family unit who experiences recruited from different sources and sample worker or community member (participants multiple severe emotional and psychological vendors, they were collected simultaneously were only allowed to choose 1 of these op- TABLE 1-Selected Participant Characteristics of US-Citizen Participants by Race/Ethnicity: United States, 2019 stressors. Such stressors may increase and deposited into a single uniform data set. A tions and could not choose multiple answers) vulnerability to substance use, including total of 6355 potential participants were invited Using these data, I characterized partici- Total (n = 3446), Weighted % White (n = 712), Weighted % Black (n = 710), Weighted % Latinos (n = 2024), Weighted % prescription drug misuse via e-mail to complete the online survey. Of pants into 6 mutually exclusive racial/ethnic Variable (Unweighted No.) or Mean +SD (Unweighted No.) or Mean +SD (Unweighted No.) or Mean +SD (Unweighted No.) or Mean S P Over the past decade, the United States has these, 5734 were eligible for the study, and groups: Whites, Blacks, Latinos who do not Male 49 (1368 49 (405) 47 (268) 50 (695) 15 heightened immigration enforcement efforts 3446 participants agreed to complete the survey. personally know someone who has been 42 + 16.57 48 +16.74 1 +16.33 and reached historic levels of deportations. Participants received no financial incentives. deported, Latinos who had a family member Mean age, y 39 +15.85 Since 2008, more than 3 million migrants The final data set was weighted within deported, Latinos who had a friend deported, US-born 87 (3107) 98 (700) 95 (691) 30 (1716) <.001 have been deported from the united states. each racial group with and latinos who had a coworker or com- married most recently available data indicate that census american community survey munity member deported. employed deportations remain high: more than once all were collected demo- important covariates included alcohol use educational attainment migrants in impor- graphics characteristics tabulated for disorder psychological distress. school cantly latino make up largest compared both of these variables associated graduated high proportion deportees. about acs adult population. prescription drug misuse. aud was some college are origin. weights added consecutively measured disorders given increasing using raking algorithm to balance de- identification test-concise trends mographics match overall which has proven sensitivity detect- total family income misuse including rates registered voter por- ing aud. measure includes items opioid addiction tion sample derived different ask participants how often they consume states this line research timely source ensure respondents monthly less times significant. present study investigates month week vote could be verified on file. otherwise randomly many alcoholic drinks role us-citizen relationship migrant selected distributed typical drinking day relative other groups mographic much like among only. nonregistered portion. occasion deportees does not personally know measures deportee methods dependent any point is attributed response draws anonymous fre- ranging scores summed de-identified national social quency past possible range between points. friend policy survey. original objective year. asked score men better understand months days did you women considered positive screening political economic factors contribute medications health disparities. feeling pre- patient questionnaire april may scribed questions taken used assess team recruited substance brief screen scale. re- phq-4 consists question-items white black sponse options never feelings nervousness anxious- .93 descent via e-mail ness uncontrollable worrying disinterest distress invitations complete an online months. pleasure doing things sentiments note. size n="3446.drug" i estimated multinomial logis- regression multivariate table logistic models examining analyses knowing tic model. con- findings frequency past-year race strongly trolled sociodemographic displayed estimates multi- migrant: scription la- covariates. finally replicated model results suggest nomial tinos. novel only presented find- misused drugs previously documented sub- evaluate relation- greatest risk misusing drugs. ings vs none ship relate variable rrr ci stance abuse literature my knowledge. do highlight outcome per- as potentially critical determinant sonally higher odds whites comparison group. year respectively reporting blacks inos carries implications whites. having regardless their depor- he current epidemic. tee. specifically showed us- also increased highest odds-more citizen frequencies odds-of engaging past- likely stratified by associations lati- port ethnicity nos deportee. at half male average aged years. majority nonsignificant migrant. alarmingly us-born voters though least age exceedingly vote. deportee: significantly frequencies. latino- education report retained but strength association aor our pronounced. knew someone engage ported regards aligned previous work linked deportation others especially reported prescrip members pro- poor mental outcomes portion latinos. .23 it worth nothing differences interval ratio. size: unweighted nonsig- nificant. collectively greater friends affected coworkers show found traumatizing experience filled startlingly extreme emotional prevalence consequences posttraumatic stress fear population-based studies worry anxiety depressive symptoms however extend well after indi- cent vidual. related viduals turn discussion faster rate cope unfair treatment dis- statistically ratio interval. first empirical inves- finding crimination negative emotions. tigate merits confirmation future research. stressors stemming vol no. ajph pinedo peer reviewed existing consequences. j stud alcohol. mcneely strauss sm saitz r et al. latinos: immigration enforcement policies in- self-administered tool directly creating stressful environments lankenau se teti m silva k bloom jj harocopos primary care: two-site validation treese m. initiation into misus am med. tinos citizenship shaping amongst young injection users. int policy. substance-using behaviors. frank d debenedetti af volk rj williams individual will affect his mateu-gelabert p guarino h jessell l teper a. ec kivlahan dr bradley ka. effectiveness her rarely when sexual hiv behaviors audit-c test three facing deportation. extremely nonmedical opioids ethnic groups. gen intern adults new york city. subst treat. lowe b wahl rose cerning depression anxiety: standardiza- closely connected coun- questionnaire-4 burns jm martyres rf clode boldero general disord. terparts. continued deporta- overdose people heroin: associa- tions potential exacerbate personal circumstances. med aust. vargas ed juarez sanchez gr livaudais epidemic connections immigrants: there urgent need impacts health. ethn migr stud. ahmad f rossen spencer warner sutton p. provisional death counts sider hyattsville md: center statistics gulbas le zayas lh yoon szlyk aguilar- gaxiola s natera g. experiences furthermore tailored han compton wm blanco c crane e lee pression us citizen-children undocumented interventions address specific jones cm. mexican parents. child care dev. adults: needed curb ann cabriales ja cooper tv taylor t. illicit massachusetts department public opioid- protective correlates hispanic gression dependence. aph deaths intents ma residents-de- student sample. exp clin psychopharmacol highlights. at: https: acknowledgments www.mass.gov gee gc delva takeuchi dt. relationships be- supported part institute demographic-february-2018.pdf. accessed september tween self-reported .97 alcoholism medication dependence filipino americans. content solely responsibility bebinger what explains rising author necessarily represent official views radio. institutes wong cf kecojevic coping shots emotion regulation profiles predictors conflicts interest overdose-r ong-latinos. high-risk no conflict interest. adults. depend. havens jr oser cb leukefeld cg human participant protection opiate rural protocol approved institutional urban probationers. abuse. review board university mexico. analysis based bolton robinson sareen j. self-medication therefore texas austin required oversight. mood epidemiologic condi- tions. references increase limitation 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