The Hispanic Americans Baseline Alcohol Survey (HABLAS): Alcohol consumption and sociodemographic predictors across Hispanic national groups

Men of Mexican ethnicity, alcohol use, and help-seeking: "I can quit on my own."

INTRODUCTION

Hispanics report higher rates of problematic alcohol use compared to non-Hispanic Whites while also reporting lower rates of alcohol treatment utilization compared to non-Hispanics. The study employs Anderson's Behavioral Model of Healthcare Utilization Model to guide the exploration of alcohol use, help-seeking and healthcare utilization.

METHODS

The present qualitative study explored help-seeking and alcohol treatment utilization for Hispanic men of Mexican ethnicity. A total of 27 participants (Mage = 35.7, SD = 10.82) completed a semi-structured interview that explored the treatment experiences and underlying psychological mechanisms that shaped their help-seeking.

RESULTS

Through a thematic content analysis, the following themes emerged: 1) perceiving need with subthemes of familismo, role as protector and provider, and positive face; 2) predisposing beliefs on help-seeking; and 3) treatment experiences and elements of patient satisfaction with subthemes of monetized treatment, respect, and perceiving professional stigma.

CONCLUSIONS

The findings in this article may assist in improving strategies for increasing alcohol treatment utilization among men of Mexican ethnicity. By exploring beliefs, values, and experiences health researchers can develop culturally informed intervention strategies.

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.

Investigating the association between discrimination, internalizing symptoms, and alcohol use among Latino/a immigrants in the United States

Internalizing symptoms associated with anxiety and depression have been correlated with harmful alcohol use among Latino/as, but little attention has been paid to assessing the association between perceived discrimination and harmful alcohol use. The present study was designed to investigate the association between perceived discrimination, internalizing symptoms associated with anxiety and depression, and harmful alcohol use among Latino/a immigrants living in the United States (US). Our sample included 426 Latino/a immigrants. Their mean age was 40.05 years (SD = 6.50), 65.50% were women, 80.00% had a partner, 54.20% lived on less than $2,000 a month, and 41.50% reported having attained a college degree. Perceived discrimination was assessed using the Perceived Discrimination Scale, anxious symptoms were assessed using the GAD-7, depressive symptoms were assessed using the CES-D short form, and harmful alcohol use was assessed using AUDIT. We estimated a linear regression model using cross-sectional, self-reported data. The model was statistically significant, R 2 = 0.38, F (8, 425) = 32.09, p < 0.01. Discrimination was significantly associated with AUDIT scores, (β = 0.21, p < 0.01) after accounting for covariates and for symptoms of anxiety and depression. Our results indicate that experiences of discrimination in the US are associated with increased harmful alcohol use even after controlling for other variables. These findings may be useful in designing coping interventions specifically for Latino/a immigrants to reduce the risk of alcohol use disorder. This study also has political and public health implications for acknowledging the detrimental health consequences of experiencing discrimination, providing support to the position that reducing racism and discrimination represent important public health priorities.

The role of sociocultural factors on alcohol self-efficacy and protective drinking behaviors among Hispanic/Latinx young adults

OBJECTIVES

Hispanic/Latinx drinkers have been found to experience more adverse alcohol-related consequences than any other racial/ethnic group. Due to this, researchers have looked at the connection between drinking and cultural factors, alongside discrimination, to further analyze what sociocultural factors lead to negative outcomes when drinking.

DESIGN

Researchers used a sample of Hispanic/Latinx young adult drinkers (n = 710) with an average age of 22.43 (SD = 6.69), recruited through social media and assessed on several factors, including protective behavioral strategies (PBS), alcohol use severity, bicultural self-efficacy, discrimination, acculturation, and enculturation.

RESULTS

Utilizing an observed variable path analysis, results showed perceived discrimination to have a significant effect on all variables in the model (bicultural self-efficacy, acculturation, enculturation, PBS self-efficacy, PBS use, and alcohol use severity). Acculturation was positively associated with PBS self-efficacy, while enculturation was positively associated with PBS use. PBS self-efficacy was positively correlated with PBS use and negatively associated with alcohol use severity. There was a significant total indirect effect from perceived discrimination to alcohol use severity through various paths (i.e. PBS self-efficacy, acculturation, and bicultural self-efficacy), with the strongest path to occur through PBS self-efficacy.

CONCLUSIONS

Findings showcase the risk and protective effects of various sociocultural factors on drinking behaviors among young adults. PBS self-efficacy was found to have robust protective effects against alcohol use severity. Future research should continue to investigate these sociocultural and behavioral factors in order to develop efforts to mitigate hazardous alcohol use among Hispanic/Latinx young adult drinkers.

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.

Adverse Childhood Experiences and Risk Patterns of Alcohol and Cannabis Co-Use: A Longitudinal Study of Puerto Rican Youth

PURPOSE

Adverse childhood experiences (ACEs) are common in Puerto Rican youths. Few large longitudinal studies of Latine youth examined what predicts co-use of alcohol and cannabis in late adolescence and young adulthood. We investigated the prospective association between ACEs with alcohol/cannabis co-use in Puerto Rican youth.

METHODS

Participants from a longitudinal study of Puerto Rican youth (n = 2,004) were included. Using multinomial logistic regressions to test associations between prospectively reported ACEs (11 types, reported by parents and/or children, categorized as 0-1, 2-3, and 4+ ACEs) with young adult alcohol/cannabis use patterns in the past month (i.e., no lifetime use, low-risk [no binge drinking and cannabis use < 10], binge-drinking only, regular cannabis use only, and alcohol/cannabis co-use). Models were adjusted for sociodemographic variables.

RESULTS

In this sample, 27.8% reported 4+ ACEs, 28.6% endorsed binge drinking, 4.9% regular cannabis use, and 5.5% alcohol/cannabis co-use. Compared to individuals with no lifetime use, those reporting 4+ (vs. 0-1) ACEs had greater odds of low-risk use (adjusted odds ratio [aOR] 1.60, 95% confidence interval [CI] = 1.04-2.45), regular cannabis use (aOR 3.13 95% CI = 1.44-6.77), and alcohol/cannabis co-use (aOR 3.57, 95% CI = 1.89-6.75). In relation to low-risk use, reporting 4+ ACEs (vs. 0-1) was associated with 1.96 odds (95% CI = 1.01-3.78) of regular cannabis use and 2.24 odds (95% CI = 1.29-3.89) of alcohol/cannabis co-use.

DISCUSSION

Exposure to 4+ ACEs was associated with the occurrence of adolescent/young adulthood regular cannabis use and alcohol/cannabis co-use. Importantly, ACEs exposure differentiated young adults who were co-using compared to those engaged in low-risk use. Preventing ACE or interventions for Puerto Rican youth experiencing 4+ ACEs may mitigate negative consequences associated with alcohol/cannabis co-use.

Use of an Automated Bilingual Digital Health Tool to Reduce Unhealthy Alcohol Use Among Latino Emergency Department Patients: A Randomized Clinical Trial

Importance

Alcohol use disorders have a high disease burden among US Latino groups. In this population, health disparities persist, and high-risk drinking has been increasing. Effective bilingual and culturally adapted brief interventions are needed to identify and reduce disease burden.

Objective

To compare the effectiveness of an automated bilingual computerized alcohol screening and intervention (AB-CASI) digital health tool with standard care for the reduction of alcohol consumption among US adult Latino emergency department (ED) patients with unhealthy drinking.

