Is duration of residence a proxy for acculturation? The case of health risk behaviors among international immigrants

AIMS

Among international immigrants, health changes by duration of residence are commonly interpreted as an expression of acculturation to the receiving country context. This study compares changes in immigrants' health risk behaviors by duration of residence to changes by acculturation levels, in order to assess whether duration of residence can be regarded as a proxy for acculturation.

METHODS

Using data from a previous systematic review, we identified 17 quantitative studies examining changes in alcohol, tobacco and drug use, physical inactivity, and diet by both duration of residence and acculturation level in the same population. We compared the directionality and consistency of these associations through tabulation and vote counting.

RESULTS

The majority of studies reported no or inconsistent changes in health risk behaviors by duration of residence versus by acculturation, including with opposite directionality. Four studies reported significant estimates with consistent directionality, while five reported consistent, non-significant estimates.

CONCLUSIONS

Our findings suggest that duration of residence should not be used as a proxy for acculturation when studying health risk behaviors among immigrants. Researchers should consider additional time-dependent factors to explain behavioral changes by duration of residence.

Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis

Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I² = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I² = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I² = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.

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.

Alcohol Use and Problem Drinking Among Male Mexican and Central American Im/migrant Laborers

This review addresses a growing concern regarding alcohol use in adult male Latino im/migrant laborers in the United States. The review draws from alcohol studies focusing on “Hispanic” populations, and from health behavior studies of Latino im/migrant laborers, research that includes alcohol use. Specifically, this review addresses (a) alcohol consumption and drinking patterns among Mexican and Central American im/migrant laborers, and (b) health and social consequences of alcohol use. After reviewing more than 200 articles, 30 studies meeting key criteria were selected for review. Survey data show lower alcohol use in Latino im/migrants as compared with U.S. Latino and non-Latino populations, but also a relation between problem drinking and acculturation. Ethnographic research reveals heavy drinking and negative health and social consequences in a significant number of Latino im/migrant laborers. How structural-environmental and culture-based factors combine to influence problem drinking in the United States is discussed along with recommendations for future research.

Drinks per day in women of Mexican origin: does birth place matter?

Historically, Mexican-born women who immigrate to the United States (U.S.) have lower levels of alcohol use and higher rates of abstinence compared with Mexican American women born in the U.S. and other racial groups in the U.S. As such, immigrant women's alcohol use has received limited attention by the research community. Gaps in knowledge of their alcohol use patterns, changes in healthy drinking recommendation for women, and projections of population growth in both Mexican immigrant and Mexican American populations support the need for the study. Data from the Center for Disease Control's National Health Interview Survey were used to explore alcohol use differences in women of Mexican origin born in and outside of the U.S. In addition, the relationship between years in the U.S. and drinks per day was explored in Mexican immigrant women. The results indicated that Mexican immigrant women who drink are drinking above recommended levels and the younger immigrant women are drinking more drinks per day than young Mexican American women. These changes point to the importance of developing culturally sensitive interventions for this expanding segment of the population.

The relationship of language acculturation (English proficiency) to current self-rated health among African immigrant adults

Although over 1.5 million African immigrants live in the US, few studies have examined the relationship of language acculturation to health outcomes among African immigrant adults. The primary objective of this research was to investigate the relationship between English proficiency and current self-rated health among African immigrant adults. Using a cross-sectional design, a secondary data analysis was performed on baseline data from the African immigrant adult subsample (n = 763) of the 2003 New Immigrant Survey, a longitudinal study of lawful permanent residents. Limited English proficiency (LEP), increased duration of US residence, older age at immigration, being male, less than 12 years of education, poor pre-migration health, and chronic disease were associated with good/fair/poor current self-rated health. Findings support consideration of pre-migration health and chronic disease in future acculturation and health studies, and provision of linguistically competent interventions for LEP African immigrants at risk for poor health outcomes.

