Satisfaction with care and decision making among parents/caregivers in the pediatric intensive care unit: a comparison between English-speaking whites and Latinos

PURPOSE

Because of previously documented health care disparities, we hypothesized that English-speaking Latino parents/caregivers would be less satisfied with care and decision making than English-speaking non-Latino white (NLW) parents/caregivers.

MATERIALS AND METHODS

An intensive care unit (ICU) family satisfaction survey, Family Satisfaction in the Intensive Care Unit Survey (pediatric, 24 question version), was completed by English-speaking parents/caregivers of children in a cardiothoracic ICU at a university-affiliated children's hospital in 2011. English-speaking NLW and Latino parents/caregivers of patients, younger than 18 years, admitted to the ICU were approached to participate on hospital day 3 or 4 if they were at the bedside for greater than or equal to 2 days. Analysis of variance, χ(2), and Student t tests were used. Cronbach αs were calculated.

RESULTS

Fifty parents/caregivers completed the survey in each group. Latino parents/caregivers were younger, more often mothers born outside the United States, more likely to have government insurance or no insurance, and had less education and income. There were no differences between the groups' mean overall satisfaction scores (92.6 ± 8.3 and 93.0 ± 7.1, respectively; P = .80). The Family Satisfaction in the Intensive Care Unit Survey (pediatric, 24 question version) showed high internal consistency reliability (α = .95 and .91 for NLW and Latino groups, respectively).

CONCLUSIONS

No disparities in ICU satisfaction with care and decision making between English-speaking NLW and Latino parents/caregivers were found.

Cultural measures associated with sexual risk behaviors among Latino youth in Southern California: a longitudinal study

CONTEXT

Cultural variables have been associated with sexual risk behaviors among Latino youth, but findings across studies are inconsistent.

METHODS

A longitudinal study of acculturation patterns followed Latino youth in Southern California from 2005 to 2012. Data from 995 participants were used in logistic and ordered regression analyses to test whether cultural variables measured in high school were associated with sexual risk behaviors in emerging adulthood, and whether gender moderated these associations.

RESULTS

The cultural value of respect for parents was negatively associated with participants' odds of reporting an earlier age at sexual debut (odds ratio, 0.8) and condom nonuse at most recent sexual intercourse (0.8). A measure of acculturation reflecting U.S. cultural practices was positively associated with the likelihood of being sexually experienced (1.2), having concurrent sexual partners (1.5) and, among males only, having a greater number of sexual partners (1.3). Second- and later-generation immigrant youth had lower odds of not using a condom at most recent sexual intercourse than first-generation youth (0.6 and 0.5, respectively). Strength of endorsement of Latino cultural practices was negatively associated with females' lifetime number of partners (0.8), but positively associated with males' (1.4).

CONCLUSIONS

The cultural measures associated with Latino youths' sexual behaviors differed across outcomes and by gender. Further understanding of these associations and their underlying mechanisms may help inform the development of culturally sensitive sexual health interventions.

Bicultural stress, identity formation, and alcohol expectancies and misuse in Hispanic adolescents: a developmental approach

Hispanic immigrant youth engage in increased health risk behaviors, such as alcohol misuse, due in part to being confronted with acculturative stress in addition to facing major normative developmental challenges, such as identity consolidation (Berry et al. in Appl Psychol 55:303-332, 2006). Using a developmental psychopathology framework, in the present study we examined the effect of bicultural stress on alcohol misuse among immigrated Hispanic adolescents, indirectly through trajectories of identity formation and alcohol expectancies. Our sample consisted of 302 recently immigrated Hispanic adolescents (53 % male; Mage = 14.5 at baseline) who were interviewed every 6 months for 3 years. Bivariate growth curve modeling was used to examine the influence of initial early bicultural stress on later alcohol misuse via change in identity development (i.e., coherence and confusion) and subsequent growth in cognitive alcohol expectancies. Findings revealed that initial levels and growth of identity coherence were not significantly associated with either bicultural stress or tension reduction (TR) alcohol expectancies. Multiple mediation analyses indicated that the effect of bicultural stress at time 1 on the frequency of being drunk at time 6 was mediated via high initial levels of identity confusion, followed by growth in risky TR expectancies (T4-T6). A developmental approach to the genesis of alcohol use problems in immigrant youth is discussed.

Consumers' perceptions of vape shops in Southern California: an analysis of online Yelp reviews

Background

E-cigarettes are sold at many different types of retail establishments. A new type of shop has emerged, the vape shop, which specializes in sales of varied types of e-cigarettes. Vape shops allow users to sample several types. There are no empirical research articles on vape shops. Information is needed on consumers’ beliefs and behaviors about these shops, the range of products sold, marketing practices, and variation in shop characteristics by ethnic community and potential counter-marketing messages.

Methods

This study is the first to investigate marketing characteristics of vape shops located in different ethnic neighborhoods in Los Angeles, by conducting a Yelp electronic search and content analysis of consumer reports on vape shops they have visited. The primary measure was Yelp reviews (N = 103 vape shops in the Los Angeles, California area), which were retrieved and content coded. We compared the attributes of vape shops representing four ethnic communities: African American, Hispanic/Latino, Korean, and White.

Results

Vape shop attributes listed as most important were the selection of flavors or hardware (95%), fair prices (92%), and unique flavors or hardware (89%). Important staff marketing attributes included being friendly (99%), helpful/patient/respectful (97%), and knowledgeable/professional (95%). Over one-half of the shops were rated as clean (52%) and relaxed (61%). Relatively few of the reviews mentioned quitting smoking (32%) or safety of e-cigarettes (15%). The selection of flavors and hardware appeared relatively important in Korean ethnic location vape shops.

Conclusions

Yelp reviews may influence potential consumers. As such, the present study’s focus on Yelp reviews addressed at least eight of the FDA’s Center for Tobacco Products’ priorities pertaining to marketing influences on consumer beliefs and behaviors. The findings suggest that there were several vape shop and product attributes that consumers considered important to disseminate to others through postings on Yelp. Lack of health warnings about these products may misrepresent their potential risk. The main influence variables were product variety and price. There was only a little evidence of influence of ethnic neighborhood; for example, regarding importance of flavors and hardware. Shop observational studies are recommended to discern safety factors across different ethnic neighborhoods.

Electronic supplementary material

The online version of this article (doi:10.1186/s12971-014-0022-7) contains supplementary material, which is available to authorized users.

Post-traumatic growth, stressful life events, and relationships with substance use behaviors among alternative high school students: a prospective study

A highly stressful life event (SLE) can elicit positive psychosocial growth, referred to as post-traumatic growth (PTG) among youth. We examined PTG and the number of SLEs for their influence on substance use behaviours among a sample of older, diverse alternative high school students participating in a drug prevention programme (n=564; mean age=16.8; 49% female; 65% Hispanic). Surveys assessed PTG, SLEs and substance use behaviours at the two-year follow-up. Multilevel regression models were run to examine the effect of PTG and the number of SLEs on frequency of substance use at the two-year follow-up, controlling for baseline substance use, sociodemographic variables, peer substance use, attrition propensity and treatment group. Greater PTG scores were associated with lower frequencies of alcohol use, getting drunk on alcohol, binge drinking, marijuana use and less substance abuse at the two-year follow-up, but not associated with cigarette or hard drug use. Also, PTG did not moderate the relationship between cumulative number of SLEs and substance use behaviours, rather PTG appears to be protective against negative effects of a single, life-altering SLE. Fostering PTG from a particularly poignant SLE may be useful for prevention programmes targeting alcohol, marijuana and substance abuse behaviours among high-risk youth.

