The role of gender and acculturation on determining the consumption of alcoholic beverages among Mexican-Americans and Central Americans in the United States

Association between acculturation surrogates and alcohol consumption in rural-to-urban migrants: The PERU MIGRANT study

Introduction

There is a paucity of information about the association between acculturation and alcohol consumption in rural-to-urban migrants who move to urban environments usually characterized by a higher prevalence of alcohol consumption than their rural places of origin.

Objectives

To evaluate the cross-sectional association between surrogates of acculturation and alcohol consumption in Peruvian rural-to-urban migrants; to explore the effects of sex and age at migration on these associations; and to explore this association longitudinally.

Methods

Data from the PERU MIGRANT Study, which evaluated a cohort of Peruvian rural-to-urban migrants from 2007 to 2012, were analyzed. Four acculturation surrogates were evaluated: language preference on the radio, language spoken at home, Spanish proficiency, and length of residence in urban area. Alcohol consumption was defined as having consumed alcohol in the last year at the time of the baseline survey, while onset of alcohol consumption was defined as having consumed alcohol in the last year at the follow-up survey. Poisson regressions with robust variance were performed to estimate crude and adjusted prevalence ratios (PR) and relative risks (RR) with a 95% confidence interval (95% CI) to cross-sectional and longitudinal analyses respectively.

Results

Data from 567 rural-to-urban migrants, mean age 47.6 years (SD ±11.5), 52% females, was included in the study. Crude cross-sectional analyses showed an association between acculturation surrogates and alcohol consumption, but these were not observed in adjusted regressions. In the sex-stratified analyses, only women showed an association between Spanish proficiency and alcohol consumption, where those with higher language proficiency had a 22% higher prevalence of alcohol consumption (PR: 1.22, 95% CI: 1.04-1.43). Analyses stratified by age at migration showed no association between acculturation surrogates and alcohol consumption. On the longitudinal analyses, acculturation surrogates were not associated with the onset of alcohol consumption.

Conclusions

No association between acculturation surrogates and alcohol consumption in cross-sectional and longitudinal analyses were found. The only exception was observed in female migrants according to their Spanish proficiency and alcohol consumption .

The combined relations of gender, enculturation, and depressive symptoms with health risk behaviors in Mexican-Americans: a moderated mediation analysis

Objectives: The present study investigated the relationships of enculturation and depressive symptoms with health risk behavior engagement in Mexican-American college students and examined how these relationships differed by gender. Previous research has noted consistent gender differences in health risk behavior (e.g. alcohol use, substance use, and risky sexual behavior) among Latina/os, and emphasized the role of U.S. acculturation in this difference. Research examining the role of heritage cultural retention (i.e. enculturation), and including the added influence of mental health variables, such as depressive symptoms, is currently lacking. This study sought to address this gap.Design: A large sample (N = 677) of Mexican-American college students from four universities (located in New York, California, Florida, and Texas) completed an online questionnaire assessing health risk behaviors and corresponding variables.Results: We found that males who endorsed more behavioral enculturation and depressive symptoms were more likely to engage in health risk behavior than all others in the sample. Contrary to previous literature, no relationship was found between behavioral enculturation and health risk behavior in females.Conclusion: The current study found behavioral enculturation to be associated with depressive symptoms, and in turn with health risk behaviors among the males in our sample. Additional research will be needed to identify the mechanism underlying the relationship between enculturation and depressive symptoms as well as between depressive symptoms and risky behavior.

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.

Comparative Effectiveness of 2 Interventions for Hispanic Caregivers of Persons with Dementia

OBJECTIVES

To compare the effectiveness of 2 caregiver interventions with known efficacy: the Resources for Enhancing Caregiver Health-Offering Useful Treatment (REACH-OUT) and the New York University Caregiver Intervention (NYUCI).

DESIGN

1:1 randomized pragmatic trial.

SETTING

New York City.

PARTICIPANTS

Informal Hispanic caregivers of persons with dementia (N=221; mean age 58.2, 82.8% female, 63.3% adult children, 31.7% spouses).

INTERVENTION

Participants were randomized to 6 months of NYUCI (n=110) or REACH-OUT (n=111), balanced on characteristics at baseline. All participants were referred for social supportive services.

MEASUREMENTS

The primary outcomes were changes between baseline and 6 months in depressive symptoms, measured using the Geriatric Depression Scale (GDS), and caregiver burden, measured using the Zarit Caregiver Burden Scale (ZCBS).

RESULTS

There were no differences in outcomes between NYUCI and REACH-OUT. Both interventions showed a reduction in burden (REACH-OUT: 5.2 points, 95% confidence interval (CI)=2.2-8.1, p<.001; NYUCI: 4.6-points, 95% CI=1.7-7.5, p=.002). There were no significant changes on the GDS. Effects for the ZCBS were significant only for spouses and older caregivers.

CONCLUSION

Although there were no significant intervention group differences, both interventions resulted in significantly reduced burden for Hispanic caregivers at 6 months, particularly for spouses and older caregivers.

Affective decision-making moderates the effects of automatic associations on alcohol use among drug offenders

BACKGROUND

This study used a dual-process model of cognition in order to investigate the possible influence of automatic and deliberative processes on lifetime alcohol use in a sample of drug offenders.

OBJECTIVE

The objective was to determine if automatic/implicit associations in memory can exert an influence over an individual's alcohol use and if decision-making ability could potentially modify the influence of these associations.

METHODS

168 participants completed a battery of cognitive tests measuring implicit alcohol associations in memory (verb generation) as well as their affective decision-making ability (Iowa Gambling Task). Structural equation modeling procedures were used to test the relationship between implicit associations, decision-making, and lifetime alcohol use.

RESULTS

Results revealed that among participants with lower levels of decision-making, implicit alcohol associations more strongly predicted higher lifetime alcohol use.

CONCLUSION

These findings provide further support for the interaction between a specific decision function and its influence over automatic processes in regulating alcohol use behavior in a risky population. Understanding the interaction between automatic associations and decision processes may aid in developing more effective intervention components.

