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CORK Bibliography: Acculturation

93 citations. January 2003 to present

Prepared: March 2009

Akins S; Mosher C; Smith CL; Gauthier JF. The effect of acculturation on patterns of Hispanic substance use in Washington state. Journal of Drug Issues 38(1): 103-118, 2008. (38 refs.)

A growing body of research on Hispanic substance use in the United States has found acculturation to result in increased drug use. This study contributes to this research by analyzing the effect of acculturation on Hispanic substance use in Washington State, a state with a rural and dispersed Hispanic population. Findings reveal acculturation to have a strong positive effect on levels of illicit drug use, hard drug use, binge drinking and bender drinking among Hispanics.

Allen ML; Elliott MN; Fuligni AJ; Morales LS; Hambarsoomian K; Schuster MA. The relationship between Spanish language use and substance use behaviors among Latino youth: A social network approach. Journal of Adolescent Health 43(4): 372-379, 2008. (42 refs.)

Purpose: Greater acculturation is associated with higher rates of substance use among Latino adolescents, but the reasons are poorly understood. One potential explanation is that social networks chan.-e with acculturation, leading to decreased protection and increased risk. Our objective was to identify Spanish language-sensitive individual and social network attributes associated with substance use in Latino adolescents. Methods: Latino eighth-grade students in a Los Angeles public middle school completed a computerized. self-administered survey about tobacco, alcohol, drug use. and parental monitoring: and description of 30 social network members. Regression analyses were used to estimate the independent associations of network-level Spanish language use and other factors With a substance use behavior scale. Mediation analysis: identified Spanish language-sensitive attributes. Results: Network-level Spanish language use was associated with a substance use scale in bivariate but not multivariate models. Protective Spanish language-sensitive attributes included greater numbers of extended family members in the network, less substance use among network members. and greater perceived Parental monitoring. Risky Spanish language-insensitive attributes include more high school aged network members. Conclusions: These results suggest that parental monitoring and some characteristics of social networks account for the relationship between Spanish language use and substance use among Latino adolescents. Clinic- or community-based interventions that enhance protective characteristics of social networks in Latino adolescents may be effective.

Amundsen EJ; Rossow I; Skurtveit S. Drinking pattern among adolescents with immigrant and Norwegian backgrounds: A two-way influence? Addiction 100(10): 1453-1463, 2005. (48 refs.)

Aim: To assess the association between drinking behaviour among adolescents with both immigrant and native backgrounds with aspects of acculturation. Design: Cross-sectional school survey among 15-16 year olds. Setting and participants All students, a total of 8361, in 10th grade during spring 2000 and 2001 in Oslo, Norway with response rate 88.3%. The sample consisted of 1213 students with an immigrant background and 4627 students with a Norwegian background. Measurements: Indicators of the length of the acculturation process were assessed as first versus second generation and in terms of length of stay in Norway. The proportion of Muslim students in school was an indicator of social environment 'dryness'. Drinking behaviour was assessed as drinking alcohol ever, drinking frequency and intoxication frequency. Findings: A smaller proportion of immigrant students were current drinkers, frequent drinkers and drank to intoxication compared with adolescents with a Norwegian background. Adjusted two-level analyses showed that alcohol drinking was less common among immigrant students with a short stay in Norway and with a large proportion of Muslim students in school. In those with a Norwegian background there was a larger proportion of abstainers, and those who drank did so less frequently and were less frequently intoxicated the larger the proportion of Muslim students there was in their school. Conclusion: Drinking behaviour among adolescents in a multicultural and heterogeneous society seems to reflect a bi-directional acculturation process where the majority population tend to adapt to the behaviours of the immigrant population which in turn, to a varying degree, tends to adapt to the behaviour of the majority population.

Arroyo JA; Miller WR; Tonigan JS. The influence of Hispanic ethnicity on long-term outcome in three alcohol-treatment modalities. Journal of Studies on Alcohol 64(1): 98-104, 2003. (32 refs.)

Objective: Prior research has suggested that treatment seeking Hispanic clients are not likely to affiliate with Alcoholics Anonymous (AA). It was hypothesized that AA 12-step facilitation therapy (TSF) would therefore be less effective than cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET) for Hispanics, particularly for those with low acculturation. Method: Outcomes for nonHispanic white (n = 105; 70% male) and Hispanic (n = 100; 80% male) clients at the New Mexico site within Project MATCH were analyzed for evidence of differential treatment response. A pretreatment measure of acculturation to non-Hispanic white culture was available for 80 of the Hispanic clients. Results: Self- identified ethnicity mediated treatment response at distal follow-up, as measured by frequency and intensity of alcohol consumption (p < .02). Hispanics drank with more intensity than did non-Hispanic whites when assigned to TSF; non-Hispanic whites in TSF drank with less frequency than those in the combined CBT and MET conditions. The modest outcome advantage for TSF observed in Project MATCH appears to have been limited to non-Hispanic clients. Contrary to prediction, level of acculturation did not mediate treatment response at proximal (Months 1-6 after treatment) or distal follow-up (Months 7-12). Conclusions: Ethnic self-identification may interact with treatment outcomes in complex ways that are not directly associated with the factors tapped by commonly used measures of acculturation.

Asbridge M; Tanner J; Wortley S. Ethno-specific patterns of adolescent tobacco use and the mediating role of acculturation, peer smoking, and sibling smoking. Addiction 100(9): 1340-1351, 2005. (50 refs.)

Aims: The objectives of this study are to identify the relationship between ethnic identity and tobacco use, and to examine the mediating effects of peer and sibling smoking and acculturation. Design and measurements: Data were drawn from a cross-sectional survey of 3400 Toronto students, sampled from 30 schools between 1998 and 2000. Primary ethnic identity was based on adolescents' self-identification of their ethnic heritage condensed to 12 groups for analysis. Tobacco use was measured as a dichotomy, predicting non-smoking in the past year. Multivariate logistic regression models were employed to test for baseline differences in non-smoking by ethnic identity. Subsequent models adjusted for controls (age, gender, social class, religious attendance, educational achievement) and introduced mediators. Findings: Results indicated that smoking varied among adolescents of differing ethnic identities. Adolescents of western European, eastern European and southern European ethnicity were considerably less likely to be non-smokers, while Chinese, South Asian and East Indian and West Indian youth were more inclined to be non-smokers. The discrepancies in rates of non-smoking among western European and South Asian and East Indian adolescents were explained by a combination of peer and sibling smoking and acculturation; among southern European and eastern European youth via peer and sibling smoking; and by neither peer and sibling smoking nor acculturation for Chinese and West Indian youth. Conclusions: This paper demonstrates that disparities in tobacco use among certain ethnic groups can be explained by peer and sibling smoking and acculturation; however, for other ethnic groups, knowledge of the processes that account for differences in tobacco use remains less clear.

B, Evelyn. The story of a bi-cultural, Latina addict. Journal of Social Work Practice in the Addictions 5(1/2): 185-189, 2005. (0 refs.)

This present the memoirs of Evelyn B, a bi-cultural, Latina addict. Evelyn is a first generation American. The story focuses on her life story of abuse, drugs, and recovery.

Bal DG. Cancer and social justice: A demographic, economic, historic, sociocultural, and ethical perspective. Cancer 104(12, Supplement S): 2891-2894, 2005. (3 refs.)

