Pathways from acculturation stress to substance use among latino adolescents

Psychoactive substance use among Russian migrants relocated in Georgia following the 2022 invasion of Ukraine: Qualitative study

INTRODUCTION

Study aimed at exploring the experience of migrants from Russia who use psychoactive substances, who arrived in Georgia in the wake of the invasion of Ukraine.

METHODS

Qualitative individual interviews and focus group discussions. The data collection took place from May to August 2023.

RESULTS

The final sample consisted of 23 respondents, who were mostly young and employed. Participants left Russia because of the war in Ukraine and the threat of conscription in Russia, but also due to political dissent. Participants experienced depressive symptoms and a worsening of mental health conditions. The increased consumption of sedatives and alcohol was closely associated with the efforts to manage stress and depression, acting as a means to cope with adverse effects on mental health. The absence of leisure alternatives emerged as a significant factor, with drug use becoming a feature of socialising in circumstances where such behaviour was not typical in their Russian lives. Participants exhibited low awareness of available relevant health services (including drug-related) and typically addressed recurrent health needs by consulting Russian specialists online or Russian-speaking professionals within Georgia's migrant community.

DISCUSSION AND CONCLUSIONS

Migration was associated with a deterioration in mental health status and substance use often manifested as a maladaptive strategy to cope with mental health problems. The difficulties encountered in the process of assimilation contributed to behaviours related to drug consumption. Immigration policies need to be inclusive of the health needs of migrants and provide opportunity to integrate effectively into society.

Peer Discrimination, Deviant Peer Affiliation, and Latino/a Adolescent Internalizing and Externalizing Symptoms: A Prospective Study

OBJECTIVE

U.S. Latino/a adolescents experience high levels of ethnic discrimination, particularly in new immigrant destinations. Due to the salience of peers during adolescence, this study examined how peer discrimination related directly and indirectly, through deviant peer affiliation, to changes in Latino/a adolescents' internalizing and externalizing symptoms. Culture-specific moderators hypothesized to buffer discrimination impacts on adolescent symptomology included Spanish language enculturation and adolescents' social ties to relatives in the family's country-of-origin.

METHOD

The sample of 547 Latino/a adolescent participants from the Caminos al Bienestar study (55.4% female; age M = 12.8, range = 11-16) was selected at random from middle schools in a large, suburban school district in Atlanta, Georgia. Three time points of survey data spaced roughly 6 months apart were collected during 2018 and 2019.

RESULTS

Results from longitudinal structural equation models revealed that peer discrimination was associated indirectly with increased externalizing symptoms, through increases in affiliation with deviant peers (β = 0.05; SE = 0.02; B = 0.02; 95% CI = 0.01, 0.09). We did not observe direct or indirect effects of peer discrimination on changes in internalizing symptoms, and we found no significant protective effects of either Spanish language enculturation or social ties with the country-of-origin.

CONCLUSIONS

Ethnic discrimination by peers may lead to deviant peer affiliation and, in turn, increased externalizing behaviors. Future research identifying protective factors that buffer discrimination impacts on deviant peer affiliation is needed to inform the development of interventions that can prevent Latino/a adolescents' externalizing symptoms.

Correlates of Alcohol Use Likelihood for Latino Immigrant Youth in an Emerging Context

Using a three-wave prospective longitudinal design spanning 3 years, we assessed alcohol use likelihood trajectories and their correlates among a community sample of Latino immigrant adolescents in the emerging immigrant context of Western Oregon. Results from growth mixture modeling revealed two distinct classes: lower risk youth who reported little likelihood of alcohol use but whose trajectory was increasing, and higher risk youth who reported higher likelihood of alcohol use and whose trajectory was stable. We found significant differences between the two classes such that lower risk youth reported greater levels of Latino cultural orientation and parental monitoring, whereas higher risk youth reported greater levels of family cultural stress and delinquency. Results are discussed in terms of prior research and theory.