Design, Setting, and Participants

This bilingual unblinded parallel-group randomized clinical trial evaluated the effectiveness of AB-CASI vs standard care among 840 self-identified adult Latino ED patients with unhealthy drinking (representing the full spectrum of unhealthy drinking). The study was conducted from October 29, 2014, to May 1, 2020, at the ED of a large urban community tertiary care center in the northeastern US that was verified as a level II trauma center by the American College of Surgeons. Data were analyzed from May 14, 2020, to November 24, 2020.

Intervention

Patients randomized to the intervention group received AB-CASI, which included alcohol screening and a structured interactive brief negotiated interview in their preferred language (English or Spanish) while in the ED. Patients randomized to the standard care group received standard emergency medical care, including an informational sheet with recommended primary care follow-up.

Main Outcomes and Measures

The primary outcome was the self-reported number of binge drinking episodes within the last 28 days, assessed by the timeline followback method at 12 months after randomization.

Results

Among 840 self-identified adult Latino ED patients (mean [SD] age, 36.2 [11.2] years; 433 [51.5%] male; and 697 [83.0%] of Puerto Rican descent), 418 were randomized to the AB-CASI group and 422 to the standard care group. A total of 443 patients (52.7%) chose Spanish as their preferred language at enrollment. At 12 months, the number of binge drinking episodes within the last 28 days was significantly lower in those receiving AB-CASI (3.2; 95% CI, 2.7-3.8) vs standard care (4.0; 95% CI, 3.4-4.7; relative difference [RD], 0.79; 95% CI, 0.64-0.99). Alcohol-related adverse health behaviors and consequences were similar between groups. The effect of AB-CASI was modified by age; at 12 months, the relative reduction in the number of binge drinking episodes within the last 28 days in the AB-CASI vs standard care group was 30% in participants older than 25 years (RD, 0.70; 95% CI, 0.54-0.89) compared with an increase of 40% in participants 25 years or younger (RD, 1.40; 95% CI, 0.85-2.31; P = .01 for interaction).

Conclusions and Relevance

In this study, US adult Latino ED patients who received AB-CASI had a significant reduction in the number of binge drinking episodes within the last 28 days at 12 months after randomization. These findings suggest that AB-CASI is a viable brief intervention that overcomes known procedural barriers to ED screening, brief intervention, and referral to treatment and directly addresses alcohol-related health disparities.

Trial Registration

ClinicalTrials.gov Identifier: NCT02247388.

Similarities and Differences in Alcohol & Other Drug Dependence Among Hispanic/Latino Subgroups: A Disaggregation Approach

Background

Hispanic/Latino (H/L) heritage civilians out-number all other non-White ethnic groups in the United States. When studied as one group, H/L diversity is ignored, including rates of drug misuse. This study's aim was to examine H/L diversity regarding drug dependence by disaggregating how the burdens of active alcohol or other drug dependence (AODD) might change if we were to address syndromes drug by drug.

Method

Studying non-institutionalized H/L residents from the National Surveys on Drug Use and Health (NSDUH) 2002-2013 probability samples, we utilized online Restricted-use Data Analysis System variables to identify ethnic heritage subgroups and active AODD via computerized self-interviews. We estimated case counts of AODD with analysis-weighted cross-tabulations and variances from Taylor series. Radar plots disclose AODD variations when we simulate the reductions of drug-specific AODD one by one.

Results

For all H/L heritage subgroups, the most substantial AODD decline might be achieved by reducing active alcohol dependence syndromes, followed by declines of cannabis dependence. The burdens due to active syndromes attributed to cocaine and pain relievers vary somewhat across subgroups. For the Puerto Rican subgroup, our estimates reveal potentially important burden reduction if active heroin dependence can be decreased.

Conclusion

A sizeable reduction in the H/L population health burden attributable to AODD syndromes might be achieved via the effective decline of alcohol and cannabis dependence among all subgroups. Future research includes a systematic replication with recent NSDUH survey data, as well as various stratifications. If replicated, the need for targeted drug-specific interventions among H/L will become unequivocal.

Movement if Life-Optimizing Patient Access to Total Joint Arthroplasty: Alcohol and Substance Abuse Disparities

Alcohol use disorders (AUDs) and substance use disorders (SUDs) place patients undergoing total joint arthroplasty at notable risk for complications. AUD and SUD disproportionately affect vulnerable communities and often coexist. Following is a discussion of the presence of these disorders in vulnerable populations and approaches to screening for them to optimize care and reduce the risks of joint arthroplasty surgery. 25.1% of American adults report binge drinking in the past year, and 5.8% of American adults carry a diagnosis of AUD. Alcohol consumption and AUD disproportionately affect American Indians/Alaskan Natives, and heavy episodic drinking is highest in Latinx and American Indians. AUD is higher in those who are unemployed, have lower education level, and those who are single/divorced. Alcohol use in the preoperative period is associated with difficulty maintaining blood pressure during surgery, infections, wound disruptions, and increased length of stay. In addition, patients with AUD or unhealthy alcohol use have a greater comorbidity burden, including liver disease and dementia, that predisposes them to poor surgical outcomes. Optimization in these vulnerable populations include proper screening, cessation programs, psychosocial interventions, assessment of support systems, and pharmacologic interventions. 38% of adults battle a drug use disorder. Twenty-one million Americans have at least one addiction, but only 10% receive treatment. Rates of opioid use and opioid-related deaths have continued to rise. Recreational drug use is highest in American Indians. Marijuana use is highest in Black and Latinx lesbian, gay, and bisexual women. Overall, substance use is associated with depression and anxiety; discrimination based on race, ethnicity, sex, or sexual preference is also deeply interwoven with depression, anxiety, and substance use. Preoperative use of opioids is the number one predictor of prolonged chronic postoperative opioid use. Optimization in these vulnerable groups begins with appropriate screening, followed by psychosocial interventions, social work and substance abuse counseling, and pharmacologic therapies.

Trends and correlates of spatially aggregated alcohol-involved crashes among Whites and Hispanics in California

AIMS

This paper examines trends and correlates of alcohol-involved motor vehicle crashes (AMVCs) in California between 2005 and 2016 among Hispanic and non-Hispanic Whites (Whites hereafter). Together these two groups comprise 76% of the state population. The paper also examines whether alcohol outlet density, percentage of Hispanics in census tract populations, and distance to the U.S./Mexico border are related to greater risks for AMVCs. The border is of interest given the greater availability of alcohol in the area.

METHODS

Crash data come from Statewide Integrated Traffic Records System maintained by the California Highway Patrol. Sociodemographic and community characteristics data from the U.S. Census and alcohol outlet density were aggregated to census tracts. Total motor vehicle crashes and AMVCs were related to these characteristics using hierarchical Bayesian Poisson space-time models.

RESULTS

There were over two million injury and fatality crashes during the period of analysis, of which 11% were AMVCs. About 1.7% of these crashes had fatalities. The rate of AMVCs increased among both Whites and Hispanics until 2008. After 2008, the rate among Whites declined through 2016 while the rate among Hispanics declined for 2 years (2009 and 2010) and increased thereafter. Crash distance from the border (RR = 1.016, 95% CI = 1.010 to 1.022) and percent Hispanic population (RR = 1.006; 95% CI = 1.003 to 1.009) were well-supported results with 95% credible intervals that did not include 1. The percentages of the following: bars/pubs, males, individuals aged 18 to 29 and 40 to 49 years, U.S. born population, individuals below the 150% poverty level, unemployed, housing vacant, and housing owner-occupied were all positively associated with AMVCs and well supported.