Measuring Acculturation Gap Conflicts among Hispanics: Implications for Psychosocial and Academic Adjustment

This study examined the factor structure and validity of the Acculturation Gap Conflicts Inventory (AGCI), a new instrument developed to measure the types of recurring conflicts that young people experience as part of the parent-child acculturation gap. Participants included 283 Hispanic young adults who completed the AGCI and existing measures of acculturation, family dynamics, psychosocial, and academic adjustment. Principal axis factor analysis revealed three factors with good internal consistency: Autonomy Conflicts, Conflicts over Preferred-Culture, and Dating/Being Out Late Conflicts. These factors correlated in the expected direction with acculturative stress and family dynamics variables. Autonomy Conflicts explained more than 25% of the variance in the acculturation gap conflicts items investigated, and this factor demonstrated incremental validity in predicting psychosocial and academic adjustment beyond the variance accounted for by other acculturative stress variables. The AGCI can be valuable to researchers from a variety of disciplines interested in measuring acculturation-related intergenerational conflicts among Hispanic youth that may be predictive of adjustment.

Determinants of Host Society Acculturation and Its Relationship with Health Behaviors and Outcomes: A New Research and Intervention Framework

Host society acculturation (or reverse acculturation) is a complex, multifactorial process reflecting the attitude- and behavior-level impact of immigrants on the host society. However, this phenomenon has rarely been the subject of systematic research in the area of public health. Using qualitative and quantitative findings from different health behavior domains, we strove to identify potential individual- and environment-level determinants of host society acculturation. Next, we developed a context-driven multilevel public health research and intervention framework for the study of the relationship between host society acculturation and health practices and outcomes. The framework posits a number of associations to be evaluated by future multidisciplinary research nationally and internationally.

Children's executive function and high-calorie, low-nutrient food intake: mediating effects of child-perceived adult fast food intake

OBJECTIVE

This study tested the relationships among child executive function (EF), child-perceived parent fast food intake, and child self-reported subsequent consumption of high-calorie, low-nutrient (HCLN) food.

DESIGN

One year and 6-month longitudinal observation from a larger randomized controlled trial.

SETTING

Southern California elementary schools.

PARTICIPANTS

Fourth- and fifth-grade children (N = 1,005) participating in the Pathways to Health obesity prevention program.

RESULTS

Child EF problems were associated with higher concurrent HCLN intake (B = 0.29, SE = 0.10, p < .001) and had a significant indirect effect through higher perceived frequency of parent fast food intake (indirect effect = 0.17, 95% confidence interval [CI] = [0.11, 0.25], p < .001). Longitudinally, child EF problems did not significantly predict higher HCLN intake a year and a half later (B = 0.01, SE = 0.10, p = .92, n = 848) but did have a significant indirect effect through higher perceived parent fast food intake (indirect effect = 0.05, 95% CI = [0.02, 0.10], p < .001).

CONCLUSIONS

Children's EF difficulties may increase their perception of parent concurrent fast food intake, contributing to their own unhealthy food intake. However, EF problems may not directly affect HCLN intake across time, except when problems are associated with child perception of more frequent parent consumption of convenience foods. Future research is needed to investigate the possibility that helping children perceive and understand role models' convenience food consumption may improve child dietary consumption patterns.

Acculturation and perceived discrimination: predictors of substance use trajectories from adolescence to emerging adulthood among Hispanics

PURPOSE

Previous studies have documented associations between cultural factors and substance use among Hispanic adolescents. Negative cultural experiences such as discrimination have been associated with an increased risk of substance use among Hispanic adolescents, whereas positive cultural resources, such as maintenance of Hispanic cultural orientations, have shown protective effects. However, few studies have examined the continuing influence of cultural factors on substance use from adolescence to emerging adulthood.

METHODS

We surveyed a cohort of Hispanic adolescents in Southern California in 9th, 10th, and 11th grades, and 3-4 years after high school. Growth curve analyses were conducted to examine the effects of U.S. acculturation, Hispanic acculturation, ethnic identity, and perceived discrimination on change in tobacco, alcohol, and marijuana use over time.

RESULTS

Higher perceived discrimination at baseline was significantly associated with a higher intercept (initial level) of tobacco, alcohol, and marijuana use. Higher initial level of Hispanic acculturation was significantly associated with a lower slope of tobacco, alcohol, and marijuana use.

CONCLUSIONS

Cultural phenomena such as acculturation and perceived discrimination can continue to affect substance use through the transition to emerging adulthood. Health education interventions are needed to help Hispanics navigate this developmental transition without engaging in substance use.

The effect of neighborhood and individual characteristics on pediatric critical illness

The relationship between neighborhood/individual characteristics and pediatric intensive care unit (PICU) outcomes is largely unexplored. We hypothesized that individual-level racial/ethnic minority status and neighborhood-level low socioeconomic status and minority concentration would adversely affect children's severity of illness on admission to the PICU. Retrospective analyses (1/1/2007-5/23/2011) of clinical, geographic, and demographic data were conducted at an academic, tertiary children's hospital PICU. Clinical data included age, diagnosis, insurance, race/ethnicity, Pediatric Index of Mortality 2 score on presentation to the PICU (PIM2), and mortality. Residential addresses were geocoded and linked with 2010 US Census tract data using geographic information systems geocoding techniques. Repeated measures models to predict PIM2 and mortality were constructed using three successive models with theorized covariates including the patient's race/ethnicity, the predominant neighborhood racial/ethnic group, interactions between patient race/ethnicity and neighborhood race/ethnicity, neighborhood socioeconomic status, and insurance type. Of the 5,390 children, 57.8% were Latino and 70.1% possessed government insurance. Latino children (β = 0.31; p < 0.01), especially Latino children living in a Latino ethnic enclave (β = 1.13; p < 0.05), had higher PIM2 scores compared with non-Latinos. Children with government insurance (β = 0.29; p < 0.01) had higher PIM2 scores compared to children with other payment types and median neighborhood income was inversely associated with PIM2 scores (β = -0.04 per $10,000/year of income; p < 0.05). Lower median neighborhood income, Latino ethnicity, Latino children living in a predominantly Latino neighborhood, and children possessing government insurance were associated with a higher severity of illness on PICU admission. The reasons why these factors affect critical illness severity require further exploration.