In the current presentation, as a first-generation Asian-American immigrant, the author discussed the dire inequities of the current cancer prevention and control systems in the U.S. and attempted to analyze the root causes of the problem. The universal concern is that the occurrence of cancer, cancer's behavioral antecedents, (diet, physical activity, and tobacco use), the early detection of cancer, and cancer survivorship all relate inversely to education, income, social class, and white race. In other words, not only are cancer rates higher among lesser educated, poorer, and socially deprived individuals, but the availability and benefits of primary, secondary, and tertiary cancer prevention also are rationed, consciously or subconsciously, by current society within and outside the borders of the U.S. Asian Americans are one of the unrecognized populations among these deprived groups. The objective of this article was to provide a thoughtful perspective on this very real problem and why it persists. Because of the audience at the Asian American Network for Cancer Awareness, Research, and Training meeting, where the current report was presented, the author tried to avoid a treatise on Asian philosophy and values but could not resist the comment that, in archaic Chinese terms, the public health and health care systems in the U.S. today lack balance and harmony.

Baluja KF; Park J; Myers D. Inclusion of immigrant status in smoking prevalence statistics. American Journal of Public Health 93(4): 642-646, 2003. (38 refs.)

Objectives. Data from the 1995-1996 and 1998-1999 Current Population Survey tobacco use supplements were used to examine smoking prevalence statistics by race/ethnicity and immigrant status. Methods. Smoking prevalence statistics were calculated, and these data were decomposed by country of birth for Asian immigrants to illustrate the heterogeneity in smoking rates present within racial/ethnic groups. Results. Except in the case of male Asian/Pacific Islanders, immigrants exhibited significantly lower smoking prevalence rates than nonimmigrants. However, rates varied according to country of birth. Conclusions. This research highlights the need to disaggregate health statistics by race/ethnicity, sex, immigrant status, and, among immigrants, country of birth. Data on immigrants' health behaviors enhance the development of targeted and culturally sensitive public health smoking prevention programs.

Bock BC; Niaura RS; Neighbors CJ; Carmona-Barros R; Azam M. Differences between Latino and non-Latino White smokers in cognitive and behavioral characteristics relevant to smoking cessation. Addictive Behaviors 30(4): 711-724, 2005. (43 refs.)

Adult smokers were recruited during routine health care visits at primary care clinics located in three urban hospitals and were given a brief intervention and nicotine replacement therapy. Analyses compared bicultural (BC: n=60) or less acculturated (LA: n=138) Latinos and non-Latino White (NL: n=417) participants. Both Latino groups were significantly different from NL subjects in smoking rate and nicotine dependence. However, BC and NL subjects differed significantly from LA subjects in perceived benefits of quitting, perceived risk from smoking, and negative affect smoking. LA subjects had higher cessation rates than either BC or NL groups. Regression analyses showed that nicotine dependence and confidence in quitting predicted cessation at month 6, and acculturation appeared to moderate the relationship between smoking cessation and both confidence in quitting and nicotine dependence. These results provide support for the viability of brief interventions for smoking provided through health care delivery systems. Results also suggest that characteristics previously shown to be predictive of successful cessation in mixed or non-Latino populations may not be equally predictive of cessation across members of diverse populations.

Borges G; Medina-Mora ME; Lown A; Ye Y; Robertson MJ; Cherpitel C et al. Alcohol use disorders in national samples of Mexcicans and Mexican-Americans: The Mexican National Addiction Survey and the US National Alcohol Survey. Hispanic Journal of Behavioral Sciences 28(3): 425-449, 2006. (33 refs.)

The authors show associations between immigration and alcohol disorders using data from the 1995 and 2000 U.S. National Alcohol Surveys and the 1998 Mexico National Household Survey on Addictions. The prevalence of alcohol dependence was 4.8% for the Mexicans, 4.2% for the Mexico-born immigrants, and 6.6% for the U.S.-born Mexican Americans. They found a general lack of significance for the immigration variables with few consistent dose-response findings for alcohol use disorders. High acculturation was associated with higher risks for women; however, unexpectedly, high acculturation was associated with lower risks for males. Among Mexican Americans, the impact of immigration to the United States on the prevalence of alcohol use disorders differs by gender. Male and female differences and possible sources of immigrant selection are important issues for future research.

Caetano R; Clark CL. Acculturation, alcohol consumption, smoking, and drug use among Hispanics. IN: Chun KM; Organista PB; Morin G, eds. Acculturation: Advances in Theory, Measurement, and Applied Research. Washington, DC: American Psychological Association, 2003. pp. 223-239. (51 refs.)

The objective of this chapter is to discuss the influence of acculturation on drinking, drinking problems, smoking, and drug use among Hispanics. Also presented are data regarding trends between 1984 and 1995 on the relationship between acculturation and alcohol consumption among Hispanics in the US. This review of literature suggests that the associations of acculturation with alcohol consumption and alcohol-related problems are complex and depend on gender, age, birthplace, generational status, national origin, and social setting. The existing evidence seems to most clearly indicate that acculturation is positively associated with alcohol consumption, especially among women. The results also suggest that acculturation-related analyses must control for the effects of various sociodemographic factors to protect against reporting spurious associations that may occur within sociodemographic categories across acculturation levels.

Caetano R; Ramisetty-Mikler S; McGrath C. Acculturation, drinking, and intimate partner violence among Hispanic couples in the United States: A longitudinal study. Hispanic Journal of Behavioral Sciences 26(1): 60-78, 2004. (41 refs.)

This article examines the 5-year association between acculturation, drinking, and male-to-female partner violence and female-to-male partner violence among Hispanic couples in the United States. A national representative sample of Hispanic couples 18 years of age or older was interviewed in 1995 and 2000. Both members of the couple were independently interviewed. Differences in prevalence rates of male-to-female partner violence and female-to-male partner violence, incidence, and recurrence across acculturation groups are not significant. Drinking is associated with acculturation among women. Couples with mixed acculturation level (high-medium) are less at risk for male-to-female partner violence. An increase of five standard drinks per week in men's drinking decreases the risk of female-to-male partner violence by 10%. Acculturation level at Time 1 is not associated with male-to-female partner violence and female-to-male partner violence status 5 years later.

Caetano R; Ramisetty-Mikler S; Rodriguez LA. The Hispanic Americans Baseline Alcohol Survey (HABLAS): The association between birthplace, acculturation and alcohol abuse and dependence across Hispanic national groups. Drug and Alcohol Dependence 99(1-3): 215-221, 2009. (39 refs.)

Hispanics are heterogeneous in national origin, evidenced by wide ranges of alcohol abuse and dependence rates across different Hispanic national groups. This paper examines associations between 12-month rates of DSM-IV alcohol abuse and dependence with birthplace and acculturation. The 2006 Hispanic Americans Baseline Alcohol Survey, using a multistage Cluster sample design, interviewed 5224 adults (18+ years) in five selected U.S. metropolitan areas: Miami, New York, Philadelphia, Houston, and Los Angeles. Comprehensive data on drinking behavior were collected and the analyses include bivariate and multivariate regression techniques. Alcohol abuse and dependence rates were higher among U.S.-born Puerto Ricans and South/Central Americans compared to their foreign-born counterparts, while no such differences were found for Cuban and Mexican Americans. Overall, those with higher acculturation report higher rates of abuse and dependence (statistically significant only for abuse among Puerto Ricans). Risk factors for abuse include being male and being in the high acculturation group. Risk factors for dependence include being male, being Puerto Rican or Mexican American, having less thin a college education, and being U.S.-born. Hispanics Were found to share several common risk factors with the larger U.S. population for abuse and dependence, such as male gender, lower education, and lower income.