CONCLUSIONS

Between 2005 and 2016 the rate of AMVCs in California declined among Whites but not among Hispanics. Population-level indicators of percent Hispanic population, distance to the U.S. Mexico border, gender, age distribution, and socioeconomic stability were positively associated with crash rates, indicating that important contextual characteristics help determine the level of AMVC rates in communities.

Discrimination-Based Acculturative Stress, Depression, and Alcohol Use among Latina Emerging Adults During Initial Months in the USA

Background

The present study examined the links between discrimination-based acculturative stress (DAS), depressive symptoms, and alcohol use among recently immigrated Latina young adults and explored potential within-group Latina ethnic differences.

Methods

Structural equation modeling was used to assess these relations among 530 Latina young adults (age 18-23) who had immigrated to the U.S. within approximately 12 months prior to assessment.

Results

Women reporting more DAS indicated more depressive symptoms and alcohol use than counterparts reporting less DAS. Women reporting more time in the U.S. experienced higher levels of DAS. Undocumented participants, and those who had lived in the U.S. for less time, reported more depressive symptoms than their peers.

Discussion

Findings highlight the need for mental health clinicians to attend to their local sociopolitical climate context for discriminatory practices and integrate cultural factors in mental health and alcohol use interventions targeting Latina young adults who recently immigrated to the U.S.

Drinking in Mexico by Whites and Hispanics on and off the US/Mexico border in California

This paper compares drinking patterns of Whites and Hispanics who after crossing the U.S./Mexico border drink and do not drink in Mexico. Data came from a household survey of 1,209 adults 18 to 39 years of age in California. Residence near the US/Mexico border increases the likelihood of drinking in Mexico (AOR = 4.57; 95%CI = 2.45-8.52; p < .001). Hispanics (AOR = 1.91; 95%CI = 1.26-2.90; p < .01), those who drink more frequently (AOR = 1.05; 95%CI = 1.02-1.09; p < .01) and those who drink six or more drinks in day (AOR = 1.91; 95%CI = 1.26-2.29; p < .01) are more likely than Whites and lighter drinkers to report this behavior. Crossing the U.S./Mexico border to drink is influenced by living close to the border, Hispanic ethnicity, and drinking many drinks in a day.

Drinking cultures and socioeconomic risk factors for alcohol and drug use disorders among first- and second-generation immigrants: A longitudinal analysis of Swedish population data

BACKGROUND

Few longitudinal studies investigate predictors of substance use incidence among immigrants. The current study describes substance use disorders in immigrants to Sweden, focusing on drinking culture in the country of origin and socioeconomic status (SES), and how these intersect with generational status to influence risk.

METHODS

Using pseudonymized Swedish population registry data, we track onset of alcohol use disorder and drug use disorder in a longitudinal study of 815,778 first-generation immigrants and 674,757 second-generation immigrants from 64 countries over a 6-year period. Cox regression analysis estimated risks of alcohol and drug use disorders in second-generation immigrants compared to first-generation, and moderation analyses assessed interactions of generational status with country-of-origin per capita alcohol consumption and SES.

RESULTS

Immigrants and second-generation immigrants originating from countries with high levels of alcohol consumption had higher risks for alcohol and drug use disorders. Immigrants with high SES had lower risks for alcohol and drug use disorders. The interaction between generational status and country-of-origin alcohol consumption was significant for drug use disorder (not for alcohol use disorder), with drug use disorder risk for second-generation immigrants being highest for those from countries with the lowest level of country-of-origin per capita alcohol consumption. The interaction between generational status and SES was significant for alcohol use disorder, with low-SES second-generation immigrants showing markedly higher risk than first-generation immigrants with comparable SES.

CONCLUSIONS

Among immigrants in Sweden, second-generation immigrants are at increased risk of developing alcohol and drug use disorders, particularly if they have lower SES. Policy and community attention to these high-risk subgroups in immigrant communities is warranted.

Pain Prevalence, Chronicity and Impact Within Subpopulations Based on Both Hispanic Ancestry and Race: United States, 2010-2017

We provide national surveillance estimates of pain chronicity, severity and impact in adult subpopulations defined by both Hispanic Ancestry and Race. Data are from 144,434 adults who completed validated questionnaires in the 2010-2017 National Health Interview Survey asking about pain status within the last 3 (N = 84,664) or 6 months (N = 59,770). Multivariable logistic regression was used to assess the relationship between pain and ethnicity/race. Compared to White Puerto Rican participants, White participants with Central/South American and Mexican ancestry had reduced odds of reporting Category 3-4 pain and High-Impact Chronic Pain (HICP), while those of Cuban ancestry had reduced odds of only HICP - eg, White participants with Mexican ancestry had 32% lower odds of having Category 3-4 pain and 50% lower odds of having HICP. While no differences were seen between White Puerto Rican and White Non-Hispanic participants for Category 3-4 pain, White Non-Hispanics had 40% lower odds of reporting HICP. Asian Non-Hispanic and Black Non-Hispanic participants had significantly lower odds of reporting Category 3-4 pain and HICP compared to White Puerto Rican participants, eg, Black Non-Hispanic participants had 26% lower odds off having Category 3-4 pain and 42% lower odds of having HICP. Perspective: By examining pain status in discrete demographic groups based on Hispanic Ancestry and Race, this report further documents substantial difference in health status among underserved populations and provides a baseline for continuing surveillance research on pain, with the eventual goal of eliminating disparities in pain assessment and treatment.

Alcohol use severity, depressive symptoms, and optimism among Hispanics: Examining the immigrant paradox in a serial mediation model

OBJECTIVE

Hispanic immigrants exhibit more positive outcomes than U.S.-born Hispanics across educational, psychological, and physical health indices, a phenomenon called the immigrant paradox. We examined the immigrant paradox in relation to alcohol use severity among Hispanic young adults while considering both positive (optimism) and negative (depressive symptoms) processes.

METHOD

Among 200 immigrant and U.S.-born Hispanic young adults (Mage  = 21.30; 49% male) in Arizona and Florida, we tested whether optimism and depressive symptoms statistically mediated the relationship between nativity and alcohol use severity. Specifically, we examined whether Hispanic immigrants reported greater optimism than their U.S.-born counterparts, and whether such optimism was, in turn, associated with less depressive symptoms and thus lower alcohol use severity.

RESULTS

Indirect effects were significant in hypothesized directions (nativity → optimism → depressive symptoms → alcohol use severity).

CONCLUSIONS

Both positive and negative psychological processes are important to consider when accounting for the immigrant paradox vis-à-vis alcohol use severity among Hispanic young adults.

Alcohol use and problems among Latinas at risk of an alcohol-exposed pregnancy: The role of acculturation and interpersonal factors

Path analysis was used to examine the role of acculturation, helping relationships, partner status, age, and education on heavy drinking and alcohol problems among 119 Latina adults at risk of an alcohol-exposed pregnancy (AEP). Greater acculturation was positively related to more helping relationships and heavy drinking, and there was an indirect positive relationship between acculturation and alcohol problems. There was also a positive relationship between helping relationships and alcohol problems, and a negative relationship between helping relationships and being partnered. Knowledge of the mechanisms by which acculturation and interpersonal factors influence behavior change can inform potential targets for intervention among Latinas with AEP risk.

