Pre- and Post-Immigration Correlates of Alcohol Misuse among Young Adult Recent Latino Immigrants: An Ecodevelopmental Approach

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.

Impact of legal status regularization on undocumented migrants’ self-reported and mental health in Switzerland

Undocumented migrants face cumulative difficulties like precarious living and working conditions or exclusion from health services that might negatively influence their health. Little is known about the evolution of undocumented migrants' self-reported health (SRH) and mental health after they get documented. This study aims to observe the effect of legal status regularization on SRH and mental health in a cohort of migrants undergoing regularization in Geneva, Switzerland. We evaluate SRH with the first item of the Short Form Survey (SF12) and depression as a proxy of mental health with the PHQ-9 questionnaire over four years among 387 undocumented and newly documented migrants. Using hybrid linear models, our data show that regularization has no direct effect on SRH, but has direct positive effects on mental health in a longitudinal perspective, even when controlling for competing factors. The arrival of the pandemic did not alter these effects. Migrants tend to evaluate their subjective health status more positively than the prevalence of screened depression shows. Those findings point towards better targeted policies that could reduce the burden of depression among undocumented migrants.

Alcohol use among adult recent Latino/a immigrants: the role of stress, forced migration, and adherence to traditional gender roles

Background: Previous research conducted among Latino/a immigrants has shown the underlying effect that exposure to stress after immigrating to the U.S. (i.e. health access, racial/ethnic discrimination, and language barriers) has on alcohol use patterns. However, given the demographic shifts in recent immigrants, understanding the influence of stress before (i.e. poverty, healthcare, and educational opportunities) and after immigration on their alcohol use (i.e. alcohol consumption and drinking behaviors in the past 12 months) in the context of migration and traditional gender roles is warranted.Objectives: To examine the (a) cumulative effects of pre- to post-immigration stress, (b) respective moderating effects of traditional gender roles, and (c) forced migration on alcohol use for men and women.Methods: Hierarchical multiple regression and moderation analyses were conducted on a cross-sectional sample of 529 (N = 268 men, N = 261 women) adult (18-34 years) from recent Latino/a immigrants in South Florida.Results: Gender had a statistically significant difference on alcohol use, (F 527) = 18.68, p < .001, with men (p = 4.36 ± SE =.22) reporting higher alcohol use than women (p = 3.08 ± SE =.20). Post-immigration stress (β = .12, p = .03) but not pre-migration stress had a statistically significant association with alcohol use. There is no interaction effect by traditional gender roles and forced migration on the associations between pre- to post-immigration stress and alcohol use.Conclusion: Results suggest that post-immigration stress may be a reasonable intervention target to mitigate alcohol use among recent Latino/a immigrants, particularly among men.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Early trajectories of cigarette and ENDS use among young adult recent Latino immigrants to U.S

Background: Recent Latino immigrants (RLIs) to the U.S. have shown high smoking rates during their first year since arrival, raising concern about future escalation of tobacco use.Objective: To examine trajectories of cigarette and Electronic nicotine delivery systems (ENDS) use among RLIs from pre-immigration (T0) through their first (T1) and second (T2) year in the U.S.Methods: Data originated from a longitudinal study of 540 (50% females) RLIs aged 18-34. Inclusion criteria was residing in Miami/Dade County (MDC), and having immigrated from a Latin American country within the past year. Trajectories were identified by using the Proc Traj procedure (SAS©, v 9.4).Results: Rates of cigarette use per month declined from 11.8 days/month in T0 to 4.9 d/m in T2. Rates for ENDS use however, increased from T0 (1.1 d/m) to T1 (1.8 d/m) and then lowered back to 0.9 d/m in T2. Four separate cigarette and e-cigarette use trajectories were identified. Only one of them showed increase in cigarette (10.6% of RLIs), and ENDS use (4.5% of RLIs). Being male, and not completing high school were significant factors in explaining smoking trajectories. Being younger than 30 years old was largely associated with ENDS use. No evidence of a substitution effect between cigarette and ENDS use was found.Discussion/Conclusions: Interventions to discourage tobacco use among Latino immigrants should begin early in the immigration process, aimed to preserve initial reductions and dissuade those at risk of increased tobacco use overtime.

Mapping Problematic Drinking Trends over Time in Urban, Semi-Urban, and Rural Populations

Current alcohol public health policy in Australia is not uniform but is generally focused on restricting access and early prevention of problematic alcohol use. Semi-urban and rural populations are at greater risk of disease and other poor health outcomes due to a variety of factors. Little is known about problematic drinking patterns over time in semi-urban and rural populations. This study aims to assess patterns of problematic drinking defined as both long-term risky and heavy episodic drinking over time by age, sex, and mental health status among urban, semi-urban and rural populations). Four waves (2004 to 2016) of the Australian NDSHS (National Drug Strategy Household Survey) were analyzed to assess problematic drinking of participants over 18 years of age. We used regression models and predictive margins to identify trends in problematic drinking over time based on age, sex, and mental health status. Our results show young adults across all regions, males, and mentally well individuals in urban areas have reductions in the risk of problematic drinking over time. Middle-aged adults across all regions, females, and those with varying mental health presentations in rural areas have some increases in risk of problematic drinking over time. The general conclusion is that targeted alcohol-related public health policy may need to change and focus on females, middle-aged individuals, and those living in rural areas. Programs to support problematic drinking in people with mental health disorders may also need to be a priority.

