Patterns of drug use among Cuban-American, African-American, and white non-Hispanic boys

Does Ethnic Identity Moderate the Relationship between Racial Discrimination and Cannabis Use among US- and non-US Born Black Emerging Adults?

Race-based experiences of discrimination (EOD) have been documented as a risk factor for substance use among Black individuals, particularly during emerging adulthood, with ethnic identity serving as a protective influence. Our study extends epidemiologic research on EOD and cannabis use by examining this relation in U.S. and non-U.S. born Black emerging adults across immigrant generations (N = 466, 30% first-generation immigrants, 49% second-generation immigrants, and 21% non-immigrants). Results from self-reported data indicated EOD were associated with an increased likelihood of lifetime cannabis use, while ethnic identity was not significantly related to any odds of lifetime cannabis use. Odds of lifetime use was lower among first-generation immigrants compared to non-immigrants. Although the interaction between ethnic identity and EOD was not significantly associated with cannabis use, the results indicated that for second-generation immigrants, the probability of lifetime use decreased as ethnic identity increased. These findings underscore the importance of ethnic identity as a protective factor for cannabis use, especially among Black immigrants who have been racialized over generations in the United States, providing implications for future study and intervention.

A Critical Review and Meta-Analysis of the Associations Between Acculturation and Alcohol Use Outcomes Among Hispanic Americans

Acculturation has been studied as one key sociocultural determinant that helps explain ethnic disparities in alcohol use outcomes among Hispanic Americans. Primary studies and other systematic reviews have found between-study inconsistencies regarding the extent to which acculturation is associated with alcohol use outcomes among Hispanic Americans. To better examine whether acculturation is distinctly linked to drinker status, drinking frequency, volume, intensity, binge drinking, and hazardous alcohol use/drinking problems, and to identify individual and methodological factors that moderate these associations, we conducted a comprehensive research synthesis. A systematic review was conducted on research pertaining to the associations between acculturation and alcohol use among Hispanics. We included 88 independent study samples (N = 68,282) coded from 68 manuscripts published in 1987 to 2017. Standard and robust variance estimation (RVE) meta-analyses were conducted to calculate the correlations between acculturation and overall alcohol use. We also conducted a series of analyses to examine the weighted mean correlations between acculturation and 6 specific drinking outcomes. We found a statistically significant correlation between acculturation and overall alcohol use (r = 0.09, p < 0.001). Acculturation was associated with drinker status (r = 0.10, p < 0.001), drinking intensity (r = 0.09, p = 0.001), binge drinking (r = 0.05, p = 0.006), and hazardous alcohol use/drinking problems (r = 0.06, p = 0.006), but not drinking frequency (r = 0.02, p = 0.56) or volume (r = 0.01, p = 0.73). Gender, acculturation dimension, acculturation domain, age group, and sampling settings were found to explain between-study variability in some of these associations. Findings show small relations between acculturation and various alcohol use outcomes, but the effects are relatively more robust among Hispanic women, adults, and when studies measured U.S. cultural orientation, linguistic acculturation, and behavioral practices.

Substance use and treatment outcomes among Spanish-speaking Latino/as from four acculturation types

The purpose of this study was to examine the association of acculturation with substance use treatment outcomes in a sample of treatment-seeking Latino/as (N = 405). The study used data from a multisite randomized controlled trial of a culturally adapted version of Motivational Enhancement Therapy delivered in Spanish. Berry, Kim, Minde, and Mok's (1987) acculturation model was used to divide the sample into 4 types (integrated, assimilated, separated, marginalized), based on Bicultural Involvement Questionnaire scores. One-way analyses of variance, chi-squared tests, and repeated-measures regression were used to examine baseline acculturation, posttreatment outcomes, and follow-up outcomes. All participants were of Latino/a background, and 88.4% of the sample was male. Participants with greater acculturation to American culture (i.e., integrated and assimilated acculturation types) reported more substance use and associated problems at baseline, χ²(3) = 20.5, p < .001, with the integrated type reporting the highest percentage of substance use disorder symptoms and problems (67.6%). No significant differences in substance use were detected among acculturation types posttreatment or at follow-up. Although the integrated and assimilated acculturation types were associated at baseline with more substance use and associated problems, all acculturation types seemed to benefit at posttreatment from an evidence-based culturally adapted treatment. (PsycINFO Database Record

Nation of Origin, Gender, and Neighborhood Differences in Past-Year Substance Use among Hispanics and Non-Hispanic Whites

This analysis of the National Household Survey on Drug Abuse (NHSDA) focuses on correlates of substance use among Hispanic groups. Using 1994-B and 1996 NHSDA surveys (U.S. Department of Health and Human Services [USDHHS], 1996, 1998), these analyses use sampling areas to control for intracluster correlation and its subsequent effect on empirical conclusions. Models are specified for alcohol, cigarettes, marijuana, cocaine, and any illicit drug, controlling for national origin, gender, age, socioeconomic status, language, and family structure. Results indicate that models failing to account for intracluster correlation may lead to erroneous ethnic contrasts of substance use. Also, substance use varies widely by national origin—and Hispanic men and women have highly divergent patterns of use, more so than non-Hispanic White men and women. Finally, controlling for neighborhood does not wholly diminish ethnic contrasts in substance use.