Decomposing the Healthy Immigrant Effect: The Role of GDP of Birth Country in Immigrant Health

Drawing on the social-ecological systems perspective of health, this study explores whether the deteriorating trend of immigrant health over time differs depending on immigrants' pre-migration macro-level factors in their birth country. Using the Household, Income, and Labor Dynamics in Australia survey (N = 1,847), we conducted an HLM analysis to examine the association among GDP per capita in the birth country, length of stay, and immigrants' health status post-migration. Support was found for both the negative association between the length of stay and health and the positive association between the GDP of the birth country and health. The negative association between length of stay and health was stronger among immigrants from low GDP countries compared to those from high GDP countries. Our findings suggest the importance of the population-level characteristics of the birth country in understanding healthy immigrant effect post-migration.

Perceived ethnic discrimination, ethnic-racial socialization, and substance use among ethnic minority adolescents

Perceived discrimination is a significant problem among ethnic minority adolescents and has been consistently linked to negative outcomes, including substance use, although few studies examine this relation with more than one time point. The present study adds to the literature by examining whether ethnic-racial socialization moderates the effects of perceived discrimination at time 1 on recent substance use six months later in a sample of ethnic minority, public high school students in Southern California. The results from analyses of survey data showed that perceived discrimination did not predict the likelihood of the outcomes, and they suggest that discrimination based on attributes other than ethnicity, such as immigration or documentation status, may be operating in the sample. Future research should simultaneously analyze effects of discrimination by type of attribute as well as level (e.g., intragroup, intergroup, and structural). With regard to ethnic-racial socialization in the multivariate models, cultural socialization was negatively related to the likelihood of the outcomes. Preparation for bias was positively related to the likelihood of the outcomes. Promotion of mistrust was not statistically significantly related to the likelihood of the outcomes. Although the socialization variables did not moderate the effect of perceived discrimination, they were clearly related to substance use in multiple ways, suggesting that future research continue to distinguish the effects of socialization by type to better understand how they can be addressed to optimize youth outcomes.

The direct and indirect effects of family and school-related factors on Latino adolescent substance use

Latino adolescents continue to have high usages of alcohol and other harmful substances when compared with other ethnic groups (Centers for Disease Control & Prevention, 2005; Telzer, Gonzales, & Fuligni, 2014). This study focuses on the direct and indirect effects of family and school-related factors that impact Latino adolescent substance use comparing male and female groups. Structural equation modeling (SEM) was used to analyze the relationship between maternal monitoring knowledge, the adolescent-teacher relationship, family stress and substance use through academic achievement and school engagement mediators using data from 359 Latino boys and 480 Latina girls from a West Texas area school district. Results indicated that maternal monitoring knowledge was negatively associated with substance use while family stress was positively associated with substance use. Gender differences were found between the influence of maternal monitoring knowledge and academic achievement and among other indirect paths to substance use. Academic achievement completely mediated the relationship between the adolescent-teacher relationship and substance use for both genders while school engagement was also found to be a significant mediator for girls and not boys. Implications are discussed.

Acculturative stress and emotional eating in Latino adolescents

PURPOSE

Despite data that suggest Latino adolescents experience acculturative stress (i.e., feeling overwhelmed by conflicting cultural practices, language problems, and ethnic self-consciousness) and endorse elevated levels of emotional eating, there has been an absence of research examining the relations between acculturative stress and emotional eating in this population. The purpose of the present study was to (1) examine the associations between acculturative stress, emotional eating, and change in BMIz scores in Latino adolescents over a 3-month period, and (2) compare Latino and non-Latino adolescents on measures of acculturative stress, emotional eating, and body mass index (BMI).

METHODS

The sample comprised 168 Latino (mean age 13.69 years; SD 0.88) and 278 non-Latino (mean age 13.68 years; SD 0.79) middle and high school students. Participants completed the Emotional Eating Scale for Children and Adolescents (EES-C), the Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale for Children (SAFE-C), and a demographic questionnaire. Participants had their height and weight measured after completing the questionnaires and at a second-time point, approximately 3 months after time 1 measurements. Independent samples t tests and Cohen's d effect sizes were used to investigate whether there were differences between Latino adolescents and non-Latino adolescents. Pearson correlations were computed to examine associations between acculturative stress, emotional eating, and change in BMIz scores in the Latino sample.

