Bicultural stress and adolescent risk behaviors in a community sample of Latinos and non-Latino European Americans

Subjective effects as predictors of substance use disorders in a clinical sample: A longitudinal study

BACKGROUND

The literature on the association between subjective effects (SEs; i.e., how an individual perceives their physiological and psychological reactions to a drug) and substance use disorders (SUDs) is largely limited to community samples. The present study addressed the following aims in a clinical sample: whether SEs predict general versus substance-specific SUD in adolescence and adulthood after controlling for conduct disorder symptoms (CDsymp); whether SEs predict SUDs across drug classes; whether SEs predict change in SUD from adolescence to adulthood; and whether there are racial/ethnic differences in associations.

METHODS

Longitudinal analyses were conducted using data from a sample of 744 clinical probands recruited from residential and outpatient SUD treatment facilities in CO during adolescence (Mage = 16.26) and re-assessed twice in adulthood (Mages = 22.56 and 28.96), approximately seven and twelve years after first assessment. SEs and CDsymp were assessed in adolescence. SUD severity was assessed at adolescence and twice during adulthood.

RESULTS

SEs assessed in adolescence robustly predicted general SUD for legal and illegal substances in adolescence and adulthood, whereas CDsymp predicted SUD primarily in adolescence. Higher positive and negative SEs in adolescence were associated with greater SUD severity after controlling for CDsymp, with similar magnitudes. Results indicated cross-substance effects of SEs on SUD. We found no evidence for racial/ethnic differences in associations.

CONCLUSIONS

We investigated the progression of SUD in a high-risk sample with greater odds of sustained SUD. In contrast to CDsymp, both positive and negative SEs consistently predicted general SUD across substances in adolescence and adulthood.

Immigration Enforcement and Hispanic Youth Substance Use: Is Depression a Mediator?

Hispanic adolescents report earlier onset and higher substance use rates than their non-Hispanic White and Black peers. This study examines the associations between the immigration-related arrest of a family member and substance use among Hispanic early adolescents and explores the mediating role of depressive symptoms as the mechanism explaining the association. We apply a mediated multiple linear regression analysis on 661 Hispanic youth attending 7th grade in an urban school district in a south-central, new arrival state. We found that Hispanic early adolescents who experienced the immigration-related arrest of a family member reported significantly higher substance use than Hispanic youth who did not experience the arrest of a family member due to immigration enforcement. Moreover, we found this relationship to be fully mediated by depressive symptoms. Findings suggest that even though the majority of Hispanic youth in the U.S. are citizens, experiencing the immigration-related arrest of a family member is not uncommon and has critical implications for poor mental health and maladaptive coping behaviors.

Assessing Racial and Ethnic Discrimination in Children: A Scoping Review of Available Measures for Child Health Disparities Research

Objectives: To characterize the availability, content, and psychometric properties of self-reported measures that assess race/ethnicity-related discrimination or psychosocial stress and have potential relevance to studies of health disparities in children and adolescents. Design: Using PRISMA extension guidelines for scoping reviews, we searched Ovid Medline, CINAHL, PsychInfo, and Scopus databases from 1946 to April 20, 2020, using the search terms "stress," "child," "adolescents," "discrimination," and "psychometrics." We limited the search to articles in English, with children and adolescents, in the United States. For each measure, we extracted information about the content, reliability, and construct validity. Results: The 12 measures that met inclusion criteria assessed discrimination or stress from racial discrimination in African American children and adolescents (n=8), acculturative stress in Hispanic/Latino children (n=1), or bicultural stress in Mexican American adolescents (n=2), and one measure assessed both discrimination-related and acculturative stress in Hispanic/Latino children. The majority (n=7) articles were published between 2001 and 2010. All discrimination measures evaluated individual experiences of discrimination and one also evaluated stressfulness of discrimination and coping. The acculturative stress measures assessed general stress and immigration-related discrimination, and the bicultural stress measures evaluated many different aspects of biculturalism. Conclusions: Despite the recent increased interest in the racial discrimination and stress as a contributor to racial or ethnic health disparities affecting U.S. children and adolescents, the small number of eligible measures identified and incomplete coverage of various types of racial and ethnic discrimination within and across population groups indicates a currently inadequate capacity to conduct child health disparity studies on this issue.

Mental health in Somali youth in the United States: the role of protective factors in preventing depressive symptoms, suicidality, and self-injury

Objectives: Community, school, family, and individual factors protect against mental illness in general samples of adolescents. How these assets apply to Somali youth resettled to the United States (U.S.), a group with significant trauma exposure, remains unclear. We aimed to quantify which protective factors are associated with lower prevalence of depressive symptoms, suicidality, and self-injury among Somali youth in the U.S. compared with their non-Hispanic white peers.Design: Participants consisted of 8th, 9th, and 11th grade respondents to the 2016 Minnesota Student Survey, an anonymous school-administered statewide survey with 85.5% school district participation, who identified as Somali ethnicity (n = 1552) or as non-Hispanic white (n = 80,583). Multivariable logistic regression assessed odds of depressive symptoms, suicidal ideation and attempts, and self-harm, using eight protective factors (i.e. internal developmental assets, school engagement, empowerment, and family and teacher connectedness, caring adults and after-school activity frequency and quality) as independent variables. Models were run separately for Somali and white youth.Results: Somali youth reported similar rates of depressive symptoms, but lower levels of suicidal ideation or attempts and self-harm behaviors than their white peers (p < 0.001). All eight protective factors were associated with outcomes in the expected direction for white youth. For Somali youth, internal developmental assets (aOR 0.79, 95% CI: 0.65-0.97), empowerment (aOR 0.58, 95% CI: 0.45-0.73), family connectedness (aOR 0.60, 95% CI: 0.51-0.71), perception of caring adults in the community (aOR: 0.84, 95% CI: 0.76-0.92), and quality of after-school activities (aOR: 0.72, 95% CI: 0.61-0.86) were protective against depressive symptoms, with similar patterns for other outcomes. Other school factors protected Somali youth less consistently.Conclusions: Previously established protective factors against mental illness, particularly school factors, do not universally apply to Somali youth. Interventions that strengthen individual, family, or community factors, or that increase the relevance of school factors, should be explored for these youth.