Associations between ethnic labels and substance use among Hispanic/Latino adolescents in Los Angeles

Self-identification with ethnic-specific labels may indicate successful ethnic identity formation, which could protect against substance use. Alternatively, it might indicate affiliation with oppositional subcultures, a potential risk factor. This study examined longitudinal associations between ethnic labels and substance use among 1,575 Hispanic adolescents in Los Angeles. Adolescents who identified as Cholo or La Raza in 9th grade were at increased risk of past-month substance use in 11th grade. Associations were similar across gender and were not confounded by socioeconomic status, ethnic identity development, acculturation, or language use. Targeted prevention interventions for adolescents who identify with these subcultures may be warranted.

Problematic substance use among Hispanic adolescents and young adults: implications for prevention efforts

Using data collected between 2005 and 2012 from a longitudinal study of acculturation patterns and substance use among Hispanic youth in Southern California (N = 2722), we fit multivariate logistic regression models to estimate the association of type and frequency of drug use, friend and parent drug use, cultural orientation (measured by the ARSMA-II), and psychological distress (CES-D score) in 10th grade with problematic substance use (measured with the RAPI) in (i) 11th grade and (ii) young adulthood. We conclude that future intervention efforts with Hispanic adolescents and young adults should target polysubstance and problem users and emphasize inter-individual, structural, and cultural processes as they relate to problematic substance use.

Domains of acculturation and their effects on substance use and sexual behavior in recent Hispanic immigrant adolescents

This study evaluated the immigrant paradox by ascertaining the effects of multiple components of acculturation on substance use and sexual behavior among recently immigrated Hispanic adolescents primarily from Mexico (35 %) and Cuba (31 %). A sample of 302 adolescents (53 % boys; mean age 14.51 years) from Miami (n = 152) and Los Angeles (n = 150) provided data on Hispanic and US cultural practices, values, and identifications at baseline and provided reports of cigarette use, alcohol use, sexual activity, and unprotected sex approximately 1 year later. Results indicated strong gender differences, with the majority of significant findings emerging for boys. Supporting the immigrant paradox (i.e., that becoming oriented toward US culture is predictive of increased health risks), individualist values predicted greater numbers of oral sex partners and unprotected sex occasions for boys. However, contrary to the immigrant paradox, for boys, both US practices and US identification predicted less heavy drinking, fewer oral and vaginal/anal sex partners, and less unprotected vaginal/anal sex. Ethnic identity (identification with one's heritage culture) predicted greater numbers of sexual partners but negatively predicted unprotected sex. Results indicate a need for multidimensional, multi-domain models of acculturation and suggest that more work is needed to determine the most effective ways to culturally inform prevention programs.

Peer influences: the impact of online and offline friendship networks on adolescent smoking and alcohol use

PURPOSE

Online social networking sites (SNSs) have become a popular mode of communication among adolescents. However, little is known about the effects of social online activity on health behaviors. The authors examined the use of SNSs among friends and the degree to which SNS activities relate to face-to-face peer influences and adolescent risk behaviors.

METHODS

Longitudinal egocentric friendship network data along with adolescent social media use and risk behaviors were collected from 1,563 10th-grade students across five Southern California high schools. Measures of online and offline peer influences were computed and assessed using fixed-effects models.

RESULTS

The frequency of adolescent SNS use and the number of their closest friends on the same SNSs were not significantly associated with risk behaviors. However, exposure to friends' online pictures of partying or drinking was significantly associated with both smoking (β = .11, p < .001) and alcohol use (β = .06, p < .05). Whereas adolescents with drinking friends had higher risk levels for drinking, adolescents without drinking friends were more likely to be affected by higher exposure to risky online pictures (β = -.10, p < .05). Myspace and Facebook had demographically distinct user characteristics and differential effects on risk behaviors.

CONCLUSIONS

Exposure to risky online content had a direct impact on adolescents' risk behaviors and significantly interacted with risk behaviors of their friends. These results provide evidence that friends' online behaviors should be considered a viable source of peer influence and that increased efforts should focus on educating adolescents on the negative effects of risky online displays.

Implementing trials of complex interventions in community settings: the USC-Rancho Los Amigos pressure ulcer prevention study (PUPS)

BACKGROUND

Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)-Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to (1) participant recruitment and retention, (2) intervention delivery and fidelity, (3) randomization and assessment, and (4) potential inadvertent treatment effects.

PURPOSE

We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury.

METHODS

Individuals with spinal cord injury recruited from RLANRC were assigned to either a 12-month preventive intervention group or a standard care control group. The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries, medical treatment costs, and quality of life. These outcomes are assessed at 12 and 24 months after randomization. Additionally, we are studying the mediating mechanisms that account for intervention outcomes.

RESULTS

PUPS has been successfully implemented, including recruitment of the target sample size of 170 participants, assurance of the integrity of intervention protocol delivery with an average 90% treatment adherence rate, and enactment of the assessment plan. However, implementation has been replete with challenges. To meet recruitment goals, we instituted a five-pronged approach customized for an underserved, ethnically diverse population. In intervention delivery, we increased staff time to overcome economic and cultural barriers to retention and adherence. To ensure treatment fidelity and replicability, we monitored intervention protocol delivery in accordance with a rigorous plan. Finally, we have overcome unanticipated assessment and design concerns related to (1) determining pressure ulcer incidence/severity, (2) randomization imbalance, and (3) inadvertent potential control group contamination.

LIMITATIONS

We have addressed the most daunting challenges encountered in the recruitment, assessment, and intervention phases of PUPS. Some challenges and solutions may not apply to trials conducted in other settings.

CONCLUSIONS

Overcoming challenges has required a multifaceted approach incorporating individualization, flexibility, and persistence, as well as the ability to implement needed mid-course corrections.

Do adolescent drug use consequences predict externalizing and internalizing problems in emerging adulthood as well as traditional drug use measures in a Hispanic sample?

The present study compares statistical models for three conceptualizations of drug use in 11th grade (past 30 day ever/never use, past 30 day frequency of drug use and past 30 day drug use consequences) with externalizing and internalizing problems in emerging adulthood when controlling for age, academic achievement and socioeconomic status in a Hispanic sample. Multivariate logistic regression models for the different drug use variables were compared when modeling weapon carrying, arrest, multiple lifetime sex partners, drug/alcohol use before sex and condom use in emerging adulthood. A multivariate linear regression model was used to model depression in emerging adulthood as a function of drug use measurement controlling for other covariates and depression in adolescence. Our findings suggest that any conceptualization of drug use will produce equitable results and model fit statistics when examining externalizing problems. However, when investigating internalizing problems, such as depression, lower frequency drug use-and not high frequency-was more strongly associated with depression whereas experiencing high levels of drug use consequences-and not low levels of consequences-was associated with depression in emerging adulthood despite similar model fit values. Variation between drug use and the experience of drug use consequences may lead to misspecification of "at-risk" subgroups of drug users. Implications and future directions are discussed.