Northern Manhattan Hispanic Caregiver Intervention Effectiveness Study: protocol of a pragmatic randomised trial comparing the effectiveness of two established interventions for informal caregivers of persons with dementia

INTRODUCTION

The prevalence of dementia is increasing without a known cure, resulting in an increasing number of informal caregivers. Caring for a person with dementia results in increased stress and depressive symptoms. There are several behavioural interventions designed to alleviate stress and depressive symptoms in caregivers of persons with dementia with evidence of efficacy. Two of the best-known interventions are the New York University Caregiver Intervention (NYUCI) and the Resources for Enhancing Alzheimer's Caregivers Health (REACH). The effectiveness of the NYUCI and REACH has never been compared. There is also a paucity of data on which interventions are more effective in Hispanics in New York City. Thus, we proposed the Northern Manhattan Hispanic Caregiver intervention Effectiveness Study (NHiCE), a pragmatic clinical trial designed to compare the effectiveness of adaptations of the NYUCI and the REACH in informal Hispanic caregivers of persons with dementia in New York City.

METHODS AND ANALYSIS

NHiCE is a 6-month randomised controlled trial comparing the effectiveness of adaptations of the NYUCI and REACH among 200 Hispanic informal adult caregivers of persons with dementia. The planned number of sessions of the NYUCI and REACH are similar. The primary outcome measures are changes from baseline to 6 months in the Zarit Caregiver Burden Scale and Geriatric Depression Scale. Our primary approach to analyses will be intent-to-treat. The primary analyses will use mixed random effects models, and a full information maximum likelihood approach, with sensitivity analyses using generalised estimating equation.

ETHICS AND DISSEMINATION

NHiCE is approved by the Institutional Review Board of Columbia University Medical Center (protocol AAAM5150). A Data Safety Monitoring Board monitors the progress of the study. Dissemination will include reports of the characteristics of the study participants, as well as a report of the results of the clinical trial.

TRIAL REGISTRATION NUMBER

NCT02092987, Pre-results.

Northern Manhattan Hispanic Caregiver Intervention Effectiveness Study: protocol of a pragmatic randomised trial comparing the effectiveness of two established interventions for informal caregivers of persons with dementia

INTRODUCTION

The prevalence of dementia is increasing without a known cure, resulting in an increasing number of informal caregivers. Caring for a person with dementia results in increased stress and depressive symptoms. There are several behavioural interventions designed to alleviate stress and depressive symptoms in caregivers of persons with dementia with evidence of efficacy. Two of the best-known interventions are the New York University Caregiver Intervention (NYUCI) and the Resources for Enhancing Alzheimer's Caregivers Health (REACH). The effectiveness of the NYUCI and REACH has never been compared. There is also a paucity of data on which interventions are more effective in Hispanics in New York City. Thus, we proposed the Northern Manhattan Hispanic Caregiver intervention Effectiveness Study (NHiCE), a pragmatic clinical trial designed to compare the effectiveness of adaptations of the NYUCI and the REACH in informal Hispanic caregivers of persons with dementia in New York City.

METHODS AND ANALYSIS

NHiCE is a 6-month randomised controlled trial comparing the effectiveness of adaptations of the NYUCI and REACH among 200 Hispanic informal adult caregivers of persons with dementia. The planned number of sessions of the NYUCI and REACH are similar. The primary outcome measures are changes from baseline to 6 months in the Zarit Caregiver Burden Scale and Geriatric Depression Scale. Our primary approach to analyses will be intent-to-treat. The primary analyses will use mixed random effects models, and a full information maximum likelihood approach, with sensitivity analyses using generalised estimating equation.

ETHICS AND DISSEMINATION

NHiCE is approved by the Institutional Review Board of Columbia University Medical Center (protocol AAAM5150). A Data Safety Monitoring Board monitors the progress of the study. Dissemination will include reports of the characteristics of the study participants, as well as a report of the results of the clinical trial.

TRIAL REGISTRATION NUMBER

NCT02092987, Pre-results.

Depression, Acculturation, and Motivations for Alcohol Use among Young Colombian, Dominican, and Puerto Rican Men

Increasing numbers of young Hispanic men are being treated for alcohol abuse and its consequences. To provide culturally competent services, there must be an understanding of subcultural differences in the antecedents of alcohol abuse and drinking problems. The present study examined the impact of depression, acculturation, and motivations as antecedents for drinking and drinking-related problems among 288 Colombian, Dominican, and Puerto Rican men. Path analyses suggest that for all three groups, depression is associated with drinking for psychological motivational reasons. Psychological motivations, in turn, have a direct impact on heavy drinking and drinking problems. The model for Puerto Ricans suggests psychological motivations are the only direct predictor of drinking problems. For Dominicans, depression appears to be an important direct contributor to drinking problems, whereas for Colombians, acculturation seems to directly contribute to drinking problems. Implications for practice and research are discussed.

Drinking among U.S. Hispanics: A Multivariate Analysis of Alcohol Consumption Patterns

This article explores the relationship between various demographic measures and alcohol consumption patterns among U.S. Hispanics, using data collected as part of the 5-year project, Preventing Alcohol Trauma: A Community Trial, funded by the National Institute on Alcohol Abuse and Alcoholism. In particular, it addresses the impact of gender, age, and other exogenous measures on four drinking pattern measures: drinker status (current drinker versus abstainer), drinking frequency, average drinks per occasion, and variance in drinking patterns. The article applies a series of models originally developed by Gruenewald and colleagues concerning a subsample of the project’s phone-survey Hispanic subsample. Results indicate that although consumption patterns for U.S. Hispanics are similar to those in the general population, they differ in a number of important respects. Specifically, being divorced or separated, as opposed to single, appeared to elevate drinking levels. Additionally, males in their 30s, as opposed to in their 20s, appeared at greatest risk for problematic consumption patterns. The implications of these differences for the health of U.S. Hispanics are noted.

