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MANUSCRIPT 

Socioeconomic Barriers to Health Outcomes 

in Hispanic Populations Impact by Fentanyl 

along the Texas-Mexico Border  
 

Marisol Acosta1, Sarah Colunga1,2, Ashlyn Gonzalez1,3, Alexsandra Longoria1,3,4, Sophia Mina1,5, 

Rebecca Saenz1,6, Joselyn Salinas1, 7, Madison Thomas1, 8, Joncarlo Rodriguez1,9 

 
1DHR Health High School and Community Outreach  
2  Monte Alto High School 
3 South Texas ISD World Scholars 
4 Jubilee Academies 
5  IDEA Toros College Preparatory 
6    Rio Hondo ISD 
7 La Joya ISD 
8  McAllen ISD  
9 Lasara ISD  

 

Received: July 12, 2024 

Accepted for publication: January 6, 2025  

 

Introduction 

This literature review examines the challenges of addressing socioeconomic barriers to health 

outcomes in Hispanic populations impacted by fentanyl along the Texas-Mexico border. This 

vulnerable population faces converging factors that exacerbate fentanyl use risks and hinder 

access to effective interventions. The Texas-Mexico border region, a unique binational 

environment, presents a complex interplay of social, economic, and cultural influences shaping 

health outcomes. This review explores three key areas: health disparities among Hispanic 

populations along the Texas-Mexico border, the importance of addressing socioeconomic 

barriers, and fentanyl’s specific health impact within this demographic. This exploration will 

highlight the interconnectedness of these factors and underscore the need for comprehensive, 

culturally sensitive, and community-based approaches to mitigate fentanyl's devastating 

consequences in this region. 

Health Disparities and Socioeconomic Barriers 

This section examines the interplay of health disparities and socioeconomic barriers impacting 

health outcomes for Hispanic populations along the Texas-Mexico border, particularly 

concerning rising fentanyl use. This region presents converging vulnerabilities: poverty, limited 

healthcare access, cultural and linguistic barriers, and navigating a binational context. 



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Understanding these multifaceted challenges is crucial for developing effective interventions and 

policies to mitigate the fentanyl crisis’s devastating effects on this population. 

Socioeconomic Factors and Health Outcomes 

Socioeconomic factors powerfully shape health outcomes within Hispanic communities along 

the Texas-Mexico border [1]. Poverty and lower educational attainment [2] limit access to 

resources promoting well-being. Financial constraints restrict access to nutritious food, safe 

housing, and reliable transportation [3], contributing to chronic health conditions and increased 

substance use vulnerability. Limited English proficiency creates communication barriers, 

hindering effective healthcare utilization [4]. These intersecting factors disproportionately impact 

Hispanic communities. For instance, a study of Hispanic manufacturing workers along the border 

found a strong association between lack of health insurance, delayed medical care, unmet 

medical needs, and lower preventive service rates (flu vaccination and cervical cancer screening) 

[5]. This highlights how economic insecurity directly translates into poorer health outcomes. 

Barriers to Healthcare Access 

Accessing quality healthcare remains a significant challenge for Hispanic populations along the 

Texas-Mexico border [6]. Several factors contribute to this disparity, including a shortage of 

healthcare providers, particularly in rural areas [2]. Many border counties report some of the 

worst US health disparity statistics, including limited access to quality healthcare and lower 

cancer screening rates [7]. Lack of insurance exacerbates this, leaving many unable to afford 

essential medical services [5]. A study of breast cancer incidence and survival along the border 

found that while adjusted survival rates were similar or even better for Hispanic women in some 

cases, disparities persisted in diagnosis and treatment access [7]. This underscores addressing the 

entire continuum of care, from prevention and early detection to treatment and long-term 

management. Even when insured, navigating the healthcare system can be daunting, especially 

with limited English proficiency [4]. Cultural factors, like traditional health beliefs and practices 

[8], can influence healthcare-seeking behaviors and create additional barriers to mainstream 

medical services. 

Education, Employment, and Health 

Education and employment are crucial pathways to improved health access and outcomes [3]. 

Higher education correlates with increased health literacy, empowering informed decisions, and 

more effective healthcare system navigation [4]. Stable employment provides health insurance 

access, which is critical for timely medical care and preventive services [5]. However, many 

Hispanic individuals along the border face education and employment challenges. Lower 

educational attainment limits job opportunities, perpetuating a cycle of poverty and poor health 

[2]. Many regional employment opportunities offer low wages and limited benefits [5], leaving 

workers vulnerable to economic instability and without resources for quality healthcare. A study 

exploring acculturation and healthy lifestyle habits in border communities found a complex 



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interplay between cultural adaptation and health behaviors [3]. Less acculturated individuals 

reported healthier dietary habits but were less likely to engage in regular physical activity, 

highlighting the need for culturally sensitive health promotion programs considering the unique 

context of border communities. This complex landscape of socioeconomic barriers and health 

disparities creates a significant challenge for addressing the fentanyl crisis within Hispanic 

communities along the Texas-Mexico border. 

Fentanyl Crisis in Hispanic Communities 

The fentanyl crisis disproportionately impacts vulnerable communities, including Hispanic 

populations along the Texas-Mexico border. This section examines the intersection of 

socioeconomic factors, fentanyl use, and public health implications within this demographic. It 

analyzes fentanyl use’s devastating impact, explores the correlation between socioeconomic 

status and fentanyl-related health issues, and identifies specific overdose trends among Hispanic 

border populations. 

