The use of the Puerto Rican Biculturality Scale with Puerto Rican drug users in New York and Puerto Rico

The Impact of Acculturation on Skin Cancer Risk and Protective Behaviors in Hispanic Populations

The US Hispanic population faces rising skin cancer risks and poorer clinical outcomes, despite lower incidence rates. Acculturation, adopting elements of the dominant culture, may influence skin cancer attitudes and behaviors among Hispanics. We systematically reviewed PubMed articles from 2000 to 2023. Peer-reviewed English articles that assessed the relationship between acculturation and skin cancer in the Hispanic population were included. Andreeva et al. observed that lower acculturation levels correlated with increased use of shade and protective clothing (P < 0.05). More acculturated Latinos were more likely to use sunscreen, but this association weakened after adjusting for covariates (P > 0.48). Heckman et al. highlighted significant differences in skin cancer concern among Hispanic youth, with less acculturated individuals expressing greater worry (P < 0.05). Coups et al. found that higher acculturation was linked to less sun protective clothing usage and more frequent sunburns. Their subsequent online survey indicated that English-acculturated Hispanics engaged less in protective behaviors. Viola et al. reported that English-acculturated Hispanics perceived greater suntan benefits and had lower perceptions of skin cancer risk, severity, and concerns about photo-aging, along with higher melanoma risk factors, compared to Spanish-acculturated Hispanics. Acculturation influences skin cancer attitudes and behaviors in Hispanics. Tailored interventions based on acculturation levels are essential to reduce skin cancer risk. For example, educating English-acculturated Hispanics about skin cancer risks and prioritizing knowledge dissemination for Spanish-acculturated individuals may be effective approaches. These findings emphasize the need for targeted skin cancer prevention efforts to address disparities among US Hispanics.

Young Puerto Rican Mothers' Cultural Orientation and Parenting Behaviors: Associations with Subsequent Child Emotion Dysregulation

Objective

Children of Latinx adolescent mothers are at risk for regulatory difficulties. However, a paucity of research has examined parenting behaviors and children's early emotional development in such families.

Design

Longitudinal associations between observed parenting behaviors (sensitivity, directiveness, child-directed language) at 18 months and children's emotion dysregulation at 18 and 24 months were tested among young mainland Puerto Rican mothers (N = 123) and their toddlers. Given the cultural variability present in Latinx families, whether mothers' cultural orientation moderated these associations was also tested.

Results

Maternal sensitivity predicted less child emotion dysregulation at 24 months at all levels of cultural orientation. Directiveness was unrelated to dysregulation. Child-directed language predicted lower dysregulation only when mothers endorsed lower levels of American cultural orientation.

Conclusions

It is important to consider families' cultural context when identifying maternal behaviors that are most beneficial to child development.

Biculturalism and adjustment among U.S. Latinos: A review of four decades of empirical findings

Incorporating both heritage (e.g., Latino) and national (e.g., American) cultural systems into our sense of self (i.e., bicultural identity) and developing the ability to successfully respond to demands associated with each of these systems (i.e., bicultural competence) have been theorized to be central to the development and positive adjustment of U.S. Latinos, a group that represents a large segment of the country's population. In this comprehensive review, we examined empirical research on biculturalism among U.S. Latinos spanning four decades (1980-2020), with a focus on synthesizing the field's understanding of antecedents and consequents associated with biculturalism and identifying directions for future research. Our review of 152 empirical articles revealed that this literature was characterized by multiple approaches to the conceptualization (i.e., dual-cultural adaptation, dual-cultural identity, bicultural identity integration, and bicultural competence) and subsequent operationalization of biculturalism. Although each conceptualization has different implications for the conclusions that can be drawn regarding an aspect or facet of biculturalism and potential influence on adjustment, a significant majority (78%) of studies, across conceptualizations, provided evidence supporting a positive association between biculturalism and Latinos' adjustment. In addition, a relatively small body of qualitative work was identified, and findings largely informed potential antecedents of biculturalism. We review this literature with attention to: the aspects of biculturalism that are associated with Latinos' adjustment (i.e., psychosocial and physical health), how sample characteristics may limit the generalizability of this work, and important directions for future research both in terms of conceptualization and study design.