Alcohol Use and Problem Drinking Among Male Mexican and Central American Im/migrant Laborers

This review addresses a growing concern regarding alcohol use in adult male Latino im/migrant laborers in the United States. The review draws from alcohol studies focusing on “Hispanic” populations, and from health behavior studies of Latino im/migrant laborers, research that includes alcohol use. Specifically, this review addresses (a) alcohol consumption and drinking patterns among Mexican and Central American im/migrant laborers, and (b) health and social consequences of alcohol use. After reviewing more than 200 articles, 30 studies meeting key criteria were selected for review. Survey data show lower alcohol use in Latino im/migrants as compared with U.S. Latino and non-Latino populations, but also a relation between problem drinking and acculturation. Ethnographic research reveals heavy drinking and negative health and social consequences in a significant number of Latino im/migrant laborers. How structural-environmental and culture-based factors combine to influence problem drinking in the United States is discussed along with recommendations for future research.

Abdominal Wall Defects among Mexican American Infants: The Effect of Maternal Nativity

BACKGROUND

US-born Mexican American women have greater rates of preterm birth and consequent overall infant mortality than their Mexico-born peers. However, the relation of Mexican American women's nativity to rates of congenital anomalies is poorly understood. Hispanic ethnicity and young maternal age are well-known risk factors for gastroschisis.

OBJECTIVE

To determine the extent to which nativity of Mexican American women is associated with abdominal wall defects.

METHODS

Stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort. Only Mexican American infants were studied. Maternal variables examined included nativity, age, education, marital status, parity, and prenatal care usage.

RESULTS

Infants with US-born Mexican American mothers (n=451,272) had an abdominal wall defect rate of 3.9/10,000 compared with 2.0/10,000 for those with Mexico-born mothers (n=786,878), RR=1.9 (1.5-2.4). Though a greater percentage of US-born (compared wtih Mexico-born) Mexican American mothers were teens, the nativity disparity was actually widest among women in their 20s. The adjusted (controlling for maternal age, education, marital status, parity, and prenatal care) odds ratio of abdominal wall defects among infants of US-born (compared with Mexico-born) Mexican American mothers was 1.6 (1.2-2.0).

CONCLUSIONS

US-born Mexican American women have nearly a two-fold greater rate of delivering an infant with an abdominal wall defect than their Mexico-born counterparts. This phenomenon is only partially explained by traditional risk factors and highlights a detrimental impact of lifelong residence in the United States, or something closely related to it, on the pregnancy outcome of Mexican American women.

Blood is thicker than booze: Examining the role of familism and gender in alcohol use and related consequences among Hispanic college students

The present study evaluated cultural, ethnic, and gender differences in drinking and alcohol-related problems among Hispanic students. Familism protects against negative outcomes in Hispanic populations, thus we expected familism to buffer against alcohol problems. Participants (N = 623; 53% female) completed a battery of measures. Results suggested that familism was protective against drinking. Furthermore, alcohol use mediated the association between familism and alcohol-related problems. In sum, understanding that culture plays an important role in people's behaviors and identifying protective factors is critical to inform culturally sensitive prevention and intervention efforts.

Intergenerational transmission of the effects of acculturation on health in Hispanic Americans: a fetal programming perspective

We propose a transdisciplinary, life span framework for examining the underlying cause of the observed intergenerational decline in health among Hispanic Americans. We focus on acculturation, and we posit that acculturation-related processes in first-generation Hispanic immigrant mothers may affect the intrauterine development of an unborn child, via the process of fetal programming, to produce phenotypic effects that may alter the susceptibility for noncommunicable chronic diseases. In this manner, an intergenerational cascade of perpetuation may become established. Our framework may shed light on the biological, behavioral, and social causes of intergenerational cycles of vulnerability among immigrant minority groups, with public health and policy implications for primary prevention and intervention.

Factors associated with alcohol consumption patterns in a Puerto Rican urban cohort

OBJECTIVE

There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts.

DESIGN

Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender.

SETTING

Greater Boston area, MA, USA.

SUBJECTS

Puerto Rican adults (n 1292), aged 45-75 years.

RESULTS

Eight per cent of men and 39% of women were lifetime abstainers; 40% of men and 25% of women were former drinkers; 31 % of men and 27% of women were moderate drinkers; and 21% of men and 8% of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers.

CONCLUSIONS

High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.

Alcohol use as a determinant of HIV risk behaviors among recent Latino immigrants in south Florida

Information on the association between alcohol use and Latino sexual risk behavior prior to immigrating to the United States is scarce. Given this population's rapid growth, documenting the influence of alcohol use on recent Latino immigrants' (RLI) sexual risk behaviors is essential. Data prior to immigration were retrospectively collected from 527 RLI ages 18-39 years. Quantity and frequency of alcohol use during the 90 days prior to immigration and pre-immigration sexual risk behaviors were measured. Structural equation modeling was used to examine the relationships. Males, single participants, and participants with higher incomes reported more alcohol use. Higher alcohol use was associated with lower condom use frequency, having sex under the influence, and more sexual partners among all participants. Results point to the importance of creating interventions targeting adult RLI men, given their likelihood to engage in alcohol consumption, sex under the influence of alcohol, and sex with multiple partners without using condoms.

The Hispanic Americans Baseline Alcohol Survey (HABLAS): the association between acculturation, birthplace and alcohol consumption across Hispanic national groups

Acculturation to U.S. society has been associated with an increase in drinking and binge drinking among Hispanics. This paper examines the association between acculturation and three drinking-related outcomes: average number of drinks consumed, binge drinking, and drinking 12 drinks or more in a single day in four major Hispanic national groups. The 2006 Hispanic Americans Baseline Alcohol Survey used a multistage cluster sample design to interview 5224 adult Hispanics (18+ years) in five selected U.S. metropolitan areas: Miami, New York, Philadelphia, Houston, and Los Angeles. The four national groups interviewed were: Puerto Ricans, Cuban Americans, Mexican Americans, and South/Central Americans. The survey response rate was 76%. Data on drinking behavior were collected and the analyses include bivariate and multivariate regression techniques. Multivariate analysis did not show an association between acculturation and volume of drinking, binge drinking, or drinking 12 or more drinks in a single day among men. Acculturation stress, however, was associated with drinking 12 or more in a day among men. Among women, high acculturation was associated with a higher volume of drinking, and it also interacted with national group to increase the likelihood of binge drinking. Acculturation does not have a homogeneous effect on drinking across gender and Hispanic national groups. The results confirm that acculturation has a more consistent association with increased drinking and binge drinking among women than among men. The effect of acculturation is therefore gender-specific. This heterogeneity across Hispanic national groups must be considered in future research, treatment, and prevention efforts.

