Re-examining whether and why acculturation relates to drinking outcomes in a rigorous, national survey of Latinos

Protective effects of ethnic enclaves: Testing pathways to alcohol use and use disorders in Mexican American young adults

Ethnic enclave residence is associated with decreased risk for drinking and related problems, but less is known about the mechanisms that explain this association. Informed by theories of social control, we used a multilevel framework to examine whether negative attitudes toward drinking mediated associations between ethnic enclave residence (i.e., neighborhood linguistic isolation) and alcohol outcomes among Mexican American young adults (N = 628) in Southern California. Model 1 assessed mediation effects in the pathways from linguistic isolation to current drinking and alcohol use disorder (AUD). Model 2 adjusted for parental drinking attitudes and neighborhood alcohol availability. There were differential associations by gender in direct effects of linguistic isolation and negative drinking attitudes on both drinking and AUD. Among women only, linguistic isolation was related to greater abstinence and decreased AUD after accounting for social control proxies of parent attitudes and alcohol availability. Young adults' own drinking attitudes did not mediate relationships between linguistic isolation and alcohol outcomes. This study offers evidence on the importance of disaggregating Hispanic national groups by gender to uncover social mechanisms within ethnic enclave settings for tailored supports in reducing risk of drinking and alcohol-related harms.

The relationship between discrimination, alcohol use severity, and PTSD symptoms among Latinx heavy drinkers

INTRODUCTION

Discrimination is linked to alcohol use severity among Latinx adults, who also show high prevalence rates of PTSD compared to non-Latinx adults. We know little about whether PTSD symptoms affects the relationship between discrimination and alcohol use severity. We hypothesized that the association between discrimination and alcohol use severity might differ by level of PTSD symptom severity.

METHODS

This is a secondary cross-sectional analysis of data collected at baseline from a completed randomized clinical trial testing the relative efficacy of a culturally adapted motivational interview designed to address discrimination and drinking behavior against an unadapted motivational interview for Latinx adults. Eligible participants screened positive for the NIAAA Single Alcohol Screening Question for heavy drinking days, identified as Latinx, and were 18-65 years old. We assessed the Everyday Discrimination Scale, Primary Care PC-PTSD screener, Alcohol Use Disorder Identification Test, and the Short Acculturation Scale for Hispanics. The study analyzed the main and interactive effects of discrimination and PTSD symptoms on alcohol use severity, while controlling for age, sex, household income, and acculturation.

RESULTS

After controlling for covariates in model 2, the interaction of discrimination and PTSD symptoms was significantly related to alcohol use severity. Simple slopes analysis indicated that discrimination was positively related to alcohol use severity among those with high (1 SD above the mean) but not low (1 SD below the mean) levels of PTSD symptoms.

CONCLUSIONS

Evidence suggests that the experiences of discrimination were associated with alcohol use severity among those who reported more PTSD symptoms. Specifically, discrimination may have a stronger effect on alcohol use severity among Latinx adults who report more PTSD symptoms. Screening Latinx adults for heavy drinking days, discrimination, and PTSD symptoms is clinically important. Culturally adapted alcohol interventions that target discrimination may be particularly effective for Latinx individuals with more PTSD symptoms.

Lifetime use of alcohol and cannabis among U.S. adolescents across age: Exploring differential patterns by sex and race/ethnicity using the 2019 NSDUH data

Background

Early use of alcohol and cannabis is associated with health and social problems. It is unclear how lifetime use changes for each additional year of age during adolescence, and whether this change varies by sex and race/ethnicity. This study characterized lifetime rates of alcohol and cannabis use by age among 12- to 17-year-old American youth and explored differential patterns by sex and race/ethnicity.

Methods

Data were obtained from the 2019 National Survey on Drug Use and Health. Analyses were restricted to 12-17-year-olds who were non-Hispanic White, non-Hispanic Black, or Hispanic/Latino (n = 11,830). We estimated the increase in lifetime use of alcohol and cannabis by age for the full sample and stratified by sex and race/ethnicity. Slopes of the regression lines were compared to assess differential patterns across groups.

Results

In these cross-sectional analyses, reported lifetime use increased substantially from age 12 to 17 for alcohol (6.4 % to 53.2 %) and cannabis (1.3 % to 35.9 %). The increase in lifetime alcohol use was slightly, but not significantly, steeper among girls than boys (F1,8 = 3.40, p = 0.09). White and Latino youth showed similar rates of increase in lifetime alcohol use, which was significantly flatter among Black youth (F2,12=21.26, p<0.0001). Latino youth had a slightly, but not significantly, steeper increase in lifetime cannabis use than White and Black youth (F2,12=3.17, p = 0.07).

Conclusions

Reports of lifetime alcohol and cannabis use substantially increase from age 12 to 17 and the rates are different according to sex and race/ethnicity, highlighting the need for early and tailored substance use prevention in adolescents.

A characterization of pre- to post-immigration alcohol use among recent Latino immigrants to the United States before and during the COVID-19 pandemic

BACKGROUND

Although Latino immigrants to the United States tend to display a gradual increase in alcohol use after immigration, such escalation may not generalize to all Latino/a groups. This study examines patterns of alcohol use shown by recent Latino immigrants (RLIs) to Miami/Dade County (MDC), Florida covering a period from pre-immigration to the first two years after immigration. Differences in alcohol use prior to and during the COVID-19 pandemic were also assessed.

METHODS

Data came from an on-going longitudinal study of 540 young adult (50% female) RLIs. Inclusion criteria were age 18 to 34, residing in MDC and having immigrated from a Latin American country within the past year. Respondent-driven sampling was the primary recruitment strategy.

RESULTS

Recent Latino immigrants reported a decline in alcohol use from before immigration (18.3 drinks per month, d/m) to the first (13.9 d/m), and second years (10.4 d/m before and 12.9 d/m during the pandemic lockdown) in MDC. The decline, which was moderated by RLIs' sex and legal residency status, was halted by the pandemic lockdown. While "to celebrate" was the most often cited reason for drinking, "to forget" was often cited during the lockdown.

CONCLUSIONS

The noted decrease in alcohol use since immigration may reflect the unique array of support and resources available to RLIs in MDC. Nevertheless, some RLIs increased their alcohol use over time, particularly during the COVID-19 pandemic. This disparate impact of the pandemic on alcohol use calls attention to the need to identify the most vulnerable RLIs to MDC and develop targeted interventions for them.

Triangulation of evidence on immigration and rates of alcohol use disorder in Sweden: Evidence of acculturation effects

BACKGROUND

This study aimed to determine the robustness of the impact of immigration on risk for alcohol use disorder (AUD) using different measures, designs, and immigrant regional cohorts.

METHODS

The analytic sample included all individuals born between 1950 and 1990 and registered in Sweden from 1973 to 2017. Using Cox regression models, we examined the risk for AUD from Swedish nationwide registries in immigrants to Sweden from seven geographical regions: Africa, Asia and Oceania, Eastern Europe, Finland, Latin America and the Caribbean, Middle East/North Africa, and Western countries. We assessed greater exposure to Swedish culture, which we interpreted as increasing acculturation, by (i) comparing first-generation immigrants and their children with no and one native Swedish parent and (ii) examining age at immigration. The baseline comparison group was the native Swedish population. We also examined AUD risk in first-generation sibling pairs discordant for their age at immigration.

RESULTS

In nearly all immigrant cohorts in Sweden, increasing degrees of acculturation, as assessed by both our variables, were associated with rates of AUD that approached those of the Swedish population. These findings occurred in both men and women and both regional cohorts whose first-generation immigrants had lower and higher levels of AUD than native-born Swedes. For most cohorts, the rates of change with acculturation were greater in women than in men. In sibling pairs from most regions, the sibling who was younger at immigration had a higher rate of AUD.

