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De Leon AN, Dvorak RD, Perrotte JK, Klaver SJ, Peterson R, Magri TD, Burr EK, Leary AV, Aguilar B. The role of sociocultural factors on alcohol self-efficacy and protective drinking behaviors among Hispanic/Latinx young adults. ETHNICITY & HEALTH 2024; 29:553-577. [PMID: 38714915 DOI: 10.1080/13557858.2024.2345916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/16/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVES Hispanic/Latinx drinkers have been found to experience more adverse alcohol-related consequences than any other racial/ethnic group. Due to this, researchers have looked at the connection between drinking and cultural factors, alongside discrimination, to further analyze what sociocultural factors lead to negative outcomes when drinking. DESIGN Researchers used a sample of Hispanic/Latinx young adult drinkers (n = 710) with an average age of 22.43 (SD = 6.69), recruited through social media and assessed on several factors, including protective behavioral strategies (PBS), alcohol use severity, bicultural self-efficacy, discrimination, acculturation, and enculturation. RESULTS Utilizing an observed variable path analysis, results showed perceived discrimination to have a significant effect on all variables in the model (bicultural self-efficacy, acculturation, enculturation, PBS self-efficacy, PBS use, and alcohol use severity). Acculturation was positively associated with PBS self-efficacy, while enculturation was positively associated with PBS use. PBS self-efficacy was positively correlated with PBS use and negatively associated with alcohol use severity. There was a significant total indirect effect from perceived discrimination to alcohol use severity through various paths (i.e. PBS self-efficacy, acculturation, and bicultural self-efficacy), with the strongest path to occur through PBS self-efficacy. CONCLUSIONS Findings showcase the risk and protective effects of various sociocultural factors on drinking behaviors among young adults. PBS self-efficacy was found to have robust protective effects against alcohol use severity. Future research should continue to investigate these sociocultural and behavioral factors in order to develop efforts to mitigate hazardous alcohol use among Hispanic/Latinx young adult drinkers.
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Affiliation(s)
- Ardhys N De Leon
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Robert D Dvorak
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | | | - Samantha J Klaver
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Roselyn Peterson
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Tatiana D Magri
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Emily K Burr
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Angelina V Leary
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Bradley Aguilar
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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Wang K, Ortiz DV, Colón L, Sun F, Falcón L. The moderating role of everyday discrimination on the association between post-traumatic stress and loneliness among older Puerto Ricans. Aging Ment Health 2023; 27:1388-1395. [PMID: 36444946 PMCID: PMC10225478 DOI: 10.1080/13607863.2022.2149695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES This study examines the relationship between post-traumatic stress and loneliness and whether this relationship varies by perceived everyday discrimination among older Puerto Ricans. METHODS A total of 304 Puerto Ricans aged 60 and above from Wave 3 of the Boston Puerto Rican Health Study were included. Ordinary least squares regression examined the association between post-traumatic stress, perceived everyday discrimination, and loneliness. RESULTS Post-traumatic stress was significantly associated with a higher level of loneliness (β = 0.282; p < 0.001; 95% CI: 0.142, 0.423). The interaction effect between post-traumatic stress and perceived everyday discrimination on loneliness was statistically significant (β = 0.083; p < 0.05; 95% CI: 0.062, 0.230). More specifically, the positive association between post-traumatic stress and loneliness becomes more robust with the increase in perceived everyday discrimination. CONCLUSION Given an increase in population size on the U.S. mainland and migration from Puerto Rico due to natural disasters and declining economic conditions, it is essential to better understand the effect of perceived discrimination against older Puerto Ricans on the mainland United States as well as those who immigrated and stayed through older age. Outreach strategies and interventions that address perceived discrimination can help mitigate loneliness among older Puerto Ricans who experienced trauma.