A pilot binational study of health behaviors and immigration

In the US, Mexican immigrant women often have better health outcomes than non-Hispanic white women despite a greater health risk profile. This cross-sectional pilot study compared women living in Chavinda, Michoacán (n = 102) to women who had migrated from Mexico to Madera, California (n = 93). The interview gathered information on acculturation and risk behaviors including smoking, alcohol use and number of sexual partners. The results suggest that more acculturated women living in the US are more likely to consume alcohol. US residence and higher acculturation level was marginally associated with having more than one sexual partner. There were no differences between odds of smoking among Chavinda and Madera women. While results with acculturation are not consistently significant due to small sample sizes, the results are suggestive that acculturation among immigrant Hispanic women in the US may be associated with adverse health behaviors, and selective migration seems less likely to account for these differences.

Mental health service utilization for psychiatric disorders among Latinos living in the United States: the role of ethnic subgroup, ethnic identity, and language/social preferences

PURPOSE

To examine aspects of Latino experience in the US as predicting service utilization for mood, anxiety, and substance disorders.

METHODS

Latino participants 18 and older in the NESARC (N = 6,359), a US national face to face survey. Outcomes were lifetime service utilization for DSM-IV lifetime mood/anxiety or substance disorders, diagnosed via structured interview (AUDADIS-IV). Main predictors were ethnic subgroup, ethnic identity, linguistic/social preferences, nativity/years in the US, and age at immigration.

RESULTS

Higher levels of Latino ethnic identity and Spanish language/Latino social preferences predicted lower service utilization for mood disorders [ethnic identity OR = 0.52, language/social OR = 0.44] and anxiety disorders [ethnic identity OR = 0.67, language/social OR = 0.47], controlling for ethnic subgroup, disorder severity, time spent in the US, and economic and practical barriers Service utilization for alcohol/drug disorders was low across all Latino subgroups, without variation by examined predictors.

CONCLUSION

Ethnic/cultural factors are strong determinants of service utilization for mood/anxiety, but not substance use disorders among Latinos in the US strategies to increase service utilization among Latinos with psychiatric disorders should be disorder specific, and recognize the role of ethnicity and identity as important components of a help-seeking model.

Binge drinking among male Mexican immigrants in Rural North Carolina

While it is clear that alcohol use among immigrants from Mexico has serious consequences, limited data exist on the correlates of this behavior for Mexican immigrants residing in rural, traditionally non-Hispanic settings. A cross-sectional survey with an outreach approach was used to target 173 male Mexican immigrants in rural eastern North Carolina. Questionnaires including demographics, pre and post immigration alcohol use, acculturation, stress, social support, and depressive symptoms were administered through oral interview by trained bilingual interpreters. Results show a higher prevalence of binge drinking in the study sample compared to rate of alcohol use by Hispanics in the United States. Relationships were identified between Pre-immigration alcohol use, lower perceived social support, socialization within one's own cultural group, and binge drinking. These findings provide a preliminary basis in the development of interventions to address the problem of binge drinking in this population. Further exploration of the interaction between social isolation and social support is also needed.

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 Hispanic Americans Baseline Alcohol Survey (HABLAS): Alcohol consumption and sociodemographic predictors across Hispanic national groups

OBJECTIVE

To examine differences in alcohol consumption among Hispanic national groups in the United States [Puerto Ricans, Mexican, Cuban, and Dominican South Central (D/SC) Americans] and identify sociodemographic predictors of drinking and binge drinking (four drinks for women and five for men in a 2-hr period).

METHOD

The study used a household probability sample of adult Hispanics in five metropolitan areas in the United States. Comprehensive data on alcohol consumption were collected. Analyses included bivariate and multivariate regression techniques.

RESULTS

Puerto Rican and Mexican American men reported higher drinking rates, weekly consumption, and binge drinking than D/SC and Cuban Americans. Women drank significantly less than men. Mexican American women reported the highest abstention rate (61%); Puerto Rican women drank more per week and binged more frequently compared with their counterparts in other groups. Puerto Rican origin, initiating drinking during high school years (<18), and male gender (US- or foreign-born) were significant predictors of weekly alcohol consumption. Being younger, being single, Puerto Rican or D/SC American origin, initiating drinking at <18 years, being a US- or foreign-born male and being a US-born female were significant predictors of binge drinking.

CONCLUSIONS

There are considerable differences in drinking behavior across Hispanic national groups as well as between men and women. Results underscore the need to recognize heterogeneity in drinking practices while designing effective prevention interventions in the community.

Acculturation and HPV infection among Latinas in the United States

OBJECTIVE

To describe the relationship between acculturation and human papillomavirus (HPV) infection among diverse US Latinas, a group at high risk for cervical cancer.

METHODS

Using survey and medical testing data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES), we examined the relationship between acculturation level and HPV infection among diverse Latinas (n=503) and Mexican American women (n=442). Multivariable logistic regression was performed using infection with any type of HPV and with high-risk oncogenic genotypes as outcome variables.

RESULTS

More acculturated Mexican American women were more likely to be infected with high-risk HPV than less acculturated women. In multivariate analyses, Mexican Americans with higher levels of self-rated English language ability (2.48 OR, 95% CI: 1.42-4.33); with birth in the US (2.07 OR, 95% CI: 1.03-4.16); and with US born parents (2.98 OR, 95% CI: 1.45-3.72) were more likely to be infected with high-risk HPV genotypes. Mexican American women with higher levels of acculturation were more likely to test positive for other sexually transmitted infections.

CONCLUSION

Higher acculturation levels related to more frequent infection with high-risk HPV genotypes and other STIs among US Mexican American women. This association may in part be due to engagement in sexual behaviors.