Predictors of Sexual Activity in Haitian-American Adolescents

This study examined the impact of individual, peer, family, school, and neighborhood level variables on sexual activity among 276 Haitian-American adolescents. Differences between those who were sexually active and those who were not were analyzed using Chi square and t tests. Significant factors at p ≤ 0.1 were entered into logistic regression for the full group and for girls-only. Half of males and 36.6 % of females were sexually active. The multivariable model revealed that adolescents were more likely to be sexually active if they reported delinquent behaviors; had sexually active friends; and were living with only one parent, friends or relatives. For girls, living with both parents was protective against sexual activity, while substance use and emotional distress were risk factors. No language or acculturation measures were associated with sexual activity. Haitian-American adolescents may benefit from interventions that focus on gender-specific, contextual and cultural factors to prevent early sexual activity.

Substance Use among a National Sample of Asian/Pacific Islander Men Who Have Sex with Men in the U.S

The objectives of this study were to describe drug use among Asian/Pacific Islander (API) men who have sex with men (MSM) and to examine how nativity (and acculturation as a secondary correlate) predicted such use. A total of 445 self-identified API MSM from seven metropolitan cities participated in a national HIV serological testing and psychosocial and behavioral assessment study. Results indicate clubbing was significantly associated with higher levels of substance use. Additionally, participants who were U.S.-born were more likely to have reported marijuana use and those with higher levels of acculturation reported less marijuana use. Our bivariate findings suggest that foreign-born status and acculturation experience may provide a protective effect against marijuana use among API MSM. These associations largely did not hold in our multivariate models. Future research should more fully examine the role of acculturation and nativity in substance use behaviors.

Gender differences in alcohol and drug use among Hispanic adults: the influence of family processes and acculturation

We examine the influence of family processes and acculturation for gender differences in alcohol and drug use among a sample representative of the Hispanic population in Miami-Dade County, Florida (N = 734). We found that (a) increases in age at marriage and acculturation were associated with greater substance use, (b) the associations between age at marriage, acculturation, and substance use were found to be greater for Hispanic women than men, and (c) with each additional child born, Hispanic women are increasingly less likely to use substances than Hispanic men. Data reveal that family processes and acculturation jointly impact substance use.

Problematic substance use among Hispanic adolescents and young adults: implications for prevention efforts

Using data collected between 2005 and 2012 from a longitudinal study of acculturation patterns and substance use among Hispanic youth in Southern California (N = 2722), we fit multivariate logistic regression models to estimate the association of type and frequency of drug use, friend and parent drug use, cultural orientation (measured by the ARSMA-II), and psychological distress (CES-D score) in 10th grade with problematic substance use (measured with the RAPI) in (i) 11th grade and (ii) young adulthood. We conclude that future intervention efforts with Hispanic adolescents and young adults should target polysubstance and problem users and emphasize inter-individual, structural, and cultural processes as they relate to problematic substance use.

Racial and ethnic differences in the immigrant paradox in substance use

Using data from the National Longitudinal Studies of Adolescent Health, the present study examines self-reported substance use (cigarettes, tobacco, and marijuana) among youth from different immigration generations to determine the immigrant paradox in substance use for different racial and ethnic groups as well as factors contributing to the relationship between immigration and substance use. Results of data analysis indicate the immigrant paradox in substance use among non-Hispanic Whites, Asians, and Hispanics, but not among non-Hispanic Blacks. The study also shows that factors explaining the immigrant paradox in substance use vary with racial and ethnic groups, but English use at home, friends' cigarette and marijuana use appear to be the most important mediating factors. Findings from the study suggest that effective interventions in youth substance use require an understanding of adaptation patterns in different racial and ethnic groups, so that factors associated with adaptation problems experienced by particular groups will be appropriately addressed.

Who's at risk? Ethnic drinking cultures, foreign nativity, and problem drinking among Asian American young adults

OBJECTIVE

Despite the low overall prevalence of alcohol use among Asian Americans, rates of alcohol use disorder are high among Asian American young adults. The influence of ethnic drinking cultures on immigrants and their descendants has been overlooked in past research. We took an integrative approach to examine the influence of ethnic drinking culture, acculturation, and socioeconomic disparities on problem drinking among Asian American young adults.

