Acculturation and alcohol among Latino adults in the United States: a comprehensive review

Racial prejudice and unfair treatment: interactive effects with poverty and foreign nativity on problem drinking

OBJECTIVE

Although racial and ethnic minorities are often disadvantaged in multiple ways, little research has examined the interactive effects of multiple forms of disadvantage in these populations. The current study describes the independent and interactive effects of perceived prejudice, perceived unfair treatment, poverty, and foreign nativity on problem drinking outcomes among Black and Latino adults.

METHOD

The data source was Black (n = 504) and Latino (n = 766) drinkers from the nationally representative, weighted 2005 National Alcohol Survey. Perceived prejudice was assessed using a composite measure of racial stigma consciousness; perceived unfair treatment was assessed using a single item. Respondents whose per capita household income was below the 2004 poverty guidelines were coded as "poor"; nativity status was assessed among Latinos. Outcomes included past-year drinking to drunkenness, any drinking-related consequences, and two or more dependence symptoms.

RESULTS

In bivariate tests, higher levels of unfair treatment were significantly associated with all three outcomes among Blacks (marginally so for drunkenness) and dependence symptoms among Latinos. Further, higher racial stigma was significantly associated with higher rates of any drinking consequences among Latinos. In multivariate logistic regressions, six significant or marginally significant interactions emerged. For each, the pattern of results suggested stronger associations between perceived prejudice/unfair treatment and problem drinking given either poverty or foreign nativity.

CONCLUSIONS

Although findings were somewhat mixed, the pattern of results tentatively supports the hypothesis that associations between problem drinking and both prejudice and unfair treatment can be exacerbated given the presence of other stressors, particularly among Latinos. Results extend the literature on the health consequences of prejudice and discrimination, highlighting important effects of cumulative adversity and suggesting a need to focus particularly on drinkers exposed to the combined effects of multiple stressors in prevention and treatment efforts.

A cross-national study on Mexico-US migration, substance use and substance use disorders

BACKGROUND

Epidemiologic research has consistently found lower prevalence of alcohol and drug use disorders among Hispanic immigrants to the US than among US-born Hispanics. Recent research has begun to examine how this change occurs in the process of assimilation in the US. We aimed to study immigration, US nativity, and return migration as risk factors for alcohol and drug use among people of Mexican origin in both the US and Mexico.

METHODS

Data come from nationally representative surveys in the United States (2001-2003; n=1208) and Mexico (2001-2002; n=5782). We used discrete time event history models to account for time-varying and time-invariant characteristics.

RESULTS

We found no evidence that current Mexican immigrants in the US have higher risk for alcohol or alcohol use disorders than Mexicans living in Mexico, but current immigrants were at higher risk for drug use and drug use disorders. Current Mexican immigrants were at lower risk for drug use and drug disorders than US-born Mexican-Americans. US nativity, regardless of parent nativity, is the main factor associated with increasing use of alcohol and drugs. Among families of migrants and among return migrants we found increased risk for alcohol use, drug use and alcohol and drug use disorders. Evidence of selective migration and return of immigrants with disorders was found regarding alcohol use disorders only.

CONCLUSIONS

Research efforts that combine populations from sending and receiving countries are needed. This effort will require much more complex research designs that will call for true international collaboration.

Acculturation of Pacific mothers in New Zealand over time: findings from the Pacific Islands Families study

BACKGROUND

The epidemiological investigation of acculturation has often been hampered by inconsistent definitions and measurement, and methodological short-comings. Adopting a bi-directional model, with good theoretical and psychometric properties, this study aimed to describe the temporal, ethnic and socio-demographic influences of acculturation for a group of Pacific mothers residing in New Zealand.