The Hispanic Americans Baseline Alcohol Survey (HABLAS): predictors of alcohol attitudes and expectancies in Hispanic national groups

BACKGROUND

Multiple theoretical frameworks identify attitudes and expectancies as important predictors of alcohol behavior. Few studies have examined demographic predictors of these evaluative and belief-based cognitive mediators in the general population, and none have examined them in large-scale studies of Hispanics, a group at higher risk for drinking behavior and problems. This study probes the extent to which dimensions of attitudes and expectancies share common demographic predictors in a large sample of Puerto Ricans, Cuban-Americans, Mexican-Americans, and South/Central Americans.

METHODS

The 2006 Hispanic Americans Baseline Alcohol Survey (HABLAS) used a multistage cluster sample design to interview 5,224 individuals randomly selected from households in Miami, New York, Philadelphia, Houston, and Los Angeles. This study focused on 2,773 respondents self-identified as current drinkers. Multiple linear regression was used to identify predictors of positive and negative dimensions of attitudes and expectancies, controlling for various background variables.

RESULTS

Religious affiliation selectively predicted alcohol attitudes, with Catholics having more positive and fewer negative attitudes than other religious groups. Hispanic group selectively predicted alcohol expectancies, with Cuban-Americans having less positive and less negative expectancies than other groups. Being U.S.-born or male predicted more positive attitudes and expectancies, but birthplace and gender did not predict negative dimensions of attitudes or expectancies. Higher acculturation and more education were linked to a decreased tendency to agree with any item. Age was positively and negatively associated with negative expectancies and positive attitudes, respectively, and having never been married, higher income, and unemployment were each linked to fewer negative attitudes.

CONCLUSIONS

Although there is some overlap, attitudes and expectancies are influenced by different sociodemographic variables. Positive and negative dimensions of those constructs also show distinct patterns of relations. Prevention and treatment programs targeting cognitive mediators of behavior should be mindful of these differential determinants and future modeling endeavors should incorporate them.

Too young to drink but old enough to drive under the influence: a study of underage offenders as seen in substance abuse treatment in Texas

Driving under the influence (DUI) is a major road safety problem. Historically, alcohol has been assumed to play a larger role in crashes and DUI education programs have reflected this assumption, although recent evidence suggests that younger drivers are becoming more likely to drive drugged than to drive drunk. This is a study of 7096 Texas clients under age 21 who were admitted to state-funded treatment programs between 1997 and 2007 with a past-year DUI arrest, DUI probation, or DUI referral. Data were obtained from the State's administrative dataset. Multivariate logistic regressions models were used to understand the differences between those minors entering treatment as a DUI as compared to a non-DUI as well as the risks for completing treatment and for being abstinent in the month prior to follow-up. A major finding was that over time, the primary problem for underage DUI drivers changed from alcohol to marijuana. Being abstinent in the month prior to discharge, having a primary problem with alcohol rather than another drug, and having more family involved were the strongest predictors of treatment completion. Living in a household where the client was exposed to alcohol abuse or drug use, having been in residential treatment, and having more drug and alcohol and family problems were the strongest predictors of not being abstinent at follow-up. As a result, there is a need to direct more attention towards meeting the needs of the young DUI population through programs that address drug as well as alcohol consumption problems.

Looking under the Hispanic umbrella: cancer mortality among Cubans, Mexicans, Puerto Ricans and other Hispanics in Florida

Cancer is the second leading cause of death among Hispanics. Most of the cancer statistics available both at the state and national levels report cancer statistics for all Hispanics as an aggregate group. The goal of this paper is to provide a population-based overview of cancer mortality among Hispanics (Cubans, Mexicans, Puerto Ricans and other Hispanics) in Florida from 1990 to 2000 and to explore the demographic diversity of this growing ethnic group. The study population consisted of Hispanics and White non-Hispanics who died from cancer. Cancer mortality rates and proportion of cancer deaths by type and age at death for the selected racial/ethnic groups were calculated. Our findings indicate that the cancer death rates of the Hispanic subgroups compared favorably with those of White non-Hispanics and that cancer rates often presented for all Hispanics mask important differences between the different ethnic subgroups that fall under the Hispanic umbrella.

Effects of parental monitoring, parent-child communication, and parents' expectation of the child's acculturation on the substance use behaviors of urban, Hispanic adolescents

This cross-sectional study was conducted on 1,936 Hispanic adolescents of mean age 14.0 years (standard deviation= 0.4) from seven Los Angeles area schools. The effects of perceived parental monitoring and parent-child communication on the adolescents' self-reported past thirty day cigarette smoking and alcohol and marijuana use behaviors were analyzed. In addition, the relationships between parents' expectations of the child's acculturation and adolescents' drug use behaviors were examined. Parental monitoring and parent-child communication were found to have statistically significant inverse associations with all three drug types when controlling for one another and the demographic variables assessed in the study. Parents' expectation of the child's acculturation to the U.S. was found to be inversely related with alcohol use. Parental monitoring and parent-child communication were not found to mediate the relationship between parents' expectation of the child's acculturation and alcohol use.

Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics

OBJECTIVES

We examined self-reported health status, health behaviors, access to care, and use of preventive services of the US Hispanic adult population to identify language-associated disparities.

METHODS

We analyzed 2003 to 2005 Behavioral Risk Factor Surveillance System data from 45 076 Hispanic adults in 23 states, who represented 90% of the US Hispanic population, and compared 25 health indicators between Spanish-speaking Hispanics and English-speaking Hispanics.

RESULTS

Physical activity and rates of chronic disease, obesity, and smoking were significantly lower among Spanish-speaking Hispanics than among English-speaking Hispanics. Spanish-speaking Hispanics reported far worse health status and access to care than did English-speaking Hispanics (39% vs 17% in fair or poor health, 55% vs 23% uninsured, and 58% vs 29% without a personal doctor) and received less preventive care. Adjustment for demographic and socioeconomic factors did not mitigate the influence of language on these health indicators.

CONCLUSIONS

Spanish-language preference marks a particularly vulnerable subpopulation of US Hispanics who have less access to care and use of preventive services. Priority areas for Spanish-speaking adults include maintenance of healthy behaviors, promotion of physical activity and preventive health care, and increased access to care.