Prescription Drug and Cannabis Use among Recent Latinx Immigrants Pre- and Post-Immigration to the US

Introduction: Shifts in the sociopolitical context of Latin America have led to steep increases in recent Latinx immigrants (RLI) arriving in the US within the context of forced migration. Yet, little is known about how adverse experiences of RLIs before and after immigration may impact their health including drug use. The purpose of this study was to examine prescription drug and cannabis use before and just after immigration among RLIs and how this drug use is influenced by pre-and post-immigration factors. Methods: This study utilized baseline data from a study examining pre- to post-immigration drinking and driving trajectories among RLI in the United States (US). Baseline criteria included: self-identifying as a Latinx immigrant, 18 - 34 years old, who recently immigrated from a Latin American country. Multivariate logistic regression was conducted to determine predictors of drug use both prior to and after immigrating. Results: There were 540 RLI, 50.2% male and 47.8% subjected to forced migration. Prescription and illicit drug use decreased post-immigration with sedatives being the most common. Higher levels of education was associated with increased odds of pre-immigration prescription drug use and cannabis use. Those experiencing forced migration were more likely to engage in prescription drug use before and after immigration, while no associations were found for cannabis use. Conclusion: Findings suggest a need for increased substance use and mental health services among RLIs arriving within the context of forced migration. More research is needed to understand the trajectories of drug use among RLI as their time in the US increases.

Alcohol use severity among recent Latino immigrants: Associations of acculturation, family history of alcohol use and alcohol outcome expectancies

Having a family history of alcohol (FH+) use is a well-documented risk factor for alcohol use and alcohol related problems. However, there are limited studies examining the impact of FH + on current alcohol use among Latino immigrants. This study aimed to determine the influence of having a FH + on current alcohol use among Latino immigrants and the influence of alcohol outcome expectancies (AOEs) and acculturation on this relationship. This is a longitudinal secondary data analysis of data from the Recent Latino Immigrant Study (RLIS), the first community-based cohort study to examine pre- to post-immigration alcohol use trajectories of young adult Latino immigrants. Linear mixed models were performed to assess the association between various pre- and post-immigration factors and alcohol use among Latino immigrants. There were 518 young adult Latino immigrants with 18.7% reporting a FH + with those with a FH + having higher mean AUDIT score compared to those without (4.74 vs. 3.81; p = 0.028). Positive AOEs were associated with increase AUDIT scores. FH + individuals with greater positive AOEs experienced higher AUDIT scores compared to FH- individuals. Family cohesion was protective against alcohol use while endorsement of Americansism was associated with increased alcohol use. Theses results provide the framework for more in-depth exploration regarding the influences of FH+, AOEs, and acculturation have on the alcohol use among Latino immigrants. Future longitudinal research studies should account for whether traditional cultural values mediate or moderate the relationship between a FH+, AOE, and alcohol use of Latino immigrants.

Undocumented immigrants and mental health: A systematic review of recent methodology and findings in the United States

This study reviewed the methodology and findings of 44 peer-reviewed studies on psychosocial risk factors associated with mental health outcomes among undocumented immigrants (UIs) in the United States. Findings showed a considerable advancement over the past seven years in the methods and measures used in the included studies. Nonetheless, there is a need for continued methodological rigor, innovative study designs, greater diversity of samples, and in-depth exploration of constructs that facilitate resilience. Identifying avenues to reduce risk in this population is essential to inform intervention and advocacy efforts aimed at overcoming distress from the current U.S. anti-immigrant and socio-political climate.