METHODS

Pacific mothers of a cohort of Pacific infants born at a large tertiary hospital in South Auckland in 2000 were interviewed at 6-weeks, 4-years and 6-years postpartum. At each measurement wave a home interview lasting approximately 90 minutes was conducted with each mother. Adapting the General Ethnicity Questionnaire, two scales of acculturation were elicited: one measuring New Zealand cultural orientation (NZAccult) and one measuring Pacific Islands cultural orientation (PIAccult). Acculturation scores were standardised and analysed using random intercept polynomial and piecewise mixed-effects regression models, accounting for the longitudinal nature of the repeated measured data. Mothers who immigrated to New Zealand and those who lived their lives in New Zealand were investigated separately.

RESULTS

Overall, 1276 Pacific mothers provided 3104 NZAccult and 3107 PIAccult responses over the three measurement waves. Important and significant differences were observed in both bi-directional acculturation measures between the two maternal groups studied. New Zealand cultural orientation increased, on average, linearly with years lived in New Zealand both for immigrant mothers (0.013 per year, 95% CI: 0.012, 0.014), after adjusting for maternal age, and for mothers who lived their lives in New Zealand (0.008 per year, 95% CI: 0.06, 0.010). Immigrant mothers maintained their Pacific cultural orientation for, on average, 12 years before it began to linearly decrease with each year lived in New Zealand thereafter (-0.009 per year, 95% CI: -0.010, -0.008), after adjusting for maternal age. Mothers who lived their lives in New Zealand had a Pacific orientation that was, on average, unchanged regardless of the number of years lived in New Zealand. Significant ethnic and socio-demographic variations were noted.

CONCLUSIONS

Understanding the patterns and trajectories of acculturation over time, and its key determinants, is necessary for the development of appropriate targeted health policy and care in typically vulnerable and marginalised immigrant populations.

The Influence of Linguistic Acculturation and Gender on the Initiation of Substance Use Among Mexican Heritage Preadolescents in the Borderlands

This article examined the impact of linguistic acculturation and gender on the substance use initiation of a sample of 1,473 Mexican heritage preadolescents attending 30 public schools in Phoenix, Arizona. It was hypothesized that linguistic acculturation operates differently as a risk or protective factor for young children than for older youth. The study used discrete-time event history methods to model the rate at which nonusing children initiate substance use. Alcohol, cigarettes, marijuana, and inhalants were studied separately while inhalant use was examined more closely. Results suggested that while linguistic acculturation is a risk factor for Mexican heritage preadolescents, this association depended on gender, the linguistic acculturation context (family, friends, or media), and the type of substance. For inhalants, higher linguistic acculturation with friends was inversely associated with drug initiation both for boys and girls. Implications for preventive science and future intervention research are discussed.

Correlates of heavy drinking behaviors of Latino mothers and their adult daughters

This study explored associations between adult Latina heavy drinking behaviors and potential psychosocial and demographic correlates. It used mother-daughter dyads and a cross-sectional design. Data were drawn from a community-based sample of 158 dyads of adult Latinas (n=316), age 18 years or older, recruited between 2004 and 2006. Bivariate and multivariate statistical methods, including logistic regression and pathway models, were used to analyze data. The study found that protective factors for heavy drinking behaviors for the mother included daughter's social support and mother's age, while for the daughter, they were mother's attachment and daughter's country of birth. Risk factors for daughter's heavy drinking behaviors were mother's social support and daughter's education. For both mother and daughter, chronic stress and drinking behavior associations were mediated by attachment and social support. Preventive interventions should target increasing levels of mother-daughter attachment and daughter's social support while decreasing stress levels for mothers and daughters.

Moderated mediation regarding the sun-safe behaviors of U.S. Latinos: advancing the theory and evidence for acculturation-focused research and interventions

Recent studies revealed a negative association between acculturation and sun-safe behaviors, possibly mediated by education level, health status, and social networks. We sought to elucidate this relationship by exploring the moderating effects of gender and health insurance on each mediated path. We used data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Acculturation, assessed by a four-item index, was the primary predictor; use of sunscreen and protective clothing were the primary outcomes, assessed by frequency scales. Moderated mediation was tested with an established causal moderation method. The mediated association between acculturation, education level and sunscreen use might be stronger among women than men (P < 0.08). We found no evidence of moderated mediation for use of protective clothing. The findings suggest ways of refining the theoretical and empirical rationale for sun safety research and interventions with Latinos. Studies should replicate these models with longitudinal data.

