Vulnerability, Social Networks, Sites, and Selling as Predictors of Drug use among Urban African American and Puerto Rican Emerging Adults

This paper reviews the results of research conducted with African American and Puerto Rican emerging adults between the ages of 18 and 25 whose life experiences increase vulnerability to drug use and pose some significant challenges in achieving milestones widely recognized as important in achieving adult status. Literature on drug use in adolescence suggests that personal vulnerability accounts for most experimental and problem drug use. Included in the vulnerability construct are religiosity, perceived risk, social influence, drug access, social norms, and social risk defined primarily as exposure to various forms of violence. This study shows that personal vulnerability explains only some of the variance in use and predicts variance differently with respect to different specific drugs and polydrug use. Further, it argues that additional contextual factors including social networks, party and club attendance, and drug selling activities, all typical of emerging adulthood and urban lifestyle, are also important factors in enhancing potential for accelerated drug use during this developmental period. Finally, it notes that the consequences of these activities have implications for further economic and social marginalization of urban, multiethnic low income emerging adults.

Drug Use among Puerto Ricans: Ethnic Identity as a Protective Factor

This study assesses the relationship of multiple drug risks, Puerto Rican identity, and drug use. In addition, the risk/protective and protective/protective paradigms for examining interactive effects of ethnic identity and drug risks on drug use were assessed. Structured interviews were conducted with 555 Puerto Rican males andfemales whose mean age was 19. Each risk and two ethnic variables were related to drug use. Regressions showed that cultural knowledge, being culturally active, group attachment, and identification with Puerto Ricans offset the impact of risks on drug use. Ethnic variables also enhanced the protective effect of other protective factors. These results substantiate expanding risk-buffering models to include ethnic identity and the protective role of ethnic identity for Puerto Rican youth.

Smoking Behavior of Puerto Rican Women: Evidence from Caretakers of Adolescents in Two Urban Areas

This study examines cigarette smokingpatterns amongPuertoRican women responsible for caring for adolescents in two metropolitan areas in the Northeastern United States. The age-adjusted prevalence of cigarette smoking in the caretaker sample was higher than the rates for all adult women in the 1985 National Health Interview Survey and the 1986 Adult Use of Tobacco Survey. Smoking prevalence among the caretakers was very similar to the rate reported byPuertoRican women in theNew York City area interviewed during the Hispanic Health and Nutrition Examination Survey. Logistic regression analysis indicated that educational attainment, religious affiliation and marital status influenced the probability that a caretaker currently smokeL Acculturation had a modest positive effect on current smoking. Puerto Rican women may be an important target group for smoking cessation programs because quit rates among ever smokers are still comparatively low and because many of these women are light smokers.

Acculturation and cigarette smoking in Hispanic women: A meta-analysis

The present study was a random-effects model meta-analysis of 26 studies published between 1990 and 2010 (k = 32; n = 39,777) that (a) examined the association between acculturation and cigarette smoking in Hispanic women and (b) evaluated age, national origin, and measure and dimensionality (unidimensional vs. bidimensional) of acculturation as moderating variables. Results indicate a strong positive relationship and suggest larger effects of acculturation on cigarette smoking in women of Mexican descent as compared with women originating from other Latin American countries for current and lifetime smoking, as well as smoking overall. The effect of acculturation on cigarette smoking was larger in adults as compared with adolescents for current smoking and smoking overall. Few differences in effect size by measure or dimensionality of acculturation emerged. Results are discussed with regard to implications for future research and the measurement of acculturation.

Substance use, generation and time in the United States: the modifying role of gender for immigrant urban adolescents