Analysis of Fentanyl Use and its Implications on Public Health 

Fentanyl, a synthetic opioid significantly more potent than heroin [9], has infiltrated drug 

supplies, dramatically increasing overdose risks. Escalating fentanyl-related overdose deaths 

underscores the urgent need for targeted interventions [9]. While the opioid crisis initially 

stemmed from prescription opioid misuse, it now includes increased illicitly manufactured 

fentanyl availability [9]. This shift has broadened the crisis, reaching beyond individuals with 

prior prescription opioid dependence to encompass broader populations, including Hispanic 

communities along the Texas-Mexico border. With its unique binational environment [6], this 

border presents particular challenges to healthcare access, especially for vulnerable populations. 

The region's high poverty rate, increased prevalence of birth defects, and limited access to 

genetic services [10] exacerbate existing health disparities. These factors create a context where 

the fentanyl crisis can flourish, exploiting pre-existing vulnerabilities. 

The public health implications of fentanyl use are multifaceted. Increased mortality rates due to 

overdose are a primary concern. Beyond mortality, fentanyl use leads to other health 

complications: severe respiratory depression, neurological damage, and increased risk of 

infectious diseases like HIV and hepatitis C [11]. These consequences strain healthcare systems, 

particularly in resource-limited border regions. The fentanyl crisis often overlaps with other 

health disparities prevalent in Hispanic communities, such as diabetes and cardiovascular disease 

[12], complicating treatment and prevention.  

Correlation Between Socioeconomic Status and Fentanyl-Related Health Issues 

Socioeconomic factors crucially shape vulnerability to fentanyl use and its associated health 

consequences. Lower socioeconomic status is associated with increased substance use disorder 

risk, including opioid addiction [13]. Poverty, limited educational opportunities, and lacking 



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healthcare access [4] create a vulnerability cycle predisposing individuals to substance use and 

hindering access to treatment and recovery services. Along the Texas-Mexico border, these 

socioeconomic disparities are compounded by immigration status and language barriers [6], 

further limiting access to essential health services. For example, uninsured individuals are more 

likely to delay seeking medical care and face financial barriers to needed services [5]. This delay 

can be detrimental to a fentanyl overdose, where timely medical intervention is crucial. 

 The lack of health insurance among many Hispanic manufacturing workers along the border 

further restricts preventive health services access and contributes to delayed medical care [5]. 

Poverty significantly impacts health outcomes in border communities, influencing healthcare, 

education, and basic resource access [2]. These factors interact to create a complex web of 

vulnerability, increasing fentanyl use and related health issue risks. Webb County, Texas, 

residents, for instance, experience health disparities stemming from extreme poverty and 

inadequate healthcare access, including scarce primary care and behavioral health services [2]. 

This limited access creates significant barriers to effectively addressing the fentanyl crisis within 

these communities. 

Trends in Fentanyl-Related Overdoses Among Hispanic Populations 

Data indicate a concerning trend of increasing fentanyl-related overdoses among Hispanic 

populations, particularly along the Texas-Mexico border [7]. While national trends show 

declining colorectal cancer (CRC) incidence among Hispanics, the decline is less pronounced 

than other racial/ethnic groups, particularly among Hispanic men residing near the US-Mexico 

border [14]. This suggests border proximity contributes to health outcome disparities. The 

increasing prevalence of fentanyl in the drug supply is a major driver, as even small amounts can 

be lethal [15]. The COVID-19 pandemic has exacerbated existing health disparities and 

socioeconomic vulnerabilities [16], potentially contributing to increased substance use and 

overdose rates. 

Analyzing Texas Cancer Registry data reveals a complex interplay of factors influencing breast 

cancer incidence and survival among Hispanic women [7]. While some studies report later 

diagnosis and worse outcomes in this population, research also indicates potential protective 

factors among women residing in border counties, particularly those in lower poverty levels [7]. 

Further investigation is needed to understand these complex trends and identify specific 

interventions to address the fentanyl crisis effectively within Hispanic communities along the 

border. The ongoing Avanzando Caminos cohort study explores multifaceted factors influencing 

cancer survivorship among Hispanics/Latinos, including sociocultural, medical, psychosocial, 

and biological factors [17]. This research may provide valuable insights into the interplay 

between cancer survivorship, socioeconomic factors, and substance use, including fentanyl, 

within this population. 

  



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Community Health Initiatives 

This section examines community health initiatives along the Texas-Mexico border addressing 

socioeconomic barriers contributing to fentanyl-related health outcomes in the Hispanic 

population. It explores existing programs mitigating health disparities, evaluates community-

based interventions’ effectiveness in improving care access, and highlights promotoras’ 

(community health workers) role in outreach and education. 

