Traditions and alcohol use: a mixed-methods analysis

Cultural adaptations and cultural factors in EBI implementation with Latinx communities

Introduction

Cultural factors are constructs that capture important life experiences of Latinx/Hispanic individuals, families, and communities. Despite their importance for Latinx communities, Latinx cultural factors have yet to be fully incorporated into the literature of many social, behavioral science, and health service fields, including implementation science. This significant gap in the literature has limited in-depth assessments and a more complete understanding of the cultural life experiences of diverse Latinx community residents. This gap has also stifled the cultural adaptation, dissemination, and implementation of evidence based interventions (EBIs). Addressing this gap can inform the design, dissemination, adoption, implementation, and sustainability of EBIs developed to serve Latinx and other ethnocultural groups.

Methods

Based on a prior Framework Synthesis systematic review of Latinx stress-coping research for the years 2000-2020, our research team conducted a thematic analysis to identify salient Latinx cultural factors in this research field. This thematic analysis examined the Discussion sections of 60 quality empirical journal articles previously included into this prior Framework Synthesis literature review. In Part 1, our team conducted an exploratory analysis of potential Latinx cultural factors mentioned in these Discussion sections. In Part 2 we conducted a confirmatory analysis using NVivo 12 for a rigorous confirmatory thematic analysis.

Results

This procedure identified 13 salient Latinx cultural factors mentioned frequently in quality empirical research within the field of Latinx stress-coping research during the years 2000-2020.

Discussion

We defined and examined how these salient Latinx cultural factors can be incorporated into intervention implementation strategies and can be expanded to facilitate EBI implementation within diverse Latinx community settings.

Exploring Feasibility of mHealth to Manage Hypertension in Rural Black Older Adults: A Convergent Parallel Mixed Method Study

OBJECTIVE

The purpose of this study was to explore perceived ease of use, usability, and the feasibility of using mobile health applications to manage hypertension self-care in rural Black older adults with hypertension.

METHODS

A convergent parallel mixed method design was used to study a purposeful sample of 30 Black older adults (29 females, 1 male) from rural East Texas. Quantitative data included demographic characteristics and measured blood pressure, height, and weight, along with questionnaires: the Hill-Bone Compliance to High Blood Pressure Therapy Scale, the Krousel-Wood Medication Adherence Scale-4, and the Technology Acceptance Model Questionnaire (adapted). Qualitative data were obtained from five focus groups and analyzed using thematic analysis.

RESULTS

Mean age was 66.3 ± 9.6 years. Less than half of the participants (46.7%) had a systolic and/or diastolic blood pressure >130/80. Greater participant adherence was noted with the Hill-Bone Compliance scale (63.3%) than the Krousel-Wood scale (23.3%). With the Technology Acceptance Model, perceived ease of use was significantly correlated with behavioral intention (r = 0.654, p < 0.000) and perceived usefulness (r = 0.585, p < 0.001), while behavioral intention was negatively associated with age r = -0.047 (p=0.009). Focus group data revealed five themes: 1) useful, 2) counterintuitive, 3) communication, 4) comfort with the status quo, and 5) educate/show me how.

CONCLUSION

Smartphone technology and other health-related computer technologies were not preferred by older adults in this study due to limited digital literacy. Simplicity and easy navigation in the design of mHealth apps are needed to improve treatment adherence and blood pressure control in rural older adults with hypertension.

CLINICAL RELEVANCE

Mobile health applications have the potential to increase self-management of chronic hypertension if users are digitally literate. Health-care providers need to assess older patients for digital literacy and offer educational support and assistance.

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

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

Acculturation profiles and alcohol use among Hispanic Americans

Hazardous alcohol use among Hispanics makes for a critical public health issue that warrants empirical examination. Whereas research shows positive associations between alcohol-related outcomes and acculturation, it is unclear how enculturation and acculturation x enculturation are linked to alcohol use. Hispanic American undergraduate and graduate students (N = 348, 61.8% women, M_age = 21.82, 83.3% undergraduates) completed questionnaires assessing their levels of acculturation, enculturation, and alcohol use. Enculturation was negatively associated with social drinking-related consequences. Acculturation was positively associated with alcohol consumption, and enculturation buffered this association. Findings highlight the utility of considering acculturation profiles in understanding Hispanic alcohol use.