CONCLUSIONS

An examination of both sexes and two different proxies for acculturation provides consistent support for socio-cultural influences on AUD risk. Our co-sibling analyses suggest that a meaningful proportion of this effect is likely to be causal in nature.

Associations of Acculturation and Gender with Obesity and Physical Activity among Latinos

Objective: Latinos disproportionately experience overweight/obesity (OWOB) and insufficient physical activity (PA), which are risk factors for numerous health conditions. Whereas numerous studies investigate acculturation as a determinant of OWOB and PA, few have examined acculturation multidimensionally, and none has examined its interaction with gender. Methods: Participants were 140 Latino adults. Primary outcomes were status as OWOB and endorsement of insufficient PA. Acculturation was measured with the Multidimensional Acculturation Scale II. Logistic regression analyses were used to examine the moderating effect of gender on the relationship between each acculturation scale and outcome, controlling for education, nativity, and smoking status. Results: Greater Spanish proficiency was significantly associated with lower odds of insufficient PA. Greater American Cultural Identity was significantly associated with higher odds of OWOB. Women had significantly higher odds of endorsing insufficient PA compared to men. Gender did not moderate the relationship between acculturation and either OWOB or PA. Conclusions: Acculturation is similarly associated with OWOB and insufficient PA for Latino men and women. Cultural identity may need to be considered to target OWOB interventions. Acculturation may be less important, and gender more important, to consider for appropriate targeting of PA interventions.

Acculturation and drinking behavior among Latinxs: a narrative review

Research suggests that acculturation is associated with increased alcohol consumption among Latinxs. The purpose of this narrative review is to contribute to this literature by examining the association between acculturation and alcohol use within current theoretical and etiological frameworks on cultural norms, acculturative stress, and acculturative gaps. This review also compares the utility of these explanatory frameworks for guiding future research. Two databases (PubMed and PsycInfo) were used to identify peer-reviewed studies pertaining to the associations between acculturation and alcohol use among Latinxs. Studies that examined drinking norms, acculturative stress, acculturation gaps, and drinking behavior in Latinxs were included. The types of study approaches and designs included quantitative, qualitative, cross-sectional, cohort, and longitudinal studies published between January 2000 and December 2021. Quality assessment and data synthesis were conducted by two reviewers. A total of 65 articles reporting empirical studies were included in the final review. Eighteen studies did not utilize a specific framework, but generally supported that acculturation is associated with increased alcohol consumption and alcohol related consequences among Latinxs. Additionally, sixteen studies examined cultural norms, twenty-two examined acculturative stress, while only nine utilized a gap discrepancy framework. Studies examining drinking norms appeared to largely explain changes in drinking behavior among Latinas, while studies examining acculturative stress seemed to be better equipped to explain changes in drinking behavior among Latino men. Meanwhile, the Gap Discrepancy Model articulates the gap between old and new cultural influences and can be conceptualized as an additional dimension of acculturative stress.

Alcohol abstinence and binge drinking: the intersections of language and gender among Hispanic adults in a national sample, 2002-2018

PURPOSE

Prior research examining alcohol use using national data has often overlooked vital heterogeneity among Hispanics, especially that related to language dominance and gender. We examine the prevalence of alcohol abstinence and-given prior research suggesting that many Spanish dominant Hispanics do not drink-examine rates of binge drinking among past-year alcohol users with a focus on the intersections of language and gender among Hispanics, while drawing comparisons with non-Hispanic (NH) White and NH Black adults.

METHODS

Drawing from the National Survey on Drug Use and Health-a nationally representative survey between 2002 and 2018-we examine the year-by-year prevalence of alcohol abstinence and binge drinking among adults ages 18 and older in the United States.

RESULTS

A disproportionate number of Spanish-dominant Hispanics abstain from alcohol use (54%), with particularly high levels of alcohol abstinence observed among Spanish dominant women (men: 39%, women: 67%). The prevalence of alcohol abstinence among English-dominant Hispanic men (24%) and women (32%) is far lower, approximating that of NH Whites (men: 23%, women: 32%). Importantly, however, among Spanish-dominant drinkers, the prevalence of binge drinking (men: 52%, women: 33%) is comparable to or greater than NH Whites (men: 42%, women: 32%). Binge drinking levels among English-dominant Hispanic men (50%) and women (37%) are greater than among their NH White counterparts.

CONCLUSION

Findings paint a complex picture; consistent with prior research, we see that many Hispanics abstain from alcohol, but we also see new evidence underscoring that-among Hispanic drinkers-the prevalence of binge drinking is disconcertingly elevated.

Structural racism and reflections from Latinx heavy drinkers: Impact on mental health and alcohol use

BACKGROUND

Discrimination and social inequity increase risk for alcohol use disorders among Latinxs. An alcohol intervention trial that led to significant reductions in alcohol-related consequences also produced significant reductions in mental health symptoms for Latinx heavy drinkers. In the current qualitative study, we explore this trial's mental health effect by examining participants' perspectives on the social context of immigration, i.e., structural barriers, and associations among the immigrant experience, stigma, depressive/anxiety symptomatology, and alcohol consumption.

METHODS

Study participants were eligible if they completed the clinical trial, exhibited levels of depressive and anxiety symptoms that exceeded the range for clinical depression (≥18, CES-D) and anxiety (≥12, BAI) at baseline, and demonstrated significant declines in depression and anxiety symptoms 12 months following their completion of the trial. The study coded 24 participant transcripts using ATLAS.ti and thematic analysis.

RESULTS

Participants reported their responses to structural barriers (e.g., a lack of educational supports, difficulties accessing safety net programs). Reported experiences of exclusion and discrimination were associated with depressive and anxiety symptoms. Stigmatization processes included feeling isolated and contributed to poor mental health. Participants reported drinking to cope with low mood.

CONCLUSIONS

Structural barriers are exclusionary because they limit full participation and communicate who does/does not belong along race/ethnic lines, i.e., structural racism. Feeling stigmatized for being different was associated with feelings of anxiety and depression among our immigrant participants. Future interventions must focus on stressors associated with the constraints of being an immigrant. Understanding how structural barriers and structural racism impact health behavior can enrich the design and impact of interventions for socially disadvantaged Latinx individuals.

Alcohol-Related Disparities Among Women: Evidence and Potential Explanations

Although research on alcohol-related disparities among women is a highly understudied area, evidence shows that racial/ethnic minority women, sexual minority women, and women of low socioeconomic status (based on education, income, or residence in disadvantaged neighborhoods) are more likely to experience alcohol-related problems. These problems include alcohol use disorder, particularly after young adulthood, and certain alcohol-related health, morbidity, and mortality outcomes. In some cases, disparities may reflect differences in alcohol consumption, but in other cases such disparities appear to occur despite similar and possibly lower levels of consumption among the affected groups. To understand alcohol-related disparities among women, several factors should be considered. These include age; the duration of heavy drinking over the life course; the widening disparity in cumulative socioeconomic disadvantage and health in middle adulthood; social status; sociocultural context; genetic factors that affect alcohol metabolism; and access to and quality of alcohol treatment services and health care. To inform the development of interventions that might mitigate disparities among women, research is needed to identify the factors and mechanisms that contribute most to a group's elevated risk for a given alcohol-related problem.