Cultural Influences on Substance Use Among Hispanic Adolescents and Young Adults: Findings From Project RED

Hispanic adolescents represent a growing segment of the U.S. population. In addition to the typical stressors encountered during adolescence, Hispanic adolescents may experience acculturative stress, perceived discrimination, and conflicts with parents about acculturation, which can lead to maladaptive behaviors such as substance use. Personal cultural resources may help Hispanic youth cope with cultural stressors and avoid substance use, but little is known about how such factors affect decisions about substance use. In 2005, my research group began studying a group of Hispanic adolescents in Los Angeles. The participants completed surveys annually about cultural issues such as acculturation, ethnic identity, and perceived discrimination; family and peer relationships; and use of alcohol, tobacco, and marijuana. We found that Hispanic adolescents' perceptions that they were discriminated against put them at greater risk for substance use, and that Hispanic orientation protected the youth from substance use. The findings can inform the development of culturally relevant prevention interventions for Hispanic adolescents and emerging adults.

Effects of language of assessment on the measurement of acculturation: measurement equivalence and cultural frame switching

The present study used a randomized design, with fully bilingual Hispanic participants from the Miami area, to investigate 2 sets of research questions. First, we sought to ascertain the extent to which measures of acculturation (Hispanic and U.S. practices, values, and identifications) satisfied criteria for linguistic measurement equivalence. Second, we sought to examine whether cultural frame switching would emerge--that is, whether latent acculturation mean scores for U.S. acculturation would be higher among participants randomized to complete measures in English and whether latent acculturation mean scores for Hispanic acculturation would be higher among participants randomized to complete measures in Spanish. A sample of 722 Hispanic students from a Hispanic-serving university participated in the study. Participants were first asked to complete translation tasks to verify that they were fully bilingual. Based on ratings from 2 independent coders, 574 participants (79.5% of the sample) qualified as fully bilingual and were randomized to complete the acculturation measures in either English or Spanish. Theoretically relevant criterion measures--self-esteem, depressive symptoms, and personal identity--were also administered in the randomized language. Measurement equivalence analyses indicated that all of the acculturation measures--Hispanic and U.S. practices, values, and identifications-met criteria for configural, weak/metric, strong/scalar, and convergent validity equivalence. These findings indicate that data generated using acculturation measures can, at least under some conditions, be combined or compared across languages of administration. Few latent mean differences emerged. These results are discussed in terms of the measurement of acculturation in linguistically diverse populations.

Evaluation of a fotonovela to increase depression knowledge and reduce stigma among Hispanic adults

Fotonovelas-small booklets that portray a dramatic story using photographs and captions-represent a powerful health education tool for low-literacy and ethnic minority audiences. This study evaluated the effectiveness of a depression fotonovela in increasing depression knowledge, decreasing stigma, increasing self-efficacy to recognize depression, and increasing intentions to seek treatment, relative to a text pamphlet. Hispanic adults attending a community adult school (N = 157, 47.5 % female, mean age = 35.8 years, 84 % immigrants, 63 % with less than high school education) were randomly assigned to read the fotonovela or a low-literacy text pamphlet about depression. They completed surveys before reading the material, immediately after reading the material, and 1 month later. The fotonovela and text pamphlet both produced significant improvements in depression knowledge and self-efficacy to identify depression, but the fotonovela produced significantly larger reductions in antidepressant stigma and mental health care stigma. The fotonovela also was more likely to be passed on to family or friends after the study, potentially increasing its reach throughout the community. Results indicate that fotonovelas can be useful for improving health literacy among underserved populations, which could reduce health disparities.

Perceived context of reception among recent Hispanic immigrants: conceptualization, instrument development, and preliminary validation

Context of reception has been discussed widely in the sociological and anthropological literature, but no measures of this construct exist. We designed a measure of perceived context of reception and provide initial support for the factorial validity, internal consistency reliability, and incremental and discriminant validity of scores generated by this measure. A sample of 302 recent-immigrant Hispanic parent-adolescent dyads from Miami and Los Angeles completed the new perceived context of reception measure, as well as measures of perceived discrimination; Hispanic/American cultural practices, values, and identifications; and depressive symptoms. In Phase 1, exploratory and confirmatory factor analyses extracted a factor for negative perceived context of reception. A subscale corresponding to this factor was used in Phase 2; for parents and adolescents, negative perceived context of reception and perceived discrimination were differentially associated with acculturation-related variables-suggesting discriminant validity between perceived discrimination and negative perceived context of reception. For adolescents at both sites and for parents in Los Angeles only, the negative perceived context of reception dimensions were significantly associated with depressive symptoms 6 months later, over and above the contribution made by perceived discrimination--suggesting incremental validity. Results are discussed in terms of perceived context of reception as a new and emerging construct.

Emerging adulthood themes, role transitions and substance use among Hispanics in Southern California

INTRODUCTION

Hispanic emerging adults appear to be at especially high risk for substance use but little is known about their risk and protective factors. A crucial next step to reducing substance use among this priority population may involve understanding how transition-to-adulthood themes are associated with substance use. Intervention and prevention programs could also benefit from information about which if any specific transitions undergone in emerging adulthood are associated with substance use.

METHODS

Hispanic emerging adults (aged 18 to 24) completed surveys indicating their identification with transition-to-adulthood themes, role transitions in the past year, and use of alcohol and marijuana. Logistic regression models were used to examine the associations between transition-to-adulthood themes and past-month binge drinking and marijuana use, controlling for age and gender. Separate logistic regression models explored the association between each individual role transition and past-month binge drinking and marijuana use, controlling for age and gender and using a Bonferonni correction.

RESULTS

Among the participants (n=1,390), 41% were male, the average age was 21, 24% reported past-month marijuana use and 34% reported past-month binge drinking. Participants who felt emerging adulthood was a time of focusing on others were less likely to report marijuana use and binge drinking. Among the 24 transitions, five were significantly associated with past-month marijuana use and 10 were significantly associated with past-month binge drinking.

CONCLUSION

Findings suggest transition-to-adulthood themes as well as specific changes experienced by emerging adults are meaningful for Hispanics and should be explored in prevention and intervention programs in the future. Future research should determine what specific mechanisms are making these transitional processes risk factors for substance use.

Cultural and social influences on adolescent smoking dissipate by emerging adulthood among Hispanics in Southern California

The aim of the present study was to identify risk factors for smoking among Hispanic adolescents and determine whether these factors continued to influence smoking into emerging adulthood. Data were drawn from 932 Hispanics in the greater Los Angeles area who were surveyed in high school in 2007 and then again in emerging adulthood from 2010 to 2012. Logistic regression assessed the associations between predictors in adolescence and smoking in adolescence while an order one transition logistic model assessed predictors in adolescence and smoking in emerging adulthood. Adult and sibling smoking status, perceptions of smoking, perceived discrimination, and fatalism all influenced smoking in adolescence but not in emerging adulthood. Once Hispanics reach emerging adulthood different tactics to reduce smoking will be needed and are where future research should be directed.

Role transitions in emerging adulthood are associated with smoking among Hispanics in Southern California

INTRODUCTION

Smoking initiation seldom occurs after emerging adulthood, making prevention critical during this phase of the life course. Among emerging adults, Hispanics have an especially high risk for cigarette use. Emerging adulthood scholars suggest role transitions commonly experienced by this age group may lead to substance use including cigarette experimentation and/or progression, contributing to the high smoking rates exhibited by Hispanics.