Cultural Stress in the Age of Mass Xenophobia: Perspectives from Latin/o Adolescents

During the last four years, xenophobic rhetoric directed toward Latino immigrants in U.S. media outlets and political forums has greatly increased. Using a general inductive approach, this qualitative study examined the forms of cultural stress, with a focus on discrimination and xenophobia, experienced by Latino adolescents in urban U.S. settings in 2018 and 2019. Six focus groups were conducted in Miami and Los Angeles (three groups per city) with first- and second-generation tenth-grade Latino students (n = 34). The following four themes emerged from the data: perceived discrimination from other Latino subgroups (in-group discrimination), perceived discrimination from non-Latino groups (out-group discrimination), internalization of stressors and discrimination experienced by participants' parents, and the current U.S. political rhetoric surrounding immigration. Understanding cultural stress among Latino adolescents provides valuable insight for future interventions to offset negative health outcomes associated with cultural stress.

Associations between network-level acculturation, individual-level acculturation, and substance use among Hispanic adolescents

Acculturation is associated with substance use behaviors in Hispanic adolescents. However, there is limited research determining whether the individual's friends' acculturation patterns also influence substance use. Tenth-grade students (N = 970) participated in Project RED, a study of substance use and social networks among Hispanic youth in Southern California. Acculturation and substance use data from both the respondent and their nominated friends were regressed on lifetime cigarette use, marijuana use, and alcohol use controlling for sibling substance use, sex, depressive symptoms, and network measures. Respondent's Hispanic orientation was significantly associated with lower odds of both cigarette and marijuana use, whereas respondent's friends' US orientation was associated with higher odds of cigarette use. When controlling for network-level acculturation, individual-level U.S. orientation was not associated with substance use. Participants who nominated more friends had lower odds of cigarette use. Among this sample of Hispanic adolescents, affiliating with U.S.-oriented friends was associated with a higher risk for smoking. Substance use prevention efforts should consider encouraging Hispanic youth to maintain their cultural heritage and foster friendship groups that support abstinence and promote Hispanic and bicultural identity.

The role of perceived discrimination in substance use trajectories in Hispanic young adults: A longitudinal cohort study from high school through emerging adulthood

PURPOSE

Associations between discrimination and substance use have been identified cross-sectionally in multiple populations including Hispanics. However, there is limited research exploring this phenomenon longitudinally in Hispanic youth over the transition from adolescence through emerging adulthood (EA).

METHODS

Hispanic youth in Southern California (n = 1457) completed surveys over 11 years, from 2006 to 2017, including three high school collection waves and five EA collection waves. Multinomial logistic regression models were used to explore the associations between perceived discrimination during high school and cigarette and marijuana use in both high school and EA, controlling for gender, socioeconomic status, acculturation, and EA discrimination.

RESULTS

Compared with those who never used cigarettes or marijuana in high school and EA, perceived discrimination in high school was a significant predictor of two patterns of use: high school initiators who discontinued use of smoking (RRR = 1.677, 95%CI = 1.292-2.176) and/or marijuana (RRR = 1.464, 95%CI = 1.162-1.844), and high school initiators who continued smoking (RRR = 1.492, 95%CI = 1.196-1.861) and/or marijuana use (RRR = 1.249, 95%CI = 1.052-1.482) into EA. For late initiators who did not use in high school but started in EA, perceived high school discrimination was a significant predictor for cigarette smoking (RRR = 1.193, 95%CI = 1.036-1.373) but not for marijuana use.

CONCLUSIONS

Perceived discrimination during adolescence is associated with substance use trajectories across both adolescence and EA. Culturally tailored prevention programs that provide training in skills to cope with psychosocial stressors could improve Hispanic adolescent health.

Effects of sexual/gender minority- and race-based enacted stigma on mental health and substance use in female assigned at birth sexual minority youth

OBJECTIVE

People of color who are also sexual and gender minorities (SGM) experience forms of enacted stigma based on both their racial/ethnic identity and their SGM status. We set out to test the effects of enacted stigma specific to race/ethnicity and SGM identity on mental health and substance use problems among female assigned at birth (FAB) SGM of color.

METHOD

Data come from a community-based sample of FAB SGM who also identified as racial/ethnic minorities (N = 352). The effects of racial discrimination, SGM victimization, and sexual orientation microaggressions on depression symptoms, anxiety symptoms, alcohol-related problems, and marijuana-related problems were tested using linear regression and negative binomial models.

RESULTS

Enacted stigma based on both race/ethnicity and SGM status were significant predictors of mental health outcomes and alcohol-related problems within the same model, which suggested that both uniquely contributed to poorer health. There was little support for interactive effects between the multiple forms of enacted stigma. Marijuana-related problems were best explained by enacted stigma based on race/ethnicity only.