The relationship between psychosocial status, acculturation and country of origin in mid-life Hispanic women: data from the Study of Women's Health Across the Nation (SWAN)

METHOD

To test the hypothesis that psychosocial symptomatology differs by country of origin and acculturation among Hispanic women, we examined 419 women, aged 42-52 years at baseline, enrolled in the New Jersey site of the Study of Women's Health Across the Nation (SWAN). Women were categorized into six groups: Central (CA, n = 29) or South American (SA, n = 106), Puerto Rican (PR, n = 56), Dominican (D, n = 42), Cuban (Cu, n = 44) and non-Hispanic Caucasian (NHC, n = 142). Acculturation, depressive symptoms, hostility/cynicism, mistreatment/discrimination, sleep quality, social support, and perceived stress were assessed at baseline. Physical functioning, trait anxiety and anger were assessed at the fourth annual follow-up. Comparisons between Hispanic and non-Hispanic Caucasians used χ², t test or non-parametric alternatives; ANOVA or Kruskal-Wallis testing examined differences among the five Hispanic sub-groups. Multivariable regression models used PR women as the reference group.

RESULTS

Hispanic women were overall less educated, less acculturated (p < 0.001 for both) and reported more depressive symptoms, cynicism, perceived stress, and less mistreatment/discrimination than NHCs. Along with D women, PR women reported worse sleep than Cu women (p < 0.01) and more trait anxiety than SA and Cu women (p < 0.01). Yet, PR women were most acculturated (21.4% highly acculturated vs. CA (0.0%), D (4.8%), SA (4.8%) and Cu (2.3%) women; p < 0.001). In regression models, PR women reported depressive symptoms more frequently than D, Cu, or SA women, and reported trait anxiety more frequently than Cu or SA women. Greater acculturation was associated with more favorable psychosocial status, but PR ethnicity was negatively related to psychosocial status.

CONCLUSION

Psychosocial symptomatology among Hispanic women differs by country of origin and the relatively adverse profile of Puerto Rican women is not explained by acculturation.

Periconceptional binge drinking and acculturation among pregnant Latinas in New Mexico

Binge drinking during pregnancy might lead to the development of Fetal Alcohol Spectrum Disorders in the offspring. Latinas are often considered a low-risk group for alcohol abuse, although recent reports indicate that the prevalence of alcohol consumption in this group is increasing due to changing cultural norms. The predictors of alcohol consumption during pregnancy among Latinas are largely unknown. We explored predictors of periconceptional drinking among Latinas (n=155) recruited into an ongoing cohort study at the University of New Mexico. Women were interviewed by a bilingual trained interviewer about any episodes of binge drinking (>or=4 drinks/occasion) a month around their last menstrual period (LMP) and were administered a TWEAK questionnaire. Sociodemographic, lifestyle, and reproductive health characteristics were also ascertained. Predictors of binge drinking were identified by Chi-square test and logistic regression in univariate and multivariable analyses, respectively. Backward selection procedure was used to identify covariates that were independently associated with binge drinking in the final model. The mean age of participants was 27.0+/-5.8 years and 69% were foreign born. In the entire sample, 17.4% of pregnant Latinas admitted at least one binge-drinking episode in the month around their LMP. Results of multivariate analysis indicate that Latinas born in the United States have a much greater risk of binge drinking in the periconceptional period (odds ratio [OR]=3.2; 95% confidence interval [CI]: 1.2, 8.9) compared with foreign-born Latinas. Similarly, Latinas who primarily speak English at home were at much greater risk (OR=3.6; 95% CI: 1.3, 10.5) compared with primarily Spanish-speaking women. No other variables were identified as significant predictors in multivariable models. Our results indicate that more acculturated Latinas are at much greater risk of binge drinking before conception and in early pregnancy compared with less acculturated Latinas. Culturally sensitive interventions should be developed to address risky alcohol consumption among Latinas of reproductive age.

