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

Nativity and the risk of opioid use disorder among Hispanic/Latinx women in primary care in Los Angeles, CA

BACKGROUND

While rates of opioid use disorder (OUD) are lower among women compared to men, nativity may have disproportionate impacts on OUD risk among Hispanic/Latinx women but remain understudied.

OBJECTIVE

To assess the association between country of birth and reported OUD risk among low-income Hispanic/Latinx women in primary care in Los Angeles, CA.

METHODS

This was a cross-sectional study of 1189 non-pregnant, Hispanic/Latinx women attending two federally qualified health centers in Los Angeles between March and July 2013. OUD risk was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and moderate-to-high risk was defined as ASSIST score ≥ 4.

RESULTS

Overall, 4.2% of women (n = 49) were at moderate-to-high risk for OUD. Risk for OUD was higher among US-born women compared to foreign-born women (6.7 vs. 1.7%; p < .01), those who reported 2+ chronic medical conditions (p < .01), and those who were at moderate-to-high risk for other substance use disorders (p < .01). In multivariable logistic regression analyses, being U.S.-born was independently associated with being at moderate-to-high risk for OUD among Hispanic/Latinx women as compared to those who were foreign-born (AOR = 2.8; 95% CI 1.2-6.8).

CONCLUSION

Among low-income Hispanic/Latinx women presenting to primary care, one in twenty patients is at-risk for OUD. The odds of moderate-high risk of OUD were three times as high in US-born compared to foreign-born women, and higher among those with chronic medical conditions and those at risk of other substance use disorders. Gender-specific and culturally-tailored screening for OUD may inform overdose prevention interventions for US-born Hispanic/Latinx women.

Intersectional forms of racism and sexual minority stress are associated with alcohol use among Latinx sexual minority men with greater Hispanic/Latinx cultural orientation

Background: Latinx sexual minorities with increased levels of acculturation report higher rates of alcohol use, and discrimination may impact this association. Yet, there is little research examining the concomitant impact of racism and sexual minority stress (i.e. intersectional discrimination) and the additive effect of acculturation on Latinx sexual minority men's risk for hazardous alcohol consumption.Objectives: This study investigated the role of perceived stressfulness of intersectional discrimination in the relation between acculturation (US cultural orientation/Hispanic cultural orientation) and alcohol use among Latinx sexual minority men.Methods: A structural equation model was utilized to test the indirect effect of discrimination between acculturation and alcohol use with a sample of 357 Latinx sexual minority men (M_age = 28.39) recruited via Amazon MTurk.Results: The indirect effect between the Hispanic cultural orientation to alcohol use through intersectional forms of discrimination was significant and positive (b = .19, SE = .03, p < .01). The indirect effect for the US cultural orientation to alcohol use through intersectional forms of discrimination was significant and negative (b = -.10, SE = .03, p < .01).Conclusion: Contrary to previous literature, Latinx sexual minority men with a higher Hispanic cultural orientation reported higher levels of intersectional forms of discrimination, which in turn was associated with increased alcohol use. Those with a higher US cultural orientation reported lower levels of intersectional forms of discrimination, which in turn was associated with decreased alcohol use. These findings may help identify mechanisms that exacerbate health disparities for Latinx sexual minority men.

Addressing social stressors in a brief motivational interview improve mental health symptoms for Latinx heavy drinkers

OBJECTIVE

Depressive and anxiety symptoms co-occur with hazardous drinking among Latinxs. This secondary analysis of a clinical trial to reduce hazardous drinking (motivational interviewing adapted to address social stressors [CAMI] vs. motivational interviewing [MI]) examined effects on anxiety/depressive symptoms. Discrimination and acculturation were examined as moderators.

METHODS

Latinx (n = 296) hazardous drinkers (2+ occasions/month of heavy drinking; 4/5 drinks/occasion, females/males) were randomized to CAMI/MI. Generalized estimating equations analyzed how treatment conditions and interactions were related to depressive and anxiety symptoms after controlling for covariates.

RESULTS

Baseline symptoms (anxiety, depression) exceeded clinical thresholds (Anxiety ≥8, M = 14.62, SD = 13.52; Depression ≥ 12, M = 18.78, SD = 12.57). Cultural adaptation of motivational interviewing (CAMI) showed significantly lower anxiety and depressive symptoms (6/12 months, respectively) than MI. CAMI with high baseline discrimination reported significantly less depression than MI (12 months).

CONCLUSIONS

Explicitly addressing social stressors may be a beneficial adjunct to treatment for Latinx drinkers.

Alcohol use severity among Hispanic emerging adults: Examining the roles of bicultural self-efficacy and acculturation

OBJECTIVE

This study aimed to (1) examine respective associations of acculturation orientations (e.g., U.S. orientation and Hispanic orientation) and domains (e.g., social groundedness and role repertoire) of bicultural self-efficacy, the perceived confidence to function effectively within the receiving culture and the heritage culture, with alcohol use severity among Hispanic emerging adults. This study also aimed to (2) examine potential moderating factors of respective associations among acculturation orientations and bicultural self-efficacy with alcohol use severity.

METHOD

200 Hispanic emerging adults from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey. Inclusion criteria were being ages 18-25, self-identify as Hispanic or Latina/o, and currently living in Maricopa County or Miami-Dade County. Data were analyzed using hierarchical multiple regression and moderation analyses.

RESULTS

Findings indicate that neither of the acculturation orientations nor role repertoire had main effects with alcohol use severity. However, higher social groundedness was associated with lower alcohol use severity. Moderation analyses indicate that the interaction between the U.S. orientation and study site and the interaction between the Hispanic orientation and social groundedness were statistically significant in relation to alcohol use severity.