RESULTS

Latino adolescents endorsed significantly higher acculturative stress on the SAFE-C compared to non-Latino adolescents (Latino mean 30.81; non-Latino mean 25.64; p < 0.001; Cohen's d effect size = 0.35). In the Latino sample, acculturative stress was associated with higher levels of emotional eating. Latino and non-Latino adolescents endorsed similar levels of emotional eating.

CONCLUSIONS

The present findings provide preliminary evidence that acculturative stress may serve as a risk factor for emotional eating among Latino adolescents. Future obesity prevention and intervention programs developed for Latino adolescents may benefit from addressing acculturative stress, particularly among more recent Latino immigrants.

LEVEL OF EVIDENCE

Level 3, case-control analytic study.

The Roles of Familism and Emotion Reappraisal in the Relations Between Acculturative Stress and Prosocial Behaviors in Latino/a College Students

Researchers have demonstrated mixed associations between acculturative stress and prosocial behaviors (actions intended to benefit others) among Latino/a adolescents and emerging adults. The current study aimed to examine the relations between acculturative stress and Latino/a young adults' prosocial behaviors via familism values and emotion reappraisal. Participants were 1,527 Latino/a college students (M _age = 20.35 years, SD = 3.88; 75.2% women) from universities across the United States. The results demonstrated direct and indirect links between acculturative stress and prosocial behaviors. Specifically, acculturative stress was positively related to familism values, which in turn were positively associated with multiple forms of prosocial behaviors. Additionally, emotion reappraisal was positively associated with specific forms of prosocial behaviors. There was also evidence that familism and emotion reappraisals moderated the associations between acculturative stress and specific forms of prosocial behaviors. Discussion focuses on the interplay of culture-related and emotion-regulation processes associated with Latino/a young adults' positive social outcomes.

Saliendo Adelante: Stressors and Coping Strategies Among Immigrant Latino Men Who Have Sex With Men in a Nontraditional Settlement State

Immigrant Latino men who have sex with men (MSM) are marginalized along multiple dimensions (e.g., ethnicity, sexual orientation, language use), which can negatively affect their health and well-being. As little is known about how this subgroup experiences the stress of marginalization and how, in turn, they cope with such stress, this study investigated stressors and coping strategies to better understand the factors shaping Latino MSM health. Assisted by a community advisory committee, we conducted in-depth interviews with 15 foreign-born Latino MSM in a nontraditional settlement state. Drawing on grounded theory methods, we analyzed transcripts iteratively to identify processes and characterize themes. Results were confirmed in member check interviews (n = 4) and findings were further contextualized through key informant interviews (n = 3). Participants reported ubiquitous, concurrent stressors due to being an immigrant, being a sexual minority, and being working poor. In particular, homophobia within families and local Latino communities was seen as pervasive. Some participants faced additional stressors due to being undocumented and not being Mexican. Participants drew on four types of coping strategies, with no dominant coping response: passive coping (i.e., not reacting to stressors); attempting to change stressors; seeking social support; and seeking distractions. Family ties, especially with mothers, provided key emotional support but could also generate stress related to participants' sexuality. This study lays a foundation for future work and is particularly relevant for Latino MSM in nontraditional settlement states. Findings may inform future interventions to reduce stressors and increase resiliency, which can positively affect multiple health outcomes.

Epidemiology of Substance Use among Forced Migrants: A Global Systematic Review

INTRODUCTION

Forced migration is occurring at unprecedented levels. Forced migrants may be at risk for substance use for reasons including coping with traumatic experiences, co-morbid mental health disorders, acculturation challenges and social and economic inequality. This paper aimed to systematically review the literature examining substance use among forced migrants, and identify priority areas for intervention and future research.