Cultural considerations for intimate partner violence and HIV risk in Hispanics

Immigration from Latin America is changing the demographics of the United States. By the year 2050, one of every four persons in the United States will be of Hispanic ethnicity. As this segment of American society grows, interventions that improve health status for these individuals must be expanded and enhanced. HIV infection disproportionately affects people in the Hispanic community. Hispanics have unique cultural and social characteristics and norms that place them at risk for HIV exposure. The purpose of this report is to highlight culturally related issues that have been associated with HIV risk in Hispanics. Clinicians can broaden their knowledge of and appreciation for the complex cultural issues related to HIV research. Additionally, clinicians can steer interventions toward more culturally competent care for this rapidly growing segment of American society.

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.

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Rates and predictors of DUI across Hispanic national groups

This paper examines rates of self-reported driving under the influence (DUI) of alcohol and 12-month and lifetime DUI arrest rates among Mexican Americans, Puerto Ricans, Cuban Americans and South/Central Americans in the U.S. population. Using a multistage cluster sample design, a total of 5224 individuals 18 years of age and older were selected from the household population in five metropolitan areas of the U.S.: Miami, New York, Philadelphia, Houston and Los Angeles. The survey weighted response rate was 76%. Among men, 21% of Mexican Americans, 19.9% of South/Central Americans, 11.6% of Puerto Ricans and 6.9% of Cuban Americans reported DUI. Rates were lower among women, ranging from 9.7% for Mexican Americans to 1.3% for Cuban Americans. Mexican American men had the highest 12-month arrest rate (1.6%) and the highest lifetime arrest rate (11.2%). Drinkers who reported DUI were heavier drinkers than those not reporting DUI according to a variety of indicators. However, most DUI incidents involved non-alcohol-dependent drivers. Mexican Americans and South Central/Americans, men, younger drivers, those with less than high school education, those with higher income and higher alcohol consumption were more likely to report DUI and DUI arrests. These findings show that Hispanic national groups in the U.S. are diverse regarding drinking and DUI-related experiences.

Acculturation and alcohol among Latino adults in the United States: a comprehensive review

BACKGROUND

In light of the inconsistent evidence associating acculturation with drinking outcomes among Latinos in the United States, the current paper comprehensively reviews the literature on this topic.

METHODS

Studies were eligible for review if they (1) were published in a refereed journal, (2) were published in English, (3) sampled Latino/Hispanic adults aged 18+, (4) examined self-reported drinking behavior, alcohol-related problems, and/or alcohol abuse/dependence, and (5) reported original results or unique analyses from a larger dataset. The review includes only studies using composite scales of acculturation. Studies were identified via electronic databases (i.e., PSYCHINFO, ETOH, and PUBMED) using search terms, and combinations thereof, including "acculturat*," "alcohol*," "Latino," and "Hispanic." This search was supplemented by recursive checking and author searches. Thirty-two articles were identified and coded on methodological characteristics; results from 24 disaggregating genders and using appropriate outcomes were summarized.

RESULTS

Higher acculturation was very consistently associated with higher odds of drinking among women, even controlling for demographic covariates. The evidence for women also suggested associations between higher acculturation and heavier drinking on other outcomes, including total volume, drinking frequency, typical quantity, heavy/problem drinking, drinking problems, and abuse/dependence, despite some null results. Relationships were weaker and ambiguous among men. Some evidence suggested that highly acculturated men are (compared with peers low on acculturation) more prone to drink, and perhaps as a result, can show higher consumption and problems. However, results also implied that, among male drinkers, higher acculturation may be associated with a lighter drinking pattern. Important study limitations were identified, including low power, aggregation of nondrinkers with drinkers, restrictive sampling, measurement issues, and analytical issues.

CONCLUSIONS

The pattern of results suggests important associations between acculturation and drinking outcomes-particularly for women-but conclusions are tempered by serious methodological limitations. The review urges further research, particularly large-scale, longitudinal studies, addressing these limitations.

Country of origin, age of drinking onset, and drinking patterns among Mexican American young adults

This study examines relationships between country of origin, age of drinking onset, and adverse drinking outcomes among young adult Mexican Americans in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Logistic regression models estimate associations between age of drinking onset, age of onset in relation to age at immigration, and adverse drinking outcomes, controlling for sex, age, employment, education, marital status, and income. Adjusted analyses indicate the odds of adverse drinking outcomes decreased as age of drinking onset increased. Mexican Americans who initiated drinking in Mexico had significantly lower odds of current or lifetime harmful drinking than U.S. born but the odds were not significantly different between foreign-born Mexican Americans who initiated drinking in the U.S. and U.S. born. Irrespective of whether drinking onset was in Mexico or the U.S., foreign-born Mexican Americans had lower odds of alcohol abuse than U.S. born. However, odds of dependence were not significantly different between foreign-born and U.S.-born Mexican Americans. While findings suggest that being foreign born may be protective, further research on social and cultural factors impacting drinking onset and related outcomes among young Mexican Americans may help inform prevention efforts.

Acculturation, gender, and alcohol use among Mexican American college students

Prior research with non-college samples of Mexican Americans has demonstrated that gender moderates the association between acculturation and alcohol use. We replicated this finding in a college student sample and attempted to account for the differential impact of acculturation on Mexican American men and women by examining the mediating effects of social context, family conflict and psychological functioning. Participants were 148 Mexican Americans (67% female; M age 23 years) from three state universities in California and Texas who completed self-report surveys. In multivariate analyses controlling for age, maternal education, living situation, and site, linguistic acculturation was associated with increased alcohol use and misuse among women but not men. Two social context variables (social facilitation and family drinking) mediated the association between acculturation and alcohol use (heavy drinking, past year alcohol use, and a composite drinking variable) among women. The findings highlight the importance of social context for understanding alcohol use by Latina college students and indicate directions for future research and intervention development.

Correlates of alcohol and tobacco use among Mexican immigrants in rural North Carolina

This study examined the relationship among sociodemographic, cultural, and psychological factors associated with alcohol and tobacco use among Mexican immigrants in the rural south. Questionnaires including sociodemographics, alcohol and tobacco use, acculturation, and stress were administered to 173 Mexican immigrants residing in rural eastern North Carolina. Gender, preimmigration use, and occupational/economic stress were significant predictors for alcohol use, with preimmigration use significant for tobacco use, suggesting that alcohol and tobacco use may be related to previous behavior, rather than acculturation to American society. Stress, setting, and preimmigration substance use would be important factors to address in the immigrant's health history.