CONCLUSIONS

Racially diverse FAB SGM are at unique risk of experiencing multiple forms of discrimination and aggression based on their minority identities that each contribute negatively to their wellbeing. Consideration of the multiple forms of enacted stigma they face is necessary for understanding health disparities in these populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Latino adolescents' daily bicultural stress and sleep: Gender and school context moderation

OBJECTIVE

Bicultural stress (i.e., challenge arising from navigating 2 cultural contexts) has significant consequences for Latino youth's health, but researchers have yet to examine the implications of bicultural stress for adolescents' sleep. The goals of this study were to examine whether individual and day-to-day (within-person) differences in bicultural stress were associated with Latino adolescents' sleep onset latency (i.e., time to fall asleep), sleep midpoint (i.e., sleep schedule), sleep duration (i.e., time asleep), and subjective sleep quality.

METHOD

Participants were 209 Latino late adolescents (Mage = 18.10 years; 64.4% female) attending over 90 different high schools who completed 7 daily diary surveys while wearing actigraph wristwatches (N = 1,320 daily observations). Participants also reported sleep problems in a standard survey. Statistical interactions were tested to assess moderation by gender and coethnic school composition.

RESULTS

On average, more bicultural stressors across the week were associated with lower average sleep duration and more sleep problems for male (compared to female) adolescents and youth attending schools with higher (compared to lower) Latino student enrollment. Regarding day-to-day differences, more daily bicultural stressors than usual predicted longer sleep onset latency that night for male adolescents, earlier sleep midpoint that night, and less sleep duration that night for youth attending higher Latino-enrollment schools.

CONCLUSIONS

Latino adolescents' everyday experiences of bicultural stress relate to differences in sleep duration, timing, and quality, with important variation by gender and school context. Results advance existing theory regarding social position factors that differentiate the health implications of bicultural stress for Latino youth. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Disentangling relationships between bicultural stress and mental well-being among Latinx immigrant adolescents

BACKGROUND

The Acculturative Process and Context Framework (Ward & Geeraert, 2016) proposes that acculturative stressors influence psychological well-being over time. In fact, extant literature has linked bicultural stress with psychological functioning; yet, no studies have explored the causal dominance of bicultural stress. The purpose of the present study was to evaluate the directionality of prospective relations among bicultural stress and psychosocial functioning (i.e., depressive symptoms, hopefulness, and self-esteem) in Latinx immigrant adolescents across 5 waves.

METHOD

There were 303 Latinx adolescents who were recruited for this study from Los Angeles and Miami and were assessed across 5 waves at 6-month intervals. Adolescents were 14.50 years old on average (SD = .88) and 53.16% were male. Adolescents reported living in the United States for 2.07 years on average (SD = 1.87). A Random-Intercept Cross-Lagged Panel Model (RI-CLPM) was used to examine the between- and within-person relations among bicultural stress, depressive symptoms, hopefulness, and self-esteem in a comprehensive model.

RESULTS

The comprehensive RI-CLPM including bicultural stress, depressive symptoms, hopefulness, and self-esteem exhibited excellent model fit. Between-person, trait-like relations among constructs ranged from small to large, as expected. Within-person, cross-lagged estimates among constructs were overall inconsistent, with some evidence that, within individuals, self-esteem influences later hopefulness.

CONCLUSION

Findings from this study indicate that the RI-CLPM is an effective strategy to examine bicultural stress and well-being processes among adolescents. There is a need for further research examining bicultural stress among Latinx immigrant youth, particularly within prevention and intervention studies. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

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.

Alcohol initiation among recently immigrated Hispanic adolescents: Roles of acculturation and sociocultural stress

There is a growing recognition for the need for research to explore the unique and interactive effects of acculturation and sociocultural stress on alcohol initiation. Building on this research agenda, the current study sought to explore the independent and interactive effects of acculturation (i.e., heritage and U.S. cultural practices and identification) and sociocultural stress (i.e., perceived discrimination, perceived context of reception, and bicultural stress) on alcohol initiation among recently immigrated Hispanic adolescents. Data were taken from a 6-wave longitudinal study with 302 recently immigrated Hispanic adolescents (53% boys; Mage = 14.51 years at baseline; range = 14-17 years) and their families. Discrete-time survival models indicated that none of the acculturation indicators directly predicted alcohol initiation. Sociocultural stress-and specifically, bicultural stress-predicted alcohol initiation. There were significant interactions between acculturation and sociocultural stress in predicting alcohol initiation. Further research considering multiple components of acculturation and sociocultural stressors is needed to broaden our understanding of the potential role of sociocultural processes in alcohol initiation among Hispanic youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Peer Victimization, Mood Symptoms, and Alcohol Use: Examining Effects among Diverse High School Youth

Peer victimization is associated with alcohol use among adolescents. However, few studies have examined the mediating role of depression and anxiety, or differences by race. The current study examined the prospective relationship of peer victimization, depressive and anxiety symptoms, and alcohol use across two timeframes: 9th to 11th grade and 10th to 12th grade among African American and White youth. Two thousand two hundred and two high school youth (57.6% female) who identified as either African American (n = 342, 15.2%) or White (n = 1860, 82.6%) provided data on study variables. Path analysis among the overall sample indicated that anxiety symptoms was a significant mediator for both timeframes, with depressive symptoms mediating the pathway during the 10th to 12th grade timeframe. The findings were most consistent among White youth, with no significant indirect effects observed for African American youth. Thus, addressing depressive and anxiety symptoms may be effective targets to decrease alcohol use risk as a result of peer victimization among White youth. However, further research is needed to better understand risk models for peer victimization exposure on substance use outcomes among racial/ethnic minority youth.