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Affiliation(s)
- Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Daniel Vélez Ortiz
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Lisa Colón
- Department of Human Development, Washington State University
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Luis Falcón
- College of Fine Arts, Humanities and Social Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Cano MÁ, De La Rosa M, Schwartz SJ, Salas-Wright CP, Keum BTH, Lee CS, Pinedo M, Cobb CL, Field CA, Sanchez M, Castillo LG, Martinez P, Lorenzo-Blanco EI, Piña-Watson B, de Dios MA. Alcohol Use Severity among Hispanic Emerging Adults: Examining Intragroup Marginalization, Bicultural Self-Efficacy, and the Role of Gender within a Stress and Coping Framework. Behav Med 2023; 49:172-182. [PMID: 34818984 PMCID: PMC9126992 DOI: 10.1080/08964289.2021.2006130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Most research on cultural stressors and alcohol has focused on intercultural stressors. Continuing to exclude intracultural stressors (e.g., intragroup marginalization) from alcohol research will yield a biased understanding of the experiences of Hispanics living in a bicultural society. As we amass more studies on intracultural stressors, research will be needed to identify mutable sociocultural factors that may mitigate the association between intracultural stressors and alcohol. To address these limitations, we examined the association between intragroup marginalization and alcohol use severity and the extent to which gender and bicultural self-efficacy may moderate this association. A convenience sample of 200 Hispanic emerging adults ages 18-25 (men = 101, women = 99) from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Higher intragroup marginalization was associated with higher alcohol use severity. Gender functioned as a moderator whereby intragroup marginalization was associated with higher alcohol use severity among men, but not women. Also, higher social groundedness functioned as a moderator that weakened the association between intragroup marginalization and alcohol use severity. Role repertoire did not function as a moderator. Our findings are significant because they enhance the reliability of the association between intragroup marginalization and alcohol use severity, and the moderating effect of gender in this respective association. This emerging line of research suggests that alcohol interventions targeting Hispanics may have a significant limitation by not accounting for intracultural stressors.
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Affiliation(s)
- Miguel Ángel Cano
- College of Public Health & Social Work, Florida International University
| | - Mario De La Rosa
- College of Public Health & Social Work, Florida International University
| | | | | | - Brian T H Keum
- Department of Social Welfare, University of California, Los Angeles
| | | | | | - Cory L Cobb
- College of Education, University of Texas at Austin
| | - Craig A Field
- Department of Psychology, University of Texas at El Paso
| | - Mariana Sanchez
- College of Public Health & Social Work, Florida International University
| | | | | | - Elma I Lorenzo-Blanco
- Department of Human Development and Family Sciences, University of Texas at Austin Texas Tech University
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Perceived racial discrimination and suicidal behaviors among racial and ethnic minority adolescents in the United States: Findings from the 2021 adolescent behaviors and experiences survey. Psychiatry Res 2022; 317:114877. [PMID: 36244159 DOI: 10.1016/j.psychres.2022.114877] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 01/05/2023]
Abstract
The objectives of this study were to investigate: (1) the prevalence of perceived racial discrimination (PRD) in school, among racial/ethnic minority adolescents, and (2) the association between PRD and suicidal behaviors among racial/ethnic minority adolescents in the United States. Data from a sample of 3241 racial/ethnic minority adolescents (53.7% female) from the 2021 Adolescent Behaviors and Experiences Survey were analyzed using binary logistic regression. Controlling for other factors, racial/ethnic minority adolescents who experienced PRD had 1.57 times higher odds of experiencing suicidal ideation (adjusted odds ratio (AOR) = 1.57, 95% Confidence Intervals (CI) = 1.09-2.25), 1.64 times higher odds of making a suicide plan (AOR = 1.64, 95% CI = 1.09-2.49), and 1.67 times higher odds of attempting suicide (AOR = 1.67, 95% CI = 1.04-2.68) during the past year. Other factors associated with suicidal behaviors included self-identifying as lesbian/gay, bisexual, or other/questioning; experiencing cyberbullying; feeling sad or hopeless; and poor mental health during the pandemic. The findings of this study extend past research and demonstrate that racial/ethnic minority adolescents who experienced PRD were more likely to report suicidal behaviors over and above other well-established risk factors for suicidal behaviors. Future studies that employ longitudinal designs are needed to elucidate mechanisms underlying these associations.