METHODS

Seven medical, allied health and social science databases were searched from inception to September 2015 in accordance with PRISMA guidelines to identify original peer-reviewed articles describing any findings relating to alcohol and/or illicit drug use among refugees, internally displaced people (IDPs), asylum seekers, people displaced by disasters and deportees. A descriptive synthesis of evidence from quantitative studies was conducted, focusing primarily on studies which used validated measures of substance use. Synthesis of evidence from qualitative studies focused on identifying prominent themes relating to the contexts and consequences of substance use. Critical Appraisal Skills Programme (CASP) checklists were used to assess methodological quality of included studies.

RESULTS

Forty-four quantitative (82% cross-sectional), 16 qualitative and three mixed-methods studies were included. Ten studies were rated as high methodological quality (16%), 39 as moderate quality (62%) and 14 as low quality (22%). The majority of research was conducted among refugees, IDPs and asylum seekers (n = 55, 87%), predominantly in high-income settings. The highest-quality prevalence estimates of hazardous/harmful alcohol use ranged from 17%-36% in camp settings and 4%-7% in community settings. Few studies collected validated measures of illicit drug use. Seven studies compared substance use among forced migrants to other migrant or native-born samples. Among eight studies which conducted multivariable analysis, male sex, trauma exposure and symptoms of mental illness were commonly identified correlates of substance use.

CONCLUSION

Our understanding of substance use among forced migrants remains limited, particularly regarding persons displaced due to disasters, development and deportation. Despite a growing body of work among refugee-background populations, few studies include refugees in low and middle-income countries, where over 80% of the global refugee population resides. Findings suggest a need to integrate substance use prevention and treatment into services offered to forced migrants, particularly in camp settings. Efforts to develop and evaluate interventions to reduce substance use and related harms are needed.

Substance abuse and batterer programmes in California, USA: factors associated with treatment outcomes

The association between substance abuse and intimate partner violence is quite robust. A promising area to improve treatment for the dual problems of substance abuse and violence perpetration is the identification of client characteristics and organisational and programme factors as predictors of health outcomes. Therefore, we examined associations of client, organisational and programme factors with outcomes in community health settings. Directors of 241 substance use disorder programmes (SUDPs) and 235 batterer intervention programmes (BIPs) reported outcomes of programme completion and substance use and violence perpetration rates at discharge; data collection and processing were completed in 2012. SUDPs having more female, non-white, younger, uneducated, unemployed and lower income clients reported lower completion rates. In SUDPs, private, for-profit programmes reported higher completion rates than public or private, non-profit programmes. SUDPs with lower proportions of their budgets from government sources, and higher proportions from client fees, reported better outcomes. Larger SUDPs had poorer programme completion and higher substance use rates. Completion rates in SUDPs were higher when clients could obtain substance- and violence-related help at one location, and programmes integrated violence-prevention contracting into care. In BIPs, few client, organisational and programme factors were associated with outcomes, but the significant factors associated with programme completion were consistent with those for SUDPs. Publicly owned and larger programmes, and SUDPs lacking staff to integrate violence-related treatment, may be at risk of poorer client outcomes, but could learn from programmes that perform well to yield better outcomes.

Pathways to Drinking Among Hispanic/Latino Adolescents: Perceived Discrimination, Ethnic Identity, and Peer Affiliations

We examined whether discrimination experienced by Hispanic/Latino adolescents is associated (a) directly with adolescent alcohol use or (b) indirectly with adolescent alcohol use via mediation by ethnic identity and/or peer associations. Data were drawn from an NIAAA-funded randomized controlled trial evaluating the efficacy of a Guided-Self Change intervention for Hispanic/Latino youth with alcohol and interpersonal violence problems (R01 AA12180; see Wagner et al., 2014). The current sample included 371 Hispanic/Latino teenagers (mean age = 16.3 years [SD = 1.37]; 38% female). Using structural equation modeling (SEM), results revealed that perceived discrimination was indirectly related to alcohol consumption through positive (non-drinking) peer affiliations. Additionally, ethnic identity was found to moderate the relationship between discrimination and positive peer affiliation. These findings further our understanding about how discrimination and ethnic identity interact, as well as provide directions for how the effectiveness of prevention models may be enhanced for reducing underage drinking among Hispanic/Latino adolescents.