Are first-generation adolescents less likely to be overweight? Results from a survey of Boston youth

The effect of years of residence in the US on the weight of adolescents is unclear. We examined the association between generation (i.e. 1st, 1.5, 2nd, and 3rd) and weight indicators among Boston adolescents. Data are from a sample of 1,420 9-12th grade public school students in Boston, Massachusetts. We used self-reported information to calculate generation and weight characteristics (i.e., body mass index (BMI), BMI z-score, overweight status), and ran multivariate analyses to estimate the association between generation and weight characteristics, adjusting for race/ethnicity, gender, age and school. In pooled multivariate models, 1.5 generation, second generation, and third generation youth had significantly higher mean BMI scores and mean BMI z-scores than first generation youth. Second (RR 1.87, 95% CI 1.13-3.12) and third generation youth (RR 2.06, 95% CI 1.21-3.50) were also significantly more likely to be overweight than first generation youth. In multivariate models stratified by sex, this pattern persisted for females only. There is a positive, linear trend in BMI by generation that differs by gender. Mechanisms underlying this association should be addressed.

Alcohol use among recent Latino immigrants before and after immigration to the United States

BACKGROUND

US-born Latinos have higher rates of alcohol use than Latinos who have immigrated to the United States. However, little is known about the pre-immigration drinking patterns of Latino immigrants or about the changes in their drinking behaviors in the 2 years post-immigration.

OBJECTIVES

This article reports findings of a longitudinal study that compared rates of regular, binge, and heavy drinking among a cohort of recent Latino immigrants, ages 18-34, prior to immigration to the United States and in the 2 years post-immigration.

METHODS

Baseline data were collected on the drinking patterns of 405 Latino immigrants living in the United States for 12 months or less. A follow-up assessment occurred during their second year in the United States.

RESULTS

Findings indicate that number of days of drinking declined significantly post-immigration. Binge alcohol use (five or more drinks on the same occasion during the past 90 days) significantly declined during the post-immigration period. Heavy alcohol use (five or more drinks on the same occasion on five or more days during the past 90 days) also significantly decreased.

CONCLUSIONS

Results suggest a need for continued exploration of pre-immigration drinking patterns and research to uncover underlying factors associated with declines in rates of problematic alcohol use among recent Latino immigrants.

SCIENTIFIC SIGNIFICANCE

The results of this study can aid in furthering our understanding of the alcohol use of Latino immigrants ages 18-34 prior to and post immigration to the United States to guide future research and the development of culturally tailored clinical interventions.

Substance use, generation and time in the United States: the modifying role of gender for immigrant urban adolescents

Although immigrant youth have lower rates of substance use than US born youth, whether substance use varies by generation and time in the US is unclear. This study examines adolescent alcohol, tobacco and marijuana use by generation/time in US (i.e., first generation, in US ≤4 years; first generation, in US >4 years; second generation; and third generation or higher). Data come from a 2008 survey of Boston, Massachusetts public high school students (n = 1485). Multivariable logistic regression models were used to examine the association between generation/time in the US and risk of past 30-day substance use, adjusting for age and race/ethnicity. To determine whether the associations differed by gender, we fit gender stratified regression models. The prevalence of substance use was lowest among immigrants who had been in the US ≤4 years. Among girls, generation/time in US was not related to alcohol use or to tobacco use. For boys, being an immigrant regardless of number of years in the US, as well as second generation was associated with a significantly lower risk of tobacco use, compared to third generation youth. Additionally, immigrant boys who had been in the US ≤4 years had a significantly lower risk of alcohol use. Among both boys and girls, all first and second generation youth were significantly less likely to report marijuana use compared to third generation youth. Immigrant youth have a lower risk of alcohol, tobacco and marijuana use relative to US born youth; however the protective effect of foreign nativity on alcohol was eroded much more quickly than for tobacco or marijuana. The effects of generation and time in US on substance use differ by gender and the particular substance.

Alcohol use among Latinos: a comparison of pre-immigration, post-immigration, and US born Latinos

US born Latinos have higher rates of alcohol use than Latino immigrants. Yet, little is known about drinking patterns of Latinos before their immigration to the US This exploratory study compares the past month regular, binge, and heavy alcohol use patterns of Latino immigrants prior to immigration with that of post-immigration and US born Latinos. Data on past month alcohol use prior to immigration was collected from 516 recent adult Latino immigrants. Results were compared with US born and post-immigration Latinos using national aggregate data. Alcohol use patterns among Latino immigrants prior to immigration were similar to that of US born Latinos. Alcohol use patterns were lower among Latinos after immigration when compared to pre-immigration and US born Latinos. This study provides a foundation for further exploration of the drinking patterns of Latinos in the US before they immigrated to this country. Findings suggest more research is needed to uncover the underlying factors associated with the higher rates of alcohol use among Latinos prior to their immigration when compared to alcohol use patterns of post-immigration 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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Human capital, resources, and healthy childbearing for Mexican women in a new destination immigrant community

PURPOSE

To describe a healthy mother, a healthy pregnancy, a healthy baby, and the resources essential for achieving these goals from the perspective of Mexican women in a new destination immigrant community in the United States.