METHOD

This study was a nationally representative sample of 854 Asian American young adults extracted from the Wave 4 National Longitudinal Study of Adolescent Health data. About 48% of the sample was female and 52% male. Several multiple logistic regression models were fitted.

RESULTS

Controlling for other covariates, two dimensions of ethnic drinking culture were associated with alcohol outcomes only for the foreign born: (a) detrimental drinking pattern with frequent drunkenness and alcohol-abuse symptoms and (b) drinking prevalence with alcohol-dependence symptoms. Financial hardship was a significant predictor of symptoms of alcohol abuse and dependence only for the U.S. born. Asian language use was protective against alcohol-abuse symptoms and alcohol-dependence symptoms for the foreign born.

CONCLUSIONS

Cultural and socioeconomic factors of problem drinking may be different for U.S.-and foreign-born Asian American young adults. Ethnic drinking cultures may significantly influence problem drinking of foreign-born Asian American young adults, independent of their acculturation into U.S. cultures. To inform effective interventions targeted at immigrants and their descendants, future research might further investigate the cultural and socioeconomic processes in immigrant communities that might significantly influence drinking.

Initiation and persistence of alcohol use in United States Black, Hispanic, and White male and female youth

BACKGROUND

The relation between early and frequent alcohol use and later difficulties is quite strong. However, the degree that alcohol use persists, which is often a necessary cause for developing alcohol-related problems or an alcohol use disorder, is not well studied, particularly with attention to race and gender. A novel statistical approach, the Multi-facet Longitudinal Model, enables the concurrent study of age of initiation and persistence.

METHODS

The models were applied to longitudinal data on youth alcohol use from ages 12 through 19, collected in the (U.S.) National Longitudinal Survey of Youth 1997 cohort (N=8984).

RESULTS

Results confirmed that Black adolescents initiate alcohol use at later ages than do White youth. Further, after initiation, White adolescents were substantially more likely than Black adolescents to continue reporting alcohol use in subsequent years. Hispanic teens showed an intermediate pattern. Gender differences were more ambiguous, with a tendency for boys to be less likely to continue drinking after initiation than were girls.

CONCLUSIONS

Novel findings from the new analytic models suggest differential implications of early alcohol use by race and gender. Early use of alcohol might be less consequential for males who initiate alcohol use early, Black, and Hispanic youth than for their female and White counterparts.

Gender, acculturation and alcohol use among Latina/o adolescents: a multi-ethnic comparison

This is the first study to examine the relationship between acculturation and alcohol use by gender and ethnicity using a nationally representative sample of Hispanic and non-Hispanic white adolescents. Specifically, we use data from the National Longitudinal Study of Adolescent Health (Add Health) to explore alcohol use and binge drinking for a sample that includes 6792 non-Hispanic whites, 910 Mexican Americans, 290 Cuban Americans, and 336 Puerto Ricans. Bivariate results reveal significant gender differences in alcohol use among first generation Mexican American, first generation Puerto Rican, and second generation Cuban American adolescents. In addition, these results indicate binge drinking differs significantly by gender among first generation Mexican American, first generation Cuban American, third plus generation Puerto Rican, and third plus generation non-Hispanic white adolescents. Multivariate logistic regression reveals that gender also moderates the effect of acculturation as well as ethnicity on alcohol use and abuse. Among both males and females, first generation immigrants are significantly less likely than third plus generation immigrants to use alcohol and binge drink while selective acculturation significantly reduces the odds of both behaviors. However, the effects of immigrant generation and selective acculturation on binge drinking are larger for females. Further, the trajectories that alcohol use and binge drinking follow with acculturation differ significantly by gender and ethnicity. These results reaffirm the need to further develop theoretical models and intervention strategies that are both gender-specific and culturally-specific, targeting high risk groups in particular in these efforts.

The role of family obligations and school adjustment in explaining the immigrant paradox

This study examined the role of family obligations and school adjustment in explaining immigrant adolescents’ adaptation. Despite a relatively low socio-economic status, immigrant adolescents have been found to have a pattern of adaptation superior to that of national adolescents. Immigrant adolescents’ strong sense of family obligations and positive school adjustment have been used to explain these positive adaptation outcomes. Using self-reports in a sample of 277 national adolescents (45.5% female) and a sample of 175 non-western immigrant adolescents (58.9% female), both samples with a mean age of 15 years, it was found that despite a lower socio-economic status, the adaptation of immigrant adolescents was as good as the nationals’ adaptation. Immigrant adolescents scored higher on family obligations and school adjustment. Family obligations and school adjustment were found positively related to adaptation outcomes in the national and the immigrant adolescent sample. Findings suggest that, in underprivileged environments, a strong sense of family obligations may help immigrants as well as national adolescents achieve a positive pattern of adaptation.