METHODS

Hispanic emerging adults (aged 18-24) completed surveys indicating which of a comprehensive list of role transitions they had experienced in the past year. Separate logistic regression models explored the association between each individual role transition and smoking in the past 30 days, controlling for age and gender and using a Bonferonni correction.

RESULTS

Among the sample of emerging adults (n = 1,390), 41% were male, the average age was 21, and about 21% reported cigarette use in the past 30 days. Losing a job, becoming a family member's caregiver, starting to date someone new, experiencing a breakup, being arrested, and becoming addicted to illicit drugs and/or alcohol were all associated with smoking.

CONCLUSIONS

The stress associated with navigating through changes in critical periods of the life course may lead some emerging adults to smoke. Future research should be directed toward determining what specific mechanisms make these transitional processes risk factors for smoking. These determinations could prove critical if effective prevention programs are to be designed that lead to a decrease in the smoking prevalence among Hispanic emerging adults.

Bidirectional associations between future time perspective and substance use among continuation high-school students

We examined whether a bidirectional, longitudinal relationship exists between future time perspective (FTP), measured with the Zimbardo Time Perspective Inventory, and any past 30-day use of alcohol, tobacco, marijuana, or hard drugs among continuation high school students (N = 1,310, mean age 16.8 years) in a large urban area. We found increased FTP to be protective against drug use for all substances except alcohol. While any baseline use of substances did not predict changes in FTP 1 year later. The discussion explores why alcohol findings may differ from other substances. Future consideration of FTP as a mediator of program effects is explored.

A comparison of peer influence measures as predictors of smoking among predominately hispanic/latino high school adolescents

PURPOSE

Consistent evidence has shown that one of the most significant influences on adolescent smoking is peer influence. There is considerable variation, however, in how peer influence is measured. This study constructs social network influence and selection variables from egocentric and sociometric data to compare their associations with smoking, with considerations of perceived smoking norms and adolescent popularity.

METHODS

Longitudinal data were collected in the 9th and 10th grades in October 2006 and 2007 from predominantly Hispanic/Latino adolescents in seven Southern California schools; among these adolescents, 1,950 completed surveys at both waves. Both cross-sectional (separately for 9th and 10th graders) and longitudinal models were estimated.

RESULTS

An egocentric measure of perceived friend smoking was strongly and consistently associated with individual smoking (adjusted odds ratio [AOR] ≈ 1.80, p < .001), whereas its sociometric counterpart of friend self-report smoking was only associated with smoking in the 9th-grade cross-sectional models (e.g., AOR = 1.56, p < .001) and rarely in longitudinal models. Popularity, measured by proportion of nominations received by class size, was associated with smoking and becoming a smoker (AOR = 1.67, p < .001), whereas perceived norms were not, in longitudinal models. Friend selection was also associated with becoming a smoker (AOR = 1.32, p = .05).

CONCLUSIONS

This study illustrates the utility of egocentric data for understanding peer influence and underscores the importance of perceptions and popularity as mechanisms that influence adolescent smoking.

Smoking trajectories among Koreans in Seoul and California: exemplifying a common error in age parameterization

Immigration to a nation with a stronger anti-smoking environment has been hypothesized to make smoking less common. However, little is known about how environments influence risk of smoking across the lifecourse. Research suggested a linear decline in smoking over the lifecourse but these associations, in fact, might not be linear. This study assessed the possible nonlinear associations between age and smoking and examined how these associations differed by environment through comparing Koreans in Seoul, South Korea and Korean Americans in California, United States. Data were drawn from population based telephone surveys of Korean adults in Seoul (N=500) and California (N=2,830) from 2001-2002. Locally weighted scatterplot smoothing (lowess) was used to approximate the association between age and smoking with multivariable spline logistic regressions, including adjustment for confounds used to draw population inferences. Smoking differed across the lifecourse between Korean and Korean American men. The association between age and smoking peaked around 35 years among Korean and Korean American men. From 18 to 35 the probability of smoking was 57% higher (95%CI, 40 to 71) among Korean men versus 8% (95%CI, 3 to 19) higher among Korean American men. A similar difference in age after 35, from 40 to 57 years of age, was associated with a 2% (95%CI, 0 to 10) and 20% (95%CI, 16 to 25) lower probability of smoking among Korean and Korean American men. A nonlinear pattern was also observed among Korean American women. Social role transitions provide plausible explanations for the decline in smoking after 35. Investigators should be mindful of nonlinearities in age when attempting to understand tobacco use.

Developmental trajectories of acculturation in Hispanic adolescents: associations with family functioning and adolescent risk behavior

This study examined longitudinal acculturation patterns, and their associations with family functioning and adolescent risk behaviors, in Hispanic immigrant families. A sample of 266 Hispanic adolescents (Mage  = 13.4) and their primary parents completed measures of acculturation, family functioning, and adolescent conduct problems, substance use, and sexual behavior at five timepoints. Mixture models yielded three trajectory classes apiece for adolescent and parent acculturation. Assimilated adolescents reported the poorest family functioning, but adolescent assimilation negatively predicted adolescent cigarette smoking, sexual activity, and unprotected sex indirectly through family functioning. Follow-up analyses indicated that discrepancies between adolescent and parent family functioning reports predicted these adolescent outcomes. Results are discussed regarding acculturation trajectories, adolescent risk behavior, and the mediating role of family functioning.

Bullying victimization as a mediator of associations between cultural/familial variables, substance use, and depressive symptoms among Hispanic youth

OBJECTIVES

This article examines the antecedents and consequences of bullying victimization among a sample of Hispanic high school students. Although cultural and familial variables have been examined as potential risk or protective factors for substance use and depression, previous studies have not examined the role of peer victimization in these processes. We evaluated a conceptual model in which cultural and familial factors influenced the risk of victimization, which in turn influenced the risk of substance use and depression.

DESIGN

Data were collected as part of a longitudinal survey study of 9th and 10th grade Hispanic/Latino students in Southern California (n = 1167). The student bodies were at least 70% Hispanic/Latino with a range of socioeconomic characteristics represented. We used linear and logistic regression models to test hypothesized relationships between cultural and familial factors and depression and substance use. We used a mediational model to assess whether bullying victimization mediated these associations.

RESULTS

Acculturative stress and family cohesion were significantly associated with bullying victimization. Family cohesion was associate d with depression and substance use. Social support was associated with alcohol use. Acculturative stress was associated with higher depression. The associations between acculturative stress and depression, family cohesion and depression, and family cohesion and cigarette use were mediated by bullying victimization.

CONCLUSION

These findings provide valuable information to the growing, but still limited, literature about the cultural barriers and strengths that are intrinsic to the transition from adolescence to emerging adulthood among Hispanic youth. Our findings are consistent with a mediational model in which cultural/familial factors influence the risk of peer victimization, which in turn influences depressive symptoms and smoking, suggesting the potential positive benefits of school-based programs that facilitate the development of coping skills for students experiencing cultural and familial stressors.