Overview of Programs Addressing Health Disparities 

The Texas-Mexico border region faces significant health disparities due to poverty, limited 

healthcare access, and cultural and linguistic barriers [6]. Several programs and initiatives tackle 

these challenges. The Alliance for a Healthy Border reduces health disparities through nutrition 

and physical activity education programs at community health centers [3]. Project GIVE 

(Genetic Inclusion by Virtual Evaluation) utilizes a virtual telehealth platform to provide genetic 

services to underserved Rio Grande Valley families, shortening the diagnostic journey for 

children with rare diseases [10]. Mercy Ministries of Laredo integrated primary, behavioral, and 

spiritual healthcare to improve patient outcomes in Webb County, a region characterized by 

extreme poverty and limited healthcare access [2]. STOP-HCC-HCV is a multi-component 

intervention that increases access to Hepatitis C Virus (HCV) screening and treatment in low-

income South Texas Hispanic communities [18]. These initiatives demonstrate diverse 

approaches to addressing border health disparities. 

Additionally, initiatives like the Border Health Strategic Initiative focus on community-based 

solutions for type 2 diabetes control through community engagement and collaboration between 

communities and researchers [19]. This participatory approach is also evident in the Racial and 

Ethnic Approaches to Community Health (REACH) 2010 communities, which focus on 

eliminating health disparities [19]. While these programs target specific health issues, their 

underlying principles of community engagement and collaboration are relevant to addressing the 

fentanyl crisis. 

Effectiveness of Community-Based Interventions 

Community-based interventions are crucial for improving care access, particularly for vulnerable 

populations facing socioeconomic barriers [5]. One successful example is the promotoras 

program, utilizing community health workers to provide education, address barriers, and increase 

preventive care service access [20]. Studies demonstrate promotoras’ effectiveness in improving 

cervical cancer, Pap tests, and HPV knowledge and awareness [20]. They effectively change 

attitudes, increase self-efficacy, and promote routine Pap test screening [20]. This community-

based healthcare delivery model can be adapted for fentanyl-related interventions. 

  



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Community health centers are vital in providing primary care and other essential health services 

to underserved populations [3]. As demonstrated by Mercy Ministries of Laredo, integrating 

primary, behavioral, and spiritual health care significantly improves patient outcomes, including 

quality of life and anxiety symptoms [2]. Integrating fentanyl-related services into existing 

community health centers could enhance harm reduction and treatment service access. Virtual 

telehealth platforms, like Project GIVE's [10], offer another avenue for reaching medically 

underserved populations and overcoming socioeconomic barriers to accessing genetic services. 

This approach could provide fentanyl-related education, counseling, and treatment services 

remotely. 

Role of Promotoras in Outreach and Education 

Promotoras, as trusted community members [20], bridge the gap between healthcare providers 

and the Hispanic population. Their cultural understanding and linguistic skills enable effective 

health information communication and address cultural sensitivities [4]. Studies have shown 

their success in improving health outcomes through culturally tailored interventions [8]. 

Regarding the fentanyl crisis, promotoras can raise awareness about fentanyl’s dangers, promote 

harm reduction strategies like naloxone distribution, and connect individuals with treatment 

resources. They can address stigma surrounding substance use disorders and encourage help-

seeking behavior. 

Promotoras’ effectiveness extends beyond individual-level interventions. They can mobilize 

community resources and advocate for policy changes addressing the fentanyl crisis’s root 

causes, like poverty and lacking healthcare access. By empowering community members with 

knowledge and resources, promotoras contribute to healthier, more resilient communities. Given 

their established success in other health initiatives, promotoras should be central to any 

comprehensive strategy addressing the fentanyl crisis among Hispanic border populations. Their 

cultural sensitivity, community ties, and ability to navigate complex social systems make them 

invaluable in reaching and serving this vulnerable population. 

Policy Implications 

This section analyzes policy implications stemming from socioeconomic factors and fentanyl’s 

devastating impact on Hispanic border communities. It reviews current health policies affecting 

these populations, proposes policy change recommendations, and emphasizes integrating 

socioeconomic considerations into health policy. 

Current Health Policies and their Impact 

Existing border health policies are often fragmented and inadequately address Hispanic 

communities’ unique challenges. While the Affordable Care Act (ACA) expanded insurance 

coverage, significant gaps remain, especially among undocumented immigrants and those in 

low-wage jobs with limited benefits [5]. This lack of insurance directly impacts preventive care, 



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early diagnosis, and substance use disorder treatment access [5]. Limited culturally and 

linguistically appropriate healthcare services exacerbate disparities [11]. While some policies 

focus on border security [6], they often inadequately address the public health crisis fueled by 

fentanyl trafficking, hindering effective interventions. The scarcity of primary care and 

behavioral health providers in border communities restricts access to essential services for 

individuals struggling with opioid addiction [2]. Current policies also lack comprehensive 

strategies for addressing underlying socioeconomic factors contributing to substance use 

vulnerability, such as poverty, limited educational opportunities, and employment lack [3]. 

Recommendations for Policy Changes 

Combating the fentanyl crisis and improving Hispanic border population health outcomes 

requires comprehensive policy changes. 

Enhancing Healthcare Access: Expanding affordable healthcare access is paramount. Policies 

should prioritize extending Medicaid eligibility to all low-income individuals regardless of 

immigration status, ensuring access to comprehensive health services, including substance use 

disorder treatment [5]. Increased funding for community and federally qualified health centers is 

essential for providing culturally and linguistically competent primary care and behavioral health 

services in underserved border communities [2]. Telehealth initiatives can expand healthcare 

service reach to remote areas and reduce transportation barriers [10]. Policies should address the 

healthcare provider shortage by incentivizing physicians and other healthcare professionals to 

practice in underserved border regions and supporting training programs focused on cultural 

competency and substance use disorder treatment [2]. 