Caetano R; Ramisetty-Mikler S; Wallisch LS; McGrath C; Spence RT. Acculturation, drinking, and alcohol abuse and dependence among Hispanics in the Texas-Mexico border. Alcoholism: Clinical and Experimental Research 32(2): 314-321, 2008. (33 refs.)

Background: Acculturation has been linked to an increased prevalence of alcohol-related problems. However, most of the research has been conducted with Hispanic populations in metropolitan areas of the United States, none of which is on the U.S.-Mexico border. This study examines the association between acculturation, heavy episodic drinking, and DSM-IV alcohol abuse and dependence among Hispanics in the Texas-Mexico border. Methods: The study used data from a survey conducted (2002 to 2003) along the Texas-Mexico border and included 472 male and 484 female Hispanic adults from El Paso, the Rio Grande Valley, and colonias. Based on the Acculturation Rating Scale for Mexican Americans-II scale, respondents were coded into 4 acculturation categories: "very Mexican oriented,""Mexican bicultural," "Anglo bicultural," or "very Anglo/Anglicized". Results: Acculturation was related to lower rates of alcohol use disorders among men and a higher frequency of heavy episodic drinking among women. Multivariate analyses indicate that men who report heavy episodic drinking and those who are "very Mexican,""bicultural Mexican," or "bicultural Anglo" are more at higher risk for alcohol abuse and/or dependence compared with "very Anglo/Anglicized" men. For women, acculturation level did not predict alcohol disorders. Statistical analyses included testing for bivariate associations and multivariate logistic regression predicting heavy episodic drinking alcohol abuse or dependence. Conclusions: This study suggests that acculturation has different effects on drinking for men and women. This finding needs some attention as literature also indicates that women drink more and may develop more alcohol-related problems as they acculturate. This increase in women's drinking is probably because of U.S. society's more liberal norms governing female drinking. The "bimodal" distribution of risk, in which only men in "very Anglo" group are at a lower risk than the others, may be unique to the Border. The association between acculturation and alcohol use disorders does not appear to be linear and the effect of acculturation is not uniform on individuals' drinking behavior.

Canino G; Vega WA; Sribney WM; Warner LA; Alegria M. Social relationships, social assimilation, and substance use disorders among adult Latinos in the US. Journal of Drug Issues 38(1): 69-101, 2008. (81 refs.)

Based on social control perspectives and results from prior studies, we test hypotheses about the extent to which characteristics of family and social networks are associated with substance use disorders (SUD), and whether these associations vary by sex. In this study an SUD is alcohol or illicit drug abuse or dependence as defined by criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association. With nationally representative data of adult Latinos from the National Latino and Asian American Survey (NLAAS), we found that respondents' language use with family, rather than language proficiency, appears to be a more efficient proxy for social assimilation to represent differential levels of risk of SUD. SUD was positively associated with problematic family relations for men but not women and was positively associated with more frequent interactions with friends for women but not men. The results suggest that the salient features of social assimilation associated with SUD include the context of language use and transformations in family and social network relationships that differ in important ways between Latino men and women.

Chen MS. Cancer health disparities among Asian Americans: What we know and what we need to do? Cancer 104(12, Supplement S): 2895-2902, 2005. (76 refs.)

Asian Americans are the nation's fastest growing racial group in terms of percentages, and they constitute a very heterogeneous population. The author reviewed the literature and proposed an agenda to reduce cancer health disparities based on this review and the accomplishments and aspirations of the National Cancer Institute-funded Asian American Network for Cancer Awareness, Research, and Training. The Asian American cancer burden is unique, unusual, and, to a certain extent, unnecessary. The Asian American cancer burden is unique, because Asians are the only racial/ethnic population to experience cancer as the leading cause of death. The unusual aspects of the cancer burden among Asian Americans include experiencing proportionally more cancers of infectious origin, such as human papillomavirus-induced cervical cancer, hepatitis B virus-induced liver cancer, and stomach cancer, than any other racial/ethnic population and, at the same time, experiencing an increasing numbers of cancers associated with "Westernization." To a certain extent, the cancer burden for Asian Americans is unnecessary if barriers to cancer screening, overcoming resistance to physician visits, and culturally competent interventions to reduce smoking, unhealthy diet, and increasing proper exercise can be instituted. Reducing cancer health disparities among Asian Americans will involve research into their unique, unusual, and unnecessary cancer burden.

Cherpitel CJ; Robertson M; Ye Y; Borges G; Bautista CF; Lown A et al. Comorbidity for alcohol use disorders and drug use in Mexican-origin groups: Comparison of data from national alcohol surveys in the U.S. and Mexico. Substance Use & Misuse 42(11): 1685-1703, 2007. (53 refs.)

The comorbidity, separately, of alcohol dependence and consequences of drinking with illicit drug use is compared between Mexicans and Mexicans Americans, using data from the 1995 and 2000 U. S. National Alcohol Surveys (n = 830) and the 1998 Mexico National Household Survey on Addictions (n = 3313). Among drinkers, comorbidity was significantly more prevalent among Mexican Americans than among Mexicans and was positively associated with level of acculturation among Mexican Americans. Although data may not be generalizable, they are important for a better understanding of cultural influences on the development of comorbid substance abuse conditions among Mexicans immigrating to the United States and their substance abuse treatment needs.

Choi S; Rankin S; Stewart A; Oka R. Effects of acculturation on smoking behavior in Asian americans: A meta-analysis. Journal of Cardiovascular Nursing 23(1): 67-73, 2008. (29 refs.)

Background: Cigarette smoking is the most preventable risk factor for many negative health consequences, such as cancer, heart disease, and lung disease. in the United States, the prevalence rate in Asian immigrants is high (26%-70%), with Southeast Asian men having the highest rate. Acculturation has been associated with smoking behavior in this ethnic group. Objective: The purposes of this meta-analysis are to describe the extent to which acculturation affects smoking behavior in Asian immigrants and to compare the direction and magnitude of the effect between subgroups by gender and age. Methods: Databases within PubMed, CINAHL, The Cochrane Library, and PsycINFO were searched. Twenty-one studies published in English or Korean from 1994 through 2005 met criteria, and 9 of these studies contained sufficient data. Among the 9 studies, 3 presented gender-specific data; thus, these studies were entered separately for men and women, making a total of 12 entries for final analysis. The odds ratio was used as an effect size statistic. The values of odds ratios were calculated from the data in the studies. Results: The average effect size for men was 0.53 (95% confidence interval, 0.28-0.99), indicating that acculturated men are 53% less likely to smoke than nonacculturated or "traditional" men. The average effect size for women was 5.26 (2.75-10.05), suggesting that acculturated women are 5 times more likely to smoke than traditional women. In adolescents, the average effect size was 1.92 (1.22-3.01), indicating that acculturated adolescents are almost 2 times more likely to smoke than traditional adolescents. Conclusions: Acculturation may have a protective effect on smoking behavior in Asian men and a harmful effect in Asian women and adolescents. The magnitude of effect is larger in women and adolescents than in men. Smoking cessation programs should target acculturated women, adolescents, and traditional men.

Conway KP; Swendsen JD; Dierker L; Canino G; Merikangas KR. Psychiatric comorbidity and acculturation stress among Puerto Rican substance abusers. American Journal of Preventive Medicine 32(6, Supplement S): S219-S225, 2007. (49 refs.)