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.

Description of the use of integrative mixed method in neonatal nursing

To describe the application of the integrative mixed method and its steps. Descriptive methodological study. The integrative mixed method approach was exemplified in a study conducted in neonatal nursing on maternal stress throughout the experience of premature newborns' care. Data on maternal stress level (quantitative approach) and maternal perception of care (qualitative approach) were grouped after analyzes made separately according to the analysis technique of each approach. Subsequently, quantitative and qualitative data were integrated, which originated a new set of data to be interpreted, and consequently enabled a greater understanding of the phenomenon under study and emphasized the importance of the integrative mixed method. The integration of the two approaches, qualitative and quantitative, is a denser theoretical framework with strong scientific evidence for a better understanding of the phenomenon under study than the use of a single approach, since, at the same time, it identifies the frequency of the phenomenon and the reason for its occurrence.

Sociocultural determinants of substance misuse among adult Latinas of Caribbean and South and Central American descent: A longitudinal study of a community-based sample

Few studies have examined the socio-cultural determinants of alcohol and drug misuse trajectories among adult Latinas. To assess the associations between socio-cultural determinants and alcohol and drug misuse, we used a longitudinal design to follow a sample of adult Latina mother-daughter-dyads (N = 267) for ten years, and collected four waves of data. They were adult Latinas of Caribbean, South and Central American descent. Specifically, this study investigated the effects of the following factors: (1) Individual Determinants (e.g., socioeconomic conditions, mental health, and medical status); (2) Cultural Determinants (e.g., acculturation to US culture); (3) Interpersonal Determinants (e.g., interpersonal support, relationship stress, mother-daughter attachment, intimate partner violence); (4) Community Determinants (e.g., neighborhood related stress); and (5) Institutional Determinants (e.g., religious involvement, involvement with the criminal justice system). Using hierarchical modeling, we found that taking prescribed medication on a regular basis for a physical problem, religious involvement, and mother-daughter attachment were negatively associated with drug misuse, while involvement in criminal activity was positively associated with drug misuse. Regarding alcohol misuse, results showed that age at arrival in the United States, number of years in the United States, and religious involvement were negatively associated with alcohol misuse, while involvement in criminal activity was positively associated with alcohol misuse. Based on our findings, explicit implications are provided for culturally relevant interventions.

Specific antecedents of employees’ knowledge sharing behavior

Purpose

The purpose of this study is to examine the antecedents of specific human resource management (HRM) practices and trust on knowledge sharing (KS) behavior of employees.

Design/methodology/approach

In the first phase, a questionnaire survey was used to collect the data from 350 randomly selected individuals working in banks. In the second phase, ten managerial-level employees were interviewed to triangulate the findings of the survey.

Findings

The results revealed that employees viewed trust, recruitment and selection and performance appraisals have a positive relationship with KS behavior. However, training and development and incentives have no impact on KS.

Originality/value

The value of this paper lies in the understanding gained about the interactive effects of KS and HR practices using the structural equation modeling technique. This paper will help in understanding the factors that can promote KS. This study will be helpful for employees, managers and policymakers. This study may help in highlighting the significant role of HR practices.

Assessment of acculturation in minority health research

Acculturation represents an important construct in the context of health disparities. Although several studies have reported relationships between various aspects of acculturation and health in minority populations, crucial inconsistencies remain. One likely reason for these inconsistencies may relate to limitations in the conceptualization and operationalization of acculturation, particularly in the context of health research. The acculturation construct underwent major conceptual and operational change when it was adapted from anthropology to psychology, and we argue another major shift is now required for use of this construct in health research. Issues include determining whether acculturation measures should focus on an individual's internal attitudes or overt behaviors; whether they should characterize cultural orientation status at a given point in time or change over time; whether measures should be culture-specific or more global in nature; how the issue of multiculturalism should be addressed; how measures can optimally incorporate multiple dimensions of acculturation; and whether proxy measures should be used. These issues are important in the context of health research because of their implications for determining the direct and indirect effects of cultural change on health-related biological and behavioral processes. We elaborate on and address each of these issues from a perspective that spans multiple disciplines across the biological and social sciences, and offer concrete recommendations with the ultimate goal of achieving a better understanding of the role of acculturation in minority health and health disparities.