At risk alcohol consumption with smoking by national background: Results from the Hispanic community health study/study of Latinos

INTRODUCTION

Tobacco smoking and binge or excess drinking are unhealthy behaviors that frequently co-occur. Studies of Hispanics/Latinos have mostly been of Mexican Americans although there are substantial differences in smoking and drinking by heritage background. Associated with co-use by 5 subpopulations.

METHODS

Cross-sectional data of 16,412 Hispanics/Latinos from Miami, the Bronx, Chicago and San Diego collected between 2008 and 2011 as part of the HCHS/SOL were analyzed. Smoking and alcohol consumption and demographic data were measured by self-report. Prevalence of smoking and alcohol consumption and co-use were reported. Logistic regression models examined the odds of co-use of smoking and binge or excess alcohol use by Hispanic/Latino background group.

RESULTS

Men of Cuban (10.3%), Puerto Rican (8.9%), and Mexican (8.9%) background had the highest prevalence of co-use of smoking and binge drinking compared to men of Central American (6.1%) and Dominican (6.6%) background. Women of Dominican (16.4%) and Puerto Rican (19.7%) background had the highest prevalence of binge drinking compared to women of Central American (10%) and Cuban (8%) background and Puerto Rican (34.1%) and Cuban (21.8%) women were the most likely to report current smoking compared to women of Central American (8.3%) and Mexican (10.4%) background. Acculturation was not associated with co-use among men and women. Elevated depressive symptoms were positively associated with smoking and binge drinking among men, OR = 1.5 [1.2-2.0], and women, OR = 1.5 [1.1-2.2]. Puerto Rican women had increased odds of co-use of smoking and binge or excess drinking compared to Mexican American women, OR = 3.2 [1.5-6.6].

CONCLUSIONS

Puerto Rican and Dominican Latinas and Central American and South American men have a higher prevalence of co-use.

Acculturation profiles and alcohol use among Hispanic Americans

Hazardous alcohol use among Hispanics makes for a critical public health issue that warrants empirical examination. Whereas research shows positive associations between alcohol-related outcomes and acculturation, it is unclear how enculturation and acculturation x enculturation are linked to alcohol use. Hispanic American undergraduate and graduate students (N = 348, 61.8% women, M_age = 21.82, 83.3% undergraduates) completed questionnaires assessing their levels of acculturation, enculturation, and alcohol use. Enculturation was negatively associated with social drinking-related consequences. Acculturation was positively associated with alcohol consumption, and enculturation buffered this association. Findings highlight the utility of considering acculturation profiles in understanding Hispanic alcohol use.

The Role of Acculturation and Alcohol Problems on Frequency of Cannabis Use Among Latinas at Risk of an Alcohol-Exposed Pregnancy

Background: Along with alcohol, cannabis is one of the most commonly used substances among women of childbearing age. Recent studies indicate detrimental effects of prenatal cannabis use. Because many women use these substances before realizing they are pregnant, these serious health consequences for women and their offspring are of great concern. Despite the recent upsurge in cannabis use, little is known about individual and sociocultural factors that may contribute to risk of a cannabis-exposed pregnancy, particularly among Latinas of child-bearing age also at risk of an alcohol-exposed pregnancy (AEP). Objectives: Examine the relationships of acculturation, alcohol use, alcohol problems, and psychological distress with frequency of cannabis use among adult Latinas at risk of an AEP. Methods: The hypothesized model included 76 Latinas and was analyzed using path analysis. The study used baseline data from a randomized controlled trial of an intervention targeting risky drinking and tobacco use among women at risk of an AEP in primary care clinics. Results: Greater acculturation was associated with more frequent cannabis use and greater psychological distress. There was a positive indirect relationship between acculturation and alcohol use and alcohol problems through psychological distress. Greater alcohol problems were associated with more frequent cannabis use. Greater psychological distress and alcohol use were indirectly related to more frequent cannabis use through alcohol problems. Conclusions: Findings underscore the critical role of acculturation and alcohol-related problems in cannabis use frequency and have relevant implications for preventive efforts addressing cannabis use among Latinas at risk of an AEP.

Understanding Social and Cultural Contexts of Alcohol Misuse in Mexican-Origin Hispanic Men

Evidence suggests that Hispanic and non-Hispanic White men (NHW) have comparable prevalence rates of alcohol use. However, Hispanic men consistently have higher prevalence rates of alcohol misuse compared with NHW men. Consequently, Hispanic men experience disproportionate levels of adverse health consequences of alcohol misuse when compared with NHW men. The aim of this study was to explore Hispanic male perspectives and opinions regarding alcohol use patterns that may lead to disparate rates of alcohol misuse in Hispanic males. Demographic data were collected with questionnaires. Twenty semistructured one-on-one interviews were completed in English and Spanish with Mexican-origin Hispanic men (age: 44.6 ± 11.3 years). A thematic analysis was conducted using a hybrid deductive-inductive strategy with an a priori codebook supplemented with iterative analysis of transcripts. Results suggest that alcohol misuse patterns in Hispanic males are influenced by an interaction between alcohol-related social norms and learned expressions of masculinity; a lack of knowledge of the alcohol-related health risks that further perpetuate the normalization of alcohol misuse; and expressions of masculinity and adaptive coping that lead to alcohol misuse as an escape from life stressors. Given the rapid expansion of the Hispanic population in the United States, and the disparate consequences of alcohol misuse in this population, it is imperative to consider the complex and often compounded impact of sociocultural norms and the social context on misuse-related behaviors. Viable prevention and treatment strategies should be addressed thought multicomponent, community-level strategies that more comprehensively address the complexities of alcohol misuse in this population.

Gender differences in drinking behavior among Latino/a heavy drinkers

BACKGROUND

In the United States (U.S.), higher levels of acculturation have been associated with higher rates of heavy alcohol use more consistently among Latino women than among Latino men. This paper explores mechanisms underlying the link between acculturation and alcohol use among Latino/as in the U.S. We examine alcohol use expectancies and motives from the perspectives of the social cognitive theory of gender development.

METHODS

Qualitative narratives data from six focus groups of individuals (total n = 37), who met criteria for heavy drinking (4/5 drinks/occasion for females/males), were examined separately by gender (18 females; 19 males). Coded narratives data were analyzed using a framework that compared lives in Latin America and in the U.S. Emergent themes were analyzed for their consistency across genders. Gender-specific themes were identified.

RESULTS

Changes in family structure and the loss of social networks prompted divergent patterns of drinking among men and women, such that relative to patterns in their countries of origin, drinking among Latino women increased while it decreased among Latino men. Men and women reported drinking to replace missing social bonds, a motive not frequently reported in the literature on drinking motives. Women who engaged in heavy-drinking nonetheless described traditional gender role expectations after U.S. arrival. Only men endorsed positive alcohol expectancies in Latin America. Women reported drinking to alleviate psychological distress in the U.S.

CONCLUSIONS

Pre and post-immigration comparisons revealed different drinking trajectories among men and women after immigration to the U.S. These patterns appeared to be influenced by new social contexts and changes in familial expectations regarding women's roles. Future inquiry that examines gender-specific themes in alcohol expectancies and motives unique to the experience of immigration, is warranted.