Adolescent risk behaviours and psychological distress across immigrant generations

OBJECTIVE

To examine disparities in hazardous and harmful drinking, illicit drug use, delinquency, and psychological distress among three immigrant generations of youth.

METHODS

Data on 4,069 students were derived from the 2005 cycle of the Ontario Student Drug Use Survey, a province-wide school-based survey of 7th to 12th graders. The survey employed a two-stage cluster design (school, class). Analyses include adjustments for the complex survey design, specifically stratification, clusters, and weights.

RESULTS

Both drug use and hazardous and harmful drinking increase across immigrant generations. First-generation youth report significantly less use than second-generation youth, who in turn report less use than third and later generations. Generational differences in the levels of hazardous and harmful drinking increase with age. Delinquency is significantly less among first-generation youth relative to youth of other immigrant generations. Symptoms of psychological distress are highest among first-generation youth compared to youth of other immigrant generations.

CONCLUSION

The nature of differences between foreign- and native-born adolescents varies across behaviours. As such, it is important to gain knowledge about the adjustment levels of these two groups with regard to specific components of well-being. Such knowledge is necessary for developing policies and programs to promote emotional and behavioural health.

Gender Differences in the salience of psychosocial mediators of the impact of acculturation on substance abuse among Hispanic youth in Florida

OBJECTIVES

A number of psychosocial factors have been identified as mediators of the impact that acculturation exerts on adolescent drug use. We sought to evaluate gender differences in mediators of the impact of acculturation on substance abuse.

METHODS

We used t-test and logistic regression to analyze data collected from 8,200 adolescent students who self-identified as Hispanic during the 2004 Florida Youth Substance Abuse. The dependent variable was past 30 day use of marijuana and the key independent variable was language spoken at home. The covariates were 32 risk and protective (R/P) factors for drug use as defined by the Social Development Strategy framework.

RESULTS

For boys, the ORs associated with language changed significantly with the addition of any of the R/P factors to their basic model, while for girls only the addition of the Individual domain factors significantly changed the ORs.

DISCUSSION AND CONCLUSION

These findings suggest that among boys the interventions that target any or all of the R/P factors may be able to positively alter the drug using behaviors among boys. In contrast, only the interventions that reinforce girls' innate strengths may succeed in dissuading them from initiating and perpetuating drug use. This information can be used to develop policies and interventions geared toward preventing drug problems among the growing group of adolescent of immigrant descent.

Psychosocial mediators of the impact of acculturation on adolescent substance abuse

To identify and evaluate socio-psychological factors that are associated with differences in substance abuse prevalence between non-acculturated and acculturated Florida youth, we employed t-test and logistic regression to analyze self-reported data from 63,000 middle and high school student participants in the 2004 Florida Youth Substance Abuse Survey. Questionnaire items covered socio-demographics, tobacco, alcohol, and illicit substance use; and perceptions and attitudes toward drug use. The outcome variables were past 30 day use of "any illicit drug." The key independent variable was language used at home (English/Another language). The covariates were 32 socio-psychological factors that are considered risk and protective factors for adolescent drug abuse. Findings support the growing body of evidence suggesting that acculturation status is a strong predictor of substance use among adolescents. This effect may be mediated principally through the family and peer/individual psychosocial domains. The findings may have important implications for the design and implementation of drug prevention programs targeting teenagers.

Sociocultural Stress, Smoking Risk, and Cessation Among African American Women

The common explanation as to why individuals smoke is that the act of smoking relieves psychological stress, yet very few studies have examined the association between stress and smoking from a sociocultural perspective among African American women. The current study examined the paradigm of sociocultural stress and its association between smoking risk and likelihood of quitting among African American women. One hundred ninety-eight African American women, approximately half of whom were current smokers, completed a battery of questionnaires that included a smoking risk survey and measures of acculturation, stress, and coping. A theoretically based path analytic model revealed that the acculturative stress factors of cultural mistrust (β = .39) and socialization (β = .17) were predictive of perceptions of race-related stress (R 2 = .18), which were predictive of the number of race-related events experienced (R 2 = .51), which contributed to reports of general life stress (R 2 = .07), which was subsequently associated with smoking risk (R 2 = .03). The findings suggest that smoking cessation intervention programs for African American women should be tailored to address sociocultural issues related to stress that impacts their smoking.