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Estrada F, Jones IJ, Rivera D, Ramirez A, Cerezo A. Trauma and Latinx Sexual- and Gender-Minority Immigrants in the U.S. Curr Opin Psychol 2022; 47:101439. [DOI: 10.1016/j.copsyc.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
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Nereim C, Bickham D, Rich M. Exploring Use Patterns and Racial and Ethnic Differences in Real Time Affective States During Social Media Use Among a Clinical Sample of Adolescents With Depression: Prospective Cohort Study. JMIR Form Res 2022; 6:e30900. [PMID: 35550316 PMCID: PMC9136651 DOI: 10.2196/30900] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/23/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Increasing youth mental health problems over time correlate with increasing rates of social media use (SMU); however, a proposed contributory relationship remains unproven. To better understand how SMU impacts mental health requires a more nuanced understanding of the relationship between different patterns of SMU and specific individual factors. Studies suggest that more active forms of SMU may offer mental health benefits when compared with more passive forms. Furthermore, the literature suggests important differences in patterns of SMU and affective states among those identifying as racial and ethnic minorities. Objective Using ecological momentary assessment (EMA), this study aims to investigate potential differences in affective states during active and passive forms of SMU and whether such differences vary by race and ethnicity. Methods We recruited patients seeking care at a large urban adolescent medicine clinic who exhibited at least mild depressive symptoms based on Patient Health Questionnaire-9 (PHQ-9) scores. Participants completed an enrollment survey and a 7-day EMA protocol, receiving 5 EMA questionnaires per day, which assessed real time SMU behaviors and affective states using the Positive and Negative Affect Schedule–Expanded form subscales. To correct for nonindependent data with EMA responses clustered within individuals, data were analyzed using mixed-effects modeling, allowing for a random intercept at the individual level to examine associations between EMA-reported SMU and affective states while adjusting results for age, gender, race and ethnicity, PHQ-9 score, and EMA response rate. Results A racially and ethnically diverse group of 55 adolescents aged 14 to 19 years provided a total of 976 EMA responses, averaging 17.76 (SD 8.76) responses per participant, with a response rate of 51.15%. Participants reported higher mean levels of negative affect during active SMU (F1,215=3.86; SE 0.05; t1,215=1.96; P=.05) and lower mean levels of positive affect during passive SMU (F1,369=3.90; SE 0.09; t1,369=–1.98; P=.049). However, within different racial and ethnic groups, higher levels of negative affect during moments of active SMU were seen only among Black non-Hispanic participants: F1,81=6.31; SE 0.05; t81=2.51; P=.01). Similarly, lower levels of positive affect during passive SMU were seen only among White non-Hispanic participants (F1,295=10.52; SE 0.13; t295=–3.24; P=.001). Conclusions Although in aggregate, adolescents with depressive symptoms experienced more negative affect during active SMU and less positive affect during passive SMU, these mean outcomes were driven solely by greater negative affect during active SMU by Black non-Hispanic participants and lower positive affect during passive SMU by White non-Hispanic participants. Differences in intentionality, content, context, and expectations of SMU among youths across racial and ethnic groups may result in different affective outcomes. Exploration of the interactions among cultural differences in SMU strategies and characteristics will be critical to furthering our understanding of the impact of SMU on youth mental health.