Reducing Health Disparities: Policies must be tailored to Hispanic communities’ needs. 

Culturally and linguistically appropriate public health campaigns are crucial for raising 

awareness about fentanyl dangers and promoting prevention and treatment service access [11]. 

Community-based interventions, like the promotoras program [20], have shown promise in 

increasing health knowledge and improving preventive care access among Hispanic women. 

Similar models can be adapted for fentanyl prevention and intervention efforts. Policies should 

prioritize addressing social determinants of health that contribute to disparities. This includes 

investing in programs promoting economic development, improving educational opportunities, 

and increasing safe and affordable housing access in border communities [3]. Collaborations 

between healthcare systems, social service agencies, and community organizations are essential 

for providing wraparound services addressing the multifaceted needs of individuals and families 

impacted by fentanyl. 

Addressing Fentanyl Trafficking: A comprehensive approach to the fentanyl crisis necessitates 

addressing the supply side. Strengthening cross-border collaboration with Mexican authorities is 

crucial for disrupting fentanyl trafficking networks and reducing drug availability in border 

communities [6]. Increased funding for law enforcement efforts targeting drug trafficking is 



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necessary, but it should be coupled with public health interventions focusing on prevention, 

treatment, and harm reduction. Policies should prioritize addressing fentanyl demand by 

expanding access to evidence-based treatment for opioid use disorder and supporting harm 

reduction strategies, such as naloxone distribution programs, which can save lives during 

overdoses [9]. 

Integrating Socioeconomic Considerations: Health policies must move beyond a purely 

biomedical approach and incorporate a comprehensive understanding of socioeconomic factors 

influencing health outcomes. Policies should prioritize investments in social programs 

addressing poverty, lack of education, and unemployment, recognizing these factors contribute to 

vulnerability to substance use and other health problems [3]. Data collection and surveillance 

systems should be strengthened to track socioeconomic factors' impact on health outcomes and 

evaluate intervention effectiveness. Policies should promote community-based participatory 

research, engaging Hispanic communities in identifying their needs and developing culturally 

appropriate solutions [10]. 

The Importance of Integrating Socioeconomic Considerations 

Integrating socioeconomic considerations into health policy is not simply social justice but 

pragmatically necessary for effectively addressing the fentanyl crisis and improving health 

outcomes. Studies consistently show socioeconomic factors, such as poverty, limited education, 

and unemployment, are strongly associated with increased substance use disorder risk, poorer 

health outcomes, and higher mortality rates [21]. Neglecting these factors leads to ineffective 

policies that fail to address the root causes of health disparities. By incorporating socioeconomic 

considerations, policies can be tailored to vulnerable populations’ specific needs, promoting 

health equity and improving overall population health. Furthermore, addressing socioeconomic 

factors can lead to long-term cost savings by reducing healthcare utilization and enhancing 

productivity. Investing in early childhood education and job training programs can significantly 

impact long-term health and economic outcomes [3]. Integrating socioeconomic considerations 

into health policy is crucial to a healthier and more equitable society. This integration requires a 

multi-sectoral approach involving collaboration between healthcare systems, social service 

agencies, educational institutions, and community organizations. By working together, these 

entities can create a comprehensive support network addressing the complex needs of individuals 

and families impacted by fentanyl and other health challenges. Ongoing policy evaluation and 

adaptation are essential to ensure their relevance and effectiveness in addressing the evolving 

needs of border communities. The fentanyl crisis presents a significant challenge but also an 

opportunity to create innovative and transformative policies promoting health equity and 

improving all border residents’ well-being. 

  



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Future Research Directions 

This review explored the complex interplay of socioeconomic barriers and fentanyl’s devastating 

impact on Hispanic border populations. While existing research illuminates certain aspects of 

this public health crisis, significant gaps hinder effective intervention and policy development. 

This section outlines crucial future research directions to address this urgent issue 

comprehensively. 

Identifying Gaps in Current Research 

Acknowledging and addressing existing gaps in our understanding of socioeconomic factors 

exacerbating the fentanyl crisis among Hispanic border communities is critical. While studies 

have examined health disparities in this region [6] [22], focusing on diabetes [12] [23], cancer 

[24] [7] [14], and HIV [11], research explicitly targeting the intersection of socioeconomic 

vulnerabilities and fentanyl use remains limited. Further investigation is needed to understand 

this population’s unique challenges fully. Acculturation’s role in health behaviors [3] needs 

further exploration in the context of fentanyl use, as do the specific socioeconomic factors 

influencing healthcare service access and utilization [5]. Research should examine how limited 

English proficiency [25], poverty [2], and lack of health insurance [5] contribute to increased 

fentanyl use and overdose vulnerability. Research on existing intervention effectiveness, such as 

those using community health workers (promotoras) [20], should expand to include fentanyl 

prevention and harm reduction. 

Future Studies on Health Interventions 

Building upon identified research gaps, future studies should prioritize developing and 

evaluating culturally tailored health interventions for Hispanic populations impacted by fentanyl 

along the border. These interventions must consider the region’s unique cultural context and 

address the identified socioeconomic barriers. One promising approach is using technology, such 

as mobile health (mHealth) interventions [26], to deliver education and support for individuals 

with chronic conditions like diabetes, adaptable for fentanyl prevention and harm reduction. 