Acculturation among Latino Youth and the Risk for Substance Use: Issues of Definition and Measurement

The purpose of this paper is to provide an overview of the acculturation literature with a specific focus on exploring acculturation as a concept as well as examining its measurement and relationship to substance use/abuse among Latino adolescents in the United States over the past 20 years. A brief overview of the development of theoretical models and instruments assessing acculturation over the past two decades is provided. In addition, studies examining the relationship between acculturation and substance use/abuse among these adolescents are reviewed. Findings indicate that the development of acculturation theory and measurement has been hampered by the lack of both clear terminology and consistency. In the majority of studies reviewed, acculturation appeared to be a risk factor for Latino adolescent substance use/abuse. A small majority of these studies utilized language as a sole measure of acculturation. Language preference, in combination with other proxy measures of acculturation were found to be a robust predictor of substance use/abuse outcomes for Latino adolescents. The findings are discussed in the context of recommendations for future research on the measurement of acculturation as well as on implications for preventive interventions.

TRAJECTORIES OF ACCULTURATION AND ENCULTURATION IN RELATION TO HEAVY EPISODIC DRINKING AND MARIJUANA USE IN A SAMPLE OF MEXICAN AMERICAN SERIOUS JUVENILE OFFENDERS

This study examines the longitudinal relations of multiple dimensions of acculturation and enculturation to heavy episodic drinking and marijuana use in a sample of 300 male, Mexican-American, serious juvenile offenders. We track trajectories between ages 15 and 20 and also consider the effects of participants' time spent residing in supervised settings during these years. Results showed some (although not entirely consistent) support for the hypothesis that bicultural adaptation is most functional in terms of lowered substance use involvement. The current findings demonstrate the importance of examining these relations longitudinally and among multiple dimensions of acculturation and enculturation, and they call into question simple models that suggest that greater acculturation is associated with greater substance use among Mexican-American adolescents.

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.

Early alcohol initiation and subsequent sexual and alcohol risk behaviors among urban youths

OBJECTIVES

We examined relations between early alcohol use and subsequent alcohol and sexual risk behaviors among urban adolescents.

METHODS

A total of 1034 African American and Hispanic youths completed surveys assessing alcohol and sexual behaviors at 7th and 10th grade. After we controlled for early sexual initiation, we examined relations between early drinking and subsequent alcohol and sexual behaviors.

RESULTS

Early drinking was associated with alcohol and sexual risks through mid-adolescence. Early drinkers were more likely to report subsequent alcohol problems, unprotected sexual intercourse, multiple partners, being drunk or high during sexual intercourse, and pregnancy. Among females, early drinking was also related to sexual initiation and recent sexual intercourse.

CONCLUSIONS

Prevention programs should address combined risks of early alcohol use and sexual intercourse, especially where levels of HIV and other sexually transmitted infections are elevated.

Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context

This chapter provides an overview of the concept of acculturation and reviews existing evidence about the possible relationships between acculturation and selected health and behavioral outcomes among Latinos. The effect of acculturation on Latino health is complex and not well understood. In certain areas-substance abuse, dietary practices, and birth outcomes-there is evidence that acculturation has a negative effect and that it is associated with worse health outcomes, behaviors, or perceptions. In others-health care use and self-perceptions of health-the effect is mostly in the positive direction. Although the literature, to date, on acculturation lacks some breadth and methodological rigor, the public health significance of findings in areas in which there is enough evidence justifies public health action. We conclude with a set of general recommendations in two areas-public health practice and research-targeted to public health personnel in academia, community-based settings, and government agencies.

A Comparison of African American and Cuban American Adolescent Juvenile Offenders: Risky Sexual and Drug Use Behaviors

Racial and ethnic disparities exist in HIV seroconversion rates, with African American and Hispanic youth in the 13-19-year-old age group representing 61% and 21% of new AIDS cases, respectively. The aim of this study was to examine sexual and drug use behaviors among a sample of 138 African American and Cuban American juvenile offenders. Cuban American adolescents showed higher levels of unprotected sex, higher levels of sex while using drugs, and higher levels of drug/alcohol use in the three and six months prior to confinement. These differences may be explained by multiple factors, including differences in acculturation levels among the Cuban American adolescents, differences in health messages targeted at the two groups, and family mores and norms.

Binge drinking among Latino youth: role of acculturation-related variables

This research examined the relationship between acculturation-related variables and binge drinking behavior among nationally representative samples of Mexican American, Cuban American, and Puerto Rican youth. It explored the relationship between length of residence in the United States, type of language spoken in the home (Spanish vs. English) and binge drinking in each of these subgroups. Results suggest that Latino youths with no prior history of alcohol consumption remain largely unaffected by these acculturation-related variables. Youth with a previous history of alcohol consumption experience greater likelihood of binge drinking as a function of the acculturation-related variables, but the relationships are complex.

