Alcohol and drug use, and depression among Hispanic men in early adulthood

The combined relations of gender, enculturation, and depressive symptoms with health risk behaviors in Mexican-Americans: a moderated mediation analysis

Objectives: The present study investigated the relationships of enculturation and depressive symptoms with health risk behavior engagement in Mexican-American college students and examined how these relationships differed by gender. Previous research has noted consistent gender differences in health risk behavior (e.g. alcohol use, substance use, and risky sexual behavior) among Latina/os, and emphasized the role of U.S. acculturation in this difference. Research examining the role of heritage cultural retention (i.e. enculturation), and including the added influence of mental health variables, such as depressive symptoms, is currently lacking. This study sought to address this gap.Design: A large sample (N = 677) of Mexican-American college students from four universities (located in New York, California, Florida, and Texas) completed an online questionnaire assessing health risk behaviors and corresponding variables.Results: We found that males who endorsed more behavioral enculturation and depressive symptoms were more likely to engage in health risk behavior than all others in the sample. Contrary to previous literature, no relationship was found between behavioral enculturation and health risk behavior in females.Conclusion: The current study found behavioral enculturation to be associated with depressive symptoms, and in turn with health risk behaviors among the males in our sample. Additional research will be needed to identify the mechanism underlying the relationship between enculturation and depressive symptoms as well as between depressive symptoms and risky behavior.

Gender differences in drinking behavior among Latino/a heavy drinkers

BACKGROUND

In the United States (U.S.), higher levels of acculturation have been associated with higher rates of heavy alcohol use more consistently among Latino women than among Latino men. This paper explores mechanisms underlying the link between acculturation and alcohol use among Latino/as in the U.S. We examine alcohol use expectancies and motives from the perspectives of the social cognitive theory of gender development.

METHODS

Qualitative narratives data from six focus groups of individuals (total n = 37), who met criteria for heavy drinking (4/5 drinks/occasion for females/males), were examined separately by gender (18 females; 19 males). Coded narratives data were analyzed using a framework that compared lives in Latin America and in the U.S. Emergent themes were analyzed for their consistency across genders. Gender-specific themes were identified.

RESULTS

Changes in family structure and the loss of social networks prompted divergent patterns of drinking among men and women, such that relative to patterns in their countries of origin, drinking among Latino women increased while it decreased among Latino men. Men and women reported drinking to replace missing social bonds, a motive not frequently reported in the literature on drinking motives. Women who engaged in heavy-drinking nonetheless described traditional gender role expectations after U.S. arrival. Only men endorsed positive alcohol expectancies in Latin America. Women reported drinking to alleviate psychological distress in the U.S.

CONCLUSIONS

Pre and post-immigration comparisons revealed different drinking trajectories among men and women after immigration to the U.S. These patterns appeared to be influenced by new social contexts and changes in familial expectations regarding women's roles. Future inquiry that examines gender-specific themes in alcohol expectancies and motives unique to the experience of immigration, is warranted.

A Quantitative Analysis of Latino Acculturation and Alcohol Use: Myth Versus Reality

Research on health among Latinos often focuses on acculturation processes and the associated stressors that influence drinking behavior. Given the common use of acculturation measures and the state of the knowledge on alcohol-related health among Latino populations, the current analyses tested the efficacy of acculturation measures to predict various indicators of alcohol consumption. Specifically, this quantitative review assessed the predictive utility of acculturation on alcohol consumption behaviors (frequency, volume, and quantity). Two main analyses were conducted-a p-curve analysis and a meta-analysis of the observed associations between acculturation and drinking behavior. Results demonstrated that current measures of acculturation are a statistically significant predictor of alcohol use (Z = -20.75, p < 0.0001). The meta-analysis included a cumulative sample size of 29,589 Latino participants across 31 studies. A random-effects model yielded a weighted average correlation of 0.16 (95% confidence interval = 0.12, 0.19). Additional subgroup analyses examined the effects of gender and using different scales to measure acculturation. Altogether, results demonstrated that acculturation is a useful predictor of alcohol use. In addition, the meta-analysis revealed that a small positive correlation exists between acculturation and alcohol use in Latinos with a between-study variance of only 1.5% (τ²  = 0.015). Our analyses reveal that the association between current measures of acculturation and alcohol use is relatively small.

Nation of Origin, Gender, and Neighborhood Differences in Past-Year Substance Use among Hispanics and Non-Hispanic Whites

This analysis of the National Household Survey on Drug Abuse (NHSDA) focuses on correlates of substance use among Hispanic groups. Using 1994-B and 1996 NHSDA surveys (U.S. Department of Health and Human Services [USDHHS], 1996, 1998), these analyses use sampling areas to control for intracluster correlation and its subsequent effect on empirical conclusions. Models are specified for alcohol, cigarettes, marijuana, cocaine, and any illicit drug, controlling for national origin, gender, age, socioeconomic status, language, and family structure. Results indicate that models failing to account for intracluster correlation may lead to erroneous ethnic contrasts of substance use. Also, substance use varies widely by national origin—and Hispanic men and women have highly divergent patterns of use, more so than non-Hispanic White men and women. Finally, controlling for neighborhood does not wholly diminish ethnic contrasts in substance use.