Subjective Social Status and Financial Hardship: Associations of Alternative Indicators of Socioeconomic Status with Problem Drinking in Asian Americans and Latinos

Background: Prior research shows inconsistent associations between socioeconomic status (SES) and alcohol outcomes, particularly for immigrant populations. Conventional markers of SES may not fully capture how social position affects health in these groups. Objective: We examine: (1) the associations of two alternative indicators, subjective social status (SSS) and financial hardship, with problem drinking outcomes, heavy episodic drinking (HED) and alcohol use disorder (AUD), for Asian Americans and Latinos; and (2) moderation of these relationships by educational level and nativity status. Methods: Multiple logistic regression modeling was performed using nationally-representative Asian American (n = 2,095) and Latino samples (n = 2,554) from the National Latino and Asian American Study. Age, gender, nativity, individual-level SES (income and education), unfair treatment, racial discrimination, and social support were adjusted. Results: Financial hardship was independently associated with AUD in both Asians and Latinos. Lower SSS was associated with increased AUD risk among individuals with college degrees or with US nativity in both populations. The association between financial hardship and HED was positive for US-born Latinos and foreign-born Asians, and negative for foreign-born Latinos. Conclusions: SSS and financial hardship are indicators of SES that may have particular relevance for immigrant health, independently of education and income, with SSS particularly meaningful for AUD in the more conventionally advantaged subgroups. There may be underlying processes affecting Asian and other Latino subgroups with similar socioeconomic and nativity profiles and exposing them to common risk/protective factors of AUD.

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.

Food insecurity and dietary intake by Supplemental Nutrition Assistance Program participation status among mainland US Puerto Rican adults after the 2009 American Recovery and Reinvestment Act

OBJECTIVE

The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status.

DESIGN

Pre/post analysis.

SETTING

Boston, MA, USA.

PARTICIPANTS

Data were from the longitudinal Boston Puerto Rican Health Study (2007-2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA.

RESULTS

Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants.

CONCLUSIONS

Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.

Process for developing a culturally informed brief motivational intervention

The present study culturally enhances a standard brief intervention for alcohol use. Through an iterative process engaging key stakeholders; including patients, and expert consultants, this research sought to enhance current evidence based interventions. Five culturally informed enhancements consistent with Motivational Interviewing were introduced into standard brief interventions. These culturally informed enhancements can be refined to address the cultural risk and protective factors of other priority populations. The distinctions and advantages of this approach over prior cultural adapted interventions is discussed. Importantly, the present study outlines a process for refining the culturally informed brief intervention to other target populations.

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.

Immigrant paradox? Generational status, alcohol use, and negative consequences across college

The current study examined linkages between generational status, alcohol use, wanting to get drunk, and negative alcohol-related consequences during college. We tested whether immigrant students' longitudinal alcohol use trajectories converged to dominant unhealthy patterns or whether immigrant students maintained healthier patterns across college. We also examined if the weekend exerted equal risk for students of different generations. Furthermore, we explored whether patterns were consistent among Latinx and Asian American students. Stratified random sampling identified first-year students attending a US college. A longitudinal daily diary design was used; students completed web-based surveys for up to 14 days within each of 7 semesters. Each day, participants (N = 689; n_{1st generation} = 114; n_2nd generation = 244; 51% female) reported their alcohol use and consequences (N = 55,829 days). Multi-level models demonstrated that compared to 3rd generation students, 1st generation students were more likely to abstain from alcohol and less likely to binge drink and want to get drunk. First generation students also experienced fewer negative alcohol-related consequences. The protective effect of being 1st generation was maintained across college semesters, with subgroup analyses focusing on Latinx and Asian American students largely supporting the main findings. However, for abstaining and negative consequences, the weekend effect was less pronounced for immigrants than later generation students. For example, the difference in negative consequences between 1st (vs. 3rd) generation students was largest on the weekend. Additional work is needed to understand how 1st generation students leverage protective factors to abstain from alcohol use even when exposed repeatedly to "wet" drinking environments.

Comparison of subjective response to alcohol in Caucasian and Hispanic/Latino samples

Individual differences in subjective response (SR) to alcohol (e.g., stimulation, sedation) are a significant predictor of negative alcohol outcomes. Previous studies have reported ethnic differences in SR (e.g., between some Asian populations and Caucasians), but very few studies have examined SR among Hispanic/Latino individuals. To address this gap in the literature, the present study utilized data from a large-scale, placebo-controlled alcohol administration study to examine differences in SR between Hispanic/Latino and Caucasian individuals. Social drinkers (N = 447) aged 21 to 25 years were randomized to receive either a dose of alcohol targeting a blood alcohol concentration (BAC) of .08 g% or placebo. Only non-Hispanic Caucasian participants (n = 234) and Hispanic/Latino participants (n = 87) were utilized in analyses. SR was assessed at baseline, on the ascending limb of the blood alcohol curve, at peak BAC, and on the descending limb. Repeated measures ANCOVA was utilized to examine interactions between beverage condition, ethnicity, and time predicting SR. The interaction between beverage condition, ethnicity, and time was significant only for low-arousal negative SR (negative sedative effects), such that Hispanic/Latino individuals experienced stronger sedative effects under alcohol (vs. placebo) compared with Caucasian individuals. Caucasians and Hispanic/Latinos showed a similar profile of response with respect to positive aspects of SR (e.g., stimulation). In summary, Hispanic/Latino individuals reported stronger negative SR to alcohol compared with Caucasian individuals, which may be protective against alcohol-related problems. However, future studies are needed to investigate why Hispanic/Latino males remain at relatively high risk for alcohol problems despite stronger negative SR relative to Caucasians. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Translation and pilot testing of a measure to assess hypertension self-care activities among Hispanics

OBJECTIVE

Hispanics in the US have high rates of uncontrolled hypertension in comparison to non-Hispanic whites. This pilot study reports on the translation of a validated measure, the Hypertension Self-Care Activity Level Effects (H-SCALE), for use with Spanish speakers. The H-SCALE assesses Hispanics' adherence to lifestyle activities that contribute to primary and secondary risk reduction of high blood pressure.

DESIGN

Cross-sectional data were collected from Hispanic primary care patients attending a free health clinic in Charlotte, NC. We performed basic psychometric tests and calculated descriptive statistics to assess adherence rates to recommended hypertension self-care behaviors.

RESULTS

Participants were primarily female, under age 50 and had a high-school education or less; 48% were from Mexico. Internal consistency of all H-SCALE subscales was acceptable to good. Most participants were non-smokers (80%) and alcohol abstainers (85%). Participants had low adherence to weight management practices, physical activity and healthy eating habits. One-third of those with hypertension were adherent to medication regimens.

CONCLUSION

The Spanish version of the H-SCALE is a reliable and useful tool for clinicians working with Hispanic adults. Based on these findings, all adult Hispanics need lifestyle behavior counseling for primary and secondary prevention of hypertension and other chronic diseases. The H-SCALE can provide valuable information to clinical and public health practitioners focused on chronic disease prevention and management.

DSM-5 Alcohol Use Disorder Severity in Puerto Rico: Prevalence, Criteria Profile, and Correlates

BACKGROUND

Our aim was to examine lifetime criteria profiles and correlates of severity (mild, moderate, severe) of DSM-5 alcohol use disorders (AUD) in Puerto Rico.