A longitudinal analysis of Hispanic youth acculturation and cigarette smoking: the roles of gender, culture, family, and discrimination

INTRODUCTION

Risk for smoking initiation increases as Hispanic youth acculturate to U.S. society, and this association seems to be stronger for Hispanic girls than boys. To better understand the influence of culture, family, and everyday discrimination on cigarette smoking, we tested a process-oriented model of acculturation and cigarette smoking.

METHODS

Data came from Project RED (Reteniendo y Entendiendo Diversidad para Salud), which included 1,436 Hispanic students (54% girls) from Southern California. We used data from 9th to 11th grade (85% were 14 years old, and 86% were U.S. born) to test the influence of acculturation-related experiences on smoking over time.

RESULTS

Multigroup structural equation analysis suggested that acculturation was associated with increased familismo and lower traditional gender roles, and enculturation was linked more with familismo and respeto. Familismo, respeto, and traditional gender roles were linked with lower family conflict and increased family cohesion, and these links were stronger for girls. Familismo and respeto were further associated with lower discrimination. Conversely, fatalismo was linked with worse family functioning (especially for boys) and increased discrimination in both the groups. Discrimination was the only predictor of smoking for boys and girls.

CONCLUSIONS

In all, the results of the current study indicate that reducing discrimination and helping youth cope with discrimination may prevent or reduce smoking in Hispanic boys and girls. This may be achieved by promoting familismo and respeto and by discouraging fatalistic beliefs.

The environment modifies the relationship between social networks and secondhand smoke exposure among Korean nonsmokers in Seoul and California

This study compared risks of secondhand smoke exposure (SHSe) among Korean nonsmokers in Seoul, South Korea and California, United States. Social networks were hypothesized to contain more smokers in Seoul than in California, and smokers were hypothesized to produce more secondhand smoke in Seoul than California, as Seoul's policies and norms are less restrictive. Telephone interviews were conducted with Korean adults in Seoul (N = 500) and California (N = 2830). In all, 69% (95% confidence interval [CI] = 64-74) of Koreans and 31% (95% CI = 29-33) of Korean Americans reported any SHSe. A total of 44% (95% CI = 40-47) of Korean family members smoked versus 29% (95% CI = 28-30) of Korean American family members (t = 7.84, P < .01). A 25% to 75% increase in the proportion of family members that smoked corresponded with a 13% (95% CI = 5-21) higher probability of any SHSe among Koreans compared with 6% (95% CI = 2-10) among Korean Americans. Network interventions in combination with policies and/or health campaigns may help reduce SHSe globally.

Substance use and sexual behavior among recent Hispanic immigrant adolescents: effects of parent-adolescent differential acculturation and communication

OBJECTIVES

To ascertain the effects of parent-adolescent acculturation gaps, perceived discrimination, and perceived negative context of reception on adolescent cigarette smoking, alcohol use, sexual activity, and sexual risk taking. We used an expanded, multidimensional model of acculturation.

METHOD

A sample of 302 recently immigrated parent-adolescent dyads (152 from Miami and 150 from Los Angeles) completed measures of acculturation (Hispanic and American practices and identifications, and individualist and collectivist values) and parent-adolescent communication. Adolescents completed measures of recent cigarette smoking, alcohol use, sexual behavior, and sexual risk taking.

RESULTS

Parent-adolescent gaps in American practices and ethnic identity, and perceptions of a negative context of reception, predicted compromised parent-adolescent communication. In Miami only, adolescent-reported communication negatively predicted odds of cigarette smoking, occasions of drunkenness, and number of sexual partners. Also in Miami only, parent-reported communication positively predicted these outcomes, as well as occasions of adolescent binge drinking, drunkenness, number of sexual partners, and odds of unprotected sex. The only significant findings in Los Angeles were protective effects of parent-reported communication on frequency of alcohol use and of binge drinking. Mediational effects emerged only in the Miami sample.

CONCLUSIONS

Effects of parent-adolescent acculturation gaps vary across Hispanic groups and receiving contexts. The especially strong parental control in many Mexican families may account for these differences. However, other important differences between Hispanic subgroups and communities of reception could also account for these differences. Prevention efforts might encourage Hispanic youth both to retain their culture of origin and to acquire American culture.

Perceived discrimination as a risk factor for depressive symptoms and substance use among Hispanic adolescents in Los Angeles

OBJECTIVES

Discrimination has been associated with adverse psychological and physical health outcomes, but few studies have examined the effects of discrimination on Hispanic adolescents. This study assessed the relation of perceived discrimination with depressive symptoms and drug use. Covariates included immigrant generation status (GS). A second objective was to examine the potentially moderating effect of neighborhoods' ethnic composition as suggested by Mair et al.

DESIGN

Secondary data analyses of a longitudinal survey examined self-reports of Hispanic adolescents in 9th grade (the first year of high school) and 11th grade at seven high schools in Los Angeles.

RESULTS

(1) Perceiving discrimination in 9th grade significantly predicted depressive symptoms (β=0.23, p<0.01) and drug use (β=0.12, p<0.01) in 11th grade, even after controlling for socioeconomic status, gender, acculturation, and GS in the USA. The third GS group reported significantly higher perceptions of discrimination compared to newer immigrants. (2) Neighborhoods' ethnic composition was included as a moderator of the association between perceived discrimination and the outcomes, but did not moderate the relation.

CONCLUSION

Teaching Hispanic adolescents effective strategies for coping with discrimination, such as increasing their sense of belongingness in the American mainstream, may prove useful in preventing drug use and depressive symptoms.

A review of cancer in U.S. Hispanic populations

There are compelling reasons to conduct studies of cancer in Hispanics, the fastest growing major demographic group in the United States (from 15% to 30% of the U.S. population by 2050). The genetically admixed Hispanic population coupled with secular trends in environmental exposures and lifestyle/behavioral practices that are associated with immigration and acculturation offer opportunities for elucidating the effects of genetics, environment, and lifestyle on cancer risk and identifying novel risk factors. For example, traditional breast cancer risk factors explain less of the breast cancer risk in Hispanics than in non-Hispanic whites (NHW), and there is a substantially greater proportion of never-smokers with lung cancer in Hispanics than in NHW. Hispanics have higher incidence rates for cancers of the cervix, stomach, liver, and gall bladder than NHW. With respect to these cancers, there are intriguing patterns that warrant study (e.g., depending on country of origin, the five-fold difference in gastric cancer rates for Hispanic men but not Hispanic women). Also, despite a substantially higher incidence rate and increasing secular trend for liver cancer in Hispanics, there have been no studies of Hispanics reported to date. We review the literature and discuss study design options and features that should be considered in future studies.