BACKGROUND

Traditional care and health behaviors are often cited to explain the favorable birth outcomes of Mexican-born women in the United States. Little is known about the approaches Mexican women use to have healthy babies in new destination communities.

SAMPLE

Eleven Mexican women of childbearing age in the early years of their settlement participated in semifocused ethnographic interviews.

FINDINGS

Healthy mothers have good nutrition and abstain from substance use. Healthy pregnancies are worry-free and tranquil, and healthy behaviors are supported by networks of people with good morals who motivate women and provide sound advice. Information needs include vitamin supplementation before and after pregnancy and family planning. English skills and having the courage to go out and meet people are vital for healthy childbearing.

CONCLUSIONS AND IMPLICATIONS

Informed prenatal care programs preserve diet and low substance use behaviors, reduce stress, and provide networking opportunities and information about family planning, prenatal care services, nutrition, and folic acid supplementation.

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

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

The Mexican migration to the United States and substance use in northern Mexico

AIMS

To examine the impact of migration to the United States on substance use and substance use disorders in three urban areas of northern Mexico.

DESIGN

Cross-sectional survey of immigration-related experiences and life-time and past-year alcohol and drug use, in a representative sample of respondents aged 12-65 years.

SETTING

Interviews were conducted in the cities of Tijuana, Ciudad Juarez and Monterrey during 2005. Respondents were classified into three groups: (i) 'return migrants', (ii) 'relatives of migrants' and (iii) 'others in the general population'.

FINDINGS

A total of 1630 completed interviews were obtained for a response rate of 70.5%. 'Return migrants' were more likely to have used alcohol, marijuana or cocaine at least once in their life-time and in the last 12 months, more likely to develop a substance use disorder and more likely to have a 12-month substance use disorder compared with 'others in the general population'. Among 'return migrants', longer length of time in the United States and type of work performed as an immigrant were related to higher prevalence of substance use. Among 'relatives of migrants', migration experiences were not associated with increased prevalence of substance use compared with 'others in the general population'.

CONCLUSION

This study found a link between migration to the United States and the transformation of substance use norms and pathology in Mexico. Future research on pre-migration involvement in substance use and data on the timing of events among return migrants is needed. Public health measures are likely to require cross-border coordination of research and service development.

Stigmatization, Substance Use, and Sexual Risk Behavior among Latino Gay and Bisexual Men and Transgender Persons

Following the minority stress model as a framework, we examine the associations between racial and homosexual stigma, substance use, and sexual risk behavior among a respondent-driven sample of Latino gay and bisexual men and male-to-female transgender persons (GBT) in Chicago and San Francisco (N = 643). We use structural equations to test such a model and disentangle the possible effects of the different stigmas and their corresponding dimensions (i.e., perception, experience, internalization). Findings revealed distinct pathways to sexual risk. Two are typified by experienced homosexual stigma and internalized racial stigma via multiple drug use, and two are characterized by experienced racial stigma and internalized homosexual stigma via alcohol use.

Country of origin, age of drinking onset, and drinking patterns among Mexican American young adults

This study examines relationships between country of origin, age of drinking onset, and adverse drinking outcomes among young adult Mexican Americans in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Logistic regression models estimate associations between age of drinking onset, age of onset in relation to age at immigration, and adverse drinking outcomes, controlling for sex, age, employment, education, marital status, and income. Adjusted analyses indicate the odds of adverse drinking outcomes decreased as age of drinking onset increased. Mexican Americans who initiated drinking in Mexico had significantly lower odds of current or lifetime harmful drinking than U.S. born but the odds were not significantly different between foreign-born Mexican Americans who initiated drinking in the U.S. and U.S. born. Irrespective of whether drinking onset was in Mexico or the U.S., foreign-born Mexican Americans had lower odds of alcohol abuse than U.S. born. However, odds of dependence were not significantly different between foreign-born and U.S.-born Mexican Americans. While findings suggest that being foreign born may be protective, further research on social and cultural factors impacting drinking onset and related outcomes among young Mexican Americans may help inform prevention efforts.