Background: Although acculturation to the United States has been associated with an increase in substance, mood, and anxiety disorders in Latino populations, few studies have examined this concept relative to comorbidity among these syndromes. Methods: This study compares the prevalence and patterns of psychiatric comorbidity among Puerto Ricans with substance use disorders living in San Juan (Puerto Rico) to those who have migrated to New Haven (Connecticut) and examines the association between acculturation-related stress and the prevalence and patterns of psychiatric comorbidity among those who have migrated to New Haven. Results: Lifetime levels of nearly all comorbid psychiatric disorders among respondents with substance use disorders were generally similar across sites. However, the risk of any co-occurring psychiatric disorder was higher among substance use disorder cases in New Haven who reported high levels of total acculturation stress and family-specific acculturation stress. These findings were generally accounted for by associations between affective disorders and high scores on these indicators of acculturation stress. Conclusions: The overall prevalence and patterns of psychiatric comorbidity are remarkably similar among Puerto Rican substance abusers whether they live in San Juan or have migrated to New Haven, thereby demonstrating robustness to differences in geographic location. Nevertheless, the degree of acculturation-related family stress is positively associated with co-occurring substance and psychiatric disorders, particularly affective disorders. Intervention in family strain related to the acculturation process may diminish the development of comorbid mental disorders and assist in implementing successful treatment of substance abuse.

Cortes DE; Deren S; Andia J; Colon H; Robles R; Kang SY. The use of the Puerto Rican biculturality scale with Puerto Rican drug users in New York and Puerto Rico. Journal of Psychoactive Drugs 35(2): 197-207, 2003. (58 refs.)

This study examines the psychometric properties of an acculturation scale specifically developed for Puerto Ricans with a sample of substance abusers residing in Puerto Rico and New York. In line with current conceptual models of acculturation, this instrument departs from a mutually exclusive or zero-sum conceptualization of acculturation by assessing involvement in both American and Puerto Rican cultures independently of each other. Findings from this study permitted comparisons of acculturation as experienced by Puerto Rican injection drug users in Puerto Rico and New York. Results supported the notion of independence of individuals' involvement in American and Puerto Rican cultures, thus confirming the complex nature of biculturalism. This article also examines the relevance of the study of acculturation scales that can assist in identifying the influences of the cultures of origin and destination on substance abuse and HIV risk behaviors.

Devieux JG/Malow RM; Ergon-Perez E; Samuels D; Rojas P; Khushal SR et al. A comparison of African American and Cuban American adolescen juvenile offenders: Risky sexual and drug use behaviors. Journal of Social Work Practice in the Addictions 5(1/2): 69-83, 2005. (42 refs.)

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.

Dotinga A; van den Eijnden RJJM; Bosveld W; Garretsen HFL. Methodological problems related to alcohol research among Turks and Moroccans living in the Netherlands: Findings from semi-structured interviews. Ethnicity & Health 9(2): 139-151, 2004. (30 refs.)

Objectives. To identify factors related to alcohol use among Turks and Moroccans living in the Netherlands. Furthermore, to reveal methodological problems related to research among Turks and Moroccans in general and to alcohol research among these groups in particular. Design. Individual face-to-face interviews were carried out with Dutch researchers (n=9), Turkish and Moroccan (health) practitioners working in the field with Turks (n=4) or Moroccans (n=2), and members of the target population with a Turkish (n=3) or a Moroccan background (n=2). Furthermore, focus-group interviews were held with Turkish women (n=4), Turkish men (n=3), Moroccan women (n=4) and Moroccan men (n=3) working as health professionals. Results. Alcohol use seems prevalent particularly among second-generation Turks and Moroccans and is related to: upbringing, influence of peer groups, integration and the degree in which Islamic rules are practised. Written questionnaires seem more appropriate for second-generation Turks and Moroccans, because they have fewer language problems and are more familiar with Western bureaucratic society. However, both generations may prefer face-to-face interviews since both groups fear that 'written' answers about the sensitive subject 'alcohol use' may somehow become known among community members, Similarly, an interviewer with a Dutch background may elicit more reliable answers about alcohol use than an interviewer with a Turkish or Moroccan background. Conclusion. In alcohol research special attention should be paid to second-generation Turks and Moroccans. Although it is probably easier to conduct alcohol studies in this group than in first-generation Turks and Moroccans, quantitative research is needed to test the hypothesis that written questionnaires elicit more reliable answers about alcohol use than face-to-face interviews. Furthermore, the influence of ethnic matching on response and data quality should be tested further.

Epstein JA; Doyle M; Botvin GJ. A mediational model of the relationship between linguistic acculturation and polydrug use among Hispanic adolescents. Psychological Reports 93(3(Part 1)): 859-866, 2003. (42 refs.)

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.

Fosados R; McClain A; Ritt-Olson A; Sussman S; Soto D; Baezconde-Garbanati L et al. The influence of acculturation on drug and alcohol use in a sample of adolescents. Addictive Behaviors 32(12): 2990-3004, 2007. (76 refs.)

This article reports on the associations between acculturation and substance use among 198 ninth-grade Southern California adolescents (mean age = 13.8 years). Substance use measures included 30-day (current) and lifetime use of alcohol and other drugs. Acculturation was measured using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) acculturation scale, a multi-dimensional acculturation scale yielding four acculturation strategy scores. Linear regression analyses evaluated the association between acculturation on alcohol and drug use, adjusting for several covariates. Results revealed that the assimilation acculturation strategy was significantly, but negatively associated with current alcohol use, especially among males. The separation acculturation strategy was significantly and positively associated with current alcohol use, especially among females. Marginalization was associated with greater risk for lifetime alcohol and drug use, especially among males, and a greater risk of current drug use among females. The social influence covariates were predictive of both current and Cr lifetime alcohol and drug use. Future studies should incorporate multidimensional acculturation scales in adolescent substance use to understand how different acculturation strategies impact different populations.

Fu SS; Ma GX; Tu XM; Siu PT; Metlay JP. Cigarette smoking among Chinese Americans and the influence of linguistic acculturation. Nicotine & Tobacco Research 5(6): 803-811, 2003. (38 refs.)

Less acculturated Chinese Americans experience cultural and language barriers. The present study assessed the relationship between linguistic aspects of acculturation and cigarette smoking among Chinese Americans. A cross-sectional, self-administered survey was administered to a consecutive sample of 541 Chinese American adults (aged 18 years or older) attending four pediatric, medical, or dental practices located in Philadelphia's Chinatown from November 2000 to February 2001. Linguistic acculturation was measured by adapting a reliable and valid acculturation scale developed for Southeast Asians. English and Chinese language proficiency subscales were utilized to analyze the association between language proficiency and current smoking. Whereas 25% of Chinese American men reported current smoking, only 3% of Chinese American women reported current smoking. Chinese American men with lower English proficiency reported significantly higher rates of current smoking compared with Chinese American men with a higher level of English proficiency (33% vs. 18%, p<.01). Less English-proficient Chinese American male smokers were less likely to have received advice from a physician to quit smoking (50% vs. 85%, p=.01). In multivariate analysis, increased English proficiency was associated with decreased odds of current smoking (OR=0.38, 95% CI=0.16-0.89) among Chinese American men after controlling for confounding variables. In conclusion, higher English proficiency was associated with decreased current smoking among Chinese American men. Chinese American men with limited English proficiency should especially be targeted for tobacco control interventions. Further research is needed to assess whether acculturation is associated with smoking among Chinese American women and with use of smoking cessation treatments and services by Chinese American smokers.