Maybe Small Is Too Small a Term: Introduction to Advancing Small Sample Prevention Science

Prevention research addressing health disparities often involves work with small population groups experiencing such disparities. The goals of this special section are to (1) address the question of what constitutes a small sample; (2) identify some of the key research design and analytic issues that arise in prevention research with small samples; (3) develop applied, problem-oriented, and methodologically innovative solutions to these design and analytic issues; and (4) evaluate the potential role of these innovative solutions in describing phenomena, testing theory, and evaluating interventions in prevention research. Through these efforts, we hope to promote broader application of these methodological innovations. We also seek whenever possible, to explore their implications in more general problems that appear in research with small samples but concern all areas of prevention research. This special section includes two sections. The first section aims to provide input for researchers at the design phase, while the second focuses on analysis. Each article describes an innovative solution to one or more challenges posed by the analysis of small samples, with special emphasis on testing for intervention effects in prevention research. A concluding article summarizes some of their broader implications, along with conclusions regarding future directions in research with small samples in prevention science. Finally, a commentary provides the perspective of the federal agencies that sponsored the conference that gave rise to this special section.

The relationship between nature relatedness and anxiety

This study investigated the relationship between anxiety and feelings of being connected to nature. Two standardised self-report scales, the Nature Relatedness Scale and the State Trait Inventory for Cognitive and Somatic Anxiety, were used in tandem with a qualitative question. Quantitative results indicated that connection to nature was significantly related to lower levels of overall, state cognitive and trait cognitive anxiety. Qualitative results revealed seven themes: relaxation, time out, enjoyment, connection, expanse, sensory engagement and a healthy perspective. Taken together, these results suggest that opportunities that enhance experiences of being connected to nature may reduce unhelpful anxiety.

The Associations of Financial Stress and Parenting Support Factors with Alcohol Behaviors During Young Adulthood

This study examined concurrent and prospective associations of financial stress (financial strain, lack of financial access, public assistance) and parenting support factors (relationship quality, living at home, financial support) with young adults' alcohol behaviors (alcohol use, heavy drinking, and problematic drinking) over a 5-year period. Analyses of National Longitudinal Study of Adolescent Health (Add Health) data (N = 7,159) showed that, over the study period, alcohol use and heavy drinking declined while problematic drinking increased. In addition, living at home and parental relationship quality were associated with fewer concurrent and prospective alcohol behaviors whereas financial strain and parents' financial support were associated with more alcohol behaviors. The implications for minimizing alcohol misuse in young adults amid uncertain economic conditions are discussed.

The effects of parental acculturation and parenting practices on the substance use of Mexican-heritage adolescents from southwestern Mexican neighborhoods

A sample of 189 Mexican-heritage seventh grade adolescents reported their substance use, while one of the child's parents reported parent's acculturation and communication, involvement, and positive parenting with his or her child. Higher levels of parental acculturation predicted greater marijuana use, whereas parent communication predicted lower cigarette and marijuana use among girls. A significant parent acculturation by parent communication interaction for cigarette use was due to parent communication being highly negatively associated with marijuana use for high acculturated parents, with attenuated effects for low acculturated parents. A significant child gender by parent acculturation by parent positive parenting interaction was found. For girls, positive parenting had a stronger association with lower cigarette use for high acculturated parents. For boys, positive parenting had a stronger association with reduced cigarette use for low acculturated parents. Discussion focuses on how acculturation and gender impact family processes among Mexican-heritage adolescents.

THE MODERATING EFFECTS OF ETHNIC IDENTIFICATION ON THE RELATIONSHIP BETWEEN PARENTAL MONITORING AND SUBSTANCE USE IN MEXICAN HERITAGE ADOLESCENTS IN THE SOUTHWEST UNITED STATES

The purpose of this study was to assess the combined effects of ethnic identification and perceived parental monitoring on the substance use of a sample of 162 male and 192 female Mexican heritage seventh grade adolescents. Parental monitoring predicted lower risk for substance use. An interaction of ethnic identification by parental monitoring was observed with parental monitoring exhibiting stronger effects in decreasing use of alcohol use among boys who scored low on ethnic identification. For girls, decreased substance use was predicted by stronger parental monitoring coupled with high ethnic identification. Results are discussed in terms of how the youth's ethnic identification is a distinct process from acculturation, and how ethnic identification may operate as an added protective factor in conjunction with parental monitoring, as protective factors against adolescent substance abuse.