A Critical Review and Meta-Analysis of the Associations Between Acculturation and Alcohol Use Outcomes Among Hispanic Americans

Acculturation has been studied as one key sociocultural determinant that helps explain ethnic disparities in alcohol use outcomes among Hispanic Americans. Primary studies and other systematic reviews have found between-study inconsistencies regarding the extent to which acculturation is associated with alcohol use outcomes among Hispanic Americans. To better examine whether acculturation is distinctly linked to drinker status, drinking frequency, volume, intensity, binge drinking, and hazardous alcohol use/drinking problems, and to identify individual and methodological factors that moderate these associations, we conducted a comprehensive research synthesis. A systematic review was conducted on research pertaining to the associations between acculturation and alcohol use among Hispanics. We included 88 independent study samples (N = 68,282) coded from 68 manuscripts published in 1987 to 2017. Standard and robust variance estimation (RVE) meta-analyses were conducted to calculate the correlations between acculturation and overall alcohol use. We also conducted a series of analyses to examine the weighted mean correlations between acculturation and 6 specific drinking outcomes. We found a statistically significant correlation between acculturation and overall alcohol use (r = 0.09, p < 0.001). Acculturation was associated with drinker status (r = 0.10, p < 0.001), drinking intensity (r = 0.09, p = 0.001), binge drinking (r = 0.05, p = 0.006), and hazardous alcohol use/drinking problems (r = 0.06, p = 0.006), but not drinking frequency (r = 0.02, p = 0.56) or volume (r = 0.01, p = 0.73). Gender, acculturation dimension, acculturation domain, age group, and sampling settings were found to explain between-study variability in some of these associations. Findings show small relations between acculturation and various alcohol use outcomes, but the effects are relatively more robust among Hispanic women, adults, and when studies measured U.S. cultural orientation, linguistic acculturation, and behavioral practices.

Age at Immigration and Substance Use and Problems Among Males and Females at the U.S.-Mexico Border

OBJECTIVE

Although substance use and problems among Mexican Americans are associated with both immigration to the United States and living at the U.S.-Mexico border, little is known about relationships between age at immigration and substance use by gender within the border context. The purpose of this study was to analyze the association of age at immigration with heavy alcohol use, alcohol use disorders (AUD), and drug use among Mexicans Americans living both on and off the U.S.-Mexico border.

METHOD

Household surveys were conducted, using area probability sampling of 2,336 Mexican Americans (1,185 female), ages 18-65, living at the Texas-Mexico border in the metropolitan areas of Laredo and McAllen/Brownsville, and in the nonborder location of San Antonio.

RESULTS

Females immigrating before age 12 were less likely to report heavy alcohol use (odds ratio [OR] = 0.309), and those immigrating before age 21 were less likely to report any drug use during the last year compared with their U.S.-born counterparts (OR = 0.473; OR = 0.386, respectively). Males immigrating after age 20 were less likely to report heavy alcohol use (OR = 0.478), and those immigrating between ages 12 and 20 were less likely to report AUD (OR = 0.479) and drug use (OR = 0.255) compared with their U.S.-born counterparts. Early age at immigration (before age 12) was significantly associated with drug use for males living on the border compared with those living off the border.

CONCLUSIONS

Findings suggest that among females, immigrating before age 12 (vs. being born in the United States) is protective against heavy alcohol and drug use, but among males, immigrating before age 12 results in similarly heavy patterns of use as their U.S.-born counterparts, partially supporting previous findings that early immigration is particularly risky in relation to substance use and AUD.

Affective decision-making moderates the effects of automatic associations on alcohol use among drug offenders

BACKGROUND

This study used a dual-process model of cognition in order to investigate the possible influence of automatic and deliberative processes on lifetime alcohol use in a sample of drug offenders.

OBJECTIVE

The objective was to determine if automatic/implicit associations in memory can exert an influence over an individual's alcohol use and if decision-making ability could potentially modify the influence of these associations.

METHODS

168 participants completed a battery of cognitive tests measuring implicit alcohol associations in memory (verb generation) as well as their affective decision-making ability (Iowa Gambling Task). Structural equation modeling procedures were used to test the relationship between implicit associations, decision-making, and lifetime alcohol use.

RESULTS

Results revealed that among participants with lower levels of decision-making, implicit alcohol associations more strongly predicted higher lifetime alcohol use.

CONCLUSION

These findings provide further support for the interaction between a specific decision function and its influence over automatic processes in regulating alcohol use behavior in a risky population. Understanding the interaction between automatic associations and decision processes may aid in developing more effective intervention components.

Alcohol use/abuse and help-seeking among U.S. adults: The role of racial-ethnic origin and foreign-born status

We used data from Wave 1 and Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions to examine racial-ethnic and nativity-based variations in alcohol use/abuse and treatment seeking while accounting for acculturation, stress, and social integration factors. The dependent variables included alcohol use, risky drinking, DSM-IV alcohol use disorder, and treatment seeking in the past 12 months. Racial-ethnic categories included African, European, Asian/Pacific Islander, Mexican, Puerto Rican, and other Hispanic/Latino. Acculturation, social stress, and social integration were assessed with previously validated, detailed measures. Bivariate probit models with sample selection were estimated for women and men. Immigrant status and origin associations with alcohol use/abuse and treatment seeking were strong and largely unaffected by other social factors. Europeans and men of Mexican origin had the highest while women of African, Asian/Pacific Islander, and Puerto Rican origins had the lowest rates of alcohol use/abuse. Years in the United States was associated with a higher risk of alcohol use/abuse for all immigrant groups. Foreign-born individuals were no less likely than U.S. natives to seek treatment if they were abusing or were dependent on alcohol. Further modeling of these relationships among specific immigrant groups is warranted. These findings inform alcohol rehabilitation and mental health services for racial-ethnic minorities and immigrants.

A Quantitative Analysis of Latino Acculturation and Alcohol Use: Myth Versus Reality

Research on health among Latinos often focuses on acculturation processes and the associated stressors that influence drinking behavior. Given the common use of acculturation measures and the state of the knowledge on alcohol-related health among Latino populations, the current analyses tested the efficacy of acculturation measures to predict various indicators of alcohol consumption. Specifically, this quantitative review assessed the predictive utility of acculturation on alcohol consumption behaviors (frequency, volume, and quantity). Two main analyses were conducted-a p-curve analysis and a meta-analysis of the observed associations between acculturation and drinking behavior. Results demonstrated that current measures of acculturation are a statistically significant predictor of alcohol use (Z = -20.75, p < 0.0001). The meta-analysis included a cumulative sample size of 29,589 Latino participants across 31 studies. A random-effects model yielded a weighted average correlation of 0.16 (95% confidence interval = 0.12, 0.19). Additional subgroup analyses examined the effects of gender and using different scales to measure acculturation. Altogether, results demonstrated that acculturation is a useful predictor of alcohol use. In addition, the meta-analysis revealed that a small positive correlation exists between acculturation and alcohol use in Latinos with a between-study variance of only 1.5% (τ²  = 0.015). Our analyses reveal that the association between current measures of acculturation and alcohol use is relatively small.

Factors Associated With Drinking Behavior Among Immigrant Women in Taiwan

BACKGROUND

Transnational marriage-based immigrant women in Taiwan have moved to a country where alcohol use is prevalent and they face the challenge of adaptation into a new society, which could influence their drinking behavior.

OBJECTIVES

To describe the prevalence of alcohol drinking and examine factors associated with drinking patterns among immigrant women in Taiwan.

METHODS

This study was a cross-sectional questionnaire survey and data were collected from June through November in 2013. Convenience samples of 757 immigrant women were recruited across Taiwan. Alcohol use patterns during the past year were divided into abstinent, low-risk drinking, and hazardous drinking based on the Alcohol Use Disorder Identification Test. Measures included subject characteristics, exposure to cigarettes and alcohol, acculturation level, and perceived stress.