Galaif ER; Newcomb MD; Vega WA; Krell RD. Protective and risk influences of drug use among a multiethnic sample of adolescent boys. Journal of Drug Education 37(3): 249-276, 2007. (48 refs.)

A measurement model was analyzed to demonstrate a differential distribution and cumulative exposure to psychosocial risk and protective influences of adolescent drug use among ethnically-diverse adolescent samples. The sample included U.S.-born (US) Latino (N= 837), foreign-born (FB) Latino (N= 447), White (N= 632), and African American (N = 618) adolescent boys. Psychological Distress, Peer Drug Use, and Adolescent Drug Use were significantly positively correlated with Peer Drug Use and Adolescent Drug Use. In contrast, Family, School, law abidance, and guilt were significantly negatively correlated with Peer Drug Use and Adolescent Drug Use. Multiple group analyses indicated significant similarities and differences among US and FB Latinos, and Whites. Implications for early prevention, multi-level interventions, and suggestions for future research are discussed.

Gfroerer JC; Tan LL. Substance use among foreign-born youths in the United States: Does the length of residence matter? American Journal of Public Health 93(11): 1892-1895, 2003. (11 refs.)

This study reinforces the findings of previous studies reporting lower rates of substance use among foreign-born youths compared with US-born youths, but increased risk of use as they become acculturated. A better understanding of these results could be gained by studying how acculturation interacts with known risk and protective factors for substance use. Acculturation occurs through contacts with parents and peers, formal education, and exposure to media such as television, movies, and magazines. Each of these could influence a youth's propensity to use substances. In addition, access to substances of abuse may be greater for youths who are more fluent in English or more in touch with local customs for obtaining substances. Research in this area should help prevention planners design programs that appropriately consider acculturation to reduce substance use among immigrant youth.

Grant BF; Stinson FS; Dawson DA; Chou PS. Acculturation and lifetime prevalence of DSM-VI psychiatric disorders among Mexican Americans and non-Hispanic Whites in the US: Results from the National Epidemiologic Survey an Alcohol and Related Conditions. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 198A-198A, 2004. (0 refs.)

Griffin J; Soskolne V. Psychological distress among Thai migrant workers in Israel. Social Science & Medicine 57(5): 769-774, 2003. (31 refs.)

The purpose of this cross-sectional study was to examine the associations between migration stressors and psychological distress among Thai migrant agricultural workers in Israel, and to examine the direct and indirect contribution of socio-cultural variables to this relationship. Two hundred and twenty-one Thai male workers were interviewed using a structured questionnaire that included demographic variables and occupational exposures to organophosphate pesticides (as control variables), migration stressors, intervening variables (traditional health beliefs, social support, drinking behavior, and utilization of medical services), and a psychological distress scale. In multivariate analysis, migration stressors, the migrants' traditional health beliefs, quality of current social relationships, drinking behavior, as well as age and occupational exposure were significantly associated with psychological distress. Workers who reported higher migration stressors (perceived the migration to be difficult, and often felt homesick), those with higher levels of traditional health beliefs, those whose social relationships with other Thai co-workers were poor, those who consumed either no alcohol or large amounts of alcohol, and those who reported "problem drinking" had significantly higher levels of psychological distress. A moderating effect of the quality of social relationships with co-workers on the association between homesickness and psychological distress was found. Additionally, migrants aged 28-34 and those who were experiencing eye irritation from chemicals at work had significantly increased levels of distress. The findings demonstrate the focal role of specific migration stressors and the current socio-cultural context on psychological distress of migrant workers.

Guilamo-Ramos V; Jaccard J; Johansson M; Turrisi R. Binge drinking among Latino youth: Role of acculturation-related variables. Psychology of Addictive Behaviors 18(2): 135-142, 2004. (33 refs.)

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.

Haasen C; Bistter A; Gharaei D; Toprak MA; Haferkorn J; Reimer J. Psychosocial aspects of opiate dependence among Turkish migrants in Germany. Journal of Ethnicity in Substance Abuse 3(1): 1-10, 2004. (15 refs.)

The situation of migrants with substance abuse problems has hardly been explored by German addiction research. The few existing studies show that patterns of substance abuse may be culturally transmitted and that they are affected by acculturation stress. In this study, data on 103 consecutive opiate dependent Turkish migrants was collected in an addiction counseling centre in Hamburg and analysed with the object to identify (1) specific aspects of migration stress associated with substance abuse and (2) possible protective factors for migrants. Data was collected on the course of addiction, on general socio-demographic and migration specific aspects and on areas of conflict.

Haasen C; Sinaa M; Reimer J. Alcohol use disorders among Afghan migrants in Germany. Substance Abuse 29(3): 65-70, 2008

Little is known about the effect of acculturation on patterns of alcohol use for migrants from Islamic countries. In a field study of Afghan migrants to Germany, participants who drink alcohol were screened with respect to alcohol use problems and then interviewed concerning patterns of use, mental health, and sociodemographic variables. Snowball sampling was used until 50 Afghan migrants with alcohol use disorders could be interviewed. A significant correlation was found between acculturation stress and mental distress, as well as between mental distress and severity of alcohol use. These correlations did not differ with respect to whether alcohol had been used prior to migration. The findings support the hypothesis of the effect of acculturation on problematic alcohol use. Acculturation needs to be focused on in the treatment of alcohol use disorders.

Hahm HC; Lahiff M; Guterman NB. Acculturation and parental attachment in Asian-American adolescents' alcohol use. Journal of Adolescent Health 33(2): 119-129, 2003. (46 refs.)

Purpose: To test whether the degree of acculturation predicts subsequent alcohol use among Asian-American adolescents, and to test the moderating effect of parental attachment. Methods: This was a prospective study using a sub-sample of the National Longitudinal Adolescent Health data set. A nationally representative sample of 714 Asian-American boys (n = 332) and girls (n = 382) in grades 7-12 was analyzed. In-home self-report data were collected on two types of acculturation status, alcohol use, demographics, and parental attachment. After controlling for acculturation status and background variables at Wave 1, logistic regression analysis was used to estimate the odds ratios to assess the association between acculturation and alcohol use at Wave II for adolescents. Results: Asian-American adolescents with the highest level of acculturation (English use at home, born in the United States) were identified as the highest risk group. For adolescents with low parental attachment, the odds of alcohol use were 11 times greater in the highly acculturated group than in the least acculturated group. However, the odds of alcohol use for adolescents with moderate or high levels of parental attachment did not vary across acculturation groups. Conclusions: Overall, a greater level of acculturation was associated with greater alcohol use. However, when parental attachment was taken into account, highly acculturated adolescents with moderate or high parental attachment had no greater risk than adolescents with same levels of parental attachment who were less acculturated. Thus, it appears that acculturation per se was not a risk factor unless it was accompanied by a low level of parental attachment.

Hatchett BF; Holmes KY. Attitudes of college students in a predominately Hispanic university regarding alcohol use. Journal of Ethnicity in Substance Abuse 3(2): 25-41, 2004

Research was conducted to determine the drinking-related attitudes of college students in a predominantly Hispanic university, and to determine if there are ethnic and gender-related differences in two areas: acceptable levels of consumption and situational alcohol use. Study findings reflect the need to insure that substance abuse initiatives, planning, informational, and counseling programs for students take into account the cultural implications associated with alcohol use as well as acculturation issues.