A Methodology for Conducting Integrative Mixed Methods Research and Data Analyses

Mixed methods research has gained visibility within the last few years, although limitations persist regarding the scientific caliber of certain mixed methods research designs and methods. The need exists for rigorous mixed methods designs that integrate various data analytic procedures for a seamless transfer of evidence across qualitative and quantitative modalities. Such designs can offer the strength of confirmatory results drawn from quantitative multivariate analyses, along with "deep structure" explanatory descriptions as drawn from qualitative analyses. This article presents evidence generated from over a decade of pilot research in developing an integrative mixed methods methodology. It presents a conceptual framework and methodological and data analytic procedures for conducting mixed methods research studies, and it also presents illustrative examples from the authors' ongoing integrative mixed methods research studies.

FAS prevalence in a sample of urban schoolchildren in Croatia

We present the results of active case ascertainment of fetal alcohol syndrome (FAS). This study included a sample of urban schoolchildren attending 1st to 4th grade elementary school and their mothers. Out of 912 mothers, 575 (63.04%) participated in the interview. Prenatal alcohol consumption was admitted by 15.47% and binge drinking by 3.13% of interviewed mothers. We evaluated 466 (51.09%) schoolchildren for signs of FAS or partial fetal alcohol syndrome (PFAS) using revised Institute of Medicine (IOM) diagnostic criteria. Nineteen students had features consistent with FAS or PFAS. The observed prevalence of FAS is 3 children and of PFAS is 16 children among 466 students, based on 51% participation rate. The estimated prevalence of FAS is 6.44/1000, of PFAS 34.33/1000 and overall prevalence of FAS/PFAS 40.77/1000. This is the first study of FAS prevalence in Croatia and as far as we are aware the second study in Europe.

Ethnic pride, traditional family values, and acculturation in early cigarette and alcohol use among Latino adolescents

A structural equations model examined the influence of three cultural variables of ethnic pride, traditional family values and acculturation, along with the mediating variables of avoidance self-efficacy and perceptions of the "benefits" of cigarette smoking, on cigarette and alcohol use in a sample of Latino middle school students in the Southwest. Girls (N = 585) and boys (N = 360) were analyzed separately. In both groups, higher ethnic pride and traditional family values exerted indirect effects on less cigarette smoking and alcohol use when mediated through greater self-efficacy and less endorsement of the "benefits" of cigarette smoking. Among the girls, greater ethnic pride also had a direct effect on less cigarette and alcohol use. Also, greater acculturation directly predicted more cigarette and alcohol use among the girls, but not among the boys. However, differences between the boys and girls were generally nonsignificant as revealed by multiple group latent variable models. These results offer implications for incorporating cultural variables into the design of culturally relevant prevention interventions that discourage cigarette and alcohol use among Latino adolescents.

Ecodevelopmental contexts for preventing type 2 diabetes in Latino and other racial/ethnic minority populations

Diabetes is the sixth leading cause of death in the United States and it is now cited along with obesity as a global epidemic. Significant racial/ethnic disparities exist in the prevalence of diabetes within the US, with racial and ethnic minorities disproportionately affected by type 2 diabetes and its complications. Racial/ethnic and socioeconomic factors influence the development and course of diabetes at multiple levels, including genetic, individual, familial, community and national. From an ecodevelopmental perspective, cultural variables assessed at one level (e.g., family level dietary practices) may interact with other types of variables examined at other levels (e.g., the availability of healthy foods within a low-income neighborhood), thus prompting the need for a clear analysis of these systemic relationships as they may increase risks for disease. Therefore, the need exists for models that aid in "mapping out" these relationships. A more explicit conceptualization of such multi-level relationships would aid in the design of culturally relevant interventions that aim to maximize effectiveness when applied with Latinos and other racial/ethnic minority groups. This paper presents an expanded ecodevelopmental model intended to serve as a tool to aid in the design of multi-level diabetes prevention interventions for application with racial/ethnic minority populations. This discussion focuses primarily on risk factors and prevention intervention in Latino populations, although with implications for other racial/ethnic minority populations that are also at high risk for type 2 diabetes.