Acculturative and enculturative stress, depressive symptoms, and maternal warmth: examining within-person relations among Mexican-origin adolescent mothers

Mexican-origin adolescent mothers face numerous social challenges during dual-cultural adaptation that are theorized to contribute to greater depressive symptoms. Alongside challenges, there are familial resources that may offer protection. As such, the current study examined the trajectories of depressive symptoms among 204 Mexican-origin adolescent mothers (M age = 16.80, SD = 1.00) across a 4-year period (third trimester of pregnancy, and 10, 24, and 36 months postpartum). Further, we examined the within-person relations of two unique sources of stress experienced during dual-cultural adaptation, acculturative and enculturative stress, and youths' depressive symptoms; we also tested whether adolescent mothers' perceptions of warmth from their own mothers emerged as protective. Adolescent mothers reported a decline in depressive symptoms after the transition to parenthood. Acculturative and enculturative stress emerged as significant positive within-person predictors of depressive symptoms. Maternal warmth emerged as a protective factor in the relation between enculturative stressors and depressive symptoms; however, for acculturative stressors, the protective effect of maternal warmth only emerged for US-born youth. Findings illustrate the multidimensionality of stress experienced during the cultural adaptation process and a potential mechanism for resilience among Mexican-origin adolescent mothers.

Substance Use Differences Among U.S.- Versus Foreign-Born Adolescents

The influence of perceived family conflict, family support, and peer substance use on adolescent substance use was examined in a community sample of 669 (331 female, 338 male) Latino youth, who were assessed twice over the span of 2½ years. We found greater substance use among U.S.-born Latino youth in comparison to foreign-born Latino youth at both time points. Levels of family conflict were higher, and levels of family support were lower, in families with U.S.-born versus foreign-born adolescents. Results suggest that higher family conflict, but not lower family support, may partially explain higher substance use rates among U.S.-born versus foreign-born Latino adolescents.

[Systematic review of epidemiological studies on interpersonal discrimination and mental health]

The article describes epidemiological studies on the relationship between interpersonal discrimination and mental health outcomes, updating previous literature reviews on the topic. The review included 34 papers published in PubMed from 2000 to 2010, 68% of which were based on convenience samples and 82% with a cross-sectional design. Positive and statistically significant associations were observed between discrimination and adverse mental health outcomes, particularly substance use, depression, and alcohol-related disorders. Only one third of the studies explicitly adopted a specific theoretical framework to interpret the examined relationships. Mirroring previous reviews, discrimination was positively and consistently associated with adverse mental health outcomes. However, future studies should employ robust designs for causal inference, use discrimination instruments with good psychometric properties, and adopt theoretical frameworks to interpret their findings.

Building a conceptual framework to culturally adapt health promotion and prevention programs at the deep structural level

The debate on the effectiveness and merit for the amount of time, effort, and resources to culturally adapt health promotion and prevention programs continues. This may be due, in large part, to the lack of theory in commonly used methods to match programmatic content and delivery to the culture of a population, particularly at the deep structural level. This paper asserts that prior to the cultural adaptation of prevention programs, it is necessary to first develop a conceptual framework. We propose a multiphase approach to address key challenges in the science of cultural adaptation by first identifying and exploring relevant cultural factors that may affect the targeted health-related behavior prior to proceeding through steps of a stage model. The first phase involves developing an underlying conceptual framework that integrates cultural factors to ground this process. The second phase employs the different steps of a stage model. For Phase I of our approach, we offer four key steps and use our research study as an example of how these steps were applied to build a framework for the cultural adaptation of a family-based intervention to prevent adolescent alcohol use, Guiding Good Choices (GGC), to Chinese American families. We then provide a summary of the preliminary evidence from a few key relationships that were tested among our sample with the greater purpose of discussing how these findings might be used to culturally adapt GGC.