Heim D; Hunter SC; Ross AJ; Bakshi N; Davies JB; Flatley KJ; Meer N. Alcohol consumption, perceptions of community responses and attitudes to service provision: Results from a survey of Indian, Chinese and Pakistani young people in Greater Glasgow, Scotland, UK. Alcohol and Alcoholism 39(3): 220-226, 2004. (32 refs.)

Aims: To gather prevalence data regarding alcohol consumption and gauge perceptions of community responses to alcohol and service provision in a sample of Pakistani, Indian and Chinese young people aged 16-25 years, in Greater Glasgow, Scotland, UK. Methods: A survey methodology utilizing purposive sampling techniques (n = 174) was employed. Data were collected using an interviewer-administered questionnaire. Results: Alcohol consumption amongst the target populations is currently lower than that of the general population. Predictors of alcohol consumption were found to include self-reported importance of religion (a negative association with consumption) and having same-ethnicity friends who drink alcohol. There was a lack of consensus amongst participants regarding whether service provision should be part of the mainstream or specialist for black and minority ethnic individuals. Conclusions: Alcohol consumption in the target populations may be increasing and service provision could benefit by including specialist services for black and minority ethnic groups, in addition to mainstream services that need to be culturally sensitive.

Hendershot CS; Dliworth TM; Neighbors C; George WH. Differential effects of acculturation on drinking behavior in Chinese- and Korean-American college students. Journal of Studies on Alcohol and Drugs 69(1): 121-128, 2008. (51 refs.)

Objective: Recent evidence suggests increasing rates of alcohol use and related disorders among Asian-American young adults. Relatively little research has focused on this group, and few studies have examined heterogeneity in drinking prevalence and correlates across Asian subgroups. This study examined interactive effects of ethnicity, acculturation, and gender on drinking behavior among Asian-American undergraduates. Method: Participants were 112 Chinese Americans and 108 Korean Americans (mean age = 19.2 years, 61% female) who completed measures of alcohol use, acculturation, and demographic factors. Multivariate analyses examined drinking behavior (defined as quantity, frequency, and duration) as a function of ethnicity, gender, and acculturation. Results: Overall, Korean ethnicity predicted increased drinking, and acculturation predicted decreased drinking. However, acculturation interacted with ethnicity such that its influence was protective for Korean Americans and negligible for Chinese Americans. Conclusions: Previous research implicates acculturation as a risk factor for drinking among Asian Americans, but the current findings suggest that protective effects may also exist. Results also indicate that Korean ethnicity is a risk factor particularly in the context of low acculturation. These findings illustrate the need to consider ethnic subgroup differences in drinking rates and in risk and protective factors for alcohol use among Asian Americans.

Hendershot CS; MacPherson L; Myers MG; Carr LG; Wall TL. Psychosocial, cultural and genetic influences on alcohol use in Asian American youth. Journal of Studies on Alcohol 66(2): 185-195, 2005. (59 refs.)

Objective: Environmental and cultural factors, as well as a genetic variant of the aldehyde dehydrogenase gene (the ALDH2*2 allele) have been identified as correlates of alcohol use among Asian Americans. However, concurrent examination of these variables has been rare. The present study assessed parental alcohol use, acculturation and ALDH2 gene status in relation to lifetime, current and heavy episodic drinking among Chinese and Korean American undergraduates. Method: Participants (N = 428, 51% women; 52% Chinese American, age 18-19 years) were first-year college students in a longitudinal study of substance use initiation and progression. Data were collected via structured interview and self-report, and participants provided a blood sample for genotyping at the ALDH2 locus. Results: Gender, parental alcohol use and acculturation significantly predicted drinking behavior. However, none of the hypothesized moderating relationships were significant. In contrast with previous studies, ALDH2 gene status was not associated with alcohol use. Conclusions: Results indicate that although the variables examined influence alcohol use, moderating effects were not observed in the present sample of Asian American college students. Findings further suggest that the established association of ALDH2 status and drinking behavior in Asians may not be evident in late adolescence. It is possible that ALDH2 status is associated with alcohol consumption only following initiation and increased drinking experience.

Hjern A; Allebeck P. Alcohol-related disorders in first- and second-generation immigrants in Sweden: A national cohort study. Addiction 99(2): 229-236, 2004. (26 refs.)

Aims: The risk of alcohol-related disorders in first- and second-generation immigrants in Sweden were investigated and compared with the Swedish majority population to assess how alcohol habits are modified over generations in a new society. Design: Register study based on multivariate analyses of demographic data, including information on country of birth, from the Swedish Population and Housing Census of 1985 linked to data on hospital admissions for alcohol-related disorders during 1990-99 in the National Hospital Discharge Register. Participants: The study population consisted of a national cohort of 1.25 million youth born 1968-79 and 1.47 million adults born 1929-65. Results: First- and second-generation immigrants from Finland had higher relative risks (RRs) for hospital admission because of an alcohol-related disorder compared to the Swedish majority population (socio-economic adjusted RRs 2.1 and 1.9, respectively), while first-generation immigrants born in southern Europe, the Middle East and other non-European countries had lower risks. Second-generation immigrants with heritage in southern Europe, the Middle East and other non-European countries had socio-economic adjusted RRs that were higher relative to the first generation immigrants but lower relative to the Swedish majority population. Intercountry adoptees had the highest adjusted RR (2.5). Conclusions: Patterns of alcohol abuse in the country of origin are strong determinants of alcohol-related disorders in first-generation immigrants. The patterns in second-generation immigrants are influenced by parental countries of origin as well as patterns in the majority population. The Finnish minority and intercountry adoptees are of particular concern in prevention.

Holleran LK; Jung S. Acculturative stress, violence, and resilience in the lives of Mexican-American youth. IN: Bride BE; MacMaster SA, eds. Stress, Trauma and Substance Use. New York: Routledge, 2006. (59 refs.)

This article explores how Mexican-American youth experience stress and trauma in a variety of arenas. Such youth utilize their energy, creativity, and resilience in order to cope with cultural tensions that arise from acculturative processes, role conflicts with family and peers, school challenges, and identity formation processes. Violence, in the form of internalized colonialism, external oppression, and actual violent acts (e.g., gang fights, suicides, and physical and/or sexual abuse), can be a major risk factor for negative outcomes such as substance abuse. However, this ethnographic study demonstrates that many Mexican-American adolescents navigate stressors and traumas in such a way that transforms the potentially distressing events into life-affirming rites of passage. This article explores these issues through qualitative data analyses from a study of Mexican-American youth in a Southwestern city.

Hunter SB; Wong E; Beighley CM; Morral AR. Acculturation and driving under the influence: A study of repeat offenders. Journal of Studies on Alcohol 67(3): 458-464, 2006. (36 refs.)

Objective: In California, driving under the influence (DUI) arrest and conviction rates are disproportionately higher among the Hispanic population. Acculturation and other factors associated with drinking and driving may help explain this disparity. Method: Interviews with Hispanic repeat DUI offenders were conducted immediately prior to sentencing and 2 years later. Arrest records from these offenders were also examined. Analyses were performed to examine the association between acculturation and other sociodemographic characteristics at baseline with DUI arrests and convictions at a 2-year follow-up. Results: Logistic regression modeling showed that acculturation was significantly related to self-reported DUI recidivism even after controlling for other factors associated with DUI convictions during a 2-year follow-up. Acculturation was not found to have a statistically significant relation to DUI arrest rates during that same period. Conclusions: Among a Hispanic sample of repeat DUI offenders, the less-acculturated members were more likely to report a repeat DUI conviction at 2-year follow-Lip than the more-acculturated ones, even after controlling for other characteristics associated with DUI behaviors, such as drinking severity and marital status. The same pattern was not found between acculturation and arrest rates. Acculturation may serve as a risk factor for repeat convictions. Efforts to reduce multiple DUI convictions may need to consist of ways to target persons who are less acculturated.