RESULTS

The prevalence of drinking during the past year among immigrant women was 29.9% (low-risk drinking 27.6% and hazardous drinking: 2.3%). Multinomial logistic regression showed that women who were employed, who smoked, whose husbands drank, and who interacted with Taiwanese friends frequently were significantly more likely to be in the low-risk drinking group compared with the abstinent group. Women who were divorced/widowed, who had low education levels, who smoked, and whose husbands drank were significantly more likely to be in the hazardous drinking group compared with the abstinent group.

CONCLUSIONS

More acculturation in immigrant women as indicated by working and frequently interacting with friends in mainstream society was related to low-risk drinking behavior; adversities as indicated by loss of marriage and low education level were related to hazardous drinking behavior.

Interrelationship between family history of alcoholism and generational status in the prediction of alcohol dependence in US Hispanics

BACKGROUND

Both a family history of alcoholism and migration-related factors like US v. foreign nativity increase the risk for developing alcohol use disorders in Hispanic Americans. For this study, we integrated these two lines of research to test whether the relationship between familial alcoholism and alcohol dependence changes with successive generations in the United States.

METHOD

Data were from the waves 1 and 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Subjects self-identified Hispanic ethnicity (N = 4122; n = 1784 first, n = 1169 second, and n = 1169 third or later generation) and reported ever consuming ⩾12 drinks in a 1-year period. A family history of alcoholism was assessed in first- and second-degree relatives. Analyses predicting the number of alcohol dependence symptoms were path models.

RESULTS

Alcohol dependence symptoms were associated with a stronger family history of alcoholism and later generational status. There was a significant interaction effect between familial alcoholism and generational status; the relationship of familial alcoholism with alcohol dependence symptoms increased significantly with successive generations in the United States, more strongly in women than men. Acculturation partially mediated the interaction effect between familial alcoholism and generational status on alcohol dependence, although not in the expected direction.

CONCLUSIONS

Familial alcoholism interacted with generational status in predicting alcohol dependence symptoms in US Hispanic drinkers. This relationship suggests that heritability for alcoholism is influenced by a higher-order environmental factor, likely characterized by a relaxing of social restrictions on drinking.

Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups

Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder (AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed.

Drinking, Drug Use, and Related Consequences Among University Students Completing Study Abroad Experiences: A Systematic Review

BACKGROUND

University students who complete study abroad experiences are potentially exposed to behaviors, in particular alcohol and drug use, that place their health at risk. There is a need to identify risk and protective factors and highlight knowledge gaps.

METHODS

A systematic review adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Relevant bibliographic databases and online repositories were systematically searched for both qualitative and quantitative peer-reviewed studies.

RESULTS

Eighteen articles were eligible for inclusion. Degree mobility students (DMSs-students pursuing a full bachelor or master degree in a foreign country) and Credit Mobility Students (CMSs-students participating in short term or semester study abroad programmes) show different patterns of at-risk behaviors compared to pre-departure, and to domestic or non-study abroad students. DMSs mostly consumed less alcohol and illicit substances compared to domestic students, but little information on pre-travel behavior and predictors of at-risk behaviors while abroad was available on DMSs. Most studies indicated that CMSs increased their alcohol use while abroad and reduced it when they returned home. However, there is no evidence of an increase in the negative consequences associated with alcohol misuse while abroad. Different pre-departure and abroad factors (e.g., perceptions of peer drinking norms, psychological and sociocultural adjustment abroad) were related to at-risk behaviors in the host country.

CONCLUSIONS

University students who study abroad are understudied and potentially at risk from alcohol and drug use. Knowledge gaps are discussed in relation to possible future qualitative, mixed methods and longitudinal research.

Hispanic immigrants in the USA: social and mental health perspectives

Hispanic immigration in the USA and its effect on many areas of US society are of great relevance to health care, public health, mental health, and medical and social sciences. In this report, we review and discuss pertinent literature on causes, procedures, and eventual outcomes of Hispanic migration waves throughout the last four decades. Hispanic immigrants do not constitute a monolithic group, despite the clear predominance of Mexican and Mexican-American segments. Common features of Hispanic immigrants include a younger average age, higher presence of married households, and lower educational levels than the overall US population. Differences within the Hispanic immigrant population are present in naturalisation figures, English language fluency, occupational and income status, health insurance coverage, and sense of accomplishment in the host society. We examine most of these aspects in the context of the so-called Hispanic paradox, presented as both a cause and a result of a heavily discussed acculturative process. We investigate prevalence and other data on depression, anxiety, substance abuse, and psychotic syndromes, with emphasis on the need to do further neurobiological, epigenetic, and sociocultural research in the Hispanic population.

Analysis of Acculturation, Sex, and Heavy Alcohol use in Latino College Students

24% of 917 students at California State University Long Beach who completed an alcohol use survey in 2002 (73% response) identified themselves as Latino. Because measures of acculturation reported in most adult studies positively correlated with alcohol use and sex, it was hypothesized that these associations might also apply to Latino college students. With increasing levels of acculturation, women but not men in this Latino college sample reported significantly greater occurrence of heavy drinking, positive attitudes about drinking, and perception that most of their friends use alcoholic beverages.

Alcohol Use Disorders in National Samples of Mexicans and Mexican-Americans

The authors show associations between immigration and alcohol disorders using data from the 1995 and 2000 U.S. National Alcohol Surveys and the 1998 Mexico National Household Survey on Addictions. The prevalence of alcohol dependence was 4.8% for the Mexicans, 4.2% for the Mexico-born immigrants, and 6.6% for the U.S.-born Mexican Americans. They found a general lack of significance for the immigration variables with few consistent dose-response findings for alcohol use disorders. High acculturation was associated with higher risks for women; however, unexpectedly, high acculturation was associated with lower risks for males. Among Mexican Americans, the impact of immigration to the United States on the prevalence of alcohol use disorders differs by gender. Male and female differences and possible sources of immigrant selection are important issues for future research.

Poor, persecuted, young, and alone: Toward explaining the elevated risk of alcohol problems among Black and Latino men who drink

BACKGROUND

Even given equivalent drinking patterns, Black and Latino men experience substantially more dependence symptoms and other consequences than White men, particularly at low/no heavy drinking. No known studies have identified factors driving these disparities. The current study examines this question.

METHODS

The 2005 and 2010 National Alcohol Surveys were pooled. Surveys are nationally representative, telephone interviews of the U.S. including Black and Latino oversamples; male drinkers were analyzed (N=4182). Preliminary analyses included negative binomial regressions of dependence symptom and consequence counts testing whether effects for race/ethnicity were diminished when entering potential explanatory factors individually. Additional analyses re-examined effects for race/ethnicity when using propensity score weighting to weight Blacks to Whites, and Latinos to Whites, first on heavy drinking alone, and then on heavy drinking and all explanatory factors supported by preliminary analyses.

RESULTS

Preliminary regressions suggested roles for lower individual SES, greater prejudice and unfair treatment, and younger age in the elevated risk of alcohol problems among Black and Latino (vs. White) men at low heavy drinking levels; additional support emerged for single (vs. married) status among Blacks and neighborhood disadvantage among Latinos. When Blacks and Latinos were weighted to Whites on the above variables, effects for race/ethnicity on dependence counts were reduced to nonsignificance, while racial/ethnic disparities in consequence counts were attenuated (by >43% overall).

CONCLUSIONS

Heavy drinking may be especially risky for those who are poor, exposed to prejudice and unfair treatment, young, and unmarried, and these factors may contribute to explaining racial/ethnic disparities in alcohol problems.