Drinking and driving among high-risk young Mexican-American men

Determinants of driving under the influence of alcohol (DUI) were explored among a sample of relatively young Mexican-American males with limited income and education, high levels of alcohol consumption, and regular vehicle use. Data were collected using questionnaires (N=104) and focus groups (N=27), including a focus group with wives and girlfriends (N=4). Four mechanisms that may contribute to the high rate of DUI behavior in this population were identified: (1) a subculture of permissiveness toward drinking and driving for men, (2) heavy drinking, promoted by machismo and a propensity to measure masculinity with alcohol intake, (3) inadequate knowledge of DUI statutes and inadequate understanding of the relationships between BAC, impairment, and crash risk, and (4) for undocumented drivers, lack of accountability in case of an alcohol-related incident.

An empirical evaluation of social support and psychological well-being in older Chinese and Korean immigrants

OBJECTIVES

To examine, among older Chinese and Korean immigrants: (1) the concept and measurement of perceived social support; (2) levels of social support and psychological well-being by living arrangement; and (3) whether social support is positively related to psychological well-being.

DESIGN

A convenience sample of 200 self-identified Chinese and Koreans, aged 65 years and older, were interviewed. Psychometric analysis was conducted to examine the reliability and validity of a new social support measure. Bivariate and multivariate analyses were used to examine the relationship between social support and psychological well-being.

RESULTS

Factor analysis revealed a four-factor solution of social support and adequate psychometrics of all social support scales was found. Multivariate results suggest that Koreans have more depression than Chinese (p < 0.01). Those who lived with their spouse and adult children had lower overall psychological well-being (p < 0.05) and lower positive affect (p < 0.05) compared to those who lived alone. Having more emotional/companionship support significantly (p < 0.001) contributed to better overall psychological well-being, having less depression and higher positive affect.

CONCLUSIONS

A new multidimensional social support measure for use with older Chinese and Koreans could be useful upon further validation. These results suggest that older Chinese and Koreans' psychological well-being may be negatively affected when they live with their adult children. More depression in Koreans may be related to difficulties in expanding their social network beyond Korean-speaking people.

Substance abuse prevalence and treatment among Latinos and Latinas

Substance abuse prevalence rates for Latinos/as generally mirror those of the general U.S. population; however, a number of indicators of assimilation to U.S. culture as well as sociodemographic variables predict substance use and abuse among this group. Latinos/as have poorer outcomes in substance abuse treatment programs. Yet there is little empirical evidence that explains the problems these individuals experience in treatment, and there are few studies on the use and effectiveness of mutual help groups among this population. New developments in the conceptualization and measurement of acculturation will lead to a greater understanding of the role of culture in the prevalence and treatment of substance-related problems.

Toward a theory-driven model of acculturation in public health research

Interest in studying the impact of acculturation on immigrant health has increased in tandem with the growth of the Latino population in the United States. Linear assimilation models continue to dominate public health research despite the availability of more complex acculturation theories that propose multidimensional frameworks, reciprocal interactions between the individual and the environment, and other acculturative processes among various Latino groups. Because linear and unidimensional assessments (e.g., nativity, length of stay in the United States, and language use) provide constricted measures of acculturation, the rare use of multidimensional acculturation measures and models has inhibited a more comprehensive understanding of the association between specific components of acculturation and particular health outcomes. A public health perspective that incorporates the roles of structural and cultural forces in acculturation may help identify mechanisms underlying links between acculturation and health among Latinos.

Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox

Relative to non-Latino whites, Latinos in the United States have a lower socioeconomic status (SES) profile, but a lower all-cause mortality rate. Because lower SES is associated with poorer overall health, a great deal of controversy surrounds the Latino mortality paradox. We employed a secondary data analysis of the 1991 National Health Interview Survey to test the health behavior and acculturation hypotheses, which have been proposed to explain this paradox. These hypotheses posit that: (1) Latinos have more favorable health behaviors and risk factor profiles than non-Latino whites, and (2) Health behaviors and risk factors become more unfavorable with greater acculturation. Specific health behaviors and risk factors studied were: smoking, alcohol use, leisure-time exercise activity, and body mass index (BMI). Consistent with the health behaviors hypothesis, Latinos relative to non-Latino whites were less likely to smoke and drink alcohol, controlling for sociodemographic factors. Latinos, however, were less likely to engage in any exercise activity, and were more likely to have a high BMI compared with non-Latino whites, after controlling for age and SES. Results provided partial support for the acculturation hypothesis. After adjusting for age and SES, higher acculturation was associated with three unhealthy behaviors (a greater likelihood of high alcohol intake, current smoking, a high BMI), but improvement in a fourth (greater likelihood of recent exercise). Gender-specific analyses indicated that the observed differences between Latinos and non-Latino whites, as well as the effects of acculturation on health behaviors, varied across men and women. Results suggest that the health behaviors and acculturation hypotheses may help to at least partially explain the Latino mortality paradox. The mechanisms accounting for the relationship between acculturation and risky behaviors have yet to be identified.

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.

Culture Change and Ethnic-Minority Health Behavior: An Operant Theory of Acculturation

Data on acculturation and ethnic-minority health indicate that acculturation has opposite effects on the same health behavior among different ethnic groups; opposite effects on different health behaviors within an ethnic group; opposite effects on the same health behavior for the women vs. the men of most ethnic groups; and no effect whatsoever on some health behaviors for some ethnic groups. This evidence is so incoherent that it is unintelligible, and hence it continues to be largely useless to health psychology and behavioral medicine. This paper presents a new theory of acculturation that renders these confusing data coherent by predicting such changes in minority health behavior a priori. By so doing, the operant model of acculturation has the potential to improve health promotion and disease prevention and thereby reduce ethnic health disparities.