Socio-Cultural Subgroups of Latina/o Immigrants: A Latent Profile Analysis

Socio-cultural factors, such as familismo, social support, machismo, and multigroup ethnic identity, are strongly associated with Latina/o immigrants' alcohol misuse and depressive symptoms. However, research has rarely explored whether unobserved groups of Latina/o immigrants with similar socio-cultural factors exist. Latent Profile analysis can illuminate which subgroups to target, or which socio-cultural factors need to be supported, to have an impact on the prevention and treatment of alcohol use and/or depression in the Latina/o immigrant population. Cross sectional data from on ongoing longitudinal investigation was utilized (N= 518 Latina/o adults living in Miami-Dade County, Florida and have immigrated to the US within one year prior to assessment). Latent Profile Analyses (LPA) were conducted utilizing validated measures of familismo, social support, neighborhood collective efficacy, ethnic identity, machismo, caballerismo, and marianismo. The LPA revealed three, significantly different profiles: (1) low socio-cultural protection (n=155, 29.98%), (2) high socio-cultural protection (n=21, 4.06%), and (3) high socio-, low-cultural protection (n=341, 65.96%). Profile membership was associated significantly with immigrant documentation status, education level, and past family history of substance use. Results indicate that Latina/o immigrants in the low socio-cultural protection group had significantly higher alcohol use compared to high socio-, low cultural protection group. No significant differences were found for depressive symptoms. We discuss implications of our findings and encourage researchers to continue to unpack the complexities associated with socio-cultural factors and Latina/o mental and behavioral health. Specifically, research should focus on socio-cultural factors can provide protection from negative health outcomes and increase resiliency among this population.

The Association Between Social Support and Psychological Distress in Latina Mothers Living in Miami-Dade County, Florida

BACKGROUND

This study analysed the relationship between social support and psychological distress in Latina women in Miami-Dade County. Acculturation was examined as a modifying factor.

METHODS

A 2005 data set from interviews of 155 Latina mothers in Miami-Dade County, from mother-daughter dyads, was analysed. Social support was measured using the Interpersonal Support Evaluation List (ISEL) score. Psychological distress was based on self-reporting symptoms of depression, anxiety, or suicidality. Acculturation was based on English proficiency and length of U.S. residency.

RESULTS

Compared to those with high social support, women with low social support had greater odds of reporting psychological distress (odds ratio = 7.8 [95% CI 2.70-22.10]). Acculturation did not modify the association (p=0.74).

CONCLUSIONS

Social support was inversely associated with psychological distress among Latina women. Acculturation was not an effect modifier, likely due to inadequate power. The study has clinical implications for mental illness prevention in this population.

Trial study design to test a bilingual digital health tool for alcohol use disorders among Latino emergency department patients

We describe an emergency department (ED)-based, Latino patient focused, unblinded, randomized controlled trial to empirically test if automated bilingual computerized alcohol screening and brief intervention (AB-CASI), a digital health tool, is superior to standard care (SC) on measures of alcohol consumption, alcohol-related negative behaviors and consequences, and 30-day treatment engagement. The trial design addresses the full spectrum of unhealthy drinking from high-risk drinking to severe alcohol use disorder (AUD). In an effort to surmount known ED-based alcohol screening, brief intervention, and referral to treatment process barriers, while addressing racial/ethnic alcohol-related health disparities among Latino groups, this trial will purposively use a digital health tool and seek enrollment of English and/or Spanish speaking self-identified adult Latino ED patients. Participants will be randomized (1:1) to AB-CASI or SC, stratified by AUD severity and preferred language (English vs. Spanish). The primary outcome will be the number of binge drinking days assessed using the 28-day timeline followback method at 12 months post-randomization. Secondary outcomes will include mean number of drinks/week and number of episodes of driving impaired, riding with an impaired driver, injuries, arrests, and tardiness and days absent from work/school. A sample size of 820 is necessary to provide 80% power to detect a 1.14 difference between AB-CASI and SC in the primary outcome. Showing efficacy of this promising bilingual ED-based brief intervention tool in Latino patients has the potential to widely and efficiently expand prevention efforts and facilitate meaningful contact with specialized treatment services.

Trial study design to test a bilingual digital health tool for alcohol use disorders among Latino emergency department patients

We describe an emergency department (ED)-based, Latino patient focused, unblinded, randomized controlled trial to empirically test if automated bilingual computerized alcohol screening and brief intervention (AB-CASI), a digital health tool, is superior to standard care (SC) on measures of alcohol consumption, alcohol-related negative behaviors and consequences, and 30-day treatment engagement. The trial design addresses the full spectrum of unhealthy drinking from high-risk drinking to severe alcohol use disorder (AUD). In an effort to surmount known ED-based alcohol screening, brief intervention, and referral to treatment process barriers, while addressing racial/ethnic alcohol-related health disparities among Latino groups, this trial will purposively use a digital health tool and seek enrollment of English and/or Spanish speaking self-identified adult Latino ED patients. Participants will be randomized (1:1) to AB-CASI or SC, stratified by AUD severity and preferred language (English vs. Spanish). The primary outcome will be the number of binge drinking days assessed using the 28-day timeline followback method at 12 months post-randomization. Secondary outcomes will include mean number of drinks/week and number of episodes of driving impaired, riding with an impaired driver, injuries, arrests, and tardiness and days absent from work/school. A sample size of 820 is necessary to provide 80% power to detect a 1.14 difference between AB-CASI and SC in the primary outcome. Showing efficacy of this promising bilingual ED-based brief intervention tool in Latino patients has the potential to widely and efficiently expand prevention efforts and facilitate meaningful contact with specialized treatment services.