Research should explore integrating primary, behavioral, and spiritual healthcare [2] into 

interventions addressing substance use disorders, recognizing their potential synergistic effects. 

Given the documented disparities in cancer treatment and outcomes among Hispanic populations 

[7] [24], future studies should investigate fentanyl use’s impact on cancer survivorship and 

explore interventions mitigating these detrimental effects. Studies are needed to examine the 

effectiveness of community-based interventions leveraging existing resources and social 

networks [19]. Finally, given the significant border health disparities [6] [8], research should 

assess cross-border collaboration feasibility and effectiveness in addressing the fentanyl crisis. 

  



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Multi-Disciplinary Approaches 

The fentanyl crisis’s complexity demands multi-disciplinary approaches integrating perspectives 

from public health, medicine, social work, economics, and law enforcement. Cross-discipline 

collaboration can lead to more comprehensive and effective interventions addressing fentanyl 

use and overdose root causes. Researchers could collaborate with community organizations to 

implement and evaluate interventions addressing socioeconomic factors and treatment access. 

Researchers studying rare genetic diseases in medically underserved Hispanic populations [10] 

demonstrated community engagement’s effectiveness in overcoming healthcare access barriers, 

offering a valuable model for future fentanyl-related research. Multi-disciplinary research can 

inform local, state, and national policy development. Studies examining socioeconomic factors’ 

impact on health outcomes [13] [27] can provide valuable insights for policymakers addressing 

health disparities. Given the documented disparities in melanoma immunotherapy access [28], 

multi-disciplinary research can identify strategies ensuring equitable access to life-saving 

treatments. Finally, collaboration between researchers, healthcare providers, and community 

members can develop culturally sensitive and sustainable solutions to the fentanyl crisis. This 

collaborative approach could address socioeconomic barriers [29], improve care access, and 

promote health equity for Hispanic border populations. Further “Hispanic Paradox” exploration 

[15] [30] within the fentanyl crisis context is needed to understand potential protective factors 

and community resilience. Research exploring race, ethnicity, and country of origin effects on 

cancer incidence and survival [24] can inform more tailored interventions for Hispanic 

subgroups. Finally, given the documented hepatocellular carcinoma burden among South Texas 

Hispanics [31], future research should investigate the potential link between fentanyl use and 

liver cancer risk. 

Conclusion 

This review explored the intricate challenges surrounding socioeconomic barriers to health 

outcomes among Hispanic populations impacted by fentanyl along the Texas-Mexico border. 

This border region presents a unique confluence of factors exacerbating the fentanyl crisis: 

socioeconomic disparities, limited healthcare access, cultural nuances, and cross-border 

interaction complexities. This conclusion synthesizes key findings, reinforces the urgent need for 

targeted interventions, and offers final reflections on addressing socioeconomic barriers’ critical 

importance in improving this vulnerable population’s health outcomes. 

Socioeconomic Disparities and Healthcare Access 

A recurring theme is socioeconomic disparities' significant influence on health outcomes in the 

Texas-Mexico border region. Poverty, lower educational attainment, and inadequate access to 

basic healthcare services disproportionately affect Hispanic communities [2]. These disparities 

create vulnerability to various health issues, including substance use disorders. Lack of health 

insurance is a significant barrier to accessing necessary medical care, including preventative 



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services and substance abuse treatment [5]. Uninsured individuals are more likely to delay or 

forgo necessary services due to cost [5]. This can have devastating consequences with fentanyl 

use, where timely intervention can be life-saving. Limited specialized care access, such as 

addiction treatment and mental health services, further compounds challenges faced by Hispanic 

populations struggling with fentanyl use [10]. Project GIVE demonstrates virtual platforms’ 

potential to address geographic barriers and expand genetic service access in underserved regions 

[10]. This innovative approach demonstrates leveraging technology to improve marginalized 

communities’ healthcare access, adaptable for substance abuse treatment.  

Cultural Factors and Community Engagement 

Cultural factors crucially shape health behaviors and responses to interventions. Culturally 

sensitive healthcare approaches are important, as evident in several studies [4]. Language 

barriers, cultural beliefs, and traditional practices can influence healthcare utilization and 

treatment adherence [4]. Effective interventions must consider these cultural nuances to ensure 

relevance and acceptability within Hispanic communities. Community engagement and 

partnerships are essential for developing and implementing successful programs [10]. Engaging 

community members, including community health workers (promotoras), can bridge cultural 

gaps and build trust between healthcare providers and the community [20]. Promotoras, as 

trusted community members, can disseminate health information, promote healthy behaviors, 

and facilitate healthcare service access [20]. Their involvement can enhance intervention 

effectiveness and ensure cultural appropriateness. 

Fentanyl's Impact and Targeted Interventions 

Fentanyl’s devastating impact on Hispanic border communities is undeniable. Increasing 

fentanyl-related overdoses and deaths underscore the urgency of addressing this crisis [9]. The 

border region’s unique characteristics, including easy drug trafficking and transnational criminal 

organizations’ presence, contribute to fentanyl’s availability and accessibility [9]. Targeted 

interventions are crucial to combat the fentanyl epidemic and mitigate its devastating effects on 

Hispanic populations. These interventions must address substance use’s root causes, including 

socioeconomic factors, mental health issues, and lacking treatment access. Harm reduction 

strategies, such as naloxone distribution and safe injection sites, can save lives and reduce 

harmful consequences associated with fentanyl use [9]. Expanding access to evidence-based 

treatment options, including medication-assisted treatment and behavioral therapies, is essential 

for helping individuals overcome addiction and achieve long-term recovery. 