Convergence of body mass index of immigrants to the Canadian-born population: evidence from the National Population Health Survey (1994-2006)

Recent immigrants typically have better physical health than the native born population. However, this 'healthy immigrant effect' tends to gradually wane over time, with increasing length of residence in the host country. To assess whether the body mass index (BMI) of different immigrant groups converged to the Canadian population's levels, we estimated 12-year trajectories of changes in BMI (accounting for socio-demographic changes). Using data from seven longitudinal waves of the National Population Health Survey (1994 through 2006), we compared the changes in BMI (kg/m(2)) among three groups: white immigrants, non-white immigrants and Canadian born, aged 18-54 at baseline. We applied linear random effects models to evaluate these BMI separately in 2,504 males and 2,960 females. BMI increased in Canadian born, white immigrants, and non-white immigrants over the 12-year period. However, non-white immigrants (males and females) had a lower mean BMI than Canadian born individuals during this period [Males: -2.27, 95% Confidence interval (CI) -3.02 to -1.53; Females: -1.84, 95% CI -2.79 to -0.90]. In contrast, the mean BMI in white male immigrants and Canadian born individuals were similar (-0.32, 95% CI -0.91 to 0.27). Even after adjusting for time since immigration, non-white immigrants had lower BMI than white immigrants. White male immigrants were the only sub-group to converge to the BMI of the Canadian born population. These results indicate that the loss of 'healthy immigrant effect' with regard to convergence of BMI to Canadian levels may not be experienced equally by all immigrants in Canada.

Extending the theory of planned behavior to predict alcohol, tobacco, and marijuana use among youth of Mexican heritage

This study examined the applicability of extending the theory of planned behavior to explain the normative processes in substance use among Mexican-heritage youth. The theory identifies norms, attitudes, and perceived behavioral control as predictors of intentions, which in turn, predict behaviors. To date, the theory had a limited conceptualization of norms and had not been extended to youth of Mexican descent, one of the fastest growing segments of the U.S. population and one at particular risk for alcohol, tobacco, and marijuana use. Based on norm focus theory, it was hypothesized that norms are multidimensional, consisting of parental injunctive, peer injunctive, descriptive, and personal substance use norms. Second, it was hypothesized that parental injunctive, peer injunctive, and descriptive norms indirectly affect substance use intentions through attitudes, personal norms, and perceived behavioral control. The third hypothesis postulated that the model would operate differently based on Mexican-heritage youths' country of origin. Mexican-heritage youth (N = 1,499) from 30 elementary schools in Phoenix, AZ completed questionnaires in three waves over 18 months as part of a larger study. The findings supported the first hypothesis, showing the multidimensionality of norms. The second hypothesis was partially supported by findings from a multi-group multilevel path analysis using Mplus. Descriptive norms' association with intentions was partially mediated by attitudes, personal norms, and perceived behavioral control, while parental and peer injunctive norms were fully mediated, partially supporting the second hypothesis. Contrary to the third hypothesis, the mediation model did not differ based on Mexican-heritage youths' country of origin.

Associations between acculturation and alcohol consumption of Latino men in the United States

OBJECTIVE

This study examined the relationship between acculturation and six distinct drinking outcomes. We expected high levels of acculturation to be associated with higher odds of being a drinker and, among drinkers, with lower frequency of drinking, less alcohol consumption per year, less heavy drinking, fewer episodes of drunkenness, and fewer dependence symptoms.

METHOD

The data consisted of a nationally representative sample of Latino men ages 18 and older (N = 784) from the 2005 National Alcohol Survey. The men were predominantly Mexican and Mexican American (64%), and most were born outside the United States (68%). Analyses included both bivariate and multivariate regression models using weights to adjust for sampling and nonresponse.