Although immigrant youth have lower rates of substance use than US born youth, whether substance use varies by generation and time in the US is unclear. This study examines adolescent alcohol, tobacco and marijuana use by generation/time in US (i.e., first generation, in US ≤4 years; first generation, in US >4 years; second generation; and third generation or higher). Data come from a 2008 survey of Boston, Massachusetts public high school students (n = 1485). Multivariable logistic regression models were used to examine the association between generation/time in the US and risk of past 30-day substance use, adjusting for age and race/ethnicity. To determine whether the associations differed by gender, we fit gender stratified regression models. The prevalence of substance use was lowest among immigrants who had been in the US ≤4 years. Among girls, generation/time in US was not related to alcohol use or to tobacco use. For boys, being an immigrant regardless of number of years in the US, as well as second generation was associated with a significantly lower risk of tobacco use, compared to third generation youth. Additionally, immigrant boys who had been in the US ≤4 years had a significantly lower risk of alcohol use. Among both boys and girls, all first and second generation youth were significantly less likely to report marijuana use compared to third generation youth. Immigrant youth have a lower risk of alcohol, tobacco and marijuana use relative to US born youth; however the protective effect of foreign nativity on alcohol was eroded much more quickly than for tobacco or marijuana. The effects of generation and time in US on substance use differ by gender and the particular substance.

Cigarette smoking in the adolescent children of drug-abusing fathers

OBJECTIVE

This study examined the longitudinal predictors of cigarette smoking in a sample of at-risk adolescents whose fathers were drug abusers (N = 296).

METHODS

At time 1, structured interviews were administered, separately and in private, to male and female youth (X age = 16.3) and their fathers; adolescents were reinterviewed approximately 1 year later (at time 2). Structural equation modeling was used to examine the interrelationship of time 1 paternal tobacco and illicit drug use, father-child relations, adolescent psychological adjustment, and peer group factors and adolescent smoking at time 2. A supplementary analysis assessed the same model with control on the adolescent's age, gender, frequency of contact with the father, and the father's treatment status.

RESULTS

The structural equation model showed a mediational pathway linking paternal tobacco and drug use to a weak and conflictual father-child relationship, which was associated with greater adolescent maladjustment, which in turn was related to deviant peer affiliations, which predicted adolescent smoking at time 2. There was also a direct path from paternal tobacco and drug use to adolescent time 2 smoking. The supplementary analysis found no significant differences between the models with and without control.

CONCLUSIONS

Findings provide evidence of the mechanisms that underlie the association between paternal drug use characteristics and smoking in the adolescent child. Clinical implications suggest the importance of the father-child relationship to smoking prevention programs for at-risk youth.

Association between psychiatric disorders and smoking stages among Latino adolescents

OBJECTIVE

We examined the prevalence of smoking behaviors and their association with psychiatric disorders within a representative sample of youth from Puerto Rico.

METHOD

A complex sampling design was used and analyses were conducted to account for the unequal selection probability, stratification and clustering. All analyses were weighted back to the population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0 (DISC-IV).

RESULTS

After controlling for other comorbidity, major depression and oppositional defiant disorder were significantly associated with nicotine dependence, rather than with lower levels of use. In contrast, conduct disorder was generally associated with lower levels of use rather than with nicotine dependence. As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages.

CONCLUSIONS

By examining psychiatric correlates of smoking stages within an island-wide sample of adolescents, the present study highlights those disorders that may play a role in the development and/or persistence of smoking behavior in Puerto Rico and further clarifies the appropriate targets for smoking intervention conducted in community settings.

Ethnicity and ethnic identity as predictors of drug norms and drug use among preadolescents in the US Southwest

This article reports the results of research exploring how ethnicity and ethnic identity may "protect" adolescents against drug use and help them form antidrug use norms. This study was conducted in 1998 and is based on a sample of 4364 mostly Mexican American seventh graders residing in a large southwestern city of diverse acculturation statuses. It aims at testing existing findings by conducting the research within the unique geographic and ethnic context of the Southwest region of the United States. This research examines how strength of ethnic identity plays a distinctive role in drug use behavior among the various ethnic groups represented in the sample: Mexican Americans, other Latinos, American Indians, African Americans, non-Hispanic Whites, and those of mixed ethnic backgrounds. Positive ethnic identity (i.e., strong ethnic affiliation, attachment, and pride) was associated with less substance use and stronger antidrug norms in the sample overall. Unexpectedly, the apparently protective effects of positive ethnic identity were generally stronger for non-Hispanic White respondents (a numerical minority group in this sample) than for members of ethnic minority groups. Implications for prevention programs tailored for Mexican/Mexican American students are discussed.