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.

Interparental conflict and risk behaviors among Mexican American adolescents: a cognitive-emotional model

This study used a cognitive-emotional model to examine the relations between multiple dimensions of interparental conflict and health risk behaviors among young adolescents. Participants were 151 Mexican American adolescents and their parents. At initial individual interviews, parents reported on conflict with their spouses, and adolescents reported on their parents' conflict, their appraisals of the conflict, their emotional distress, and their acculturation level. At 6-month follow-ups, adolescents reported on their risk behaviors, including substance use and sexual activity. In general, adolescents' acculturation level was not related to their risk behaviors. More frequent conflict, more conflict about the adolescent, more adolescent involvement in the conflict, and poor conflict resolution were related to greater emotional distress. More conflict about the adolescent, mothers being more demanding/dominating during conflict, and more adolescent involvement in the conflict were related to greater risk behaviors. Adolescents' cognitions mediated the link between two dimensions of parental conflict, frequency and resolution, and emotional distress. Adolescents' emotional distress mediated the association between adolescent involvement in parental conflict and adolescents' risk behaviors.

Prevalence and correlates of substance use disorders among older adolescents in Puerto Rico and the United States: a cross-cultural comparison

Although there are substantial data on adolescent substance use, little systematic research has studied the prevalence of adolescent substance disorders in general populations, let alone cultural differences in disorder prevalence. In this paper we report the prevalence and correlates of alcohol and drug use and disorder among older adolescents on Puerto Rico (PR) and in the United States (US). Data come from an island-wide survey of the PR general residential population (15-18 year old subsample, unweighted N=922) fielded in 1997, and from the National Comorbidity Survey of the US household population (15-18 year old subsample, unweighted N=641), fielded in 1991. Both surveys used a similar standardized interview based on the Composite International Diagnostic Interview (CIDI) to generate DSM-IV diagnoses. Bivariate analyses and logistic regression were used. The major findings are: (1) US youth report higher rates of lifetime alcohol and drug use and substance-related disorder than PR youth; (2) the transition to abuse or dependence occurs for one-third of US drinkers, one-fifth of drinkers in PR, and about one-half of the drug users in both US and PR; (3) there are marked variations across sites in the types of symptoms substance users are likely to experience; (4) with the exception of family income, most correlates operate similarly in both sub-samples; and (5) the majority of both US and PR youth with a past year substance use disorder did not report any service utilization in the past year.

A review of the role of social support systems in the drug use behavior of Hispanics

In this article the authors conducted a critical review of ongoing and recently completed drug abuse studies which have examined the importance of social support systems in the drug-using behavior of Hispanics. Published and unpublished preliminary data from these studies are presented and discussed. This critical review of the research literature supports earlier findings that social support systems play an important role in preventing drug abuse among Hispanics. Specifically, this review found that familial factors, peer influences, involvement with religious institutions, and after-school activities have a powerful impact on the drug-using behaviors of Hispanic child, youth and adult drug users. The authors suggest that drug prevention and treatment programs within Hispanic communities will be more successful if they incorporate social support systems into their programs. In conclusion, the authors identify areas in which the role of social support systems in the drug-using behavior of Hispanics need further investigation.

Recency of immigration, substance use, and sexual behavior among Massachusetts adolescents

OBJECTIVES

This study examined the relationships between recency of immigration, substance use, and sexual behavior.

METHODS

Surveys were conducted with 2635 Massachusetts 8th and 10th graders that allowed comparisons of health behaviors and risk and protective factors among students living in the United States "always," more than 6 years, or 6 years or less.

RESULTS

Compared with lifetime residents, immigrant youths (particularly those living in the United States 6 years or less) reported lower lifetime and recent alcohol and marijuana use (P < .001); sexual intercourse rates were similar across groups. However, recent immigrants were most likely to report peer pressures to engage in, and less parental support to avoid, risk behaviors (P < .001).

CONCLUSIONS

A window of opportunity exists to provide primary prevention programs in schools to immigrant youths that may reduce adolescent health risk behaviors.

Linguistic acculturation associated with higher marijuana and polydrug use among Hispanic adolescents

Hispanic sixth and seventh graders in 22 New York City middle schools (mean age: 12.66 years) completed self-report questionnaires with items related to drug use (cigarette smoking, alcohol use, and marijuana) use and linguistic acculturation at two assessments (N = 1299 at baseline; N = 1038 at 1-year follow-up). Adolescents who spoke English with their parents smoked marijuana more frequently than those who spoke Spanish with their parents at both surveys. By the 1-year follow-up, 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.