Policy Implications and Future Directions 

Addressing the complex challenges of socioeconomic barriers to health outcomes among 

Hispanic populations impacted by fentanyl requires a multi-faceted approach involving policy 

changes, community-level interventions, and individual-level support. Policies reducing poverty, 

improving educational opportunities, and expanding affordable healthcare access are crucial for 



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creating a healthier and more equitable environment [8]. Increased provider education on health 

disparities and cultural competency can improve healthcare service quality and effectiveness for 

Hispanic populations [8]. Investing in research to better understand this population’s specific 

needs and challenges can inform more effective intervention development. Future research 

should evaluate culturally tailored intervention effectiveness, explore social networks and 

community support’s role in promoting health, and examine policy changes’ impact on health 

outcomes. Collaboration between researchers, healthcare providers, community organizations, 

and policymakers is essential to develop and implement sustainable solutions addressing health 

disparities’ root causes and improving Hispanic border populations’ lives. This review’s findings 

highlight the urgent need for comprehensive and collaborative efforts to address the complex 

interplay of socioeconomic factors, cultural influences, and fentanyl’s devastating impact. By 

dismantling healthcare access barriers, promoting culturally sensitive interventions, and 

addressing substance use's root causes, we can strive toward a more equitable and healthier 

future for Hispanic communities along the Texas-Mexico border. 

Acknowledgements: 

Nori Zapata, MSN, RN, Senior Vice President of Education and Career Development, Vanessa 

Vera, MS, Senior Manager of High School and Community Outreach, Anisa Mirza, Intern 

Program Coordinator.  

Funding: 

Funded  by  DHR  Health High School and Community Outreach;    DHR    Health;    Region    

One    ESC GEARUP  College  Ready,  Career  Set!;  Region  One ESC   GEARUP   College   

Now,   Career   Connected; Region One ESC PATHS; Region One ESC Upward Bound  Math  &  

Science;  Benavides  ISD;  and  Jubilee Academy-Brownsville 

References 

1. Muennig PA, Reynolds M, Fink DS, Zafari Z, Geronimus AT. America’s Declining Well-

Being, Health, and Life Expectancy: Not Just a White Problem. American Journal of 

Public Health. 2018;108(12):1626-1631. doi:https://doi.org/10.2105/ajph.2018.304585 

2. Burkhalter N, Walker SS, Davis M, Flynn A. Integrating primary, Behavioral and Spiritual 

Health Care to Improve Patient Outcomes. Journal of Behavioral Health and Psychology. 

2021;10(4). doi:https://doi.org/10.33425/2832-4579/21033 

3. Ghaddar S, Brown CJ, Pagán JA, Díaz V. Acculturation and Healthy Lifestyle Habits 

among Hispanics in United States-Mexico Border Communities. Revista Panamericana de 

Salud Pública. 2010;28(3). doi:https://doi.org/10.1590/s1020-49892010000900009 

4. Prophete L. Barriers to Medication Adherence in the Hispanic Population. 

fpuscholarworks.fresno.edu. Published 2018. Accessed January 7, 2025. 

https://www.semanticscholar.org/paper/Barriers-to-medication-adherence-in-the-

Hispanic-Prophete/da707abb2afa3fdaea4353f1331c777aeaba22b3 

5. Talavera-Garza L, Ghaddar S, Valerio M, Garcia C. Health Care Access and Utilization 

among Hispanic Manufacturing Workers along the Texas-Mexico Border. Journal of 

https://doi.org/10.2105/ajph.2018.304585
https://doi.org/10.33425/2832-4579/21033
https://doi.org/10.1590/s1020-49892010000900009
https://www.semanticscholar.org/paper/Barriers-to-medication-adherence-in-the-Hispanic-Prophete/da707abb2afa3fdaea4353f1331c777aeaba22b3
https://www.semanticscholar.org/paper/Barriers-to-medication-adherence-in-the-Hispanic-Prophete/da707abb2afa3fdaea4353f1331c777aeaba22b3


Special Edition: Advanced Clinical Research Internship Session II (2024), Vol. 4 No. S1 
https://doi.org/10.47488/dhrp.v4iS1.2 

 

 
DHR Proceedings ǀ http://dhrproceedings.org 27 2024, Vol. 4 No. S1 Pg. 15-29 

Health Care for the Poor and Underserved. 2013;24(2):656-670. 

doi:https://doi.org/10.1353/hpu.2013.0072 

6. Bastida E, Brown HS, Pagán JA. Persistent Disparities in the Use of Health Care along the 

US–Mexico Border: an Ecological Perspective. American Journal of Public Health. 

2008;98(11):1987-1995. doi:https://doi.org/10.2105/ajph.2007.114447 

7. Diaz FC, Osuna-Salazar EN, Robledo C, Machiorlatti M, Sarhill N, Kwang H. Trends and 

Variations in Female Breast Cancer along the Texas-Mexico Border Trends and Variations 

in Breast Cancer along the Texas-Mexico Border. Cancer Research. 