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Affiliation(s)
- Cameron Nereim
- Division of Adolescent Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - David Bickham
- Division of Adolescent & Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael Rich
- Division of Adolescent & Young Adult Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Cano M, Perez Portillo AG, Figuereo V, Rahman A, Reyes-Martínez J, Rosales R, Ángel Cano M, Salas-Wright CP, Takeuchi DT. Experiences of Ethnic Discrimination Among US Hispanics: Intersections of Language, Heritage, and Discrimination Setting. INTERNATIONAL JOURNAL OF INTERCULTURAL RELATIONS : IJIR 2021; 84:233-250. [PMID: 34840361 PMCID: PMC8622792 DOI: 10.1016/j.ijintrel.2021.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Informed by Latino Critical Race Theory, the present study examined how intersections between English use/proficiency, Spanish use/proficiency, and heritage group shape the varying experiences of ethnic discrimination reported by US Hispanic adults. METHODS The study utilized data from 7,037 Hispanic adults from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Multivariable binomial logistic regression modeled language use/proficiency, heritage, and demographic characteristics as predictors of past-year self-reported perceived ethnic discrimination, overall and in six different settings. RESULTS Both English and Spanish use/proficiency were positively associated with increased adjusted odds of reporting ethnic discrimination overall, in public, or with respect to employment/education/ housing/courts/police; however, with respect to being called a racist name or receiving verbal/physical threats/assaults, a positive association was observed for English, yet not Spanish. Results also indicated a significant interaction between English use/proficiency and Spanish use/proficiency when predicting past-year ethnic discrimination overall or for any of the six types/settings examined, although the relationship between language use/proficiency and ethnic discrimination varied by Hispanic heritage group. CONCLUSION Study findings emphasize that experiencing some form of ethnic discrimination is relatively common among US Hispanic adults, yet the prevalence and types or settings of ethnic discrimination vary widely on the basis of demographics, immigrant generation, heritage, and the interplay between English and Spanish use/proficiency.
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Cano MÁ, Schwartz SJ, MacKinnon DP, Keum BT, Prado G, Marsiglia FF, Salas-Wright CP, Cobb CL, Garcini LM, De La Rosa M, Sánchez M, Rahman A, Acosta LM, Roncancio AM, de Dios MA. Exposure to ethnic discrimination in social media and symptoms of anxiety and depression among Hispanic emerging adults: Examining the moderating role of gender. J Clin Psychol 2021; 77:571-586. [PMID: 32869867 PMCID: PMC7878314 DOI: 10.1002/jclp.23050] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/11/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022]
Abstract
METHOD Two hundred Hispanic emerging adults from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey, and data were analyzed using hierarchical multiple regression and moderation analyses. RESULTS Higher social media discrimination was associated with higher symptoms of depression and generalized anxiety. Moderation analyses indicated that higher social media discrimination was only associated with symptoms of depression and generalized anxiety among men, but not women. CONCLUSION This is likely the first study on social media discrimination and mental health among emerging adults; thus, expanding this emerging field of research to a distinct developmental period.
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Affiliation(s)
- Miguel Ángel Cano
- Florida International University, Department of Epidemiology, Miami, FL, USA
| | - Seth J. Schwartz
- University of Miami, Department of Public Health Sciences, Miami, FL, USA
- University of Texas at Austin, Department of Educational Psychology, Austin, TX, USA
| | | | - Brian TaeHyuk Keum
- University of California, Los Angeles, Department of Social Welfare, Los Angeles, CA, USA
| | - Guillermo Prado
- University of Miami, Department of Public Health Sciences, Miami, FL, USA
| | | | | | - Cory L. Cobb
- University of Texas at Austin, Department of Educational Psychology, Austin, TX, USA
| | - Luz M. Garcini
- University of Texas Health Science Center at San Antonio, Department of Psychiatry, San Antonio, TX, USA
| | - Mario De La Rosa
- Florida International University, School of Social Work, Miami, FL, USA
| | - Mariana Sánchez
- Florida International University, Department of Health Promotion and Disease Prevention, Miami, FL, USA
| | - Abir Rahman
- Florida International University, Department of Epidemiology, Miami, FL, USA
| | - Laura M. Acosta
- University of Nebraska–Lincoln, Department of Psychology, Lincoln, NE, USA
| | | | - Marcel A. de Dios
- University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, TX, USA
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Cobb CL, Salas-Wright CP, John R, Schwartz SJ, Vaughn M, Martínez CR, Awad G, Pinedo M, Cano MÁ. Discrimination Trends and Mental Health Among Native- and Foreign-Born Latinos: Results from National Surveys in 2004 and 2013. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:397-407. [PMID: 33231824 PMCID: PMC10371212 DOI: 10.1007/s11121-020-01186-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 11/30/2022]
Abstract
We examined national trends and mental health correlates of discrimination among Latinos in the USA. We used data from two nationally representative surveys based on the National Epidemiologic Survey on Alcohol and Related Conditions collected in 2004 and 2013. Results indicated that perceived discrimination, both any and recurrent, increased for Latinos across nearly every demographic, with the greatest increases occurring for Latinos who were ages 65 and older, had household incomes less than $35,000, were less educated, were immigrants, and who lived in the Midwest. Findings also indicated that any and recurrent discrimination were associated with increased odds of a mood, anxiety, or substance use disorder and this association was observed for nearly all manifestations of discrimination. We also observed a dose-response association where experiencing discrimination in a greater number of domains was associated with increased likelihood of mood, anxiety, and substance use disorders. Results suggest that discrimination is a social stressor that has increased for Latino populations in recent years and may represent a serious risk factor for the psychological and behavioral health of Latinos. Findings are discussed in terms of prior research and the potential implications for prevention scientists working with Latino populations.