Family factors mediate discrimination related stress and externalizing symptoms in rural Latino adolescents

INTRODUCTION

Externalizing disorders are more prevalent in rural than urban settings and account for disproportionately high mental health service costs for rural adolescents. Although cultural stressors such as discrimination have been associated with externalizing problems in ethnic minority youth broadly, this relationship is understudied in Latinos, particularly those in rural settings. Further, though the associations of family processes such as familism and family conflict have been studied in relation to youth externalizing symptoms, whether these processes change in the face of adolescent discrimination stress remains unknown.

METHODS

A moderated multiple mediation model was used to examine the association between perceived discrimination, externalizing symptoms, and the indirect effect of family factors (familism, and family conflict) in a large sample (n = 455) of rural Latino youth. We also evaluated whether indirect and direct effects of discrimination on externalizing symptoms differed in boys versus girls.

RESULTS

Familism and family conflict each independently mediated the relationship between discrimination related stress and externalizing symptoms. However, discrimination had a direct effect on externalizing symptoms for boys only. In girls, this association held only when family factors were accounted for. Post-hoc analyses reveal that the moderating effect of sex on discrimination is driven by differences in rule-breaking behavior, as opposed to aggressive behavior.

CONCLUSION

Findings suggest that discrimination is associated with changes in the family environment which in turn invoke elevated risk for externalizing problems. Further, family-focused interventions that address externalizing problems may be especially effective for adolescent girls.

Culture's Influence on Stressors, Parental Socialization, and Developmental Processes in the Mental Health of Children of Immigrants

Children of immigrants represent one in four children in the United States and will represent one in three children by 2050. Children of Asian and Latino immigrants together represent the majority of children of immigrants in the United States. Children of immigrants may be immigrants themselves, or they may have been born in the United States to foreign-born parents; their status may be legal or undocumented. We review transcultural and culture-specific factors that influence the various ways in which stressors are experienced; we also discuss the ways in which parental socialization and developmental processes function as risk factors or protective factors in their influence on the mental health of children of immigrants. Children of immigrants with elevated risk for mental health problems are more likely to be undocumented immigrants, refugees, or unaccompanied minors. We describe interventions and policies that show promise for reducing mental health problems among children of immigrants in the United States.

Social Media and Sexual Behavior Among Adolescents: Is there a link?

BACKGROUND

Adolescent sexual risk taking and its consequences remain a global public health concern. Empirical evidence on the impact that social media has on sexual health behaviors among youth is sparse.

OBJECTIVE

The study aimed to examine the relationship between social media and the change in sexual risk over time and whether parental monitoring moderates this relationship.

METHODS

This study comprised a sample of 555 Latino youth aged 13-19 years from Maryland, United States completing baseline and follow-up surveys. Mixed-effects linear regression was used to examine the relationship between social media and the change in sexual risk over time and whether parental monitoring moderated the relationship.

RESULTS

Sexual risk behaviors significantly increased between baseline (T1) and follow up (T2) (mean=0.432 vs mean=0.734, P<.001). Youth sending more than 100 text messages per day had significantly higher sexual risk scores (beta=1.008, P<.001) but significantly larger declines in sexual risk scores for higher levels of parental monitoring (beta=-.237, P=.009).

CONCLUSIONS

Although adolescents exchange SMS at high rates, parental monitoring remains vital to parent-child relationships and can moderate SMS frequency and sexual risk behaviors, despite parental influence diminishing and peer pressure and social influences increasing during adolescence.

Substance use, age at migration, and length of residence among adult immigrants in the United States

In this study we scrutinize prevalence of current smoking and binge drinking among adult US immigrants, and examine whether age at migration predicts these two behaviors and moderates the effect of length of residence. Immigrant groups include those from Latin America/Caribbean, East and South Asia, Sub-Saharan Africa, Europe/Central Asia, and Middle East/North Africa. Multivariate logistic regressions are estimated using cross-sectional data from the New Immigrant Survey (N = 7,397). Results show that patterns of smoking and binge drinking vary by gender and by region of origins. In addition, arriving at age 0-9 are directly associated with higher odds of binge drinking among adult women. Among adult men, age at migration moderates the association between length of residence and substance use. Specifically, length of residence has more detrimental effects for adolescent immigrants (arriving at age 10-18) on smoking, while its detrimental effects are more pronounced for childhood immigrants (arriving at age 0-9) on binge drinking. We interpret our findings within the critical period model in epidemiological research, concluding that adolescence and childhood are critical life stages that are associated with differential effects of length of residence when looking at smoking and binge drinking among immigrant men.

Everyday discrimination and physical health: Exploring mental health processes

Goals of this study were to examine the mental health processes whereby everyday discrimination is associated with physical health outcomes. Data are drawn from a community health survey conducted with 1299 US adults in a low-resource urban area. Frequency of everyday discrimination was associated with overall self-rated health, use of the emergency department, and one or more chronic diseases via stress and depressive symptoms operating in serial mediation. Associations were consistent across members of different racial/ethnic groups and were observed even after controlling for indicators of stressors associated with structural discrimination, including perceived neighborhood unsafety, food insecurity, and financial stress.

Exploring the acculturation profiles and adaptation of children in multiethnic families in South Korea

Using a latent class analysis approach, this paper examined the acculturation profiles of children in multiethnic families in South Korea and explored whether youth’s psychological and educational adaptation varied across these profiles. The study utilized a nationally representative face-to-face survey of 2,811 native-born multiethnic youth (ages 9–15) and identified four styles of acculturation: assimilated; linguistically assimilated but psychologically diffused; integrated; and marginalized. Accounting for socio-demographic background and factors associated with acculturative stress, logistic regressions revealed that, compared to assimilated youth, marginalized youth exhibited significantly higher odds of self-reported depressive symptoms, difficulty in school work and low educational aspirations; linguistically assimilated but psychologically diffused youth were more likely to express difficulty in school work; while integrated youth did not manifest higher odds of adaptive problems. The importance of considering the context of acculturation and its implications for youth adaptation is highlighted. Limitations as well as policy implications are further discussed.