Receipt of school health education and school health service among adolescent immigrants in Massachusetts

This study assessed whether immigrant adolescents receive health education and services in schools at levels comparable to native-born peers. Surveys from 2,635 8th and 10th graders allowed comparisons between students living in the United States "always" (n = 2,080), "more than six years" (n = 299), and "six years or less" (n = 191). Immigrant students were equally likely to receive health education, more likely to use peer counseling or support groups (p < .001), and less likely to use health services (p < .05). They communicated more often with staff (p < .05), were more concerned about mental health issues (p < .01), and were likely to have these topics addressed in school (p < .05). They were more positive about health education (p < .05), learned something new (p < .01), and communicated with parents when offered (p < .001). Schools provide a critical gateway and opportunity for reaching immigrant students and families with programs designed to meet their unique health and mental health needs. Questions remain, however, about health education and services being provided to non-mainstreamed, Limited English Proficient students who recently immigrated. Implications for program and service delivery and future research are discussed.

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.

Gender differences in acculturation and aggression as predictors of drug use in minorities

High acculturation and aggression may signal increased risk of drug use among different ethnic groups. Drug use histories were compared with the degree of acculturation in 18 African-Americans and ten Hispanics. Aggressive responding was measured using The Point Subtraction Aggression Paradigm (PSAP) developed by Cherek, D.R., 1981, Psychopharmacology, 75, 339-345. Males were more acculturated and used more drugs than females. In PSAP responding, each gender responded more aggressively towards the ethnic group in which they identified with the most. Ethnic Identification and gender were associated with increased drug use. Acculturation and drug studies must consider the importance of gender within and across ethnic sub-populations.

Drug use, AIDS knowledge, and HIV risk behaviors of Cuban-, Mexican-, and Puerto-Rican-born drug injectors who are recent entrants into the United States

To date, relatively little research attention has been devoted to the HIV-risky behaviors of persons who are newly arrived in the United States and who use drugs. Data gathered from street-recruited injection drug users (IDUs) recruited in 10 United States cities who were born in Mexico, Cuba, and Puerto Rico and who are recent entrants into the United States suggest that, in comparison to US-born IDUs, Mexican-born subjects are at elevated risk for acquiring and transmitting HIV as a result of sharing needles with friends and running partners; sharing drug injection implements such as cookers, cotton, and rinse water; frequent injection in HIV-risky settings; use of unsterilized needles; and relatively frequent trading of sex for drugs or money. Puerto-Rican-born IDUs were found to inject drugs relatively frequently, and to do so relatively often in high-risk settings in which sterile injecting equipment and cleaning materials often are scarce. These data also show generally lower levels of AIDS knowledge among the in-migrant IDUs than among US-born IDUs. Respondents from each nationality group most often cited television as the source of their most useful and reliable AIDS information, but also tended to regard community outreach workers as a significant source of reliable AIDS and needle cleaning information. The high levels of involvement in HIV-risky behaviors, deficits in knowledge concerning the means of HIV transmission, and relative ease of mobility of the at-risk (for HIV) individuals examined here indicate a need for a comprehensive public health prevention initiative to limit the future spread of HIV. At a minimum, such an undertaking would do well to incorporate group-specific, culturally appropriate behavioral interventions as well as an information campaign.

Smoking initiation and smoking patterns among US college students

The ages at which 18- to 24-year-old college students started smoking and its relationship to subsequent smoking were explored, using data from the 1995 National College Health Risk Behavior Survey. Most students (70%) had tried smoking; among those who had tried, 42% were current smokers, 19% were current frequent smokers, and 13% were current daily smokers. The majority (81%) who had ever smoked daily began doing so at age 18 years or younger, and 19% began smoking daily at age 19 years or older. Women were as likely as men to report ever having smoked a whole cigarette or ever having smoked daily. Most students (82%) who had ever smoked daily had tried to quit, but 3 in 4 were still smokers. Policies and programs designed to prevent the initiation of smoking and to help smokers quit are needed at both the high school and the college levels to reduce the proportion of young adults who smoke cigarettes.

Psychosocial factors related to adolescent smoking: a critical review of the literature

OBJECTIVE

To extend the analysis of psychosocial risk factors for smoking presented in the United States surgeon general's 1994 report on smoking and health, and to propose a theoretical frame of reference for understanding the development of smoking.

DATA SOURCES

General Science Index, Medline, PsycLIT, Sociofile, Sociological Abstracts, and Smoking and Health. Holdings of the Addiction Research Foundation of Ontario Library as well as the authors' personal files.

STUDY SELECTION

Reviewed literature focused on studies that examined the association of sociodemographic, environmental, behavioural, and personal variables with smoking.