METHODS

Data are from a household random sample of individuals 18 to 64 years of age in San Juan, Puerto Rico. The survey response rate was 83%. DSM-5 AUD was identified with the Spanish version of the World Health Organization's Composite International Diagnostic Interview. The analyses also identify correlates of each severity level using an ordered logistic regression model.

RESULTS

The prevalence of lifetime DSM-5 AUD among men and women was 38 and 16%, respectively. Mild lifetime DSM-5 AUD was the most prevalent severity level among both men (18%) and women (9%). The most common criteria, independent of gender and severity level, were drinking larger quantities and for longer than planned (men range: 80 to 97%; women range: 78 to 91%) and hazardous use (men range: 56 to 91%; women range: 42 to 74%). Results from ordered logistic regression showed that the adjusted odds ratio for weekly drinking frequency, greater volume of alcohol consumed per drinking occasion, positive attitudes about drinking, drinking norms, and male gender invariantly increased risks across all DSM-5 AUD severity levels (mild, moderate, severe). Greater negative attitudes about drinking, low family cohesion, and Protestant religion were related to greater risks at higher AUD severity levels.

CONCLUSIONS

AUD prevalence is high in San Juan, Puerto Rico. Prevalence rates for some criteria are equally high across severity levels and poorly differentiate between mild, moderate, or severe DSM-5 AUD. The sociodemographic and alcohol-related risks vary across DSM-5 severity levels.

Changing Racial/Ethnic Disparities in Heavy Drinking Trajectories Through Young Adulthood: A Comparative Cohort Study

BACKGROUND

There is evidence of racial/ethnic differences in the age at which young adults age out of heavy drinking. Some studies have found Black and Hispanic drinkers engage in more frequent heavy drinking than White people beyond adulthood. Yet, the alcohol-related disparities literature has produced contradictory findings on whether an age-crossover effect is evident among racial/ethnic groups; that is, whether racial/ethnic minorities' drinking levels or trajectories are lower than White people at young ages but later exceed (or crossover) those of White people. This study extends this scant literature by assessing whether racial/ethnic differences in heavy drinking have changed over time (possibly accounting for mixed findings from prior research); and tests for an age-crossover effect in heavy drinking using longitudinal data from 2 cohorts born 20 years apart.

METHODS

Data are from the 1979 (n = 10,963) and 1997 (n = 8,852) cohorts of the National Longitudinal Survey of Youth (NLSY). Generalized estimating equations were used to model trajectories of heavy drinking frequency from ages 17 to 31. Racial/ethnic differences were determined using sex-stratified models and 3-way interactions of race/ethnicity with age, age-squared, and cohort.

RESULTS

Racial/ethnic differences in heavy drinking trajectories have changed over time in men and women. In the older NLSY cohort, Hispanic men and Black women surpassed White men's and women's heavy drinking frequency by age 31. This crossover was absent in the younger cohort, where trajectories of all racial-sex groups converged by age 31. Normative trajectories have changed in Hispanics and White people of both sexes, with a delay in age of peak frequency, and greater levels of heavy drinking in the younger cohort of women.

CONCLUSIONS

Changes in heavy drinking trajectories over time suggest the need for targeted interventions during young adulthood. While disparities in young adult heavy drinking were no longer apparent in the more recent birth cohort, continued monitoring is important.

Factors Associated with Depression Among Mexican Americans Living in U.S.-Mexico Border and Non-Border Areas

Factors associated with CES-D depression among Mexican Americans living on and off the U.S.-Mexico border are examined. Data are from two studies of Mexican American adults. The Border Survey conducted face-to-face interviews in urban U.S.-Mexico border counties of California, Arizona, New Mexico, and Texas (N = 1307). The non-border HABLAS survey conducted face-to-face interviews in Houston, Los Angeles, New York, Philadelphia, and Miami (N = 1288). Both surveys used a multistage cluster sample design with response rates of 67 and 76 %, respectively. The multivariate analysis showed that border residence and higher perceived neighborhood collective efficacy were protective for depression among men. Among men, lower education, unemployment, increased weekly drinking, and poor health status were associated with depression. Among women, alcohol-related problems and poorer health status were also associated with depression. Further examinations of how neighborhood perceptions vary by gender and how these perceptions influence the likelihood of depression are warranted.

Alcohol misuse, depressive symptoms, and HIV/STI risks of US Hispanic women

OBJECTIVES

Alcohol misuse and depressive symptoms have been linked to HIV/STI risk, but studies have rarely included Hispanic women, who have over four times greater HIV incidence than white, non-Hispanic women. Understanding the connections among alcohol misuse, depressive symptoms, and HIV/STI risks may suggest ways to meet specific needs of Hispanic women. This study's objective is to examine the relationships among alcohol misuse, depressive symptoms, and seven HIV/STI risk factors.

DESIGN

Five hundred forty-eight US Hispanic women with intake data from a randomized trial were assessed for alcohol misuse (CAGE) and depressive symptoms (CES-D). GZLM and path analyses tested relationships between alcohol misuse or depressive symptoms and HIV/STI risk factors.

RESULTS

Self-efficacy and condom use were not related to alcohol misuse or depressive symptoms, but only 15% of women reported consistent condom use. After controlling for demographics, women with alcohol misuse had significantly more perceived HIV/STI risk (OR = 2.15) and better HIV/STI knowledge (β = -.54); and women with depressive symptoms had significantly more perceived HIV/STI risk (OR = 1.76) and worse HIV/STI knowledge (β = .37).

CONCLUSIONS

Interventions to increase condom use for Hispanic women are needed, regardless of mental disorders. Working with Hispanic women with alcohol misuse or depressive symptoms presents a need (and opportunity) to address issues directly related to HIV/STI risk. Women's health practitioners have an excellent opportunity to reach women by implementing regular screening programs in clinics that serve Hispanic women. For women with high depressive symptoms, poor HIV/STI knowledge should also be addressed. Future studies should test whether integrated and tailored risk reduction interventions affect these factors and lower HIV/STI risk for Hispanic women.

Burden of hepatocellular carcinoma among hispanics in South Texas: a systematic review

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the fastest rising causes of cancer-related mortality in the United States (U.S.). Despite improved HCC screening and surveillance guidelines, significant race/ethnicity-specific disparities in hepatocellular carcinoma remain, disproportionately affecting at risk racial minorities in the U.S. The current review aims to provide an updated analysis on race/ethnicity-specific disparities in HCC epidemiology with a focus on predisposing risk factors.

CONCLUSION

Among different race/ethnicities in the U.S., Hispanics experienced the greatest burden of HCC, particularly those residing in South Texas. It is important to understand that the underlying etiologies for these disparities are complex and multi-factorial. Some of these risk factors for developing chronic liver disease include non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and alcohol use. In addition, population genetics, acculturation of ethnic minorities, and access to healthcare may be further contributing to the observed disparities in HCC. By increasing awareness, improved modalities for screening and surveillance for HCC are important in guiding future research for targeted preventive and therapeutic interventions.

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.

Prevalence and predictors of drinking, binge drinking, and related health and social problems in Puerto Rico

BACKGROUND

This paper examines prevalence and predictors of drinking, binge drinking, and alcohol-related social and health problems in Puerto Rico.

METHODS

Respondents constitute a multi-stage household probability sample (N = 1,510) from San Juan, Puerto Rico. The response rate was 83%.