Hutchinson G; Haasen C. Migration and schizophrenia: The challenges for European psychiatry and implications for the future. Social Psychiatry and Psychiatric Epidemiology 39(5): 350-357, 2004. (67 refs.)

Background: The last decade of the twentieth century has seen an unprecedented increase in the number of reports in the psychiatric literature documenting increased rates of psychotic illness among migrants in a range of European countries. In countries where high rates of immigration have been long-standing such as Britain and the Netherlands, these increased rates have also been seen in the second generation of migrants. This has impacted on psychiatry significantly with regard to the aetiology, diagnosis, and treatment of schizophrenia. Method We reviewed the literature to summarise the available evidence about the phenomenon across the European countries where these findings have been reported. Comparisons of the findings between countries were highlighted to establish their impact on psychiatry and to identify areas and implications for future research. Results: The history of this kind of research is longest in Britain and has established increased risk for non-white migrants, with Caribbean and African patients being especially vulnerable. Caribbean migrants to the Netherlands have also been found to be at increased risk, but they are predominantly of Indo-Caribbean ethnicity. In the other European countries, East and West African migrants have been implicated in some countries, while European migrants have been implicated in other countries. Social inequalities, family fragmentation and urbanicity seem to be the main hypotheses proposed for these increased rates, though, in some countries where asylum seekers and refugees form the largest group of migrants, the stress of the migratory process itself may be implicated. These may all interact with genetic vulnerability and substance abuse. Discussion: Ethnicity and differences in dominant language emerge as major structural references in this new epistemology of psychosis and both the causes and the effects on psychopathology may be filtered through an experience of social disadvantage in an urban environment.

Ji M; Hofstetter CR; Hovell M; Irvin V; Song YJ; Lee J; Park H; Paik HY. Smoking cessation patterns and predictors among adult Californians of Korean descent. Nicotine & Tobacco Research 7(1): 59-69, 2005. (46 refs.)

This paper describes smoking cessation among adult Californian residents of Korean descent, based on a telephone survey (N=2,830). The overall quit rate (number of former smokers divided by number of ever-smokers) was 55.0% (55.8% among males and 49.6% among females). Acculturation was negatively associated with 90-day abstinence after controlling for demographic, social support, health belief, environmental, lifestyle, and respiratory illness history variables (OR=0.59, 950% CI=0.38-0.91). Those with lower acculturation, higher body mass index, a social network discouraging smoking, home smoking restriction, correct beliefs about smoking harm, and significant concern about one's health were most likely to quit smoking for 90 days or longer. Results suggest that social and situational conditions should be included in the design of smoking cessation interventions among Koreans.

Kamperman AM; Komproe IH; de Jong JTVM. Migrant mental health: A model for indicators of mental health and health care consumption. Health Psychology 26(1): 96-104, 2007. (44 refs.)

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups.

Kulis S; Marsiglia FF; Hurdle D. Gender identity, ethnicity, acculturation, and drug use: Exploring differences among adolescents in the Southwest. Journal of Community Psychology 31(2): 167-188, 2003. (52 refs.)

This article presents the findings of a survey completed by 1351 predominantly Mexican American middle school students residing in a large urban center in the U.S. Southwest. The study explores possible associations between drug use attitudes and behaviors and gender (biological sex), gender identity, ethnicity, and acculturation status. Based on the concepts of "machismo" and "marianismo" that have been used to describe Mexican populations, four dimensions of gender identity were measured: aggressive masculinity, assertive masculinity, affective femininity, and submissive femininity. In explaining a variety of indicators of drug use behaviors and anti-drug norms, gender alone had limited explanatory power, while gender identity-often regardless of gender - was, a better predictor. Aggressive masculinity was generally associated with higher risk of drug use, while the other three gender identity measures had selected protective effects. However, the impact of gender identity was strongly mediated by acculturation. Less acculturated Mexican American students reported lower aggressive masculinity scores than non-Latinos. Less acculturated Mexican American girls reported both the lowest aggressive masculinity scores and the highest submissive femininity scores. More acculturated Mexican American students, along with the less acculturated Mexican American boys, did not appear to be following a polarized approach to gender identity (machismo and marianismo) as was expected. The findings suggest that some aspects of culturally prescribed gender roles can have a protective effect against drug use behaviors and attitudes, possibly for both girls and boys.

La Rosa MR; Holleran LK; Rugh D; MacMaster SA. Substance abuse among Puerto Rican and Dominican gang members in a small city setting. Journal of Social Work Practice in the Addictions 5(1/2): 21-43, 2005. (26 refs.)

Joining a gang increases an adolescent's risk for substance abuse. To better understand the contextual development of drug use behavior, this retrospective ethnographic study describes a sample of 76 young small-city mainland Puerto-Rican and Dominican males who joined gangs when they were younger. Data is presented and discussed on the drug abuse behavior including their drug using progression and the context in which such use occurs. The young average age of onset 11.2 (sd = 2.6) combined with the rapid progression to more dangerous drugs, which generally occurs within six years, demonstrates the elevated risk associated with small city gang membership. Differences in the patterns of drug use were also found between the English and Spanish speaking groups. The authors discuss the implications of the study findings on the development of interventions. Recommendations address future research possibilities on drug abuse within Latino gangs.

Landrine H; Klonoff EA. Culture change and ethnic-minority health behavior: An operant theory of acculturation. (review). Journal of Behavioral Medicine 27(6): 527-555, 2004. (194 refs.)

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.

Lindquist J. Veils and ecstasy: Negotiating shame in the Indonesian borderlands. Ethnos 69(4): 487-508, 2004. (65 refs.)

'Malu', meaning approximately shame or embarrassment, is a key emotional trope for contemporary Indonesian migrants. This paper discusses the position of 'malu' in the lives of young female migrants who work as factory workers or prostitutes on the rapidly developing Indonesian island of Batam, located on the border with Peninsular Malaysia and Singapore. It shows how veiling and the drug 'ecstasy' have both become techniques for migrants to negotiate 'malu' in the context of the demands of migration and the contradictions of everyday life on Batam.

Lopez-Gonzalez L; Aravena VC; Hummer RA. Immigrant acculturation, gender and health behavior: A research note. Social Forces 84(1): 581-593, 2005. (35 refs.)

Previous research shows that the health behavior of immigrants is favorable to that of native-born adults in the United States. We utilize pooled data from the 1998-2001 National Health Interview Surveys and multinomial logistic regression techniques to build on this literature and examine the association between acculturation and immigrant smoking and alcohol use. We also examine how acculturation relates to health behaviors by gender. Results indicate that the health behavior of more acculturated immigrant women is less positive than that of less acculturated women. For men, acculturation seems to make little difference for health behavior. Thus, it is important to not only consider how acculturation is related to health, but how the acculturation process differs across population subgroups.