Acculturation Profiles of Central Florida Puerto Ricans: Examining the Influence of Skin Color, Perceived Ethnic-Racial Discrimination, and Neighborhood Ethnic-Racial Composition

Evaluating sociocultural factors that may influence acculturation strategies rather than assuming homogeneity among different Latinx ethnic groups is important. A latent profile analysis with covariates was used to identify acculturation profiles in a sample of first-generation Central Florida Puerto Ricans ( N = 381) along bidimensional behavioral, values, and ethnic identity indicators. We examined whether three contextual covariates including (a) perceived ethnic-racial discrimination, (b) percentage of White Americans, and (c) percentage of Puerto Ricans residing in each participants’ zip code could help derive latent profile membership. Participants were categorized into three profiles. The first profile exhibited the highest levels of White American ethnic identity and high levels of Puerto Rican and White American cultural behaviors. The second profile described individuals with the lowest adherence to White American behaviors and ethnic identity. It also exhibited high attachment to Puerto Rican cultural values. The third profile exhibited high levels of Puerto Rican and White American cultural values and moderate levels of White American cultural behaviors and ethnic identity. An examination of covariates revealed that only perceived ethnic-racial discrimination had an influence on profile identification and membership, with likelihood of belonging to Profile 2 decreasing, and likelihood of belonging to Profile 1 increasing as perceived ethnic-racial discrimination increased. Perceived ethnic-racial discrimination did not influence the likelihood of Profile 3 membership. Results highlight the importance of contextualizing acculturation.

Using the Portuguese version of the Bicultural Scale in Brazil

Introduction:

Brazil has received influxes of people, mainly from Africa, Europe and Japan, forming one of the most heterogeneous populations in the world. Some groups, particularly in Southern Brazil, have retained their original cultural traditions, whilst acquiring elements of the typical local Brazilian cultural identity. This is the first study designed to formally evaluate biculturality in Brazil.

Objective:

To psychometrically assess and validate the Portuguese version of the Bicultural Scale (BS) in Brazil.

Methods:

The BS was adapted and translated to Portuguese and tested for the first time in Brazil in a sample of descendants (n = 160) from four immigrant groups and respective locations in Southern Brazil. A series of psychometric tests were conducted in order to examine the validity of the Portuguese version of the BS. Analyses of variance across scores for all subgroups were also conducted.

Results:

Factor analysis revealed two main factors contributing to most of the variance in scores. The 10 items measuring affiliation with minority cultural characteristics and the typical Brazilian culture yielded Cronbach's alpha coefficients of 0.69 and 0.78 respectively, whereas the overall Cronbach's alpha for all 20 items of the BS was 0.67. There was a significant correlation between items related to the typical Brazilian culture and the generation since immigration of research participants (r = 0.23, p = 0.004). The mean time taken to complete the questionnaire was 7.4 minutes.

Conclusion:

The results indicate that the Portuguese version of the BS is a valid, reliable and easy-to-use instrument to assess biculturality experienced by descendants of immigrants in southern Brazil.

Selecting an Acculturation Measure for Use With Latino Older Adults

The purpose of this article is to ascertain the degree to which acculturation measures have been validated for use with older Latino adults and to offer recommendations to assist practitioners and researchers in selecting an empirically sound acculturation measure. The authors analyzed the psycho-metric properties of 15 subjective acculturation instruments that sampled Latino older adult respondents in their development or validation. In general, the limited data suggest a tendency for lower acculturation scores among older Latinos. A number of scales suffer from methodological flaws or lack sufficient psychometric data. The effect of age on acculturation was infrequently analyzed, and no measure was designed specifically for use with older adults, although several measures appear to have promise for use with Latino older adults. Because Latinos are one of the fastest growing sectors of the older adult population, further attention to the development and validation of acculturation measures for this population is urged.

Time Since Migration and HIV Risk Behaviors Among Puerto Ricans Who Inject Drugs in New York City

BACKGROUND

Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites.

OBJECTIVE

Understand the persistence of these HIV behaviors.

