Changes in sociocultural stressors, protective factors, and mental health for US Latina mothers in a shifting political climate

Background

To investigate changes in sociocultural stressors and protective factors, and mental health in Latina mothers before and after the 2016 Republican presidential nomination.

Methods

We examined changes in sociocultural stressors, protective factors, and mental health from two prospective cohorts of Latina mothers from interior and border US cities (Nashville, TN, n = 39 and San Diego, CA, ns range = 78–83; 2013–2020).

Results

We identified significant longitudinal increases in depression, anxiety, and perceived stress in the border city, and reductions in protective factors (e.g., optimism, social support, and familism) across sites. Discrimination varied by location, and was associated with higher stress only at baseline in the border city, and with higher anxiety in the interior city at follow-up. Acculturative stress was consistently associated with worse mental health across time points in the border city. Various protective factors were associated with reduced stress and anxiety across time points in both cities.

Discussion

We identified decreased mental health at the border city, and reduced protective factors in Latina mothers across both study sites in the years following the 2016 presidential nomination, during a time of shifting sociopolitical climate. We also identify increased acculturative stress and discrimination over time, particularly at the border city. Interventions to maintain and enhance psychosocial protective factors amongst Latina mothers are warranted.

Autonomy and Relatedness in Cultural Context

Autonomy and agency are used extensively and often interchangeably; there is a debate regarding their intersections with relatedness and separateness. This scholarship occurs within mainly a Euro-American cultural context that provides an ideological background of individualism, shedding light on psychological thinking. The article attempts to provide a broad overview of the issues involved. Two distinct dimensions, agency and interpersonal distance, are seen to underlie the self constructs involving autonomy and relatedness that are developed in different spheres of psychological inquiry. Autonomy and relatedness are viewed as basic human needs, and though apparently conflicting, are proposed to be compatible. Problems of conceptualization and operationalization are noted that have prevented the recognition of this compatibility. A model is put forward that involves a fourfold combination of the two dimensions, leading to different types of self and the societal and familial contexts in which they develop. Recent research provides credibility to the model proposed.

Patterns of Psychological Acculturation in Adult and Adolescent Moroccan Immigrants Living in the Netherlands

Psychological acculturation patterns within a Moroccan adult and adolescent population in the Netherlands were determined through latent class analysis. The Psychological Acculturation Scale (PAS) was adapted, and strong psychometric properties were demonstrated. We found Dutch and Moroccan Psychological Acculturation Subscales (D-PAS; M-PAS). Three classes with similar patterns of acculturation were revealed for both populations. One class showed medium scores on the D-PAS and M-PAS items and one class revealed a pattern with high scores on the M-PAS and medium to high scores on the D-PAS items. The third class was characterized by low scores on the D-PAS and high scores on the M-PAS items. These acculturation classes were shown to be meaningful constructs and yield detailed information about acculturation.

Adolescent Latino Reproductive Health: A Review of the Literature

Latino adolescent reproductive health has become an increasingly important topic because of the growth in the numbers of Latino youth and because Latino youth are at high risk for negative reproductive health outcomes. Latinas now have the highest teen birth rates, and Latinos have disproportionately high rates of HIV/AIDS. These trends highlight the need for greater understanding of the sexual and reproductive health and behavior of Latino youth. This overview provides an introduction to key aspects of the Latino population. It then examines and synthesizes the existing literature by domains useful to the study of Latinos. Areas that receive in-depth coverage are socioeconomic status, family, national origin, peers and partners, and acculturation. Based on the current state of knowledge and the issues facing young Latinos, suggestions for future research and uses for existing data and past research are included.

A Review of Latino Youth Development Research and a Call for an Asset Orientation

A focus on youth development is the strongest means of prevention of problems faced by Latino youths. Latino youths are the fastest growing segment of the U.S. population and have high rates of developmental deficits. However, youth development researchers have not attended to the inclusion and reporting of results for Latino youths. This study presents a challenge to youth development researchers, service providers, and policy makers to adopt a youth development orientation in their work. A comprehensive review of six youth development journals and two Latino-focused journals allowed for the evaluation of the inclusion of Latino youths. Of 1,010 empirical articles, 30% included Latino youths, 6% reported results for Latino youths, and less than3% focused on Latino youths. The researchers reporting results for Latino youths were largely unguided by specific theoretical frameworks and heavily deficit oriented. A framework to increase attention to Latino youths in developmental research is suggested.

