Examining Border Health

Thousands of commuters cross the U.S.-Mexico border from El Paso, Texas, into Juárez every day to access health care services, work, visit family or shop for groceries.

A team of UTEP researchers led by Hector Balcazar, Ph.D, regional dean of The University of Texas Health Science Center at Houston, School of Public Health (UTSPH), El Paso Regional Campus, is looking at Hispanics living in El Paso to find out what economic, cultural, family and mobility factors are affecting health along the U.S.-Mexico border.

Funded by the Hispanic Health Disparities Research Center (HHDRC), a UTEP-UTSPH collaborative, Balcazar and co-investigator Josiah M. Heyman, Ph.D., chair of UTEP’s Sociology and Anthropology Department; Maria Amaya, Ph.D., professor of nursing; and Osvaldo Morera, Ph.D., associate professor of psychology, have worked for the last two years with a survey that examines the health care utilization patterns of El Paso residents.

“The Hispanic Health Disparities Research Center is trying to use this survey to understand the different factors that may give clues to how we can begin addressing health problems, so that we can be more aligned in how we can ameliorate health disparities by understanding people’s behaviors,” said Balcazar, HHDRC’s co-director.

From 2009 to 2010, bilingual interviewers visited 1,002 households throughout El Paso County to collect answers to 143 questions that addressed a range of topics, including social position and demographic characteristics, self-reported health status, tobacco/substance use and violence, and access and barriers to health care.Screen Shot 2014-07-24 at 1.03.19 PM

Respondents answered questions about the prevalence among family members of chronic diseases such as diabetes, cancer and hypertension. They also gave information on health-care barriers and whether or not they had sought medical care in the U.S. or Mexico in the last three years, or if a medical cost ranging from $25 to $100 would be difficult to pay.

“One of the unique things about being here on the border is that there is so much influence coming from Mexico because of people going back and forth,” said Lisa Lapeyrouse, Ph.D., a postdoctoral fellow at the HHDRC who is examining the data to produce manuscripts and other information for publication and dissemination.

According to Balcazar, trans-mobility is one of the border’s major characteristics, and researchers are exploring the implications of health disparities among border crossers.

Lack of health insurance and preventive care, along with language and cultural barriers, have created a disproportionately high prevalence among Hispanics for certain health conditions such as asthma, obesity, HIV/AIDS and tuberculosis.

“We live in many ways in two different worlds,” Balcazar said. “The border itself is a very unique milieu and we want to recognize some of its characteristics, like trans-border mobility.”

The best way to find out why people move back and forth across the border is by asking a lot of questions, he said.

The survey found that respondents with incomes between $10,000 and $20,000 are more likely to travel to Juárez than respondents with incomes of $40,000 or more. Mobile respondents also are more likely to have lower incomes because of language barriers, immigration status and related socio-cultural factors.

Less acculturated and poorer Hispanics are more likely to have access to health care and other services across the border.

The survey also found that people continue to cross the border, mainly for work or to visit family, regardless of the surge of violence in Juárez.

An analysis on mental health and the effect of stress on border crossers found that people who reported low stress had a decline in their depressive symptoms once they crossed into Juárez. However, for people who were really stressed out, going across the border didn’t make any difference.

“I think what that analysis really speaks to is that there is something protective or there is some way that people are benefiting from crossing the border,” Lapeyrouse said.

Based on survey results, researchers also are looking at mammography and whether women with or without health insurance have more mammograms in El Paso or Juárez. Lapeyrouse found that women who have health insurance are more likely to have their mammograms in the U.S., but uninsured women who rely on Mexican health care services are more likely to have a mammogram than those who are insured.

The survey has become a springboard for more research. Out of the 1,002 households, UTEP sociologist Josiah Heyman has selected 300 respondents and asked them additional questions about their experiences navigating the health care system to see what barriers they have had to overcome.

Balcazar estimates that it will take another year and a half to analyze all the survey data. The next challenge will be to develop community interventions based on the results.

“The survey is just beginning to give us some initial data that we hope to filter to the community,” Balcazar said.

UTEP School of Nursing Dean and HHDRC Director Elias Provencio-Vasquez, Ph.D., said that the survey has provided researchers with valuable information about how to address health care issues in the community, which will eventually be disseminated to health care providers.

“What we find should be sent out to the community to say, ‘These are the types of questions doctors and nurses should ask, and these are the types of programs and clinics that we should be developing in our community,’” he said.