RESULTS

Men compared to women (Coeff: .34; 95 CI = .19-.50; p < .001), those with more liberal norms (Coeff: 1.05; 95 CI = .87-1.23; p < .001) and those with more positive attitudes about drinking (Coeff: 1.06; 95 CI= .63-1.49; p < .001) have a higher average number of weekly drinks. Those in the 40-49 age group have a lower mean number of weekly drinks than those in the 18-29 age group (Coeff.: -.23; 95 CI = -.42-.03; p < .02). Those with income between $30,001 and $40,000 a year compared to those with less than $10,000, (OR: .28; 95 CI = .08-1.93; p < .039) report fewer social/health problems. Protestants compared to Catholics (AOR: 1.94; 95 CI = 1.08-3.47; p < .026), those with more liberal drinking norms (AOR: 3.62; 95 CI = 1.87-6.99; p < .001) and more positive attitudes about drinking (AOR: 3.41; 95 CI = 1.04-11.09; p < .001), and those who consume a higher number of drink per week (AOR: 1.03; 95 CI = 1.01-1.05; p < .001) and binge (AOR: 3.52; 95 CI = 2.14-5.80; p < .001) are more likely to report social and health problems associated with alcohol use.

DISCUSSION AND CONCLUSIONS

The finding that male gender is not associated with binge drinking and social and health problems was not expected. Puerto Ricans appear to drink less than the general population and Hispanics and Puerto Ricans on the U.S. mainland.

SCIENTIFIC SIGNIFICANCE

Up to date epidemiological findings provide information about high risk groups and correlates of alcohol problems in the population. These are now available for Puerto Rico and can be used in the design of prevention interventions. (Am J Addict 2016;25:478-485).

Genome-wide significant loci for addiction and anxiety

BACKGROUND

Psychiatric comorbidity is common among individuals with addictive disorders, with patients frequently suffering from anxiety disorders. While the genetic architecture of comorbid addictive and anxiety disorders remains unclear, elucidating the genes involved could provide important insights into the underlying etiology.

METHODS

Here we examine a sample of 1284 Mexican-Americans from randomly selected extended pedigrees. Variance decomposition methods were used to examine the role of genetics in addiction phenotypes (lifetime history of alcohol dependence, drug dependence or chronic smoking) and various forms of clinically relevant anxiety. Genome-wide univariate and bivariate linkage scans were conducted to localize the chromosomal regions influencing these traits.

RESULTS

Addiction phenotypes and anxiety were shown to be heritable and univariate genome-wide linkage scans revealed significant quantitative trait loci for drug dependence (14q13.2-q21.2, LOD=3.322) and a broad anxiety phenotype (12q24.32-q24.33, LOD=2.918). Significant positive genetic correlations were observed between anxiety and each of the addiction subtypes (ρg=0.550-0.655) and further investigation with bivariate linkage analyses identified significant pleiotropic signals for alcohol dependence-anxiety (9q33.1-q33.2, LOD=3.054) and drug dependence-anxiety (18p11.23-p11.22, LOD=3.425).

CONCLUSIONS

This study confirms the shared genetic underpinnings of addiction and anxiety and identifies genomic loci involved in the etiology of these comorbid disorders. The linkage signal for anxiety on 12q24 spans the location of TMEM132D, an emerging gene of interest from previous GWAS of anxiety traits, whilst the bivariate linkage signal identified for anxiety-alcohol on 9q33 peak coincides with a region where rare CNVs have been associated with psychiatric disorders. Other signals identified implicate novel regions of the genome in addiction genetics.

The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science

Similar to non-Hispanic Blacks, Hispanics/Latinos experience a range of psychosocial and physical health challenges, including high rates of poverty, neighborhood segregation, discrimination, poor healthcare access, and high rates of obesity, diabetes, and undiagnosed and late-stage diagnosed diseases. Despite such risks, Hispanics generally experience better physical health and lower mortality than non-Hispanic Whites, an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. With the basic phenomenon increasingly well-established, attention now turns to the sources of such resilience. The current aims are to briefly examine the epidemiological paradox and highlight potential sociocultural resilience factors that may contribute to the paradoxical effects. We conclude with presentation of a framework for modeling sociocultural resilience and discuss future directions for psychological contributions.

Commentary on Caetano, Vaeth, Mills, and Canino (2016): Employment Status, Depression, Drinking, and Alcohol-Use Disorders in Puerto Rico

BACKGROUND

In this commentary, we discuss a study by Caetano and colleagues (in press) that examines the relation between depression, employment status, and drinking behaviors among adults (aged 18 to 64) living in San Juan, Puerto Rico.

METHODS

We discuss the contribution of Caetano and colleagues' (in press) study to the understanding of socioeconomic risk and protective factors associated with depression and drinking behaviors among Hispanics, specifically Puerto Ricans. We focus on 3 topics: (i) gender differences in the relation between depression and employment status, (ii) the relation between participation in the workforce and drinking behaviors, and (iii) the potential role of family and contextual factors mitigating the effects of unemployment on drinking behaviors.

RESULTS

Findings suggest that in Puerto Rico, employment status, although associated with depression and drinking behaviors, was not associated with alcohol-related outcomes.

CONCLUSIONS

Caetano and colleagues' (in press) article represents an important contribution to understanding differential effects in risk and protective factors associated with drinking behaviors and alcohol-related consequences among Hispanics. Future research should focus on examining the role of family and social support to mitigate the effects of unemployment, depression, and drinking behaviors among Puerto Ricans living in Puerto Rico.

An Investigation of the Relationship Between Alcohol Use and Major Depressive Disorder Across Hispanic National Groups

BACKGROUND

There has been consistent epidemiological evidence of the association between drinking, alcohol dependence, and depression. However, most of the research has ignored potential diversity across Hispanic national subgroups. This study examines the prevalence of depression and explores its association with volume of drinking, age at first drink, binge drinking, and alcohol dependence across Mexican American, Puerto Rican, Cuban, and South/Central American Hispanic national groups.

METHODS

Data from more than 19,000 Hispanic adults were obtained from the 2010 to 2012 National Survey on Drug Use and Health. Survey logistic regression methods were used to test for differences in the relationship between major depressive disorder (MDD) and alcohol consumption across national groups.

RESULTS

The prevalence of MDD varied significantly across Hispanic national groups (χ(2)  = 67.06, p < 0.001). Puerto Ricans (14%) and Mexican Americans (9%) were most likely to have MDD. Mexican Americans had the highest prevalence of alcohol dependence, volume of consumption, and youngest age at first drink compared to Puerto Ricans, Cuban Americans, and Central/South Americans. Multivariate results suggest that the odds of alcohol dependence were nearly 4 times greater among Hispanics with MDD compared to Hispanics who did not meet the criteria for MDD. Hispanic national origin did not modify the association between MDD and alcohol use.

CONCLUSIONS

Although significant differences in the prevalence rates of MDD and alcohol-use measures emerged across Hispanic national groups, there was no evidence that the relationships between these measures were different across Hispanic national groups. Further research should investigate the root causes of these variable MDD prevalence rates to inform detection and intervention efforts targeted toward specific national groups.

The Impact of Religious Coping on the Acculturative Stress and Alcohol Use of Recent Latino Immigrants

Religion plays a prominent role in Latino culture and could be influential during difficult life transitions, such as those experienced during the immigration process. This study examines relations between religious coping, acculturative stress, and alcohol use in a sample of 415 recent Latino immigrants. Higher levels of acculturative stress were associated more positive and negative religious coping. Positive religious coping was related to lower alcohol use. Negative religious coping moderated the relationship between acculturative stress and alcohol use. Participants who used more negative religious coping had higher rates of alcohol use when experiencing high levels acculturative stress. Implications for culturally tailored prevention/interventions are discussed.