The "immigrant paradox" phenomenon: assessing problem behaviors and risk factors among immigrant and native adolescents

We investigated the "immigrant paradox" phenomenon by examining differences in problem behavior engagement and exposure to risk factors across four adolescent groups: 1,157 first-generation, 1,498 second-generation, and 3,316 White and minority third or higher generations. Latent mean differences in problem behavior engagement (i.e., academic failure, aggression, and substance use) and risk factors (i.e., low socioeconomic status, poor family relationship, and low sense of school belonging) were associated with significant differences across adolescent groups. Results supported the generational status effect by demonstrating sequentially greater adolescent problem behavior engagement. However, the difference in exposure to risk factors across adolescent groups only partially supported the immigrant paradox. Further, the multiple group analysis of the relationships between risk factors and engagement in problem behaviors showed increased susceptibility among second generation immigrants for substance use, White natives for academic failure and substance use, and minority natives for physical aggression. Study findings have implications for understanding how the immigrant paradox leads to different adjustment patterns and problem behavior manifestations among immigrant and native adolescents.

Acculturation-Related Stress and Mental Health Outcomes Among Three Generations of Hispanic Adolescents

Stress associated with acculturation and minority status among Hispanic youth is understudied. Using survey data from the Hispanic Stress Inventory–Adolescent Version (HSI-A), we examined psychosocial stress across eight domains including family economic stress and acculturation-gap stress in a national sample of three generations (first, second, and third or higher) of Hispanic adolescents ( N = 1,263). Research questions addressed generation differences in frequency of stressor events (i.e., discrimination), appraisal of these events, and mental health symptoms. Results indicated that experiences of different categories of stress were significantly related to generation status. The first generation reported more stressors and greater stress appraisal than the third-generation adolescents. Similar levels of discrimination stress were reported by participants regardless of generation. The second-generation participants reported a greater number of Acculturation Gap Stressors than the third generation, and more delinquent and aggressor behaviors than first-generation participants. An acculturation paradox was found with greater stress exposure and stress appraisals in the first-generation youth, but with lower mental health symptoms than later generations. Family integrity and more traditional family values may buffer the negative impact of greater stressor exposure among immigrants and second-generation youth when compared with third-generation adolescents.

A Longitudinal Examination of Support, Self-esteem, and Mexican-origin Adolescent Mothers' Parenting Efficacy

Guided by a risk and resilience framework, this study used a prospective longitudinal, multiple-reporter design to examine how social support from a mother figure during pregnancy interacted with Mexican-origin adolescent mothers' self-esteem to inform their parenting efficacy when their children were 10 months old. Using reports of perceived social support by adolescent mothers (Mage = 16.24, SD =099) and their mother figures (Mage = 40.84, SD = 7.04) in 205 dyads, and controlling for demographic factors (i.e., adolescent age, adolescent nativity, family income, mothers' educational attainment, adolescent-mother coresidence) and adolescents' social support from a significant other, findings indicated that social support during pregnancy was positively associated with adolescent mothers' future parenting efficacy when adolescent mothers had relatively lower self-esteem. Findings were consistent for adolescents' and mothers' reports, and emphasize the value of social support from a mother figure among adolescent mothers with lower self-esteem. Implications for interventions are presented.

Mexican-origin youth's cultural orientations and adjustment: changes from early to late adolescence

Drawing from developmental and cultural adaptation perspectives and using a longitudinal design, this study examined: (a) mean-level changes in Mexican-origin adolescents' cultural orientations and adjustment from early to late adolescence and (b) bidirectional associations between cultural orientations and adjustment using a cross-lag panel model. Participants included 246 Mexican-origin, predominantly immigrant families that participated in home interviews and a series of nightly phone calls when target adolescents were 12 and 18years of age. Girls exhibited more pronounced declines in traditional gender role attitudes than did boys, and all youth declined in familism values, time spent with family, and involvement in Mexican culture. Bidirectional relations between cultural orientations and adjustment emerged, and some associations were moderated by adolescent nativity and gender.

Cheese: an old drug in a new wrapper

BACKGROUND

An unexpected outbreak of "cheese" heroin, which contained diphenhydramine and usually acetaminophen, began in Dallas around 2004. Onset occurred among youths living in neighborhoods populated by first-generation Hispanic immigrants. Little was known about the problem or the social strengths and deficits of these youth, who were primarily inhalers ("snorters") but at risk of transitioning to injection.