RESULTS

The hypotheses were partially supported. Men at high levels of acculturation were more likely than their peers at low levels of acculturation to be drinkers but only if they had above-average incomes. Counter to expectations, among drinkers there was a protective effect of medium, rather than high, levels of acculturation on frequency of drinking, volume of alcohol consumed, drinking to drunkenness, and dependence symptoms, with a protective effect approaching significance for heavy drinking.

CONCLUSIONS

The findings have implications for future research and public health programs designed to reach Latino men in the United States.

Acculturation and sun-safe behaviors among US Latinos: findings from the 2005 Health Information National Trends Survey

OBJECTIVES

We examined the relationship between acculturation and sun safety among US Latinos.

METHODS

We used linear regression models to analyze data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Using sunscreen, seeking shade, and wearing protective clothing were the primary outcomes and were assessed by frequency scales. Acculturation was assessed with a composite index.

RESULTS

In bivariate models, acculturation was negatively associated with use of shade and protective clothing and positively associated with sunscreen use (all, P < .004). In adjusted models, acculturation was negatively associated with seeking shade and wearing protective clothing across gender and region of residence (all, P < .05).

CONCLUSIONS

Our results demonstrated both adverse and beneficial effects of acculturation on Latinos' risk behaviors relating to skin cancer. Education about sun safety is needed for all Latinos and should be tailored to different levels of acculturation. Initiatives for Latinos who are not yet acculturated could focus on reinforcing existing sun-safe behaviors and presenting new ones, such as use of sunscreen; initiatives for highly acculturated Latinos might require more resources because the objective is behavior modification.

Gender, acculturation, and other barriers to alcohol treatment utilization among Latinos in three National Alcohol Surveys

This study, using three waves of U.S. National Alcohol Surveys (1995-2005), examines lifetime alcohol treatment utilization and perceived treatment barriers among Latinos. The sample included 4,204 Latinos (2,178 women and 2,024 men); data were weighted. Analyses were linear and logistic regressions. Controlling for survey year, severity, and other covariates, male gender and English language interview predicted higher utilization generally and Alcoholics Anonymous use specifically; English interview was also associated with institutional treatment. (Effects for gender on general utilization were marginal.) Other predictors of utilization included older age, lower education, greater social pressures, greater legal consequences, greater dependence symptoms, and public insurance. Whereas men and women differed little on perceived barriers, analyses showed greater barriers among Spanish (vs. English) interviewees. Latina women's underutilization of alcohol treatment requires further research but may be partially explained by stigma. Associations between language of interview and treatment utilization imply a need for outreach and culturally sensitive programming.

Explanatory models for psychiatric illness

How can we best develop explanatory models for psychiatric disorders? Because causal factors have an impact on psychiatric illness both at micro levels and macro levels, both within and outside of the individual, and involving processes best understood from biological, psychological, and sociocultural perspectives, traditional models of science that strive for single broadly applicable explanatory laws are ill suited for our field. Such models are based on the incorrect assumption that psychiatric illnesses can be understood from a single perspective. A more appropriate scientific model for psychiatry emphasizes the understanding of mechanisms, an approach that fits naturally with a multicausal framework and provides a realistic paradigm for scientific progress, that is, understanding mechanisms through decomposition and reassembly. Simple subunits of complicated mechanisms can be usefully studied in isolation. Reassembling these constituent parts into a functioning whole, which is straightforward for simple additive mechanisms, will be far more challenging in psychiatry where causal networks contain multiple nonlinear interactions and causal loops. Our field has long struggled with the interrelationship between biological and psychological explanatory perspectives. Building from the seminal work of the neuronal modeler and philosopher David Marr, the author suggests that biology will implement but not replace psychology within our explanatory systems. The iterative process of interactions between biology and psychology needed to achieve this implementation will deepen our understanding of both classes of processes.