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Affiliation(s)
- Cory L Cobb
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Ste D5000, Austin, TX, 78712, USA.
| | | | - Rachel John
- School of Social Work, Boston University, 264 Bay State Rd, Boston, MA, 02215, USA
| | - Seth J Schwartz
- Leonard M. Miller School of Medicine, University of Miami, 1120 N.W. 14th Street, Room 1083, Miami, FL, 33136, USA
| | - Michael Vaughn
- Saint Louis University, 3550 Lindell Blvd., Room 316, St. Louis, MO, 63103, USA
| | - Charles R Martínez
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Ste D5000, Austin, TX, 78712, USA
| | - Germine Awad
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Ste D5000, Austin, TX, 78712, USA
| | - Miguel Pinedo
- Department of Kinesiology and Health Education, University of Texas at Austin, 1912 Speedway, Ste D5000, Austin, TX, 78712, USA
| | - Miguel Ángel Cano
- Florida International University, 11200 SW 8th Street AHC5, Miami, FL, 33199, USA
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Cano M, Takeuchi DT. Recent/Childhood Adversities and Mental Disorders Among US Immigrants. Front Psychiatry 2020; 11:573410. [PMID: 33312137 PMCID: PMC7703683 DOI: 10.3389/fpsyt.2020.573410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022] Open
Abstract
Past research documents the heterogeneity in US immigrants, particularly in terms of racial and ethnic categories and specific ethnic subgroups. The present study builds on this research foundation by investigating heterogeneity in immigrants' experiences of adversity, both recent and during childhood, and associations with mental disorders. Data are drawn from 6,131 adult immigrants in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Prevalence estimates for mental disorders and adversities were calculated overall and by gender. Latent class analysis was utilized to characterize patterns of self-reported experiences of childhood and recent adversities, and multinomial logistic regression established the statistical association between latent class membership and past-year mental disorder outcomes (substance use disorder only, mood/anxiety/trauma disorder only, co-occurring disorder, or no mental disorder). Neglect was the most commonly-reported childhood adversity among immigrant men and women. Prevalence of meeting criteria for a substance use disorder only, or a mood/anxiety/trauma disorder only, varied between men and women, yet no gender differences were observed in prevalence of co-occurring disorders. For latent class analyses, a five-class solution was selected based on fit indices and parsimony. Approximately 10.0% of the sample was categorized in the latent class characterized by severe childhood adversities, while 57.5% was classified in the latent class with low probabilities of reported adversities. The relative risk of meeting criteria for a past-year substance use disorder only (compared to no substance use or mood/anxiety/trauma disorder) was more than three times as high for members of the class with severe childhood adversities (RRR, 3.26; 95% CI, 2.08-5.10), as well as the class with recent employment/financial adversities (RRR, 3.82; 95% CI, 2.36-6.19), compared to the class with low adversities. The relative risk of past-year co-occurring disorders (compared to no disorder) was more than 12 times as high for those in the severe childhood adversities class (RRR, 12.21; 95% CI, 7.06-21.10), compared to the class with low adversities. Findings underscore the importance of considering both recent and childhood adversities when assessing and providing services for US immigrant groups.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX, United States
| | - David T Takeuchi
- School of Social Work, University of Washington, Seattle, WA, United States.,Department of Sociology, University of Washington, Seattle, WA, United States
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