Psychosocial Factors Associated with Substance Abuse and Anxiety on Immigrant and U.S. Born Latinos

Latinos are exposed to adverse psychosocial factors that impact their health outcomes. Given the heterogeneity and rapid growth of this population, there is an urgent need to understand the mechanisms through which psychosocial factors impact substance abuse and anxiety between immigrant and U.S. born Latino adults. The present study employs a multi-group path analysis using Mplus 7.2 to examine generational differences in the paths between affiliation culture, years of formal education, contact with important people, and length of full-time employment to substance abuse and anxiety in immigrant and U.S. born Latino adults who completed substance abuse treatment. A total of 131 participants (Mage= 36.3, SD ± 10.5, 86.3% males, 48.1% non-U.S. born with a mean length of stay of 19 years in the U.S. (SD ± 13.71) in recovery from substance abuse completed self-report measures. Results from the multi-group path analysis suggest that being more affiliated to the U.S. culture is associated with substance abuse, whereas years of formal education and longer full-time employment is associated with reduced anxiety in the immigrant group. Conversely, frequent contact with important people and affiliation to the U.S. culture are associated with fewer years of substance abuse, whereas longer full-time employment is associated with substance abuse in the U.S. born group. Anxiety and substance abuse was correlated only in the U.S. born group. The implications of these findings are discussed.

Negative symptoms and impaired social functioning predict later psychosis in Latino youth at clinical high risk in the North American prodromal longitudinal studies consortium

AIM

Examining ethnically related variables in evaluating those at risk for psychosis is critical. This study investigated sociodemographic and clinical characteristics of Latino versus non-Latino clinical high-risk (CHR) subjects and healthy control (HC) subjects in the first North American Prodrome Longitudinal Study.

METHODS

Fifty-six Latino CHR subjects were compared to 25 Latino HC and 423 non-Latino CHR subjects across clinical and demographic variables. Thirty-nine of the 56 CHR subjects completed at least one subsequent clinical evaluation over the 2.5-year period with 39% developing a psychotic illness. Characteristics of Latino CHR subjects who later converted to psychosis ('converters') were compared to those who did not ('non-converters').

RESULTS

Latino CHR subjects were younger than non-Latino CHR subjects and had less education than Latino HC subjects and non-Latino CHR counterparts. Latino CHR converters had higher scores than Latino non-converters on the Structured Interview for Prodromal Syndromes total negative symptoms that were accounted for by decreased expression of emotion and personal hygiene/social attentiveness subsections. Latino CHR converters scored lower on the global functioning:social scale, indicating worse social functioning than Latino non-converters.

CONCLUSION

Based on this sample, Latino CHR subjects may seek treatment earlier and have less education than non-Latino CHR subjects. Deficits in social functioning and impaired personal hygiene/social attentiveness among Latino CHR subjects predicted later psychosis and may represent important areas for future study. Larger sample sizes are needed to more thoroughly investigate the observed ethnic differences and risk factors for psychosis in Latino youth.

Preventing Drug Abuse Among Hispanic Adolescents: Developing a Responsive Intervention Approach

Intervention research is essential to help Hispanic American adolescents avoid drug use. This article describes an intervention research program aimed at preventing drug use among these youths. Grounded in salient epidemiological data, the program is informed by bicultural competence, social learning, and motivational interviewing theories. The program, called Vamos, is aimed at the risk and protective factors as well as the cultural prerogatives that demark the adolescent years of Hispanic American youths. Innovative in its approach, the program is delivered through a smartphone application (app). By interacting with engaging content presented via the app, youths can acquire the cognitive-behavioral skills necessary to avoid risky situations, urges, and pressures associated with early drug use. The intervention development process is presented in detail, and an evaluation plan to determine the program's efficacy is outlined. Lessons for practice and intervention programming are discussed.

Evaluation of Social Media Utilization by Latino Adolescents: Implications for Mobile Health Interventions

Background

Trends in social media use, including sending/receiving short message service (SMS) and social networking, are constantly changing, yet little is known about adolescent’s utilization and behaviors. This longitudinal study examines social media utilization among Latino youths, and differences by sex and acculturation.

Objectives

The purpose of this study was to examine Latino adolescents’ social media utilization and behavior over a 16-month period, and to assess whether changes in use differed by sex and acculturation.

Methods

This study included 555 Latino youths aged 13-19 who completed baseline and 16-month follow-up surveys. Prevalence of social media utilization and frequency, by sex and acculturation categories, was examined using generalized estimating equations.

Results

Women are more likely to use SMS, but men are significantly more likely to SMS a girl/boyfriend (P=.03). The use of Internet by men and women to research health information increased over time. Facebook use declined over time (P<.001), whereas use of YouTube (P=.03) and Instagram (P<.001) increased, especially among women and more US acculturated youths.

Conclusion

Social media is ubiquitous in Latino adolescents’ lives and may be a powerful mode for public health intervention delivery.