2020;80(4_Supplement):P6-1104-P611-04. doi:https://doi.org/10.1158/1538-

7445.sabcs19-p6-11-04 

8. Nesbitt S, Palomarez RE. Review: Increasing Awareness and Education on Health 

Disparities for Health Care Providers. Ethnicity & Disease. 2016;26(2):181-190. 

doi:https://doi.org/10.18865/ed.26.2.181 

9. Anderson J, Demeter N, Pasquires M, Wirtz S. Using the CA Opioid Overdose 

Surveillance Dashboard to Track Opioid Overdose Deaths. Online Journal of Public 

Health Informatics. 2019;11(1). doi:https://doi.org/10.5210/ojphi.v11i1.9938 

10. Vuocolo B, Sierra R, Brooks D, et al. Reducing Time to Diagnosis of Rare Genetic 

Diseases in a Medically Underserved Hispanic Population- Lessons Learned for 

Meaningful Engagement. Research Square (Research Square). Published online December 

13, 2023. doi:https://doi.org/10.21203/rs.3.rs-3699740/v1 

11. Mata H, Provencio-Vasquez E, Martinez J, De Santis J. HIV Risk Knowledge among 

Hispanic Adults in a U.S. – Mexico Border Community. Californian Journal of Health 

Promotion. 2014;12(1):88-94. doi:https://doi.org/10.32398/cjhp.v12i1.1559 

12. Geographic Disparities in Diabetes-Related Amputations—Texas-Mexico Border, 2003. 

JAMA. 2007;297(10):1051. doi:https://doi.org/10.1001/jama.297.10.1051 

13. Calip GS, Hoskins KF, Guadamuz JS. Examining the Associations among Treatment 

Declination, Racial and Ethnic Inequities, and Breast Cancer Survival. JAMA Network 

Open. 2024;7(5):e249402. doi:https://doi.org/10.1001/jamanetworkopen.2024.9402 

14. Robles A, Bashashati M, Contreras A, et al. Colorectal Cancer in Hispanics Living near 

the U.S. - Mexico Border. Revista De Investigacion Clinica. 2019;71(5). 

doi:https://doi.org/10.24875/ric.19003026 

15. Li C, Mou J. Ethnic Disparities in the Prevalence of SARS-CoV-2 Testing Positivity 

Comparing Hispanic and non-hispanic Populations. Big Data. Published online April 1, 

2022:2977-2977. doi:https://doi.org/10.1370/afm.20.s1.2977 

16. Chow DS, Glavis-Bloom J, Soun JE, et al. Development and External Validation of a 

Prognostic Tool for COVID-19 Critical Disease. Ashkenazi I, ed. PLOS ONE. 

2020;15(12):e0242953. doi:https://doi.org/10.1371/journal.pone.0242953 

17. Ramirez AG, Chalela P, Rowan S, et al. Avanzando Caminos (Leading Pathways): the 

Hispanic/Latino Cancer Survivorship Cohort Study. Cancer Epidemiology, Biomarkers & 

Prevention. 2023;32(12_Supplement):B044-B044. doi:https://doi.org/10.1158/1538-

7755.disp23-b044 

18. Flores BE, Guerrero J, Bobadilla R, Craven CK. Hepatitis C Virus (HCV) Screening and 

Treatment in South Texas US-Mexico Border Persistent Poverty Counties. Cancer 

Epidemiology Biomarkers & Prevention. 2023;32(12_Supplement):IA045-IA045. 

doi:https://doi.org/10.1158/1538-7755.disp23-ia045 

https://doi.org/10.1353/hpu.2013.0072
https://doi.org/10.2105/ajph.2007.114447
https://doi.org/10.1158/1538-7445.sabcs19-p6-11-04
https://doi.org/10.1158/1538-7445.sabcs19-p6-11-04
https://doi.org/10.18865/ed.26.2.181
https://doi.org/10.5210/ojphi.v11i1.9938
https://doi.org/10.21203/rs.3.rs-3699740/v1
https://doi.org/10.32398/cjhp.v12i1.1559
https://doi.org/10.1001/jama.297.10.1051
https://doi.org/10.1001/jamanetworkopen.2024.9402
https://doi.org/10.24875/ric.19003026
https://doi.org/10.1370/afm.20.s1.2977
https://doi.org/10.1371/journal.pone.0242953
https://doi.org/10.1158/1538-7755.disp23-b044
https://doi.org/10.1158/1538-7755.disp23-b044
https://doi.org/10.1158/1538-7755.disp23-ia045


Special Edition: Advanced Clinical Research Internship Session II (2024), Vol. 4 No. S1 
https://doi.org/10.47488/dhrp.v4iS1.2 

 

 
DHR Proceedings ǀ http://dhrproceedings.org 28 2024, Vol. 4 No. S1 Pg. 15-29 

19. Bowman BA, Vinicor F. Toward Prevention and Control of Type 2 Diabetes: Challenges 

at the U.S.-Mexico Border and beyond 1      | Scholars Portal 

Journals. Scholarsportal.info. Published 2025. Accessed January 7, 2025. 

https://journals.scholarsportal.info/details/15451151/v02i0001/nfp_tpacotatubab.xml 

20. Gareis CE, Hunter P, Leader A. The Impact of the Promotoras Program on knowledge, 

attitudes, and Cervical Cancer Screening among Hispanic/Latina women: Rapid Review. 