DATA SYNTHESIS

Adolescent smoking was associated with age, ethnicity, family structure, parental socioeconomic status, personal income, parental smoking, parental attitudes, sibling smoking, peer smoking, peer attitudes and norms, family environment, attachment to family and friends, school factors, risk behaviours, lifestyle, stress, depression/distress, self-esteem, attitudes, and health concerns. It is unclear whether adolescent smoking is related to other psychosocial variables.

CONCLUSIONS

Attempts should be made to use common definitions of outcome and predictor variables. Analyses should include multivariate and bivariate models, with some attempt in the multivariate models to test specific hypotheses. Future research should be theory driven and consider the range of possible factors, such as social, personal, economic, environmental, biological, and physiological influences, that may influence smoking behaviour. The apparent inconsistencies in relationships between parental socioeconomic status and adolescent disposable income need to be resolved as does the underlying constructs for which socioeconomic status is a proxy.

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.

Health risk behaviors of Texas students attending dropout prevention/recovery schools in 1997

This study determined prevalence of health risk behaviors of 9th through 12th grade students attending dropout prevention/recovery alternative schools in Texas in 1997. Participants were 470 youth whose health risk behaviors were assessed using the Youth Risk Behavior Survey in an anonymous, self-administered format. Behaviors measured included frequency of weapon-carrying and fighting, suicide-related behaviors, substance use, and sexual behaviors. A substantial percentage of alternative school students reported participating in behaviors that placed them at acute or chronic health risk. Differences in the prevalence of risk behaviors were noted by gender, racial/ethnic, and age subgroups. In addition, alternative school students frequently engaged in multiple risk behaviors. These findings suggest a need for comprehensive school-based health education/intervention programs to reduce the prevalence of risk behaviors in populations of alternative school students.

Similar and different precursors to drug use and delinquency among African Americans and Puerto Ricans

Correlational and net regression techniques were used to examine the commonalities and differences in risks for later drug use and delinquency among African American and Puerto Rican adolescents. Eight-eight percent of the risks were significantly related to both problem behaviors. Within the personality, family, peer, ecology, and acculturation domains, many risks independently contributed to the prediction of each problem. Only three risks had a significantly stronger relationship to one of the problem behaviors than to the other. Finding so many common predictors supports a general dimension of problem behavior and highlights the psychosocial risks for drug use and delinquency. The commonalities suggest that interventions targeting these adolescent risks might reduce both problem behaviors.

Ever vs never smoking among an urban, multiethnic sample of Haitian-, Caribbean-, and U.S.-born blacks

BACKGROUND

Despite the high rate of current smoking among blacks in the United States, to date there have been no studies comparing smoking rates or predictors of smoking among adults from different black ethnic groups living in the United States. If cancer control programs are to successfully reduce the risk of smoking-related cancers within black communities, more extensive data on demographics, knowledge, attitudes, beliefs, and practices within ethnic groups are needed.

METHODS

We conducted a structured telephone interview to assess smoking status, alcohol use, cancer-related attitudes and beliefs, and demographic information among Haitian-born (N = 165), Caribbean-born (N = 354), and U.S.-born (N = 402) blacks living in New York City in 1992.

RESULTS

Relative to U.S.-born participants, both Caribbean- and Haitian-born participants were significantly less likely to have ever smoked. Although both groups of foreign-born men were much more likely to have ever smoked relative to their female counterparts, U.S.-born men and women were equally likely to have ever smoked. Alcohol use was consistently related to smoking across ethnic and gender groups, and this association was enhanced among older drinkers. The belief that smoking is not related to cancer was associated with an almost twofold increase of ever smoking.

CONCLUSIONS

The rate of ever smoking among urban, foreign-born blacks is considerably lower than among U.S.-born blacks; among the foreign-born participants, ever smoking was lower among women relative to men. Alcohol use is an important predictor of smoking status, particularly among older drinkers.

Perinatal drug use among immigrant and native-born Latinas

Perinatal drug exposures pose a significant health hazard for women and imperil normal fetal and neonatal development. Little is known about patterns of drug exposure among pregnant immigrant and native-born Latinas in the United States. We present multivariate risk factor analyses for alcohol and illicit drug use from the California Perinatal Substance Exposure Study using a statistical probability sample (N = 11,002) of Latinas who were tested anonymously using urine toxicology screening techniques. Alcohol use during pregnancy was pervasive among both immigrant and United States-born Latinas (7%) with little variation on risk factors. Illicit drug use was found primarily in a high risk group of United States-born Latinas between 25 and 34 years of age who received no prenatal care (prevalence 50%, odds ratio of 185). Increased general awareness of perinatal alcohol risk by medical providers and public health practitioners serving this population is needed. The potential isolation of United States-born Latinas who are at risk using illicit drugs during pregnancy requires effective communication and outreach.