The Immigrant and Hispanic Paradoxes: A Systematic Review of Their Predictions and Effects

A survey of the literature indicates that reported advantages of the Immigrant and Hispanic Paradox are inconsistent and equivocal. The healthy migrant hypothesis also suggests that current research approaches consider only "healthy" groups. Other methodological concerns include the simple underreporting of deaths, and that commonly used databases may not include all significant attributes and characteristics. We conducted a systematic review, synthesizing and identifying themes not explicitly found in the current literature. We also employ a simple quantitative index to assess the scholarly strength of references. Paradox protection appears uneven and is not generalizable across races, ethnicities, age groups and genders. In addition, acculturation, health behaviors and diet, ethnicity, acculturative stress, adolescence, undocumented and uninsured status, age of arrival in the United States and length of exposure, gender and age appear to be significant in predicting any beneficial effects.

A Multicultural Approach to Health Psychology

The North American continent comprises a diverse array of individuals. Although the majority of them prescribe to the beliefs and treatments of Western biomedicine, a substantial number also practice diverse approaches to health. This article summarizes the basic tenets of major non-Western approaches to health, including the main beliefs and treatments. It bases this discussion in the context of health disparities, the existence of which presents a major problem for health care in America, and with an eye toward aiding the development of cultural competence for clinicians and health care providers nationwide.

Substance abuse, violence, HIV, and depression: an underlying syndemic factor among Latinas

BACKGROUND

Evidence from the literature suggests that substance abuse, violence, HIV risk, depressive symptoms, and underlying socioeconomic conditions are tied intrinsically to health disparities among Latinas. Although these health and social conditions appear to comprise a syndemic, an underlying phenomenon disproportionately accounting for the burden of disease among marginalized groups, these hypothesized relationships have not been formally tested.

OBJECTIVES

The aim of this study was to assess (a) if substance abuse, violence, HIV risk, and depressive symptoms comprised a syndemic and (b) if this syndemic was related to socioeconomic disadvantage among Latinas.

METHODS

Baseline assessment data from a randomized controlled community trial testing the efficacy of an HIV risk reduction program for adult Latinas (n = 548) were used to measure demographic variables, substance abuse, violence, risk for HIV, and depressive symptoms. Structural equation modeling was used to test a single underlying syndemic factor model and any relation to socioeconomic disadvantage.

RESULTS

The results of this study support the idea that HIV risk, substance abuse, violence, and depressive symptoms comprise a syndemic, χ(27) = 53.26, p < .01 (relative χ = 1.97, comparative fit index = .91, root mean square error of approximation = .04). In addition, in limited accord with theory, this factor was related to 2 measures of socioeconomic disadvantage, percentage of years in the United States (b = 7.55, SE = 1.53, p < .001) and education (b = -1.98, SE = .87, p < .05).

DISCUSSION

The results of this study could be used to guide public health programs and policies targeting behavioral health disparity conditions among Latinos and other vulnerable populations. Further study of the influence of gender-role expectations and community-level socioeconomic indicators may provide additional insight into this syndemic.

A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics

Hispanics are disproportionately affected by substance abuse, HIV infection, intimate partner violence, and mental health conditions. To address health disparities among Hispanics and other vulnerable groups, it is necessary to understand the complex interactions between health conditions clustering together (e.g., substance abuse, intimate partner violence, and HIV) and the social ecology in which these conditions exist. A syndemic orientation, a consideration of clustering epidemics and common individual, relationship, cultural, and socioenvironmental factors linking these conditions, may be helpful in developing comprehensive models that expand our ability to understand and address health disparities. The purpose of this paper is to introduce a Syndemic Model of Substance Abuse, Intimate Partner Violence, HIV Infection, and Mental Health among Hispanics, and provide evidence from the research literature to support the central relationships and risk and protective factors (i.e., potential links between conditions) depicted by the model. The development and evaluation of interventions aimed at the prevention of substance abuse, intimate partner violence, HIV/AIDS, and mental health problems as a syndemic affecting Hispanics is urgently needed. Public health nurses can initiate this endeavor with the guidance of a Syndemic Model.