Epidemiology of substance abuse among Latinos

The importance of conducting substance abuse research among ethnic minorities is underscored by findings that members of many ethnic minorities in the United States report higher rates of heavy drinking and alcohol-related problems than do Whites and have increased rates of illicit drug use, abuse, and dependence. It is important to better understand ethnic-specific substance use from a public health perspective. Recent data suggest that the prevalence of past month alcohol use and heavy alcohol use among Hispanics is lower than and the prevalence of binge drinking and alcohol abuse or dependence is comparable to that of non-Hispanic Whites. These estimates vary among Hispanic subgroups and across gender and age groups. The prevalence of past month illicit drug use is also lower among Hispanics than that of several other groups, including non-Hispanic Whites. These trends are consistent among both men and women, although the prevalence for men is nearly twice that of women in nearly all subgroups. Conversely, the prevalence of illicit drug abuse or dependence among Hispanics is slightly higher than that of non-Hispanic Whites. This article describes national level epidemiological data on the prevalence of alcohol and illicit drug use, abuse, and dependence among Latinos/Hispanics in the United States in comparison to other race and ethnic groups. Previous findings in the literature will be reviewed and new analyses using the 2002 National Survey on Drug Use and Health will be presented. Given the heterogeneity of Hispanics in the United States, data for Hispanics will be broken down by national groups whenever possible.

Posttraumatic stress disorder and alcohol misuse among women: effects of ethnic minority stressors

PURPOSE

The aims of this study were to examine the relationship between adult-onset posttraumatic stress disorder (PTSD) and subsequent alcohol use outcomes (frequent heavy drinking, alcohol abuse, and alcohol dependence) in non-Hispanic white, non-Hispanic black, and Hispanic US women, and whether this relationship was moderated by ethnic minority stressors (discrimination and acculturation).

METHODS

The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions, employing time-dependent data to conduct multiple extended Cox regression.

RESULTS

Women with PTSD were over 50 % more likely than those without PTSD to develop alcohol dependence [adjusted hazards ratio (aHR) 1.55; 95 % confidence interval (CI) 1.15, 2.08]. Hispanic and black women were at lower risk of most alcohol outcomes than white women. In race-/ethnic-specific analyses, however, PTSD only predicted alcohol abuse among Hispanic women (aHR 3.02; CI 1.33, 6.84). Higher acculturation was positively associated with all alcohol outcomes among Hispanic women and discrimination was associated with AUD among Hispanic and black women. Acculturation and discrimination modified the effect of PTSD on AUD among Hispanic women: PTSD predicted alcohol dependence among those with low acculturation (aHR 10.2; CI 1.27, 81.80) and alcohol abuse among those without reported discrimination (aHR 6.39; CI 2.76, 16.49).

CONCLUSIONS

PTSD may influence the development of hazardous drinking, especially among Hispanic women. The influence of PTSD on alcohol outcomes is most apparent, however, when ethnic minority stressors are not present.

Acculturation, hazardous drinking and depressive symptomatology among Hispanics enrolled in a clinical trial

BACKGROUND

Among Hispanics in the U.S., lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrollment, all participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms.

METHODS

Participants (N = 100) completed measures at baseline.

RESULTS

Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (n=49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men.

DISCUSSION

Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.

Hispanic Subgroups, Acculturation, and Substance Abuse Treatment Outcomes

This study explored Hispanic subgroup differences in substance use treatment outcomes, and the relationship of acculturation characteristics to these outcomes. Data were from a multisite randomized clinical trial of motivational enhancement therapy versus treatment as usual in a sample of Spanish-speaking substance abusers. Participants were Cuban American (n=34), Mexican American (n=209), Puerto Rican (n=78), and other Hispanic American (n=54). Results suggested that Cuban Americans and individuals with more connection to Hispanic culture had lower treatment retention. Hispanics born in the U.S and those who spoke English at home had a lower percentage of days abstinent during weeks 5-16, although Puerto Ricans born in the U.S. and Cuban Americans living more years in the U.S. had a higher percentage of days abstinent in weeks 1-4 and 5-16, respectively. Results may inform future hypothesis-driven studies in larger Hispanic treatment seeking samples of the relationship between acculturation and treatment outcome.

A Comparison of Substance Use Behaviors of Hispanic Men by Sexual Orientation

BACKGROUND/SIGNIFICANCE

Substance use is a public health concern in the United States. Hispanic men in the United States experience disproportionate rates of substance use when compared to other ethnic groups. Previous research with the general population of Hispanic men has identified factors that are related and may contribute to substance use. In addition, Hispanic men who have sex with men (HMSM) may experience additional social factors that may result in substance use. Despite the body of research on substance use among Hispanic men, no study to date has compared the substance use behaviors of Hispanic men by sexual orientation.

OBJECTIVES

The purpose of this study was to compare the substance use behaviors of Hispanic men by sexual orientation.

METHODS

A cross-sectional descriptive design was used to collect data from 164 community-dwelling Hispanic men (i.e., 77 heterosexual men and 87 HMSM) who resided in the South Florida area. Participants completed standardized measures of substance use and demographic characteristics.

RESULTS

Findings suggested that heterosexual men had higher rates of substance use when compared to MSM. No differences were found among the two groups of men in terms of alcohol intoxication. Religion, education, and income were not predictors of substance use. When health insurance status was controlled, MSM were less likely to report substance use.

IMPLICATIONS

As a population, Hispanic men continue to experience health disparities in terms of substance use. Because substance use renders Hispanic men at risk for other health issues, more research is needed to understand the co-occurring health disparities experienced by Hispanic men who reside in the United States.

Working the Pony

We present a model of the drinking practices of Latina immigrants who work in bars or cantinas and are compensated for drinking 8 oz beer or ponies with customers, hence working the pony. A total of 358 women recruited from 61 randomly selected cantinas were interviewed as part of a community study conducted in a metropolitan area in the U.S. Southwest. Participants reported drinking an average of 21 beers on nights they worked for ponies. Multiple regression results indicate that drinking practices are related to sociodemographic, work history, drug use, and sexual risk characteristics. The drinking of cantineras is more than 4 times higher than the heavy episodic drinking of high risk Latino male drinkers and young male restaurant workers. The findings suggest that they may be at risk of multiple health problems and could benefit from alcohol risk-reduction interventions.

Pre- to postimmigration alcohol use trajectories among recent Latino immigrants

The escalation of alcohol use among some Latino immigrant groups as their time in the United States increases has been well documented. Yet, little is known about the alcohol use behaviors of Latino immigrants before immigration. This prospective longitudinal study examines pre- to postimmigration alcohol use trajectories among a cohort of recent Latino immigrants. Retrospective preimmigration data were collected at baseline from a sample of 455 Cuban, South American, and Central American Latinos ages 18-34 who immigrated to the United States less than 1 year prior. Two follow-up assessments (12 months apart) reported on their postimmigration alcohol use in the past 90 days. We hypothesized (a) overall declines in pre- to postimmigration alcohol among recent Latino immigrants and (b) gender/documentation specific effects, with higher rates of alcohol use among males and undocumented participants compared to their female and documented counterparts. Growth curve analyses revealed males had higher levels of preimmigration alcohol use with steeper declines in postimmigration alcohol use compared to females. Declines in alcohol use frequency were observed for documented, but not undocumented males. No changes in pre- to postimmigration alcohol use were found for documented or undocumented females. This study contributes to the limited knowledge of pre- to postimmigration alcohol use patterns among Latinos in the United States. Future research is needed to identify social determinants associated with the alcohol use trajectories of recent Latino immigrants, as it may inform prediction, prevention, and treatment of problem-drinking behaviors among the largest and fastest growing ethnic minority in the United States.