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

BACKGROUND

Among Hispanics in the U.S., lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrollment, all participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms.

METHODS

Participants (N = 100) completed measures at baseline.

RESULTS

Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (n=49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men.

DISCUSSION

Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.

Factors associated with drug use among male motorbike taxi drivers in urban Vietnam

A cross-sectional study was conducted on a sample of 291 male motorbike taxi drivers (MMTDs) recruited through social mapping technique in Hanoi, Vietnam, for face-to-face interviews to examine factors associated with drug use among MMTDs using Information-Motivation-Behavioral skills (IMB) model. Among 291 MMTDs, 17.18% reported drug use sometime in their lives, 96% of whom were drug injectors. Being depressed, being originally borne in urban cities, currently residing in rural areas, having a longer time living apart from their wives/lovers, using alcohol, following Buddhism, and reporting lower motivation of HIV prevention predict significantly higher odds of uptaking drugs.

Acculturation, depression, self-esteem, and substance abuse among Hispanic men

The demographics of the United States are rapidly changing as a result of immigration from Latin America. Predictions indicate that by the year 2050, one of every four persons in the United States will be of Hispanic ethnicity. If health disparities relating to substance abuse and related mental health conditions among Hispanics are not fully understood and addressed, these will continue to grow along with this population. The purpose of this pilot study was to describe the relationships among acculturation, depression, self-esteem, and substance abuse among a community sample of Hispanic men in South Florida (N = 164, 82 heterosexual men and 82 men who have sex with men). Standardized instruments measuring acculturation, depression, self-esteem, and substance abuse were administered in English or Spanish in a face-to-face interview format. Descriptive statistics and multiple logistic regression were used to illustrate participant characteristics and test relationships among the variables. Despite the fact that the majority of participants were more acculturated to the Hispanic culture than US culture, reported low levels of education and income, were depressed, and used substances, this group of men reported high levels of self-esteem. However, age and depression were the only predictors of substance abuse. Acculturation and self-esteem were not predictors of substance abuse. Clinicians need to be aware of the high rates of depression and substance abuse in this population and screen frequently for signs and symptoms of depression and substance abuse during health care encounters.

Gender differences in the effect of linguistic acculturation on substance use among Mexican-origin youth in the southwest United States

This study tested for gender differences in the impact of linguistic acculturation on pro-drug norms, substance use intentions, and actual substance use among youth of Mexican heritage in a large metropolitan area in the Southwest United States. The authors analyzed baseline survey data provided by 2,487 middle school students of Mexican heritage who were part of a larger, multiethnic randomized efficacy trial of a drug abuse prevention program. Using multi-group structural equation modeling, the authors found that linguistic acculturation was positively and directly related to adherence to pro-drug norms, substance use intentions, and recent alcohol use, controlling for age, poor grades, and socioeconomic status. In addition, linguistic acculturation had an indirect effect on substance use intentions and recent alcohol use through pro-drug norms. The direct effect of linguistic acculturation on pro-drug norms was stronger for girls than for boys, as was its indirect effect on substance use intentions.

Perceived ethnic discrimination versus acculturation stress: influences on substance use among Latino youth in the Southwest

Using a predominately Mexican-origin Latino sample of 5th grade students from the Southwestern United States, this study examined the relative effects of perceived discrimination and acculturation stress on substance use, and it assessed whether these effects were moderated by linguistic acculturation or time in the United States. Although rates of substance use were generally low in the sample, given the young age of the participants, over half (59%) of the sample perceived some discrimination, and almost half (47%) experienced some acculturation stress. Spanish-dominant and bilingual youth perceived more discrimination than English-dominant youth, whereas youth who have been in the United States five or fewer years perceived more discrimination than youth with more time in the United States. Youth who were Spanish-dominant or were recent arrivals experienced the most acculturation stress, with levels declining as linguistic acculturation and time in the United States increased. Multiple regression estimates indicated that perceived discrimination was associated with larger amounts and higher frequency of recent substance use and an array of substance use attitudes, such as stronger intentions to use substances, espousal of pro-drug norms, more positive substance use expectancies, and peer approval of substance use. Although acculturation stress was not associated with substance use, it was positively associated with several substance use attitudes, which are known antecedents of actual use. With a few exceptions, linguistic acculturation and time in the United States did not moderate the effects of perceived discrimination or acculturation stress.

Acculturation and alcohol among Latino adults in the United States: a comprehensive review

BACKGROUND

In light of the inconsistent evidence associating acculturation with drinking outcomes among Latinos in the United States, the current paper comprehensively reviews the literature on this topic.