Latino adolescents' perceived discrimination in online and offline settings: an examination of cultural risk and protective factors

Guided by a risk and resilience framework, the current study examined the associations between Latino adolescents' (n = 219; Mage = 14.35; SD = 1.75) perceptions of ethnic discrimination in multiple settings (e.g., online, school) and several domains of adjustment (e.g., mental health, academic), and tested whether developmentally salient cultural assets (i.e., ethnic identity) directly promoted youth adjustment or moderated the negative impact of discrimination on adjustment. Each of the 3 ethnic identity components (i.e., exploration, resolution, affirmation) demonstrated evidence of promoting positive outcomes among Latino youth; furthermore, there was some evidence that the promotive effects of affirmation and resolution were significantly stronger for older versus younger adolescents. In addition, with the exception of experiences with discrimination from adults outside of the school setting, there was evidence of ethnic identity interacting with each type of discrimination to predict Latino adolescents' self-esteem, depressive symptoms, and externalizing problems. Findings suggest directions for future research and identify potential targets for intervention that may prove fruitful in programming efforts with Latino adolescents.

The role of bicultural stress and perceived context of reception in the expression of aggression and rule breaking behaviors among recent-immigrant Hispanic youth

Adolescent aggression and delinquency impede healthy adjustment in early adulthood and may have particularly serious long-term consequences for minority youth. Therefore, prevention research should examine these behaviors within a sociocultural framework among newer immigrant samples to determine whether, and how, adaptation to life in the US affects these behaviors. This study investigated the role of two sociocultural variables-bicultural stress and negative context of reception-on changes in aggression and rule breaking behaviors over two time points among recently immigrated Hispanic adolescents residing in Los Angeles (N = 136) and Miami-Dade (N = 142) counties. Linear stepwise regression models were used to assess the associations between predictors and behavioral outcomes. Bicultural stress and negative context of reception both had independent associations, above and beyond parental involvement and delinquent peer associations, with changes in aggressive and rule-breaking behavior during the first year of high school. These findings suggest that social, cultural, and interpersonal processes all influence deviant behaviors in recent-immigrant Hispanic populations. We discuss the implications of these finding for prevention and intervention research and practice. We also recommend that future research continue to examine the role of these factors over the course of adolescence and consider sociocultural influences when designing behavioral interventions for Hispanic immigrant populations.

Depressive symptoms and externalizing behaviors among Hispanic immigrant adolescents: Examining longitudinal effects of cultural stress

This study examined longitudinal effects of cultural stress (a latent factor comprised of bicultural stress, ethnic discrimination, and negative context of reception) on depressive symptoms and a range of externalizing behaviors among recently (≤5 years in the U.S. at baseline) immigrated Hispanic adolescents. A sample of 302 adolescents (53% boys; mean age 14.51 years) completed baseline measures of perceived ethnic discrimination, bicultural stress, and perceived negative context of reception; and outcome measures of depressive symptoms, cigarette smoking, alcohol use, aggressive behavior, and rule-breaking behavior six months post-baseline. A path analysis indicated that higher cultural stress scores predicted higher levels of all outcomes. These effects were consistent across genders, but varied by study site. Specifically, higher cultural stress scores increased depressive symptoms among participants in Miami, but not in Los Angeles. Findings suggest that cultural stress is a clinically relevant predictor of depressive symptoms and externalizing behaviors among Hispanic immigrant adolescents.

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.

Mechanisms of Identity Conflict

Social identities are associated with normative standards for thought and action, profoundly influencing the behavioral choices of individual group members. These social norms provide frameworks for identifying the most appropriate actions in any situation. Given the increasing complexity of the social world, however, individuals are more and more likely to identify strongly with multiple social groups simultaneously. When these groups provide divergent behavioral norms, individuals can experience social identity conflict. The current manuscript examines the nature and consequences of this socially conflicted state, drawing upon advances in our understanding of the neuropsychology of conflict and uncertainty. Identity conflicts are proposed to involve activity in the Behavioral Inhibition System, which in turn produces high levels of anxiety and stress. Building upon this framework, four strategies for resolving identity conflict are reviewed.

Health-promoting lifestyle behaviors and psychological status among Arabs and Koreans in the United Arab Emirates

Cultural variations among ethnic groups may differentially influence health and health behavior. We explored and compared health-promoting lifestyle behaviors and psychological status, including depression, anxiety, and stress, among Korean migrants (n = 117) and Arab nationals (n = 103) in the United Arab Emirates (UAE). Pender's Health Promotion Model guided this research. The Health-Promoting Lifestyle Profile was used to measure health-promoting lifestyle behaviors and Lovibond and Lovibond's Depression, Anxiety, and Stress Scale to measure psychological status. The data were analyzed using bivariate procedures and multiple linear regression. No group differences were found in total scores for health-promoting lifestyle behaviors or psychological status. Both groups scored high on self-actualization and interpersonal support; Arabs scored low on exercise, and Koreans scored low on health responsibility. Across groups, psychological status (β = -.390, p < .001), education (β = .239, p < .001), and gender (β = .238, p < .001) were significant determinants of health-promoting lifestyle behaviors in multivariate analysis. Ethnicity and religious attendance were not significant determinants. Education level had a moderating effect; for those with a lower educational level, psychological distress had a stronger negative effect on health behavior. Findings suggest considering cultural aspects, such as different values placed on physical fitness and social/interpersonal relationships, in developing and implementing health education and/or promotion programs. Assessment of psychological status (i.e., depression, anxiety, and stress) should also be included in health promotion programs and related health policies for Korean migrants and Arab nationals in the UAE.

Health-compromising behaviors among a multi-ethnic sample of Canadian high school students: risk-enhancing effects of discrimination and acculturation

This article examines whether acculturation and experiences of discrimination help to explain observed ethnic disparities in rates of three health-compromising behaviors: interpersonal violence, drinking, and cannabis use. Data were drawn from a cross-sectional survey of 3,400 high school students from Toronto, Canada, sampled in 1998-2000. Multivariate ordinary least squares and logistic regression models tested for baseline differences in the health-compromising behaviors by ethnic identity. Subsequent models adjusted for control measures and introduced acculturation and discrimination measures. Results confirm that experiences of discrimination and acculturation are risk enhancing, whereas active cultural retention appears to protect ethnic youth from participation in health-compromising activities.