CONCLUSIONS

Considering that the U.S. orientation was associated with alcohol use severity only in Arizona highlights the need for multisite studies on acculturation. Our findings demonstrate that other sociocultural processes such as acculturation can impact bicultural self-efficacy; and that the association between bicultural self-efficacy and alcohol merits further investigation. However, more thorough assessments of bicultural self-efficacy are needed to better understand its effects on alcohol.

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.

Covariates of hazardous alcohol use among sexual and gender minorities in Texas: Identifying the most vulnerable

BACKGROUND

Information is limited on the prevalence of hazardous drinking and associated covariates among sexual and gender minority (SGM) persons. These analyses estimated the prevalence of hazardous drinking and identified associated covariates.

METHODS

A total of 1273 SGM adolescents and adults living in Texas completed an online survey between March 2016 and January 2017. Variables associated with hazardous drinking at the bivariate-level (p < 0.10) were entered into multiple logistic regression models to estimate the strength of their association.

RESULTS

More than a third (39.1%) of participants meet criteria for hazardous drinking. Compared to non-hazardous drinkers, hazardous drinkers were younger (x- = 20.7 [SD = 8.9] vs. x- = 26.5 [SD = 13.8]) and more likely to be Hispanic (41.5% vs. 26.2%). Hazardous drinkers were more likely to report using substances in past 12 months, including opioids (15.3% vs. 6.7%), stimulants (26.3% vs. 12.7%), and marijuana (37.6% vs. 21.2%). More hazardous drinkers reported injecting drugs (12.3% vs. 5.8%) and having a history of incarceration (14.1% vs. 7.3%). They were less likely to be diagnosed with depression (50.2% vs. 56.5%). When entered into a multivariate logistic regression model, hazardous drinkers were more likely to be younger (aOR = 0.97 [0.95, 0.98]), Hispanic (aOR = 1.5 [1.2, 2.0]), have a history of incarceration (aOR = 2.4 [1.5, 3.6]), and use a substance, not including marijuana (aOR = 1.7 [1.3, 2.3]). They were less likely to be diagnosed with depression (aOR = 0.73 [0.6, 0.9]).

CONCLUSIONS

Our findings highlight the intersection of race and ethnicity, mental health, criminal justice involvement, and substance use and the need for tailored interventions that address underlying determinants.

A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs

OBJECTIVE

This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored.

METHOD

Latinxs (N = 296; 63% male, M age = 41 years) who reported 2+ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months.

RESULTS

Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d = .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d = .34, 95% CI [-.60, -.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d = .17, 95% CI [-.33, -.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d = .20, 95% CI [-.39, -.01]).

CONCLUSIONS

Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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

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

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

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

Child Sexual Abuse and Adult Mental Health, Sexual Risk Behaviors, and Drinking Patterns Among Latino Men Who Have Sex With Men

One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals' likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.

Depressive symptom domains and alcohol use severity among Hispanic emerging adults: Examining moderating effects of gender

OBJECTIVE

A limited amount of research has examined the effects of unique depressive symptom domains on alcohol use behavior among Hispanics of any developmental stage. This study aimed to (a) examine the respective associations between depressive symptom domains (e.g., negative affect, anhedonia, interpersonal problems, and somatic complaints) and alcohol use severity among Hispanic emerging adults, and (b) examine if gender moderates each respective association.

METHOD

181 Hispanic emerging adults (ages 18-25) completed an anonymous cross-sectional online survey. Participants completed a demographic questionnaire, the Alcohol Use Disorder Identification Test, and the Center Epidemiological Studies Depression Scale. Hierarchical multiple regression was used to estimate respective associations of negative affect, anhedonia, interpersonal problems, and somatic complaints in relation to alcohol use severity. Moderation tests were also conducted to examine if gender functioned as an effect modifier between respective depressive symptom domains and alcohol use severity.

RESULTS

Findings indicated higher levels of anhedonia were associated with higher alcohol use severity (β=0.20, p=0.02). Moderation analyses indicated that somatic complaints (β=-0.41, p=0.02) and interpersonal problems were associated with greater alcohol use severity among men (β=-0.60, p<0.001), but not women.

CONCLUSIONS

Findings underscore the need to examine the relationship between specific depressive symptom domains and alcohol use; and the importance of accounting for potential gender differences in these associations.

Substance use and treatment outcomes among Spanish-speaking Latino/as from four acculturation types

The purpose of this study was to examine the association of acculturation with substance use treatment outcomes in a sample of treatment-seeking Latino/as (N = 405). The study used data from a multisite randomized controlled trial of a culturally adapted version of Motivational Enhancement Therapy delivered in Spanish. Berry, Kim, Minde, and Mok's (1987) acculturation model was used to divide the sample into 4 types (integrated, assimilated, separated, marginalized), based on Bicultural Involvement Questionnaire scores. One-way analyses of variance, chi-squared tests, and repeated-measures regression were used to examine baseline acculturation, posttreatment outcomes, and follow-up outcomes. All participants were of Latino/a background, and 88.4% of the sample was male. Participants with greater acculturation to American culture (i.e., integrated and assimilated acculturation types) reported more substance use and associated problems at baseline, χ²(3) = 20.5, p < .001, with the integrated type reporting the highest percentage of substance use disorder symptoms and problems (67.6%). No significant differences in substance use were detected among acculturation types posttreatment or at follow-up. Although the integrated and assimilated acculturation types were associated at baseline with more substance use and associated problems, all acculturation types seemed to benefit at posttreatment from an evidence-based culturally adapted treatment. (PsycINFO Database Record