METHODS

Multiple data sources were used, including surveys, data from emergency departments, law enforcement, treatment programs, and coroner, and interviews with users and key informants.

RESULTS

Among heroin users under age 20, overdose deaths peaked in 2006, the school survey responses to using "cheese" heroin peaked in 2007, and treatment admissions peaked in 2008. Hispanic youth entering treatment were less likely to be injectors and report fewer problems than their Anglo counterparts and they were more likely to live with their families and to be supported by them. Sixty percent of the Hispanic youth had been in treatment previously and only 53% completed treatment. Cocaine and/or benzodiazepines were involved in 32% of the adolescent heroin deaths.

CONCLUSIONS

The timely use of multiple data sources enabled this outbreak to be quickly identified and monitored, and the Cheese Heroin Task Force used the collected data to help respond to the problem, although retention in treatment and readmissions remained problematic. Cultural problems including immigration status, language, and misunderstandings about the nature of treatment were barriers to successful treatment outcomes. Completion of treatment as an inhaler is critical to reducing the likelihood of transitioning to injection.

Psychometric Evaluation of the Demographic Index of Cultural Exposure (DICE) in Two Mexican-Origin Community Samples

Reliability and validity evidence is provided for the Demographic Index of Cultural Exposure (DICE), consisting of six demographic proxy indicators of acculturation, within two community samples of Mexican-origin adults (N= 497 for each sample). Factor analytic procedures were used to examine the common variance shared between the six demographic indicators hypothesized to correlate with acculturation. The index was cross-validated across two samples by comparing fit indices. Finally, index criterion validity was assessed using correlations between index scores and five common behavioral/psychological domains of Latino cultural identity: language use (Spanish and English), cultural practices, folk health beliefs, and fatalism. Results indicated that the six demographic indicators loaded onto one latent factor and that this model had good fit across both samples. In addition, DICE scores correlated with four of the five behavioral/psychological measures. Future use of the DICE as an efficient way to approximate cultural exposure is discussed.

"Watching a person who knows how to cook, you'll learn a lot". Linked lives, cultural transmission, and the food choices of Puerto Rican girls

In-depth individual interviews were conducted with mainland- and island-dwelling Puerto Rican girls (n=23) to determine how migration, acculturation, and family contexts influenced food choices. Interview data from girls with diverse migration experiences (U.S. mainland raised, recent migrants to U.S. mainland, and Puerto Rico raised) were triangulated with extensive participant observation conducted in New York State and Puerto Rico. Data analysis using a ground theory approach revealed that participants' access to traditional foods varied in three domains: mothers' (cultural orientation, health, work, and cooking skills); household (composition, presence of Puerto Rican grandmother, and cooking skills); and girls' (migration experience, food preferences and values, and cooking skills) characteristics. Four food choice types emerged from participant narratives that differed in these domains: everybody cooks, tradition keeper, seeker, and on my own. Varied language orientations and migration experiences were represented among girls across all four food choice types, ranging from consistent to limited access to traditional food, demonstrating the limitations of one-dimensional models for understanding dietary acculturation. Findings demonstrate how a multidimensional, culture-specific model, including both cultural and structural characteristics, can influence dietary acculturation at the family and household level and food choices among immigrant adolescent girls, and guide future research and interventions.

Role of acculturation research in advancing science and practice in reducing health care disparities among Latinos

An impressive body of public health knowledge on health care disparities among Latinos has been produced. However, inconclusive and conflicting results on predictors of health care disparities remain. We examined the theoretical assumptions and methodological limitations of acculturation research in understanding Latino health care disparities, the evidence for socioeconomic position as a predictor of health care disparities, and the effectiveness of cultural competency practice. Persistent use of culture-driven acculturation models decenters social determinants of health as key factors in health disparities and diminishes the effectiveness of cultural competency practice. Social and economic determinants are more important predictors than is culture in understanding health care disparities. Improvements in the material conditions of low-income Latinos can effectively reduce health care disparities.

Immigration measures and reproductive health among Hispanic youth: findings from the national longitudinal survey of youth, 1997-2003

PURPOSE

To explore relationships between immigration measures and risk of reproductive and sexual events among U.S. Hispanic adolescents.