METHODS

Studies were eligible for review if they (1) were published in a refereed journal, (2) were published in English, (3) sampled Latino/Hispanic adults aged 18+, (4) examined self-reported drinking behavior, alcohol-related problems, and/or alcohol abuse/dependence, and (5) reported original results or unique analyses from a larger dataset. The review includes only studies using composite scales of acculturation. Studies were identified via electronic databases (i.e., PSYCHINFO, ETOH, and PUBMED) using search terms, and combinations thereof, including "acculturat*," "alcohol*," "Latino," and "Hispanic." This search was supplemented by recursive checking and author searches. Thirty-two articles were identified and coded on methodological characteristics; results from 24 disaggregating genders and using appropriate outcomes were summarized.

RESULTS

Higher acculturation was very consistently associated with higher odds of drinking among women, even controlling for demographic covariates. The evidence for women also suggested associations between higher acculturation and heavier drinking on other outcomes, including total volume, drinking frequency, typical quantity, heavy/problem drinking, drinking problems, and abuse/dependence, despite some null results. Relationships were weaker and ambiguous among men. Some evidence suggested that highly acculturated men are (compared with peers low on acculturation) more prone to drink, and perhaps as a result, can show higher consumption and problems. However, results also implied that, among male drinkers, higher acculturation may be associated with a lighter drinking pattern. Important study limitations were identified, including low power, aggregation of nondrinkers with drinkers, restrictive sampling, measurement issues, and analytical issues.

CONCLUSIONS

The pattern of results suggests important associations between acculturation and drinking outcomes-particularly for women-but conclusions are tempered by serious methodological limitations. The review urges further research, particularly large-scale, longitudinal studies, addressing these limitations.

Acculturation among Latino Youth and the Risk for Substance Use: Issues of Definition and Measurement

The purpose of this paper is to provide an overview of the acculturation literature with a specific focus on exploring acculturation as a concept as well as examining its measurement and relationship to substance use/abuse among Latino adolescents in the United States over the past 20 years. A brief overview of the development of theoretical models and instruments assessing acculturation over the past two decades is provided. In addition, studies examining the relationship between acculturation and substance use/abuse among these adolescents are reviewed. Findings indicate that the development of acculturation theory and measurement has been hampered by the lack of both clear terminology and consistency. In the majority of studies reviewed, acculturation appeared to be a risk factor for Latino adolescent substance use/abuse. A small majority of these studies utilized language as a sole measure of acculturation. Language preference, in combination with other proxy measures of acculturation were found to be a robust predictor of substance use/abuse outcomes for Latino adolescents. The findings are discussed in the context of recommendations for future research on the measurement of acculturation as well as on implications for preventive interventions.

Differences by gender, ethnicity, and acculturation in the efficacy of the keepin' it REAL model prevention program

This study examined whether the efficacy of keepin' it REAL, a model program for substance use prevention in schools, was moderated by gender, ethnicity, and acculturation. Gender differences in program efficacy may arise through boys' higher risk of drug use, inadequate attention to girls' developmental issues, or cultural factors like polarized gender expectations. Data came from a randomized trial in 35 Phoenix, Arizona, middle schools involving 4,622 mostly Latino 7th graders. Using multi-level mixed models and multiple imputation missing techniques, results for the total sample showed no gender differences in program effects on recent substance use, but the program was more effective in fostering boys' than girls' anti-drug norms. Subgroup analyses demonstrated several more beneficial program effects for boys than girls (less alcohol and cigarette use and stronger anti-drug norms), but only among less acculturated Latinos. There were no gender differences in program effects among more acculturated Latinos, nor among non-Latino whites.

Should "acculturation" be a variable in health research? A critical review of research on US Hispanics

Acculturation has become a popular variable in research on health disparities among certain ethnic minorities, in the absence of serious reflection about its central concepts and assumptions. Key constructs such as what constitutes a culture, which traits pertain to the ethnic versus "mainstream" culture, and what cultural adaptation entails have not been carefully defined. Using examples from a systematic review of recent articles, this paper critically reviews the development and application of the concept of acculturation in US health research on Hispanics. Multiple misconceptions and errors in the central assumptions underlying the concept of acculturation are examined, and it is concluded that acculturation as a variable in health research may be based more on ethnic stereotyping than on objective representations of cultural difference.

Alcohol use among Dominican and Puerto Rican adolescents residing in New York City: role of Hispanic group and gender

Hispanic groups are often aggregated when examining adolescent drinking. The objective of this study was to determine the roles of Hispanic group (Puerto Rican versus Dominican) and gender in alcohol use among inner-city youth. Sixth and seventh graders in 22 New York City schools who identified themselves as Puerto Rican or Dominican completed self-report questionnaires at two assessments (N = 849 at baseline; N = 678 at 1-year follow-up). Dominican adolescents generally engaged in more alcohol use than Puerto Rican adolescents. In a number of cases, gender moderated the effect of Hispanic group on drinking. Specifically, Dominican boys reported greater use than Dominican girls, but use was similar across gender for Puerto Rican adolescents. These findings highlight the importance of considering Hispanic group and gender when examining adolescent drinking.