Acculturation stress and drinking problems among urban heavy drinking Latinos in the Northeast

This study investigates the relationship between the level of acculturation and acculturation stress and the extent to which each predicts problems related to drinking. Hispanics who met criteria for hazardous drinking completed measures of acculturation, acculturation stress, and drinking problems. Sequential multiple regression was used to determine whether the levels of self-reported acculturation stress predicted concurrent alcohol problems after controlling for the predictive value of the acculturation level. Acculturation stress accounted for a significant variance in drinking problems, while adjusting for acculturation, income, and education. Choosing to drink in response to acculturation stress should be an intervention target with Hispanic heavy drinkers.

Factors associated with alcohol consumption patterns in a Puerto Rican urban cohort

OBJECTIVE

There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts.

DESIGN

Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender.

SETTING

Greater Boston area, MA, USA.

SUBJECTS

Puerto Rican adults (n 1292), aged 45-75 years.

RESULTS

Eight per cent of men and 39% of women were lifetime abstainers; 40% of men and 25% of women were former drinkers; 31 % of men and 27% of women were moderate drinkers; and 21% of men and 8% of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers.

CONCLUSIONS

High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.

Who's at risk? Ethnic drinking cultures, foreign nativity, and problem drinking among Asian American young adults

OBJECTIVE

Despite the low overall prevalence of alcohol use among Asian Americans, rates of alcohol use disorder are high among Asian American young adults. The influence of ethnic drinking cultures on immigrants and their descendants has been overlooked in past research. We took an integrative approach to examine the influence of ethnic drinking culture, acculturation, and socioeconomic disparities on problem drinking among Asian American young adults.

METHOD

This study was a nationally representative sample of 854 Asian American young adults extracted from the Wave 4 National Longitudinal Study of Adolescent Health data. About 48% of the sample was female and 52% male. Several multiple logistic regression models were fitted.

RESULTS

Controlling for other covariates, two dimensions of ethnic drinking culture were associated with alcohol outcomes only for the foreign born: (a) detrimental drinking pattern with frequent drunkenness and alcohol-abuse symptoms and (b) drinking prevalence with alcohol-dependence symptoms. Financial hardship was a significant predictor of symptoms of alcohol abuse and dependence only for the U.S. born. Asian language use was protective against alcohol-abuse symptoms and alcohol-dependence symptoms for the foreign born.

CONCLUSIONS

Cultural and socioeconomic factors of problem drinking may be different for U.S.-and foreign-born Asian American young adults. Ethnic drinking cultures may significantly influence problem drinking of foreign-born Asian American young adults, independent of their acculturation into U.S. cultures. To inform effective interventions targeted at immigrants and their descendants, future research might further investigate the cultural and socioeconomic processes in immigrant communities that might significantly influence drinking.

The relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants

This study examines the relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants in the state of California. Data were obtained from the 2009 California Health Interview Survey and included Asian (n = 1264) and Hispanic (n = 571) adults aged 60 and older who were born outside of the US. Outcome variables included presence of past year alcohol consumption, past year binge drinking, and number of binge drinking days. Acculturation was measured with items pertaining to English use and proficiency. Hierarchical multiple or logistic regression analyses were conducted separately for each racial/ethnic group and each dependent variable. Alcohol consumption was found in less than half of the sample for both Asians (43.2%) and Hispanics (39.2%). Binge drinking was found in 3.1% of Asians and 8.4% of Hispanics. Acculturation was significantly related to past year alcohol consumption for Hispanics, past year binge drinking for Asians, and binge drinking days for Asians, such that higher level of acculturation predicted a greater likelihood of alcohol consumption but decreased likelihood of binge drinking and fewer binge drinking days. The results indicate that acculturation may be related to alcohol consumption patterns for older immigrants. This suggests future needs to develop an in-depth understanding of the health behaviors of these immigrant elderly groups.

Alcohol use disorders and perceived drinking norms: ethnic differences in Israeli adults

OBJECTIVE

Individuals' perceptions of drinking acceptability in their society (perceived injunctive drinking norms) are widely assumed to explain ethnic group differences in drinking and alcohol use disorders (AUDs), but this has never been formally tested. Immigrants to Israel from the former Soviet Union (FSU) are more likely to drink and report AUD symptoms than other Israelis. We tested perceived drinking norms as a mediator of differences between FSU immigrants and other Israelis in drinking and AUDs.

METHOD

Adult household residents (N = 1,349) selected from the Israeli population register were assessed with a structured interview measuring drinking, AUD symptoms, and perceived drinking norms. Regression analyses were used to produce odds ratios (OR) and risk ratios (RR) and 95% confidence intervals (CI) to test differences between FSU immigrants and other Israelis on binary and graded outcomes. Mediation of FSU effects by perceived drinking norms was tested with bootstrapping procedures.

RESULTS

FSU immigrants were more likely than other Israelis to be current drinkers (OR = 2.39, CI [1.61, 3.55]), have higher maximum number of drinks per day (RR = 1.88, CI [1.64, 2.16]), have any AUD (OR = 1.75, CI [1.16, 2.64]), score higher on a continuous measure of AUD (RR = 1.44, CI [1.12, 1.84]), and perceive more permissive drinking norms (p < .0001). For all four drinking variables, the FSU group effect was at least partially mediated by perceived drinking norms.

CONCLUSIONS

This is the first demonstration that drinking norms mediate ethnic differences in AUDs. This work contributes to understanding ethnic group differences in drinking and AUDs, potentially informing etiologic research and public policy aimed at reducing alcohol-related harm.

Acculturation stress, anxiety disorders, and alcohol dependence in a select population of young adult Mexican Americans

OBJECTIVES

Mexican Americans comprise one of the most rapidly growing populations in the U.S. and within this population the process of acculturation has been suggested to be associated with some mental health problems. This study sought to ascertain quantitative information indexing acculturation stress and its association with mental health disorders in a select community sample of Mexican Americans.

METHODS

Demographic information, DSM-III-R diagnoses, and information on cultural identity and acculturation stress were obtained from 240 Mexican American young adults that were recruited by fliers and were residing in selected areas of San Diego.

RESULTS

No associations were found between measures of cultural identification and lifetime diagnoses of drug or alcohol dependence, major depressive disorder, anxiety disorders or antisocial personality disorder/conduct disorder in this sample of Mexican American young adults. However, lifetime diagnoses of alcohol dependence, substance dependence, and anxiety disorders were associated with elevations in acculturation stress.

CONCLUSION

Quantitative measures of acculturation stress, but not cultural identity per se, were found to be significantly associated with substance dependence and anxiety disorders in this select population of Mexican American young adults. These data may be helpful in designing prevention and intervention programs for this high risk population.

Gender differences in the relationship between discrimination and substance use disorder among Latinos

Using data from the National Latino and Asian American Study collected in 2002-2003 (N = 2,554), we assessed the adjusted odds of lifetime substance use disorder (SUD) associated with report of both unfair treatment and racial/ethnic discrimination. Among men, SUD was increased for those reporting low, moderate, and high levels of unfair treatment compared to those reporting no unfair treatment and patterns were similar for racial/ethnic discrimination. Among women, only those reporting high levels of unfair treatment were at increased risk of lifetime SUD and no associations were observed between racial/ethnic discrimination and lifetime SUD. Future research should examine the role that discrimination plays in the development of substance misuse among Latinos.

Mexican immigration to the US and alcohol and drug use opportunities: does it make a difference in alcohol and/or drug use?