Acculturation, enculturation, and symptoms of depression in Hispanic youth: the roles of gender, Hispanic cultural values, and family functioning

The risk for depression increases as Hispanic youth acculturate to U.S. society. This association is stronger for Hispanic girls than boys. To better understand the influence of culture and family on depressive symptoms, we tested a process-oriented model of acculturation, cultural values, and family functioning. The data came from Project RED, which included 1,922 Hispanic students (53 % girls; 86 % were 14 years old; and 84 % were U.S. born) from Southern California. We used data from 9th to 11th grade to test the influence of acculturation-related experiences on depressive symptoms over time. Multi-group structural equation analysis suggested that both family conflict and cohesion were linked with depressive symptoms. Hispanic cultural values were associated with family cohesion and conflict but the strength and direction of these relationships varied across cultural values and gender. For girls and boys, familismo and respeto were associated with higher family cohesion and lower family conflict. Moreover, gender roles were linked with higher family cohesion in girls but not in boys. These results indicate that improving family functioning will be beneficial for boys' and girls' psychological well-being. This may be achieved by promoting familismo and respeto for boys and girls and by promoting traditional gender roles for girls.

Multiple peer group self-identification and adolescent tobacco use

Associations between peer group self-identification and smoking were examined among 2,698 ethnically diverse middle school students in Los Angeles who self-identified with groups such as Rockers, Skaters, and Gamers. The sample was 47.1% male, 54.7% Latino, 25.4% Asian, 10.8% White, 9.1% Other ethnicity, and 59.3% children of immigrant parents. Multiple group self-identification was common: 84% identified with two or more groups and 65% identified with three or more groups. Logistic regression analyses indicated that as students endorsed more high-risk groups, the greater their risk of tobacco use. A classification tree analysis identified risk groups based on interactions among ethnicity, gender, and group self-identification. Psychographic targeting based on group self-identification could be useful to design more relevant smoking prevention messages for adolescents who identify with high-risk peer groups.

Do cognitive attributions for smoking predict subsequent smoking development?

To develop more effective anti-smoking programs, it is important to understand the factors that influence people to smoke. Guided by attribution theory, a longitudinal study was conducted to investigate how individuals' cognitive attributions for smoking were associated with subsequent smoking development and through which pathways. Middle and high school students in seven large cities in China (N=12,382; 48.5% boys and 51.5% girls) completed two annual surveys. Associations between cognitive attributions for smoking and subsequent smoking initiation and progression were tested with multilevel analysis, taking into account plausible moderation effects of gender and baseline smoking status. Mediation effects of susceptibility to smoking were investigated using statistical mediation analysis (MacKinnon, 2008). Six out of eight tested themes of cognitive attributions were associated with subsequent smoking development. Curiosity (β=0.11, p<0.001) and autonomy (β=0.08, p=0.019) were associated with smoking initiation among baseline non-smokers. Coping (β=0.07, p<0.001) and social image (β=0.10, p=<.0001) were associated with smoking progression among baseline lifetime smokers. Social image (β=0.05, p=0.043), engagement (β=0.07, p=0.003), and mental enhancement (β=0.15, p<0.001) were associated with smoking progression among baseline past 30-day smokers. More attributions were associated with smoking development among males than among females. Susceptibility to smoking partially mediated most of the associations, with the proportion of mediated effects ranging from 4.3% to 30.8%. This study identifies the roles that cognitive attributions for smoking play in subsequent smoking development. These attributions could be addressed in smoking prevention programs.

A network method of measuring affiliation-based peer influence: assessing the influences of teammates' smoking on adolescent smoking

Using a network analytic framework, this study introduces a new method to measure peer influence based on adolescents' affiliations or 2-mode social network data. Exposure based on affiliations is referred to as the "affiliation exposure model." This study demonstrates the methodology using data on young adolescent smoking being influenced by joint participation in school-based organized sports activities with smokers. The analytic sample consisted of 1,260 American adolescents from ages 10 to 13 in middle schools, and the results of the longitudinal regression analyses showed that adolescents were more likely to smoke as they were increasingly exposed to teammates who smoke. This study illustrates the importance of peer influence via affiliation through team sports.

The most critical unresolved issues associated with race, ethnicity, culture, and substance use

This paper discusses the limitations of previous research on race, ethnicity, culture, and substance use. The study offers the following recommendations for future research in this area: (1) move beyond simple comparisons of mutually exclusive groups, (2) focus on the meaning of an ethnic label to the individual, (3) consider the complex interactions between an individual's cultural identity and the cultural context, (4) understand and acknowledge the researcher's inherent biases, and (5) translate research findings into practice and policy change.

Boosting a teen substance use prevention program with motivational interviewing

A brief motivational interviewing (MI) intervention may be a viable adjunct to school-based substance abuse prevention programs. This article describes the development and implementation of a brief MI intervention with 573 adolescents (mean age 16.8; 40.3% female, 68% Latino) enrolled in eight continuation high schools in Southern California. Study participants were assigned to the MI condition in a randomized controlled trial of Project Toward No Drug Abuse. Data are provided on dosage, topics discussed, and quality of MI determined with the Motivational Interviewing Skill Code (MISC). Results suggest that the protocol was feasible and implemented with adequate fidelity. The study's limitations are noted.

An evaluation of immediate outcomes and fidelity of a drug abuse prevention program in continuation high schools: project towards no drug abuse (TND)

The present study provides an implementation fidelity, process, and immediate outcomes evaluation of Project Towards No Drug Abuse (TND), a drug prevention program targeting continuation high school youth (n=1426) at risk for drug abuse. A total of 24 schools participated in three randomized conditions: TND Only, TND and motivational interviewing follow-up, and no treatment control. Fidelity was high: across program schools the curriculum was implemented as intended and was received favorably by students. Relative to controls, intervention conditions produced effects on hypothesized mediators, including greater gains in program related knowledge, greater reductions in drug use intentions, and positive changes in motivation. However, few generalizations to attitudes and intentions regarding risky sexual behavior were found. The pattern of results suggests that the experimental manipulations worked as intended.

Genetic and environmental influences on the association between depressive symptom dimensions and smoking initiation among Chinese adolescent twins

INTRODUCTION

Extant twin research on the depression-smoking association in adolescents has been conducted in U.S. and European samples and considered depression as a unitary phenotype. This study explored genetic and environmental influences on covariation between smoking initiation and 4 depressive symptom dimensions (positive affect [PA], negative affect [NA], somatic features [SF], and interpersonal problems [IP]) in adolescent Chinese twins.

METHODS

Questionnaires measuring current depressive symptoms and lifetime smoking initiation were administered to 602 twin pairs (M [SD] age = 12.2 (1.93) years, range 9-16 years). Cholesky bivariate decomposition models examined influences on each depressive symptom dimension, smoking initiation, and their covariation using age- and sex-adjusted threshold variables.

RESULTS

Within-twin correlations between smoking initiation and each depressive symptom dimension were significant (|r|s = .29-.61). Bivariate twin modeling showed significant genetic effects on overall depressive symptoms (55% variance), shared environment effects on NA (36%) and PA (53%), and shared environment effects on smoking initiation (46%) unique from PA. No other familial influences on the individual phenotypes (apart from those accounting for smoking-depression covariance) were significant. Relations of smoking initiation to overall depressive symptoms and IP were influenced by familial (shared environment and/or genetic) factors and nonshared environmental factors. The SF-smoking initiation relation was influenced mostly by familial factors. Only shared environment significantly influenced the association of lower PA and higher NA to smoking initiation.