METHODS

In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression.

RESULTS

A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants.

CONCLUSIONS

The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process.

Russian speaking immigrants: drug use, infectious disease and related health behavior

This article focuses on drug use, infectious disease and other factors comparing FSU males who became addicted before and after immigration to Israel. 810 drug users were surveyed in treatment centers from January 2002 to January 2012. The Addiction Severity Index and other data collection instruments were used. Those addicted before immigration have a higher level of infectious disease (i.e., HCV, HIV/AIDS and tuberculosis) and opiate use other than heroin. Those addicted after immigration reported higher rates of last 30 days sedative; cocaine and opiates other than heroin use. Injection drug use and ASI domain problem behavior were more prevalent among those addicted before immigration. Results evidence the impact of country of addiction origin on drug use patterns, infectious disease rates as well as other health related factors. Additional research of the relationship between acculturation and drug use is needed.

United states acculturation and cancer patients' end-of-life care

Background

Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients’ end-of-life treatment preferences and medical care.

Methods and Findings

In this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19-item scale developed to assess the degree of “Americanization” in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers’ USAS scores predicted patients’ communication, treatment preferences, and end-of-life medical care in multivariable models that corrected for significant confounding influences (e.g. education, country of origin, English proficiency). The USAS measure was internally consistent (Cronbach α = 0.98); and significantly associated with US birthplace (r = 0.66, P<0.0001). USAS scores were predictive of patients’ preferences for prognostic information (AOR = 1.31, 95% CI:1.00–1.72), but not comfort asking physicians’ questions about care (AOR 1.23, 95% CI:0.87–1.73). They predicted patients’ preferences for feeding tubes (AOR = 0.68, 95% CI:0.49–0.99) and wish to avoid dying in an intensive care unit (AOR = 1.36, 95% CI:1.05–1.76). Scores indicating greater acculturation were also associated with increased odds of patient participation in clinical trials (AOR = 2.20, 95% CI:1.28–3.78), compared with lower USAS scores, and greater odds of patients receiving chemotherapy (AOR = 1.59, 95% CI:1.20–2.12).

Conclusion

The USAS is a reliable and valid measure of “Americanization” associated with advanced cancer patients’ end-of-life preferences and care. USAS scores indicating greater caregiver acculturation were associated with increased odds of patient participation in cancer treatment (chemotherapy, clinical trials) compared with lower scores. Future studies should examine the effects of acculturation on end-of-life care to identify patient and provider factors that explain these effects and targets for future interventions to improve care (e.g., by designing more culturally-competent health education materials).

Cultural influences on antiretroviral therapy adherence among HIV-infected Puerto Ricans

Adherence to antiretroviral therapy (ART) is integral to the successful treatment of HIV infection. Research has indicated that HIV-infected Latinos may have difficulty adhering to ART. While studies have demonstrated strong relationships between numerous psychosocial factors and ART adherence, no research has examined if cultural factors are also involved in ART adherence among Latinos. Our study examined the relationship between acculturation to mainstream U.S. culture, bicultural self-efficacy, and ART adherence among HIV-infected Puerto Rican adults living in the United States. Participants with ≥ 95% adherence scored higher on U.S.- and Latino-involvement acculturation scales and on a measure of bicultural self-efficacy compared to those with suboptimal adherence. Among bicultural HIV-infected Puerto Ricans, both acculturation and self-efficacy to navigate between cultures were positively related to adherence. Understanding the role of an individual's sociocultural experience may help elucidate why HIV-infected Latinos have difficulties achieving optimal ART adherence and improve ART adherence interventions.