A mediational model of the relationship between linguistic acculturation and polydrug use among Hispanic adolescents

Hispanic seventh and eighth graders (N=1,038) in 22 New York City middle or junior high schools completed self-report questionnaires with items related to drug use (cigarette smoking, alcohol use, and marijuana use), linguistic acculturation (language use with parents), perceived peer smoking norms, perceived peer drinking norms, and psychological distress. Students who spoke English with their parents and bilingual students who spoke English and Spanish with their parents engaged in greater polydrug use than those who spoke Spanish with their parents. Bilingual students perceived that a higher proportion of their peers drink than those who spoke Spanish with their parents, and this higher perception of their peers' drinking was associated with greater polydrug use controlling for linguistic acculturation. In the final model, linguistic acculturation was no longer significant and peer drinking norms predicted polydrug use, peer drinking norms mediated the relationship between linguistic acculturation and polydrug use, but not peer smoking norms and psychological distress.

English language use as a risk factor for smoking initiation among Hispanic and Asian American adolescents: evidence for mediation by tobacco-related beliefs and social norms

Acculturation increases the risk of smoking among Hispanic and Asian American adolescents, but the underlying mechanisms are not understood. This study examined associations between English language use and smoking among 4,167 Hispanic and 2,836 Asian American adolescents in California. Potential mediators were assessed, including access to cigarettes, perceived consequences, friends' smoking, cigarette offers, refusal self-efficacy, and prevalence estimates of peer smoking. English language use was associated with increased risk of lifetime smoking in both groups. This association became nonsignificant after access, perceived consequences, friends' smoking, and offers were controlled for. The acculturation process (as indicated by English language use) may be associated with smoking-related psychosocial variables, which may lead to an increased risk of experimentation with smoking.

The role of social networks and media receptivity in predicting age of smoking initiation: a proportional hazards model of risk and protective factors

The increasing prevalence of adolescent smoking demonstrates the need to identify factors associated with early smoking initiation. Previous studies have shown that smoking by social network members and receptivity to pro-tobacco marketing are associated with smoking among adolescents. It is not clear, however, whether these variables also are associated with the age of smoking initiation. Using data from 10,030 California adolescents, this study identified significant correlates of age of smoking initiation using bivariate methods and a multivariate proportional hazards model. Age of smoking initiation was earlier among those adolescents whose friends, siblings, or parents were smokers, and among those adolescents who had a favorite tobacco advertisement, had received tobacco promotional items, or would be willing to use tobacco promotional items. Results suggest that the smoking behavior of social network members and pro-tobacco media influences are important determinants of age of smoking initiation. Because early smoking initiation is associated with higher levels of addiction in adulthood, tobacco control programs should attempt to counter these influences.

Ethnic and gender differences in smoking prevalence among a longitudinal sample of inner-city adolescents

PURPOSE

To determine if ethnic and gender differences in smoking (lifetime prevalence and 30-day prevalence) exist among a cohort of Asian, black, Hispanic, and white inner-city adolescents during the 3-year middle school period.

METHODS

Students in 22 urban schools completed self-report questionnaires and provided carbon monoxide breath samples at three annual assessments. Chi-square analyses were conducted to test for associations between ethnic group (Asian, black, Hispanic, and white) and smoking and to test for gender differences in smoking within each ethnic group. Additional analyses examined differences in smoking between two Hispanic subgroups (Puerto Rican and Dominican).

RESULTS

Ethnicity was associated with lifetime smoking prevalence at all three assessment points but was only associated with 30-day smoking prevalence at the 2-year follow-up. However, there were no differences in smoking between Puerto Rican and Dominican youth. Black girls reported higher lifetime smoking prevalence than black boys at all three assessments. At the 2-year follow-up, Asian boys reported higher lifetime smoking prevalence than Asian girls; Hispanic girls reported higher 30-day prevalence than Hispanic boys.

CONCLUSIONS

White and Hispanic adolescents were at higher risk for smoking relative to Asian and black adolescents. With the exception of white youth, gender differences were found within each ethnic group.

Linguistic acculturation and gender effects on smoking among Hispanic youth

BACKGROUND

Hispanic populations have been shown to be at high risk for smoking. The complex psychological process of adaptation to a different culture (acculturation) has been linked to smoking among Hispanic adults and adolescents. Although a positive association between acculturation and smoking appears to depend on gender among adults, research with Hispanic adolescents has ignored the moderating effect of gender.