CONCLUSIONS

Relations between each symptom dimension and smoking initiation are of sizeable magnitude in Chinese adolescents. Genetic and environmental factors underlying depression-smoking comorbidity may vary across different depressive symptom dimensions.

Relative income inequality and selected health outcomes in urban Chinese youth

Self reported cross-sectional data gathered in 2002 from 12,449 middle and high school students from seven major cities in China were examined to explore the association of self-perceived relative income inequality (SPRII) with general health status, depression, stress, and cigarette smoking. Two types of self-perceived relative income were evaluated: household income relative to peers (SPRII-S) and relative to their own past (SPRII-P). SPRII-S and SPRII-P were coded as three-level categorical variables: lower, equal, and higher. As hypothesized, the youth in the "Lower" SPRII-S or SPRII-P groups reported the worst general health and the highest levels of depression and stress; the youth in the "Higher" groups reported the best general health. Unexpectedly, the youth in the "Higher" groups did not report the lowest levels of depression and stress, and the relationship between SPRII and cigarette smoking was even less straightforward. The expected positive relationship between SPRII and the general health status is consistent with previous research, but the relationships between SPRII and depression, stress, and cigarette smoking behavior are not. Further studies are needed to elucidate the complex associations between SPRII and health outcomes in rapidly transforming economies such as China.

Acculturation, gender, depression, and cigarette smoking among U.S. Hispanic youth: the mediating role of perceived discrimination

Hispanic youth are at risk for experiencing depressive symptoms and smoking cigarettes, and risk for depressive symptoms and cigarette use increase as Hispanic youth acculturate to U.S. culture. The mechanism by which acculturation leads to symptoms of depression and cigarette smoking is not well understood. The present study examined whether perceived discrimination explained the associations of acculturation with depressive symptoms and cigarette smoking among 1,124 Hispanic youth (54% female). Youth in Southern California completed surveys in 9th-11th grade. Separate analyses by gender showed that perceived discrimination explained the relationship between acculturation and depressive symptoms for girls only. There was also evidence that discrimination explained the relationship between acculturation and cigarette smoking among girls, but the effect was only marginally significant. Acculturation was associated with depressive symptoms and smoking among girls only. Perceived discrimination predicted depressive symptoms in both genders, and discrimination was positively associated with cigarette smoking for girls but not boys. These results support the notion that, although Hispanic boys and girls experience acculturation and discrimination, their mental health and smoking behaviors are differentially affected by these experiences. Moreover, the results indicate that acculturation, gender, and discrimination are important factors to consider when addressing Hispanic youth's mental health and substance use behaviors.

Preliminary evidence for mediation of the association between acculturation and sun-safe behaviors

OBJECTIVES

To identify and test mediators of the relationship between acculturation and sun-safe behaviors among Latinos in the United States. We hypothesized that the effect of acculturation on use of sunscreen, shade, and sun-protective clothing would be mediated by perceived health status, educational level, access to health care, and contact with social networks regarding health matters.

DESIGN

The 2005 Health Information National Trends Survey, implemented by the National Cancer Institute.

SETTING

Nationwide survey.

PARTICIPANTS

A probability-based sample of the US civilian, noninstitutionalized adult population, comprising 496 Latino respondents.

MAIN OUTCOME MEASURES

Use of sunscreen, shade, and sun-protective clothing when outdoors on sunny days, assessed by self-report on frequency scales.

RESULTS

The positive association between acculturation and sunscreen use and the negative association between acculturation and use of sun-protective clothing were mediated by educational level (P < .05 for both). Perceived health status and contact with social networks regarding health matters were supported as mediators for sunscreen use only (P < .05). Health care access was not supported as a mediator for any of the outcomes.

CONCLUSIONS

Structural equation models revealed distinct direct and indirect paths between acculturation and each sun-safe practice. Our findings emphasize behavior-specific mediated associations and could inform sun safety programming for Latinos with low and high levels of acculturation. The models support educational level, contact with social networks regarding health matters, and perceived health status as mediators primarily for sunscreen use. Future research should test different mediators for use of shade or sun-protective clothing.

The influence of the perceived consequences of refusing to share injection equipment among injection drug users: balancing competing risks

Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens through receptive syringe sharing (RSS) and receptive paraphernalia sharing (RPS). Research into the influence of the perceived risk of HIV infection on injection risk behavior has yielded mixed findings. One explanation may be that consequences other than HIV infection are considered when IDUs are faced with decisions about whether or not to share equipment. We investigated the perceived consequences of refusing to share injection equipment among 187 IDUs recruited from a large syringe exchange program in Los Angeles, California, assessed their influence on RSS and RPS, and evaluated gender differences. Two sub-scales of perceived consequences were identified: structural/external consequences and social/internal consequences. In multiple linear regression, the perceived social/internal consequences of refusing to share were associated with both RSS and RPS, after controlling for other psychosocial constructs and demographic variables. Few statistically significant gender differences emerged. Assessing the consequences of refusing to share injection equipment may help explain persistent injection risk behavior, and may provide promising targets for comprehensive intervention efforts designed to address both individual and structural risk factors.

Secondhand smoke exposure among Hispanics/Latinos living in multiunit housing: exploring barriers to new policies

PURPOSE

Despite a high prevalence of voluntary home smoking bans and laws protecting Californians from exposure to secondhand smoke (SHS) in the workplace, many Hispanic/Latino (H/L) residents of multiunit housing (MUH) are potentially exposed to SHS from neighboring apartments. An advocacy/policy intervention was implemented to reduce tobacco-related health disparities by encouraging H/L living in MUH to implement voluntary policies that reduce exposure to SHS. This article presents findings from qualitative and quantitative data collected during development of the intervention, as well as preliminary results of the intervention.

DESIGN, SETTING, AND SUBJECTS

MUH residents in Southern California participated in focus groups (n = 48), door-to-door surveys (n = 142), and a telephone survey (n = 409).

MEASURES

Exposure to SHS, attitudes toward SHS, and attitudes toward policies restricting SHS in MUH were assessed.

RESULTS

H/L MUH residents reported high levels of exposure to SHS and little ability to protect themselves and their families from SHS. Respondents expressed positive attitudes toward adopting antismoking policies in MUH, but they also feared retaliation by smokers. The cultural values of familismo, respeto, simpatía, and personalismo influenced their motivation to protect their families from SHS as well as their reluctance to ask their neighbors to refrain from smoking. Nonsmokers were more likely to favor complete indoor and outdoor smoking bans in MUH, whereas smokers were more likely to favor separate smoking areas. The Regale Salud advocacy/policy intervention, implemented to reduce SHS exposure, prompted the passage of seven voluntary policies in apartment complexes in Southern California to prevent smoking in MUH.

CONCLUSIONS

H/L in California support voluntary policies, local ordinances, and state laws that prevent exposure to SHS in MUH, especially those that are consistent with H/L cultural values and norms for interpersonal communication.