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.

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.

Changes in Ethnic Identity and Competence in Middle Adolescents

Purpose: Evidence suggests that the construct of ethnic identity (EI) in adolescents changes over time and is related to factors including social connectedness, social competence, coping, and self-worth. Transitional changes of EI in middle adolescence have not been studied. Method: This analysis, part of a longitudinal study of health behaviors, explored how EI changes from the first year of high school to the last, and it examined relationships among EI, social connectedness, indicators of social competence, coping, and self-worth in 602 youth (49% Hispanic, 59% female). Results: EI was significantly related to social connectedness, social competence, coping, and self-worth as adolescents entered and prepared to exit high school. EI increased significantly over time for both genders and for Hispanics more so than for non-Hispanics. Discussion: Findings support and extend the conceptual framework and previous research. Socialization with one’s ethnic group is associated with developing competence and self-worth. EI development continues throughout high school. Conclusion: Findings extend our understanding of the salience of EI in adolescents in transition throughout high school. Implications: Strengthening EI may contribute to adolescents’ feelings of self-worth, skills in coping, and competence within an ethnically diverse society. Nurses might plan interventions to strengthen EI throughout adolescence.

Perceived school safety is strongly associated with adolescent mental health problems

School environment is an important determinant of psychosocial function and may also be related to mental health. We therefore investigated whether perceived school safety, a simple measure of this environment, is related to mental health problems. In a population-based sample of 11,130 secondary school students, we analysed the relationship of perceived school safety with mental health problems using multiple logistic regression analyses to adjust for potential confounders. Mental health problems were defined using the clinical cut-off of the self-reported Strengths and Difficulties Questionnaire. School safety showed an exposure-response relationship with mental health problems after adjustment for confounders. Odds ratios increased from 2.48 ("sometimes unsafe") to 8.05 ("very often unsafe"). The association was strongest in girls and young and middle-aged adolescents. Irrespective of the causal background of this association, school safety deserves attention either as a risk factor or as an indicator of mental health problems.

The border community and immigration stress scale: a preliminary examination of a community responsive measure in two Southwest samples

Understanding contemporary socio-cultural stressors may assist educational, clinical and policy-level health promotion efforts. This study presents descriptive findings on a new measure, the border community and immigration stress scale. The data were from two community surveys as part of community based participatory projects conducted in the Southwestern US border region. This scale includes stressful experiences reflected in extant measures, with new items reflecting heightened local migration pressures and health care barriers. Stressors representing each main domain, including novel ones, were reported with frequency and at high intensity in the predominantly Mexican-descent samples. Total stress was also significantly associated with mental and physical health indicators. The study suggests particularly high health burdens tied to the experience of stressors in the US border region. Further, many of the stressors are also likely relevant for other communities within developed nations also experiencing high levels of migration.

Risks, Assets, and Negative Health Behaviors Among Arkansas’ Hispanic Adolescents

This study examined the relationship between risk, assets, and negative health behaviors among a large sample of Hispanic adolescents. Data were collected from over 1,000 Hispanic youth in grades 6, 8, 10, and 12 attending school in a moderate size school district in Northwest Arkansas. Logistic regression models examined the variation in the odds of youth engaging in negative health behaviors (antisocial or drug use). Within the context of a risk-assets framework, depressive symptomatology, negative peer networks, and community disorganization were related to higher odds of engaging in negative behavior. Knowing the difference between right and wrong—having some sense of a moral order—and having parents who exerted some control (curfew, etc.) were important assets lowering the odds of engaging in negative behavior. Risks and assets help to explain negative health behaviors among Hispanic youth not unlike their non-Hispanic counterparts. The findings in this article reemphasize the need for continued focus on special populations and the framework for understanding risk behaviors.

Migrants and obstetrics in Austria--applying a new questionnaire shows differences in obstetric care and outcome

BACKGROUND

Immigration plays a major role in obstetrics in Austria, and about 18 % of the Austrian population are immigrants. Therefore, we aimed to (1) test the feasibility of a proposed questionnaire for assessment of migrant status in epidemiological research and (2) assess some important associations between procedures and outcomes in obstetrics and migration in selected departments in Austria.

METHODS

We adapted a standardized questionnaire to the main immigration groups in Austria. Information on country of origin, length of residence in Austria and German-language ability was collected from eight selected obstetrics departments. Of the 1,971 questionnaires, 1,873 questionnaires of singleton births were selected and included in the analysis.

RESULTS

We analyzed a total of 1,873 parturients with singleton births, of which 35 % had migrant status, 12 % were from ex-Yugoslavia, 12 % were from Turkey, and 12 % were from other countries. The proportion of parturients having their first care visit after the 12th week of pregnancy was higher in migrant groups (19 %). Smoking was highest in the migrants from ex-Yugoslavia (21 %). Vaginal delivery was more frequent in migrants from ex-Yugoslavia (78 %) and Turkey (83 %) than in nonmigrants (71 %) and episiotomy was more frequently performed in migrants from other countries. All differences are statistically significant.

CONCLUSIONS

Administration of a standardized questionnaire for assessment of migrant status in obstetric departments in Austria was shown to be feasible. We assessed differences in obstetric care and outcome and consequently recommend that action should be initiated in Austria toward harmonizing obstetric procedures among the migrant and the nonmigrant groups and toward minimizing risk factors.