BACKGROUND

Mexican immigrants in the US do not have increased risk for alcohol use or alcohol use disorders when compared to Mexicans living in Mexico, but they are at higher risk for drug use and drug use disorders. It has been suggested that both availability and social norms are associated with these findings. We aimed to study whether the opportunity for alcohol and drug use, an indirect measure of substance availability, determines differences in first substance use among people of Mexican origin in both the US and Mexico, accounting for gender and age of immigration.

METHODS

Data come from nationally representative surveys in the United States (2001-2003) and Mexico (2001-2002) (combined n=3432). We used discrete time proportional hazards event history models to account for time-varying and time-invariant characteristics. The reference group was Mexicans living in Mexico without migration experience.

RESULTS

Female immigrants were at lower risk of having opportunities to use alcohol if they immigrated after the age of 13, but at higher risk if they immigrated prior to this age. Male immigrants showed no differences in opportunity to use alcohol or alcohol use after having the opportunity. Immigration was associated with having drugs opportunities for both sexes, with larger risk among females. Migration was also associated with greater risk of using drugs after having the opportunity, but only significantly for males.

CONCLUSIONS

The impacts of immigration on substance use opportunities are more important for drugs than alcohol. Public health messages and educational efforts should heed this distinction.

The Hispanic Americans Baseline Alcohol Survey (HABLAS): the association between acculturation, birthplace and alcohol consumption across Hispanic national groups

Acculturation to U.S. society has been associated with an increase in drinking and binge drinking among Hispanics. This paper examines the association between acculturation and three drinking-related outcomes: average number of drinks consumed, binge drinking, and drinking 12 drinks or more in a single day in four major Hispanic national groups. The 2006 Hispanic Americans Baseline Alcohol Survey used a multistage cluster sample design to interview 5224 adult Hispanics (18+ years) in five selected U.S. metropolitan areas: Miami, New York, Philadelphia, Houston, and Los Angeles. The four national groups interviewed were: Puerto Ricans, Cuban Americans, Mexican Americans, and South/Central Americans. The survey response rate was 76%. Data on drinking behavior were collected and the analyses include bivariate and multivariate regression techniques. Multivariate analysis did not show an association between acculturation and volume of drinking, binge drinking, or drinking 12 or more drinks in a single day among men. Acculturation stress, however, was associated with drinking 12 or more in a day among men. Among women, high acculturation was associated with a higher volume of drinking, and it also interacted with national group to increase the likelihood of binge drinking. Acculturation does not have a homogeneous effect on drinking across gender and Hispanic national groups. The results confirm that acculturation has a more consistent association with increased drinking and binge drinking among women than among men. The effect of acculturation is therefore gender-specific. This heterogeneity across Hispanic national groups must be considered in future research, treatment, and prevention efforts.

Decomposing associations between acculturation and drinking in Mexican Americans

BACKGROUND

Acculturation to life in the United States is a known predictor of Hispanic drinking behavior. We compare the ability of 2 theoretical models of this effect-sociocultural theory and general stress theory-to account for associations between acculturation and drinking in a sample of Mexican Americans. Limitations of previous evaluations of these theoretical models are addressed using a broader range of hypothesized cognitive mediators and a more direct measure of acculturative stress. In addition, we explore nonlinearities as possible underpinnings of attenuated acculturation effects among men.

METHODS

Respondents (N = 2,595, current drinker N = 1,351) were interviewed as part of 2 recent multistage probability samples in a study of drinking behavior among Mexican Americans in the United States. The ability of norms, drinking motives, alcohol expectancies, and acculturation stress to account for relations between acculturation and drinking outcomes (volume and heavy drinking days) were assessed with a hierarchical linear regression strategy. Nonlinear trends were assessed by modeling quadratic effects of acculturation and acculturation stress on cognitive mediators and drinking outcomes.

RESULTS

Consistent with previous findings, acculturation effects on drinking outcomes were stronger for women than men. Among women, only drinking motives explained acculturation associations with volume or heavy drinking days. Among men, acculturation was linked to increases in norms, and norms were positive predictors of drinking outcomes. However, adjusted effects of acculturation were nonexistent or trending in a negative direction, which counteracted this indirect normative influence. Acculturation stress did not explain the positive associations between acculturation and drinking.

CONCLUSIONS

Stress and alcohol outcome expectancies play little role in the positive linear association between acculturation and drinking outcomes, but drinking motives appear to at least partially account for this effect. Consistent with recent reports, these results challenge stress models of linear acculturation effects on drinking outcomes and provide (partial) support for sociocultural models. Inconsistent mediation patterns-rather than nonlinearities-represented a more plausible statistical description of why acculturation-drinking associations are weakened among men.

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Acculturation, Birthplace and Alcohol-Related Social Problems Across Hispanic National Groups

OBJECTIVE: To examine the association between acculturation, birthplace, and alcohol-related social problems across Hispanic national groups. METHOD: 5,224 Hispanic adults (18+ years) were interviewed using a multistage cluster sample design in Miami, New York, Philadelphia, Houston, and Los Angeles. RESULTS: Multivariate analysis shows no association between acculturation and problems among men or women. Birthplace is a risk factor for social problems among both genders. Among men, Mexican Americans, Puerto Ricans, and South/Central Americans are more likely to report social problems than Cuban Americans. Other risk factors for men are unemployment, a higher volume of drinking, and a higher frequency of binge drinking. Among women, Mexican American origin and binge drinking are also risk factors for reporting problems. CONCLUSIONS: U.S.-born Hispanics may experience stress and other detrimental effects to health because of their minority status, which may increase the likelihood of more drinking and the development of alcohol-related problems.

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.

Conceptions of acculturation: a review and statement of critical issues

This article reviews evidence for re-conceptualizing acculturation status and acculturation process in health care research with United States (U.S.) Latino populations. Prior literature on acculturation has focused on: (a) acculturative change towards the dominant culture, (b) acculturation as it occurs with Mexican Americans, and (c) language as the principal component of acculturation. We review empirically based health research on acculturation and propose an ecodevelopmental framework for better understanding the process of acculturation. We then offer recommendations that may assist public health researchers, policymakers and program developers in better understanding "real world" acculturation. This includes understanding acculturation within this ecodevelopmental context for a more complete understanding of the acculturation process and its influences on health-related behaviors, with aims of reducing or eliminating health disparities in Latino populations.

Gender, acculturation and alcohol use among Latina/o adolescents: a multi-ethnic comparison

This is the first study to examine the relationship between acculturation and alcohol use by gender and ethnicity using a nationally representative sample of Hispanic and non-Hispanic white adolescents. Specifically, we use data from the National Longitudinal Study of Adolescent Health (Add Health) to explore alcohol use and binge drinking for a sample that includes 6792 non-Hispanic whites, 910 Mexican Americans, 290 Cuban Americans, and 336 Puerto Ricans. Bivariate results reveal significant gender differences in alcohol use among first generation Mexican American, first generation Puerto Rican, and second generation Cuban American adolescents. In addition, these results indicate binge drinking differs significantly by gender among first generation Mexican American, first generation Cuban American, third plus generation Puerto Rican, and third plus generation non-Hispanic white adolescents. Multivariate logistic regression reveals that gender also moderates the effect of acculturation as well as ethnicity on alcohol use and abuse. Among both males and females, first generation immigrants are significantly less likely than third plus generation immigrants to use alcohol and binge drink while selective acculturation significantly reduces the odds of both behaviors. However, the effects of immigrant generation and selective acculturation on binge drinking are larger for females. Further, the trajectories that alcohol use and binge drinking follow with acculturation differ significantly by gender and ethnicity. These results reaffirm the need to further develop theoretical models and intervention strategies that are both gender-specific and culturally-specific, targeting high risk groups in particular in these efforts.