Correlation of dietary intake and colorectal cancer incidence among Mexican-American migrants: the multiethnic cohort study

Studies of migrants, along with geographic and temporal variations in incidence, indicate that colorectal cancer is especially sensitive to changes in environmental factors, including, most importantly, diet. The goal of this research was to examine the changes in dietary practices that may be consistent with the changing incidence of colorectal cancer in the Los Angeles Mexican-American population. Cancer incidence and dietary intake data were available for over 35,000 Latinos of Mexican national origin currently participating in the prospective Multiethnic Cohort Study, representing the largest sample of Mexican-origin Latinos of any such study in the United States. The dataset is unique in that changes in cancer rates and in dietary behaviors across three generations could be examined. Most of the change in colorectal cancer rates occurred between the first and second generations, and, correspondingly, nearly all the dietary change also occurred between the first and second generations. Although some food traditions were retained by Mexican Americans, the dietary changes due to acculturation were significant and support an association between colorectal cancer risk and certain dietary components, notably, alcohol as a risk factor and nonstarch polysaccharides and vegetables as protective factors.

The longer you stay, the bigger you get: Length of time and language use in the U.S. are associated with obesity in Puerto Rican women

This cross-sectional study examined whether length of time in the U.S., language use, and birthplace (proxy measures of acculturation) were associated with body mass index (BMI) and obesity in a sample of 174 low-income Puerto Rican women from Hartford, Connecticut. The mean BMI for the total sample (N = 174) was 27.39 (S.D. = 5.07), and nearly 34% of the sample was considered obese (BMI > or = 30). There was a statistically significant increase in BMI with length of time in the U.S. (P = 0.012) and these differences were even greater among women born in Puerto Rico (P = 0.003). Moreover, obesity prevalence was highest among women who had been in the U.S. for 10 years or more (40%), as compared to those who had been in the U.S. less than 1 year (29%; P = 0.045). There were no statistically significant associations between language and BMI for the total sample. However, among bilingual speakers born in Puerto Rico, there were significant differences in BMI according to their level of English fluency. Those who spoke fluent or very good English had a significantly higher BMI (mean = 29.72; SD = 4.12) than women whose English was good to not-so-good (mean = 26.8; SD = 5.24; P = 0.016). The findings from this study point to the need for more research on the acculturation process and obesity, in order to design culturally tailored obesity prevention programs.

Comorbidity of bipolar disorder and substance abuse in Costa Rica: pedigree- and population-based studies

BACKGROUND

The purpose of this study was to determine the prevalence of substance use disorders (substance abuse or substance dependence: SA/SD) in a large sample of Bipolar Type I (BPI) patients drawn from the Costa Rican population and to describe the effects of SA/SD on the course of their bipolar disorder.

METHOD

110 subjects from two high-risk (for BPI) Costa Rican pedigrees and 205 unrelated Costa Rican BPI subjects were assessed using structured interviews and a best estimate process. Chi(2) and survival analyses were performed to assess the effect of gender on comorbidity risk, and the effect of comorbidity on the clinical course of BPI.

RESULTS

SA/SD (primarily alcohol dependence) occurred in 17% of the BPI patients from the population sample and 35% of the BPI patients from the pedigree sample. Comorbid SA/SD was strongly associated with gender chi(2) = 16.84, P = 0.00004). In comorbid subjects, alcohol dependence tended to predate the first manic episode (chi(2) = 6.54, P < 0.025). History of SA/SD did not significantly alter the prevalence of psychosis or age of onset of mania in BPI subjects.

CONCLUSIONS

These results suggest that SA/SD comorbidity rates are lower in this type of population than in BPI patient populations in the US. Gender is a strong predictor of comorbidity prevalence in BPI patients from this population. Although SA/SD may be a risk factor for precipitating BPI in those at risk, in this population comorbid BPI subjects do not have a different onset or course of BPI in comparison to BPI patients without comorbidity.

Migration and substance use: evidence from the U.S. National Health Interview Survey

Representative data from the U.S. National Health Interview Survey are used to investigate the substance use patterns of immigrants and compare them to those of the native born populations. The information examined is from the 1991 supplementary Drug and Alcohol Use Data File, which examined the self-reported substance use behaviors of approximately 21,000 adults aged 18-44. Findings indicate that immigrants to the U.S. in the late twentieth century are less likely to use alcohol and other drugs than are native born citizens. Additional findings suggest assimilation processes by which exposure to mainstream American society leads to patterns of alcohol and illicit drug use among long term immigrants that approximates that of the native born population. The patterns of substance use observed among immigrants, however, are not consistent with acculturative stress mechanisms. These findings provide an important and representative profile of the substance use patterns of one of the largest international migration streams of the past one hundred years.

Acculturation and family functioning are related to health risks among pregnant Mexican American women

The authors examined the independent and interactive effects of acculturation status and family cohesiveness on a series of psychosocial and medical risk factors of pregnancy among 500 women of Mexican origin. In general, both higher and lower levels of acculturation produced positive or negative psychosocial and healthcare consequences, and the operative relationships depended heavily on the particular outcome chosen. Higher levels of family cohesiveness tended to foster the most constructive health and psychosocial outcomes. However, in some circumstances higher levels of family cohesiveness resulted in less coping and a lower quality of prenatal care for less acculturated women. An important implication of this study is that psychosocial and health information can be obtained through assessments that identify different subgroups of Mexican American women and depend on women's level of acculturation and family cohesiveness. Culturally competent health practitioners or clinicians can conduct these assessments in a prenatal healthcare setting.

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.

Gender, acculturation, and alcohol consumption among Mexican Americans

OBJECTIVE

This study examines the relationship between level of acculturation and drinking status among Mexican American males and females in three northern California cities.

METHOD

The data analyzed were collected through the use of a telephone survey. The sample size is 932.

RESULTS

Our results show that acculturation has a direct effect on drinking status for women in the sample but not for men. At low levels of acculturation, our results show the expected difference in drinking status by gender; with high abstention rates for women and low abstention rates for males. At high levels of acculturation there is a convergence in drinking status with females approximating the proportion of male drinkers in the sample. Additionally, acculturation was associated with "heavier" drinking for females while place of birth was associated with "heavier" drinking for males.

CONCLUSIONS

Studies of drinking patterns and related problems need to consider these factors.