METHODS

Students in 22 New York City schools completed self-report questionnaires and provided carbon monoxide breath samples at two annual assessments. Sixth and seventh graders who identified themselves as Hispanics participated in the study (N = 1,295 at baseline; N = 1,034 at 1-year follow-up). The questionnaire included items related to smoking, acculturation, and demographic characteristics.

RESULTS

Analyses were conducted to determine the effects of linguistic acculturation and gender on smoking. Girls smoked more frequently than boys at both time points. Being more acculturated was also associated with more smoking at the two survey assessments. As predicted, adolescent smoking depended on both gender and linguistic acculturation. For girls, but not boys, the highly acculturated adolescents smoked more frequently than either the bilingual or the less acculturated.

CONCLUSIONS

Based on these findings, smoking prevention programs designed for Hispanic youth may benefit from an emphasis on Hispanic culture.

Validation of an acculturation measure for Hispanic adolescents

Based on the continuing growth and youthfulness of the Hispanic population in the United States, valid cultural measures are needed for Hispanic adolescents. Hispanics living in this country experience acculturation or cultural change during their exposure to American culture. A matched sample of 994 Hispanic students and their parents completed acculturation measures. Scores on a 10-item acculturation scale completed by the adolescents' parents correlated significantly .49 with a single-item rating, a measure of acculturation by adolescents. This finding supports construct validity for a measure of language use as an index of linguistic acculturation for Hispanic adolescents.

Reliability and validity of the Smoking and Women Questionnaire among three ethnic groups

Cigarette smoking among women continues to be a major health risk to the smoker and to those around her. Programs aimed at stopping and maintaining smoking cessation have had very limited success due in part to the failure to individualize smoking cessation programs based on specific characteristics of the smoker. This study presents reliability and validity of a 14-item questionnaire developed to determine the readiness of women from three ethnic groups (non-Hispanic white, black American, and Hispanic American) to stop smoking. The Smoking and Women Questionnaire (SWQ) consists of items representative of core elements conceptualized in the Smoking/Ex-smoking Model for Women. The core factors are: beliefs/attitudes toward smoking, sociability, stress, coping, self-efficacy, motivation, nicotine dependence, and support. The SWQ was completed by both smoking and nonsmoking non-Hispanic white (N = 233), smoking and nonsmoking black American (N = 70), and smoking and nonsmoking Hispanic American (N = 73) women. The test-retest correlation coefficient over a one- to three-week period (N = 53) was .84. Cronbach alphas for whites, blacks, Hispanics, and combined groups were .81, .85, .84 and .83, respectively. Content validity was shown by experts who agreed that the core elements were represented in the SWQ. Construct validity was shown for ethnic groups separately and combined in that smokers had significantly lower SWQ scores than nonsmokers. Items representative of the core elements were rated by smokers in a similar manner irrespective of ethnicity, suggesting similar attitudes and behaviors toward smoking. Further research is needed to determine if the SWQ can predict readiness of women to stop smoking and serve as a basis for developing individualized smoking cessation programs. Implications for smoking cessation programs are reviewed.

Environmental tobacco smoke exposure among Hispanic women of reproductive age

Exposure to environmental tobacco smoke is a potential health risk for women of reproductive age and their children. Household and workplace exposures were estimated for 4256 Hispanic women age 12 to 49 who participated in the Hispanic health and nutrition examination survey. Age-specific household exposure for nonsmokers was 31% to 62% for Mexican-Americans, 22% to 59% for Puerto Ricans, and 40% to 53% for Cuban-Americans. Exposure was significantly high for Puerto Rican and Mexican-American adolescents, 59% and 62%, respectively. Workplace exposure for nonsmokers was 22% to 35% for Mexican-Americans, 28% to 33% for Puerto Ricans, and 33% to 49% for Cuban-Americans. Young Mexican-American and Puerto Rican and all Cuban-American women reported high exposure to environmental tobacco smoke in the home or workplace. Assessment of family living and smoking patterns, understanding cultural values and norms, and household smoking control and cessation strategies that are mutually derived are useful for nurses and Hispanic and Latino populations to meet the environmental tobacco smoke health objectives for the nation.