HIV and Drug Use in Puerto Rico: Findings from the ARIBBA Study

This paper presents findings from the Alliance for Research in El Barrio and Bayamón (ARIBBA) research study, which compared HIV-related risk behaviors, HIV infection rates, and mortality rates of 800 Puerto Rican injection drug users and crack smokers in East Harlem, New York, with 399 of their counterparts in Bayamón, Puerto Rico. The study was conducted from 1996 to 2004 and is among the most comprehensive ever undertaken on HIV risk behaviors of drug users in Puerto Rico. This paper presents the main findings, many of which have been published in scientific journals. The study found that drug users in Puerto Rico became infected with HIV at a rate almost 4 times higher than Puerto Rican drug users in New York, and they died at a rate that was more than 3 times as high. The findings indicate that drug users in Puerto Rico are more likely than Puerto Rican drug users in New York to engage in injection drug use and sexual behaviors that put them at risk of becoming infected with HIV. In addition, they have fewer prevention resources available to them. HIV prevention programs are scarce in Puerto Rico and the availability of drug treatment programs in Puerto Rico declined by over one third during the period examined. Additionally, significantly fewer HIV-positive drug users in Puerto Rico were taking HIV-related medications than in New York. The paper concludes with recommendations and lessons learned from the study.

HIV risk and prevention among Hispanic immigrants in New York: the salience of diversity

The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York?based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The study's limitations are noted.

A Review of Acculturation Measures and Their Utility in Studies Promoting Latino Health

The authors reviewed the acculturation literature with the goal of identifying measures used to assess acculturation in Hispanic populations in the context of studies of health knowledge, attitudes, and behavior change. Twenty-six acculturation measures were identified and summarized. As the Hispanic population continues to grow in the United States, there is a need to develop rigorous acculturation measures that include health indicators. Findings suggest that multidimensional acculturation scales are robust measurement tools when assessing nationality, cultural awareness, media and language preferences, and health status. Furthermore, aspects of Hispanic cultural lifestyle, such as beliefs about nutrition and physical activity, affect health care utilization, treatment, and prevention. Health communication researchers should consider aspects of cultural values and beliefs, and their impact on health status, for future research and health promotion interventions.

English use among older bilingual immigrants in linguistically concentrated neighborhoods: social proficiency and internal speech as intracultural variation

This research focuses on patterns of English proficiency and use-of-English among older immigrants living in linguistically concentrated, ethnic neighborhoods. A sample (n = 60) of older Puerto Ricans, who moved from the island to the mainland in their twenties, were divided into English proficiency groups (fluent, high intermediate, low intermediate) via the Adult Language Assessment Scales. Participants then provided self-ratings of their English proficiency (understanding, speaking, reading, and writing), their use of English in social domains (language spoken with own-family, in-laws, spouse, children, neighbors, and workmates), and their use of English in private psychological domains (language of talking to oneself, counting, writing notes to oneself, thinking, dreaming, praying, and expressing feelings). Finally, all participants completed the Puerto Rican Bicultural Scale. Results show a cohort of immigrant elders whose first language is protected by their ethnic neighborhoods but whose domestic and private lives are increasingly permeated by English. In particular, children emerge as powerful forces of language socialization in English for their parents. Further, there are important individual differences by level of proficiency, with a lowest proficiency group that is less acculturated, lower in socioeconomic status, and even more linguistically isolated than groups with higher proficiency. In essence, level of second language proficiency is a potent source of intracultural variation. Methodologically, the paper makes the important point that self-rated patterns of language use are consistent with scores on formal measures of proficiency. The paper also provides empirical verification of the logic of dividing language use into external, social speech and internal, psychological speech.

Biculturality and HIV-risk behaviors among Puerto Rican drug users in New York City

Biculturality refers to two independent processes of acculturation, one to the host society's culture and another to the culture of origin. This study examined the relationship between biculturality and HIV-related risk behaviors in a sample of injecting and noninjecting Puerto Rican drug users (N = 259), recruited in New York City in 2005-2006. Biculturality was measured by two scales: involvement in (i) American culture (AMBIC) and (ii) Puerto Rican culture Biculturality (PRBIC). The majority (78%) of the participants were males, with a mean age of 42 years. About half were born in Puerto Rico, and the average length of stay in the United States was 26 years. In multiple logistic-regression analysis, AMBIC was significantly related to lower injection risk after controlling for other factors including gender, age, and MMTP enrollment, while PRBIC was a significant predictor of higher sex risk. Involvement in the host culture and the culture of origin differed in their relationship to risk behaviors, indicating that incorporating assessments of biculturality may be useful in assessing and addressing migrants' behaviors, including HIV-risk behaviors. The study's limitations have been noted.