Blood is thicker than booze: Examining the role of familism and gender in alcohol use and related consequences among Hispanic college students

The present study evaluated cultural, ethnic, and gender differences in drinking and alcohol-related problems among Hispanic students. Familism protects against negative outcomes in Hispanic populations, thus we expected familism to buffer against alcohol problems. Participants (N = 623; 53% female) completed a battery of measures. Results suggested that familism was protective against drinking. Furthermore, alcohol use mediated the association between familism and alcohol-related problems. In sum, understanding that culture plays an important role in people's behaviors and identifying protective factors is critical to inform culturally sensitive prevention and intervention efforts.

Ethnic drinking cultures, gender, and socioeconomic status in Asian American and Latino drinking

BACKGROUND

Heterogeneity in drinking across national groups is well documented, but what explains such heterogeneity is less clear. To improve understanding of the underlying cultural conditions that may lead to diverse drinking outcomes, we investigate whether 3 dimensions of ethnic drinking culture (EDC)-alcohol consumption level, drinking prevalence, and detrimental drinking pattern (DDP) in the country of origin (COO)-are significantly associated with alcohol consumption in Asian Americans and Latina/os, and whether the associations vary by gender and socioeconomic status (SES) as assessed by educational level.

METHODS

A nationally representative sample of 1,012 Asian American and 4,831 Latino adults extracted from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions data was used. A series of multiple logistic and linear regression models were fitted separately for Asian Americans and for Latinos. Analyses were also stratified by gender and educational level.

RESULTS

Overall, the associations between EDC variables and drinking outcomes were more pronounced for all Asian Americans than for all Latina/os, for males than for females among Asian Americans, and for Latinas than for Latinos. In analyses simultaneously stratifying on gender and education level, however, there was a clear pattern of COO DDP associated with heavier drinking and alcohol consumption volume only for Latinos without a college degree.

CONCLUSIONS

Ethnic drinking cultures may influence drinking in Asian American and Latino subgroups, albeit to a varying degree. Low-SES Latinos may be at disproportionate risk of harmful drinking patterns pervasive in their COO. Future research might investigate the complex interplay between socioeconomic disadvantage and cultural conditions to inform targeted interventions for subgroups at high risk of alcohol-related harms.

Non-communicable diseases and preventive health behaviors: a comparison of Hispanics nationally and those living along the US-Mexico border

BACKGROUND

Non-communicable diseases (NCDs) are rising among US Hispanics, but few studies have examined the preventive health behaviors for these NCDs among Hispanics. This study compared the preventive health behaviors of smoke-free living, physical activity, fruit and vegetable consumption, and avoidance of heavy alcohol use in Hispanics in the United States and Hispanics living along the US-Mexico border.

METHODS

Two weighted data sets with information on Hispanic populations were analyzed: 1) the national Behavioral Risk Factor Surveillance Survey (n = 29,942) from 2009; and 2) the Cameron County Hispanic Cohort (n = 1,439) recruited from the US-Mexico border between 2008-2011. To compare the preventive health behaviors of the samples, within a generalized estimating equation framework, weighted univariate and multivariate logistic regression analyses were conducted controlling for age, educational attainment, employment, language, and insurance status. Statistical tests were two-sided with a significance level set at 0.05.

RESULTS

Both samples reported low engagement in preventive behaviors. However, Hispanic males and females from the US-Mexico border were significantly less likely than the national sample to meet physical activity and fruit and vegetable consumption guidelines. Also, Hispanic males from the US-Mexico border were more likely to engage in heavy alcohol use.

CONCLUSION

The lack of preventive health behaviors among Hispanics living along the US-Mexico border presents a dire prospect for NCD control in the region. Multipronged approaches to address multiple behaviors should be considered.

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.

An assessment of individual-level factors associated with alcohol treatment utilization among Mexican Americans

The purpose of this study is to identify enabling factors for treatment utilization for alcohol-related problems, and to evaluate how enabling factors vary by need for treatment, among two samples of Mexican American adults. These two distinct samples included 2,595 current and former drinkers (one sample included 787 U.S./Mexico border residents; the other sample included 740 Mexican Americans living in U.S. cities not proximal to the border). Need for treatment (alcohol disorder severity) and (male) gender were the primary correlates of treatment utilization; and there was no moderation in the enabling factors by need for treatment as "enablers" of utilization. Further theoretical and empirical research is necessary to determine which mechanisms are driving disparities in treatment utilization across racial/ethnic groups generally, and Hispanic national groups specifically.

Ethnicity and alcohol consumption among US adults with diabetes

PURPOSE

The drinking practices of a nationally representative sample of white, black, Mexican American, and other Hispanic adult diabetics are described and compared.

METHODS

Combined years (2005/2006-2011/2012) of the National Health and Nutrition Examination Survey provided home interview data from 2220 adults with self-reported diabetes of white (n = 875), black (n = 720), Mexican American (n = 402), and other Hispanic (n = 223) ethnicity. Current drinking status, the number of drinks consumed per week, and binge drinking were compared across ethnicity.

RESULTS

The multivariate findings for both diabetic men and women showed no statistically significant ethnic differences in current drinking status, and among women, there were no statistically significant ethnic differences in binge drinking. Among male diabetics, Mexican Americans consumed more drinks per week than whites (b = 0.35; 95% confidence interval, 0.13-0.58; P = .002) and were at increased risk for binge drinking (odds ratio, 2.04; 95% confidence interval, 1.30-3.21; P = .002).

CONCLUSIONS

Binge drinking is prevalent among Mexican American male diabetics. This pattern of drinking may put them at risk for poor diabetes management and control. It is important that health care providers routinely assess their patients' drinking practices and address the health risks associated with alcohol consumption.

Incidence of alcohol use disorders among Hispanic subgroups in the USA

OBJECTIVE

Hispanics are the largest ethnic minority group in the USA and a fairly heterogeneous group. But this heterogeneity has usually been ignored by grouping them into a single category. The objective of this study is to challenge that practice by providing alcohol use disorders (AUD) incidence and risk estimates across Hispanic subgroups.

METHODS

A subsample of Hispanics (n = 2371) and non-Hispanic whites (n = 7741) at risk for AUD who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions was analyzed. Weighted incidence for AUD was calculated across Hispanic subgroups. A weighted modified Poisson generalized linear model was used to estimate relative risks.

RESULTS

Compared with non-Hispanic whites, Puerto Ricans have the highest AUD incidence (3.6%; 95% CI: 0.5, 6.7) followed by Mexican-Americans (2.5%; 95% CI: 1.5, 3.6), Other Hispanics (1.6%; 95% CI: 0.1, 3.1) and Cuban-Americans (0.6%; 95% CI: 0.1, 1.2). In contrast, weighted adjusted relative risk estimates for Mexican-Americans were (RR = 3.2; 95% CI: 1.7, 6.2) but for Puerto Ricans (RR = 2.2; 95% CI: 1.0, 5.0) it was somewhat attenuated but still significant (P = 0.049). No difference was found for Cuban-Americans or Other Hispanics.

CONCLUSIONS

The annual incidence and risk for AUD varies greatly among Hispanic subgroups. Nonetheless, the practice of categorizing Hispanics as a homogenous ethnic group still continues. Our findings suggest that this practice is not only inappropriate, but also hinders a better understanding of AUD etiology, prevention, treatment and rehabilitation in the largest ethnic minority group in the USA.