METHODS

We examined generation status, language in the home and country of origin in relation to sexual activity, contraception, and childbearing among 1614 Hispanic adolescents, using nationally representative 1997-2003 longitudinal data. Multivariable analyses controlled for potentially confounding variables. Tests for effect modification by gender and Mexican origin were conducted.

RESULTS

Fewer first generation adolescents transitioned to sexual intercourse before age 18 (odds ratio [OR]=.80, 95% confidence interval [CI]=.66-.98) and fewer first and second generation sexually active teens used contraceptives consistently at age 17 (OR=.32, 95% CI=.17-.60 and OR=.50, 95% CI=.31-.80, respectively) than third-generation teens. Language was similarly associated with the transition to sexual intercourse and contraceptive practices. Versus teens of Mexican origin, teens of Puerto Rican origin and origins other than Cuba and Central/South America had greater odds of becoming sexually active; youth of all origins except Central/South America had fewer multiple live births (OR=.14-.31). Gender modified the effects of generation on consistent use of contraceptives and condoms at age 17. Gender also modified the effect of country of origin on transitioning to sexual intercourse before age 18 years.

CONCLUSIONS

Results expand on previous observations that generation, language, and country of origin are predictors of reproductive and sexual risks for Hispanic adolescents. These immigration measures may therefore be useful in targeting community and clinical preventive services.

Risky sexual behaviors in first and second generation Hispanic immigrant youth

Though official data document that Hispanic youth are at a great risk for early sexual intercourse, STDs, and teen pregnancy, only few etiological studies have been conducted on Hispanic youth; almost no work has examined potential generational differences in these behaviors, and thus, these behaviors may have been mistakenly attributed to cultural differences. The current study examined the relationships between maternal parenting (general communication, communication about sex, monitoring, support) and risky sexual behaviors, and potential moderating effects by immigration status and acculturation in 1st and 2nd generation Hispanic immigrant adolescents (N = 2,016) from the National Longitudinal Study of Adolescent Health (Waves I and II). Maternal communication about sex and maternal support emerged as key predictors of risky sexual behaviors across generational groups; neither immigration status nor acculturation moderated the maternal parenting constructs-risky sexual behaviors links. Furthermore, maternal parenting constructs and their relationships with risky sexual behaviors did not differ by generational groups.

Folk and traditional medicine use by a subset of Hispanic adolescents

Rates of Folk and Traditional Medicine (FTM) use are high among Hispanic adults. No data have been published on FTM use among the rapidly growing Hispanic adolescent population.

OBJECTIVES

To determine the prevalence of and personal factors associated with FTM use among Mexican-American adolescents.

STUDY GROUP

182 Mexican-American adolescents (14-19 years) from community-based organizations.

METHODS

We conducted a cross-sectional survey using a self-report instrument available in English and Spanish.

RESULTS

In the past year, 49 (26.9%) subjects reported FTM use, all prompted by illness: 43 (23.6%) used herbal remedies, and 8 (4.4%) used traditional healers. Five subjects reported using dangerous herbs. Among herbal users, 56.3% did not disclose FTM use to medical providers, largely due to the providers' lack of inquiry. Logistic regression comparing herbal users with non-FTM users found subjects dissatisfied with their most recent medical visit (AOR = 10.6; 95% CI = 2.8-40.7) and subjects endorsing family FTM use (AOR = 8.4; 95% CI = 4.0-30.2) were more likely to use herbal remedies. Acculturation, insurance status, socioeconomic status, and having a personal healthcare provider were not related to herbal use.

CONCLUSIONS

The use of practitioner-based FTM modalities was rare among this convenience sample of Mexican-American adolescents. Self-treatment with herbal use was common; harmful herbs were used infrequently. Access to care does not appear to motivate herb use. The high rates of herb use by dissatisfied patients, paired with high rates of non-disclosure and lack of provider inquiry, suggests that efforts to provide more culturally sensitive care, including routine inquiry about FTM use in Mexican-American adolescents, are needed. Patterns of complimentary and alternative medicine (CAM)/FTM use vary between age and ethnic cohorts.