Marijuana use among Latino adolescents: gender differences in protective familial factors

Given the important contextual function of family dynamics and traditional gender roles in Latino cultures, parental influences on substance use among Latino adolescents may differ across genders. This study examined associations between family factors (parental monitoring, parent-child communication, family cohesion, and familism) and marijuana use among 1,369 Latino adolescents in Southern California. Students from seven schools completed surveys in 9th and 11th grades. Longitudinal hierarchical linear regression analyses evaluated the associations between family factors in 9th grade and lifetime marijuana use in 11th grade, as well as gender differences in these associations. Girls reported higher levels of parental monitoring, parental communication, and familism than boys did, but there were no gender differences in family cohesiveness. In a regression model controlling for covariates and previous marijuana use, parent-child communication and family cohesion in 9th grade were each uniquely predictive of lower levels of marijuana consumption in 11th grade. Gender was a statistical moderator, such that higher levels of parent-child communication predicted lower marijuana use among boys, whereas girls' use was relatively low regardless of parent-child communication levels. Results are discussed in the light of the concurrent socialization processes of family and gender in Latino culture and its relation to preventing delinquent behaviors such as marijuana use.

Substance use disorder comorbidity with schizophrenia in families of Mexican and Central American ancestry

OBJECTIVES

The aims of this study were to estimate the frequency and course of substances use disorders in Latino patients with schizophrenia and to ascertain risk factors associated with substance use disorders in this population.

METHOD

We studied 518 subjects with schizophrenia recruited for a genetic study from the Southwest United States, Mexico, and Central America (Costa Rica and Guatemala). Subjects were assessed using structured interviews and a best estimate consensus process. Logistic regression, chi(2), t test, Fisher's exact test, and Yates' correction, as appropriate, were performed to assess the sociodemographic variables associated with dual diagnosis. We defined substance use disorder as either alcohol or substance abuse or dependence.

RESULTS

Out of 518 patients with schizophrenia, 121 (23.4%) had substance use disorders. Comorbid substance use disorders were associated with male gender, residence in the United States, immigration of Mexican men to the United States, history of depressive syndrome or episode, and being unemployed. The most frequent substance use disorder was alcohol abuse/dependence, followed by marijuana abuse/dependence, and solvent abuse/dependence.

CONCLUSION

This study provides data suggesting that depressive episode or syndrome, unemployment, male gender, and immigration of Mexican men to the United States were factors associated with substance use disorder comorbidity in schizophrenia. Binary logistic regression showed that country of residence was associated with substance use disorder in schizophrenic patients. The percentage of subjects with comorbid substance use disorders was higher in the Latinos living in the United States compared with subjects living in Central America and Mexico.

Effects of the 5th and 7th grade enhanced versions of the keepin' it REAL substance use prevention curriculum

This study assessed the outcomes of adapting the culturally-grounded, middle school, substance-use prevention intervention, keepin ' it REAL (kiR), to target elementary school students and to address acculturation. At the beginning of 5th grade, 29 schools were randomly assigned to conditions obtained by crossing grade of implementation (5th, 7th, 5th + 7th, and control/comparison) by curriculum version [kiR-Plus vs. kiR-Acculturation Enhanced (AE)]. Students (n = 1984) completed 6 assessments through the end of 8th grade. The kiR curricula generally appear no more effective than the comparison schools' programming. Students receiving either version of the kiR intervention in only the 5th grade report greater increases in substance use than did control students. Receiving the kiR-AE version twice (both 5th and 7th grades) has benefits over receiving it once.