Cancer Epidemiology, Biomarkers & Prevention. 2023;32(1_Supplement):B023-B023. 

doi:https://doi.org/10.1158/1538-7755.disp22-b023 

21. Shiels MS, Berrington de González A, Best AF, et al. Premature Mortality from All Causes 

and Drug Poisonings in the USA According to Socioeconomic Status and rurality: an 

Analysis of Death Certificate Data by County from 2000–15. The Lancet Public Health. 

2019;4(2):e97-e106. doi:https://doi.org/10.1016/s2468-2667(18)30208-1 

22. Angell SY, Cetron MS. Health Disparities among Travelers Visiting Friends and Relatives 

Abroad. Annals of Internal Medicine. 2005;142(1):67. doi:https://doi.org/10.7326/0003-

4819-142-1-200501040-00013 

23. Fisher-Hoch SP, Vatcheva KP, Rahbar MH, McCormick JB. Undiagnosed Diabetes and 

Pre-Diabetes in Health Disparities. Kirchmair R, ed. PLOS ONE. 2015;10(7):e0133135. 

doi:https://doi.org/10.1371/journal.pone.0133135 

24. Bencomo-Alvarez AE, Nhim V, Alvarado L, et al. Effects of race, ethnicity, and Country 

of Origin on Incidence and Survival in Breast Cancer. Cancer Epidemiology, Biomarkers 

& Prevention. 2023;32(1_Supplement):C066-C066. doi:https://doi.org/10.1158/1538-

7755.disp22-c066 

25. Bauer C, Zhang K, Lee M, et al. Census Tract Patterns and Contextual Social Determinants 

of Health Associated with COVID-19 in a Hispanic Population from South Texas: a 

Spatiotemporal Perspective. JMIR Public Health and Surveillance. 2021;7(8):e29205. 

doi:https://doi.org/10.2196/29205 

26. Spierling SR, Savin KL, Soriano EC, et al. Process evaluation of Dulce Digital-Me: an 

adaptive mobile health (mHealth) intervention for underserved Hispanics with diabetes. 

Translational Behavior of Medicine. Published online April 3, 2023. 

doi:https://doi.org/10.1093/tbm/ibad020 

27. Borkowski P, Borkowska N, Shaunak Mangeshkar, Adal BH, Singh N. Racial and 

Socioeconomic Determinants of Cardiovascular Health: a Comprehensive Review. 

Curēus. Published online May 2, 2024. doi:https://doi.org/10.7759/cureus.59497 

28. Ramirez FG, Alvarado L, Dwivedi A, Chacon J. Immunotherapy Treatment disparities: a 

TCR Analysis of Patients with Cutaneous Melanoma. Cancer Epidemiology, Biomarkers 

& Prevention. 2023;32(12_Supplement):B051-B051. doi:https://doi.org/10.1158/1538-

7755.disp23-b051 

29. Jones BA, Eger W, Suttiratana S, et al. Abstract S12-06: Social Determinants of Health 

(SDOH) Barriers as Predictors of Intent to Vaccinate for COVID-19 in a Vulnerable 

Population. Clinical Cancer Research. 2021;27(6_Supplement):S12-06S12-06. 

doi:https://doi.org/10.1158/1557-3265.covid-19-21-s12-06 

30. Chandhok NS, Shrestha A, Watts JM, Bradley T, Sekeres MA. Outcomes for Hispanic 

Patients with Acute Leukemia Treated at Academic Centers. Blood. 2021;138(Supplement 

1):2282-2282. doi:https://doi.org/10.1182/blood-2021-151250 

https://journals.scholarsportal.info/details/15451151/v02i0001/nfp_tpacotatubab.xml
https://doi.org/10.1158/1538-7755.disp22-b023
https://doi.org/10.1016/s2468-2667(18)30208-1
https://doi.org/10.7326/0003-4819-142-1-200501040-00013
https://doi.org/10.7326/0003-4819-142-1-200501040-00013
https://doi.org/10.1371/journal.pone.0133135
https://doi.org/10.1158/1538-7755.disp22-c066
https://doi.org/10.1158/1538-7755.disp22-c066
https://doi.org/10.2196/29205
https://doi.org/10.1093/tbm/ibad020
https://doi.org/10.7759/cureus.59497
https://doi.org/10.1158/1538-7755.disp23-b051
https://doi.org/10.1158/1538-7755.disp23-b051
https://doi.org/10.1158/1557-3265.covid-19-21-s12-06
https://doi.org/10.1182/blood-2021-151250


Special Edition: Advanced Clinical Research Internship Session II (2024), Vol. 4 No. S1 
https://doi.org/10.47488/dhrp.v4iS1.2 

 

 
DHR Proceedings ǀ http://dhrproceedings.org 29 2024, Vol. 4 No. S1 Pg. 15-29 

31. Ramirez AG, Munoz E, Holden AEC, Adeigbe RT, Suarez L. Incidence of Hepatocellular 

Carcinoma in Texas Latinos, 1995–2010: an Update. Mehta AS, ed. PLoS ONE. 

2014;9(6):e99365. doi:https://doi.org/10.1371/journal.pone.0099365 

 

 