Walking out of one culture into another: health concerns of early adolescent Latinos

Adolescence is considered a critical life transition that can lead to heightened vulnerability. Acculturation takes on increased importance during this period. The purpose of this study was to explore the relationship between acculturation and perceived health concerns of early adolescent Latinos in rural North Carolina. A qualitative descriptive design using gender-specific focus groups was conducted in the summer of 2001. Twenty-six Latino adolescents, predominantly from Mexico, participated in one of four focus groups. Acculturation was assessed using the Short Acculturation Scale (Marin & Marin, 1991). The most prevalent health concern of the girls was unsolicited physical contact and aggressive male behavior. Boys expressed concerns about stress related to financial worries and drinking alcohol. A better understanding of where Latino adolescents are located in the acculturation process can assist school nurses in developing targeted school-based prevention programs that focus on building specific skills for Latino girls and boys.

Acculturation and body image perception among Latino youth

OBJECTIVES

Examine the prevalence and predictors of body image dissatisfaction and disordered eating among Latino youth.

DESIGN

One hundred and sixty-seven Latino youth were surveyed as part of a tailored nutrition communication intervention. The youth's mean age was 12.81 years (SD = 2.74) and 54% were female. Mean self-rated health was 2.59 (SD = 1.02; range: 1 = good to 5 = poor), despite 70% reporting a desire to be thinner. Using age and gender-specific growth charts, 16% of the youth were classified as at risk for overweight and 34% were classified as overweight.

RESULTS

Among adolescents, girls (p < or = 0.001), youth who were classified as at risk for or being overweight (p < or = 0.001), and who more strongly recognized and agreed with socially sanctioned standards of appearance as represented in the media (Standardized beta St. beta = 1.86, p < or = 0.001) were more dissatisfied with their body image (R(2) = 0.57). Among children, being at risk for or overweight (p < or = 0.001), reporting a stronger affiliation with the Mexican culture (St. beta = 0.84, p < or = 0.01) and stronger expectations that a healthy diet was associated with improved appearance (St. beta = 0.63, p < or = 0.05) predicted greater body image dissatisfaction (R(2) = 0.55).

CONCLUSION

Interventions that address sociocultural attitudes toward appearance may be effective at reducing both the prevalence of body image dissatisfaction and disordered eating.

Folic acid knowledge and use in a multi-ethnic pregnancy cohort: the role of language proficiency

OBJECTIVE

To investigate the role of language proficiency as determinant of folic acid knowledge and use in a multi-ethnic pregnancy cohort.

DESIGN

Prospective cohort study.

SETTING AND POPULATION

Pregnant women from Amsterdam attending obstetric care for their first antenatal visit. Number approached: 12,373 women, response rate: 67% (8266 women aged 14-49 years). Ethnicity was based on the country of birth: the Netherlands, Surinam, Antilles, Turkey, Morocco, Ghana, other non-Western and other Western countries.

MAIN OUTCOME MEASURES

Knowledge about and use of folic acid supplements in pregnancy as elicited in a multilingual questionnaire, as well as determinants of these in ethnic groups separately.

RESULTS

Both periconceptional folic acid use and knowledge were significantly lower among Ghanaian, Moroccan, Turkish, and other non-Western women than among women born in the Netherlands or other Western countries. Language proficiency in Dutch was a major determinant of knowledge in all the ethnic groups with a mother tongue other than Dutch [adjusted odds ratios (OR): Western 3.2, non-Western (all countries combined) 7.5], while educational attainment was of secondary importance. Knowledge in turn was the strongest determinant of use (adjusted OR: Western 17.4, non-Western 27.0).

CONCLUSIONS

Periconceptional folic acid supplement use among women born in non-Dutch-speaking non-Western countries is low, reflecting a lack of knowledge that is determined by the inability to speak and understand the language of the country of residence. Measures to tackle this problem include the provision of linguistically appropriate information via ethnic health advisors, and language courses integrating health education for immigrants.

Hispanic drug abuse in an evolving cultural context: an agenda for research

Drug abuse in the U.S. Hispanic population appears to be in a dynamic state of acceleration, although there are differences in drug use patterns between U.S.-born and foreign-born Hispanics, and across Hispanic subgroups (i.e., Mexican, Cuban, Puerto Rican, and Central or South American). An understanding of the consequences of cultural adjustments for drug use is needed to effectively anticipate the scope and dimensions of illicit drug use in the largest, rapidly growing, minority group in the U.S. This paper provides an epidemiologic overview of current Hispanic drug use, summarizes research on the relationship between culture change and drug use, organized according to individual, social (i.e., family and peer group), and community level influences on drug use, and offers a systematic agenda for future research.