The New York City Puerto Rican asthma project: study design, methods, and baseline results

OBJECTIVE

We examined asthma risk factors among 274 Puerto Rican children born in New York to atopic mothers.

METHODS

We prospectively followed the cohort to measure aeroallergens in their homes and assess allergic sensitization. Baseline data are presented.

RESULTS

Maternal smoking was significantly higher among women born on the continental United States (25%) vs. those born elsewhere (11%). Cat ownership was more frequent among mainland-born women (15%) compared with those born in Puerto Rico (4%). While some aeroallergens were prevalent, few dust samples contained detectable dust mite allergens.

CONCLUSIONS

By following this cohort, we hope to identify the roles that socio-cultural factors play in the process of allergic sensitization.

The impact of syringe deregulation on sources of syringes for injection drug users: preliminary findings

In 2001, New York State enacted legislation to allow the provision of syringes by pharmacies and healthcare providers without prescription (ESAP, the Expanded Syringe Access Demonstration Program). A longitudinal study of IDUs (n=130) found that pre-ESAP, about half used only the safest source (needle exchange programs [NEPs]). Post-ESAP implementation, ESAP sources were initiated by 14%. Frequency of injection was related to ESAP use and those who used unsafe (or possibly unsafe) sources were as likely to use ESAP as those who had previously used only NEPs. The findings indicate that providing multiple sources of safe syringes for IDUs is necessary.

Late-life benzodiazepine use among Russian-speaking immigrants in Israel

PURPOSE

In this prospective study, we examine the reasons for benzodiazepine use among Russian-speaking elderly people in Israel, and we discuss issues related to immigrants. We provide information that can be applied to the improvement of age-related health and social services.

DESIGN AND METHODS

During a 6-month period, we interviewed late-life Russian-speaking immigrants in Israeli independent living facilities to determine benzodiazepine use among such individuals.

RESULTS

Among individuals interviewed, 69% reported use; 45% of those who used the substance did so daily. Respondents aged 80 and older were more likely than those aged younger than 80 to use benzodiazepines. More men (78%) than women (67%) reported use, but we found no significant difference in a comparison of gender status and pattern of drug use.

IMPLICATIONS

Although other studies of drug use show that patterns of use differ significantly among older men and women, this research indicates that gender status does not appear to influence the pattern of, and reasons for, benzodiazepine use. Additional studies are needed in order for researchers to further understand the nature and extent of benzodiazepine use. Such information should be applied to the development of policies and services that will address the quality-of-life needs of individuals who use or misuse this drug and others like it.

The Best of Both Worlds

The relations among language acculturation, biculturality, and psychological adjustment were studied in a sample of 54 young mainland Puerto Rican mothers. Participants were interviewed in the language of their choice concerning their level of symptomatology (i.e., depression, anxiety, somatization, hostility, interpersonal sensitivity), language acculturation, monocultural involvement (assessed by separate adherence to American and Puerto Rican cultural values), and dual cultural involvement (assessed by a combination of cultural values). Results indicated that biculturality significantly predicted adjustment above and beyond monocultural involvement. In addition, although biculturality and bilingualism were both significantly related to psychological adjustment, linguistic balance showed a stronger association with adjustment than biculturality. Findings are discussed in light of the family, cultural, and developmental context in which young mainland Puerto Rican mothers are embedded.

Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context

This chapter provides an overview of the concept of acculturation and reviews existing evidence about the possible relationships between acculturation and selected health and behavioral outcomes among Latinos. The effect of acculturation on Latino health is complex and not well understood. In certain areas-substance abuse, dietary practices, and birth outcomes-there is evidence that acculturation has a negative effect and that it is associated with worse health outcomes, behaviors, or perceptions. In others-health care use and self-perceptions of health-the effect is mostly in the positive direction. Although the literature, to date, on acculturation lacks some breadth and methodological rigor, the public health significance of findings in areas in which there is enough evidence justifies public health action. We conclude with a set of general recommendations in two areas-public health practice and research-targeted to public health personnel in academia, community-based settings, and government agencies.