Age at first drink, drinking, binge drinking, and DSM-5 alcohol use disorder among Hispanic national groups in the United States

BACKGROUND

This article examines age at first drink and adult drinking, binge drinking and DSM-5 alcohol use disorder (AUD) among U.S. Hispanic national groups.

METHODS

Respondents come from 2 independent studies. The Hispanic Americans Baseline Alcohol Survey used a multistage cluster sample design to interview 5,224 individuals 18 years of age and older selected from the household population in Miami, New York, Philadelphia, Houston, and Los Angeles. Respondents in the border area (N = 1,307) constituted a household probability sample of Mexican Americans living on U.S. counties that border Mexico. In both surveys, data were collected during computer-assisted interviews conducted in respondents' homes. The Hispanic American Baseline Alcohol Survey and the border sample response rates were 76 and 67%, respectively.

RESULTS

U.S.-born Hispanics begin drinking at a younger age than those who are foreign-born, independent of national group. Among foreign-born Hispanics, age of arrival in the United States is not associated with age at first drink. Results support the hypothesis that a younger age at first drink is associated with a higher mean volume of drinking, a higher probability of bingeing, and a higher probability of DSM-5 AUD. But the results do not show a clear pattern by which a particular national group would consistently show no associations or stronger associations between age at first drink and the alcohol-related outcomes under consideration.

CONCLUSIONS

An earlier age at first drinking is positively associated with heavier drinking patterns among U.S. Hispanics. However, as in other areas of alcohol epidemiology, here too there is considerable variation in age at first drink and drinking across Hispanic national groups.

CHRNA5 and CHRNA3 variants and level of neuroticism in young adult Mexican American men and women

A lifetime history of alcohol dependence has been associated with elevations in neuroticism in Mexican American young adults. The identification of genetic markers associated with neuroticism and their influence on the development of alcohol use disorders (AUD) may contribute to our understanding of the relationship between personality traits and the increased risk of AUD in Mexican Americans. The purpose of this study was to investigate associations between neuroticism and 13 single nucleotide polymorphisms (SNPs) in the nicotinic acetylcholine (nAChR) α5-subunit (CHRNA5) and α3-subunit (CHRNA3) genes in young adult Mexican American men and women. Participants were 465 young adult Mexican American men and women who are literate in English and are residing legally in San Diego County. Each participant gave a blood sample and completed a structured diagnostic interview. Neuroticism was assessed using the Maudsley Personality Inventory. The minor alleles of four CHRNA5 polymorphisms (rs588765, rs601079, rs680244 and rs555018) and three CHRNA3 polymorphisms (rs578776, rs6495307 and rs3743078) showed associations with neuroticism. Several of these SNPs also displayed nominal associations with DSM-IV alcohol and nicotine dependence, but tests of mediation suggested that these relations could be partially explained by the presence of co-occurring neuroticism. These findings suggest that genetic variations in nicotinic receptor genes may influence the development of neuroticism, which in turn is involved in the development of AUDs and nicotine dependence in Mexican American young adults.

Epidemiology of drinking, alcohol use disorders, and related problems in US ethnic minority groups

This chapter reviews selected epidemiologic studies on drinking and associated problems among US ethnic minorities. Ethnic minorities and the White majority group exhibit important differences in alcohol use and related problems, including alcohol use disorders. Studies show a higher rate of binge drinking, drinking above guidelines, alcohol abuse, and dependence for major ethnic and racial groups, notably, Blacks, Hispanics, and American Indians/Alaskan Natives. Other problems with a higher prevalence in certain minority groups are, for example, cancer (Blacks), cirrhosis (Hispanics), fetal alcohol syndrome (Blacks and American Indians/Alaskan Natives), drinking and driving (Hispanics, American Indians/Alaskan Natives). There are also considerable differences in rates of drinking and problems within certain ethnic groups such as Hispanics, Asian Americans, and American Indians/Alaskan Natives. For instance, among Hispanics, Puerto Ricans and Mexican Americans drink more and have higher rates of disorders such as alcohol abuse and dependence than Cuban Americans. Disparities also affect the trajectory of heavy drinking and the course of alcohol dependence among minorities. Theoretic accounts of these disparities generally attribute them to the historic experience of discrimination and to minority socioeconomic disadvantages at individual and environmental levels.

Acute alcohol intoxication and suicide among United States ethnic/racial groups: findings from the national violent death reporting system

BACKGROUND

To assess the prevalence and sociodemographic correlates of suicide involving acute alcohol intoxication among U.S. ethnic minorities.

METHODS

Data were derived from the restricted 2003 to 2009 National Violent Death Reporting System. The study focused on the sociodemographic and toxicological information of 59,384 male and female suicide decedents for 16 states of the United States. Acute alcohol intoxication was defined as having a blood alcohol content (BAC) ≥0.08 g/dl. Overall, 76% of decedents were tested for the presence of alcohol.

RESULTS

The proportion of suicide decedents with a positive BAC ranged from 47% among American Indians/Alaska Natives (AIs/ANs) to 23% among Asians/Pacific Islanders (PIs). Average BAC was highest among AIs/ANs. Among those who were tested for BAC, the proportion of decedents legally intoxicated prior to suicide was as follows: Blacks, 15%; AIs/ANs, 36%; Asians/PIs, 13%; and Hispanics, 28%. Bivariate associations showed that most suicide decedents who were legally intoxicated were male, younger than 30 years of age, with a high school education, not married, nonveterans, lived in metropolitan areas, and used a firearm to complete suicide. However, with the exception of Whites, most of these associations became not statistically significant in multivariate analysis.

CONCLUSIONS

Alcohol use and legal intoxication prior to completing suicide are common among U.S. ethnic groups, especially among men and those who are younger than 30 years of age. The AI/AN group had the highest mean BAC, the highest rate of legal intoxication and decedents who were particularly young. Suicide prevention strategies should address alcohol use as a risk factor. Alcohol problems prevention strategies should focus on suicide as a consequence of alcohol use, especially among AI/AN youth and young adults.

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.

Alcohol-related social problems among Mexican Americans living in U.S.-Mexico border and non-border areas

This paper examines alcohol-related social problems among Mexican Americans living along the U.S.-Mexico border and in non-border areas. Interviews were conducted among Mexican Americans in the border regions of California, Arizona, New Mexico, and Texas (N=1307). Non-border respondents were interviewed primarily in Houston and Los Angeles (N=1288) as part of the Hispanic Americans Baseline Alcohol Survey (HABLAS). Both the border and HABLAS surveys employed multistage cluster sample designs (response rates were 67% and 76%, respectively). In the bivariate analysis, there were no significant differences between border and non-border areas in the proportion of those with one or more social problem. In non-border areas, the prevalence of alcohol problems did not differ significantly by age. However, along the border the prevalence of alcohol problems was significantly different across age groups, with 18 to 29year old men and women having the highest prevalence. The final models showed no residence effect on problem likelihood. Drinking was strongly associated with problems. Although young border residents had higher problem prevalence rates than older residents, the logistic regression models showed no effect of border residence on the likelihood of problems, indicating that problems are due to alcohol consumption, not the border environment. The border, however, did appear to influence more drinking among young people. Regardless of residence, alcohol treatment and preventive interventions tailored to Mexican Americans are essential and special attention should be focused on younger individuals near the border.