Cultural stressors and mental health symptoms among Mexican Americans: a prospective study examining the impact of the family and neighborhood context

Studies of stress consistently have linked individuals' experiences of stress to maladjustment, but limited attention has been given to cultural stressors commonly experienced by minority individuals. To address this, the current study examined the links between cultural stressors and prospective changes in mental health symptoms in a sample of 710 (49 % female) Mexican American youth. In addition, the moderating role of both family and neighborhood cohesion was examined. In-home interviews were completed with youth, mothers (required) and fathers (optional) to collect data on youth's experiences of cultural stressors (discrimination and language hassles) and internalizing/externalizing behavior, and mothers' report of family cohesion and mothers' and fathers' report of neighborhood cohesion. Analyses revealed that youth's experiences of discrimination and language hassles at 5th grade were related positively to increases in internalizing symptoms at 7th grade. Additionally, youths who reported higher levels of language hassles in 5th grade experienced increases in externalizing symptoms across the 2-year span. Both family and neighborhood cohesion emerged as significant moderating factors but their impact was conditional on youth's gender and nativity. Limitations and future implications are discussed.

Risk behaviour, parental background, and wealth: a cluster analysis among Swedish boys and girls in the HBSC study

AIM

To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls.

METHODS

Data were collected from Health Behaviour in School-aged Children (HBSC), a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence.

RESULTS

In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls.

CONCLUSIONS

The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.

Experimenting with cigarettes and physical activity among Mexican origin youth: a cross sectional analysis of the interdependent associations among sensation seeking, acculturation, and gender

BACKGROUND

Sensation seeking tendencies tend to manifest during adolescence and are associated with both health-compromising behaviors and health-enhancing behaviors. The purpose of this study is to evaluate the relationship between sensation seeking and physical activity, a health-enhancing behavior, and between sensation seeking and experimenting with cigarettes, a health compromising-behavior, among a cohort of Mexican origin adolescents residing in the United States with different levels of acculturation.

METHODS

In 2009, 1,154 Mexican origin youth (50.5% girls, mean age 14.3 years (SD = 1.04)) provided data on smoking behavior, physical activity, linguistic acculturation, and sensation seeking. We conducted Pearson's χ2 tests to examine the associations between categorical demographic characteristics (i.e. gender, age, country of birth and parental educational attainment) and both cigarette experimentation and physical activity and Student's t-tests to examine mean differences on the continuous variables (i.e. sensation seeking subscale) by the behaviors. We examined mean differences in the demographic characteristics, acculturation, and both behaviors for each of the sensation seeking subscales using analysis of variance (ANOVA). To examine relationships between the sensation seeking subscales, gender, and both behaviors, at different levels of acculturation we completed unconditional logistic regression analyses stratified by level of acculturation.

RESULTS

Overall, 23.3% had experimented with cigarettes and 29.0% reported being physically active for at least 60 minutes/day on at least 5 days/week. Experimenting with cigarettes and being physically active were more prevalent among boys than girls. Among girls, higher levels of sensation seeking tendencies were associated with higher levels of acculturation and experimentation with cigarettes, but not with physical activity. Among boys, higher levels of sensation seeking tendencies were associated with higher levels of acculturation, experimenting with cigarettes and being physically active.

CONCLUSIONS

Our results suggest that interventions designed to prevent smoking among Mexican origin youth may need to address social aspects associated with acculturation, paying close attention to gendered manifestations of sensation seeking.

Cultural stressors and the hopelessness model of depressive symptoms in Latino adolescents

Depressive symptoms in Latino youth have been related to both culturally-universal and culturally-based stressors. However, few studies have examined the unique contributions of culturally-based stressors above and beyond other types of stressors. Moreover, no past studies with Latinos have examined the role of culturally-based stressors within a hopelessness model of depressive symptoms, a cognitive model with the strongest empirical support in adolescence. The current study examined these issues in a sample of 171 Latino adolescents (7th-10th grades; mean age = 14; 46 % male). The Latino adolescents were primarily Mexican-American (78 %) and born in the United States (60 %). Students completed measures during a school period on their experiences of parent-child conflict, economic stress, discrimination from peers, and acculturative stress as well as depressive symptoms and attributional style. The results indicated that culturally-based stressors (e.g., acculturative stress and discrimination) predicted greater depressive symptoms even when controlling for culturally-universal stressors (e.g., parent-child conflict, economic stress). Moreover, a negative attributional style moderated the relationship between culturally-universal stressors and depressive symptoms, but this was not the case for culturally-based stressors. Culturally-based stressors play an important role in depressive symptoms among Latino youth. These stressors predicted greater symptomatology even when controlling for other types of stressors and a negative attributional style. These findings suggest that there may be other cognitive risk factors associated with culturally-based stressors.

The Roles of Family, Peer, School, and Attitudinal Factors in Cannabis Use Across Immigrant Generations of Youth

The objective of this study was to examine the associations of family, school, peer, and attitudinal factors with cannabis use among three immigrant generations of youth. The sample consisted of 3,134 students from the 2009 Ontario Student Drug Use and Health Survey, a provincewide survey of 7th- to 12th-grade students. Results indicate that the odds of using cannabis were lower among first-generation immigrant youth than among second as well as third and later generations. The immigrant generations were more similar than different in the significance of family, school, peers, and attitudinal factors on cannabis use. Parental education, however, was found to differ in its effect on cannabis use across generations. Findings suggest that factors that influence cannabis use may be similar across immigrant generations and that further research is needed on the effects of parental education and the mechanisms through which protection and risk to immigrant generations occur.