Losoya SH; Knight GP; Chassin L; Little M; Vargas-Chanes D; Mauricio A et al. Trajectories of acculturation and enculturation in relation to heavy episodic drinking and marijuana use in a sample of Mexican American serious juvenile offenders. Journal of Drug Issues 38(1): 171-198, 2008. (73 refs.)

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.

Luengo MA; Kulis S; Marsiglia FF; Romero E; Gomez-Fraguela JA; Villar P et al. A cross-national study of preadolescent substance use: Exploring differences between youth in Spain and Arizona. Substance Use & Misuse 43(11): 1574-1596, 2008. (47 refs.)

This study aims to comparatively examine drug use in Arizona and Spain, in order to know if similarities and differences in drug use patterns justify the administration in Spain of U.S. prevention intervention programs. Data were obtained from independent samples of seventh-grade students recruited from urban public schools and surveyed in 1998: 4,035 ethnically diverse Arizona students (Latinos and non-Hispanic Whites), and 2,243 Spanish-White students. Comparisons using Odds ratios and Chi-square tests allowed assessment of differences in drug use rates between preadolescents in Arizona and Spain taking into account gender. Furthermore, ethnicity differences in preadolescent drug use and in psychosocial risk factors were explored using multivariate analysis (ANOVA and logistic regression). Our results showed similar trends in drug use between Arizona and Spain students, with gateway drugs already in use by early adolescents, and with higher rates of drug use among males than among females. However, cross-national differences in marijuana/cannabis use were noteworthy: Arizona preadolescents were over 25 times more likely to report marijuana/cannabis use than preadolescents from Spain. Moreover, when ethnic differences were considered, Latinos in Arizona reported higher marijuana/cannabis use compared with non-Latino students. Drug use patterns among Latino preadolescents, as well as the relevance of some risk factors among the diverse groups, were strongly influenced by their level of acculturation. Study limitations and the implications of our findings for early drug use prevention and future research are discussed.

Marsiglia FF; Kulis S; Wagstaff DA/Elek E; Dran D. Acculturation status and substance use prevention with Mexican and Mexican-American youth. Journal of Social Work Practice in the Addictions 5(1/2): 85-111, 2005. (58 refs.)

This study examined whether language preference, as an indicator of acculturation, moderated the effects of a culturally grounded substance use prevention intervention for Mexican and Mexican American middle school students (N = 2,146) in Phoenix, Arizona. The main hypothesis was that levels of program effectiveness would vary based on the language preference of the students and the specific culturally grounded version of the intervention they were assigned. Findings show that matching language preference to particular versions of the intervention did not influence substance use related program outcomes, but that overall program effects (intervention versus control) did vary by language preference. English-language dominant participants, the most at risk sub-group, responded more positively to the intervention, while Spanish dominant, who had low substance use rates at baseline, and bilingual participants did not demonstrate significant differences between the intervention and control groups. Implications for school social work prevention interventions and prevention science in general, are discussed.

Martinez CR; Eddy JM; DeGarmo DS. Preventing substance use among Latino youth. IN: Sloboda Z; Bukoski WJ, eds. Handbook of Drug Abuse Prevention: Theory, Science, and Practice. New York: Kluwer Academic/Plenum Publishers, 2003. pp. 365-380. (93 refs.)

This is one of several chapters that considers substance abuse prevention from the perspective of special populations. This chapter considers issues related to preventing substance use among Latino youth. The chapter begins with a discussion of the epidemiology of substance use patterns. Compared to other segments of the population, the Latino population is relatively youthful. While rates of drug use have not been higher for Latinos than other groups, they are rising. Attention then turns to the etiology of substance use, with a focus upon a social interaction learning perspective and also the impact of acculturation. The implications for prevention are discussed.

McQueen A; Getz JG; Bray JH. Acculturation, substance use, and deviant behavior: Examining separation and family conflict as mediators. Child Development 74(6): 1737-1750, 2003. (92 refs.)

This longitudinal study examined how separation and family conflict mediated the effects of two acculturation variables (English language use and generational status) on substance use (alcohol, tobacco, and marijuana use) and deviant behavior outcomes in a Mexican American high school age sample. Structural equation modeling indicated that separation was a significant mediator of the relationship between acculturation and alcohol use, tobacco use, and deviant behavior. Family conflict mediated the effects of acculturation on marijuana use and deviant behavior. Model comparisons across gender groups suggested that generational status was an influential acculturation measure for females but not males. Additionally, English language use maintained a direct effect on marijuana use among females, whereas this relationship was mediated by separation for males.

Miller JM; Miller HV; Zapata JT; Yin ZN. Mexican-American youth drug use and acculturation: A note on the mitigating effects of contextual dynamics. Journal of Drug Issues 38(1): 199-214, 2008. (38 refs.)

This study reexamines the relationship between acculturation and illicit drug use among a sample of Mexican-American adolescents in South Texas (n=3,186). Logistic regression was used to test the relationship between marijuana and cocaine use and two acculturation scales while controlling for structural properties and social dynamics characterizing use environment. Findings suggest that acculturation correlates with increased use of both substances when operationalized by language but not when measurement is based in social interaction. Gang membership was found to be a more explanative indicator of drug use than acculturation, suggesting that Mexican-American drug use is better understood through utilization of models factoring delinquent peer effects.

Mogro-Wilson C. The influence of parental warmth and control on Latino adolescent alcohol use. Hospanic Journal of Behavioral Sciences 30(1): 89-105, 2008. (36 refs.)

Latino adolescent alcohol use is related to substance use, later life addiction, and other negative outcomes. The lack of knowledge on parenting and the parent-youth relationship in Latino families in the context of acculturation and its affects on alcohol use prompted this study. Secondary data analysis using the Add Health data set indicates that high amounts of parental control function positively for Latino families, contrary to some findings for non-Latinos. In addition, parental warmth significantly reduced alcohol use and also positively affected the parent-youth relationship which decreased alcohol use. When families spoke English at home, parental control decreased which lead to an increase in alcohol use. A critical examination of the implications for the cultural understanding of parental influences on adolescent alcohol use is discussed. Findings indicate that there are unique family mechanisms for Latino families that should be considered when developing intervention options.

Office of Applied Studies; Brown JM; Council CL; Penne MA; Gfroerer JC. Immigrants and Substance Use: Findings from the 1999-2001 National Surveys on Drug Use and Health. Analytic Series A-23. Rockville MD: Office of Applied Studies, SAMHSA, 2005. (35 refs.)

This report is organized into 4 chapters and three appendices. It provides information on alcohol, tobacco, and illicit drug use among immigrants aged 18 or older in the United States during 1999-2001. The data are based on the National Survey on Drug Use and Health (NSDUH), an annual survey conducted by NIDA since 1971. Among the findings are that [1] The rates of alcohol use were lower among immigrants than among U.S.-born adults. This was true for past year use (54.3 vs. 67.8 percent), past month use (39.5 vs. 52.4 percent), past month binge use (16.9 vs. 22.3 percent), past month heavy use (3.0 vs. 6.5 percent), and the average number of drinks per week among current drinkers (6.3 vs. 8.3). [2] Among adult immigrants who were current drinkers, per capita alcohol consumption in the country of birth was associated with the current weekly alcohol consumption. [3] Rates of tobacco use were lower among immigrants than among U.S.-born adults. This was true for past year use (24.8 vs. 38.2 percent) and past month use (20.4 vs. 32.8 percent). [4] Rates of illicit drug use were lower among immigrants than among U.S.-born adults. This was true for past year marijuana use (3.5 vs. 8.8 percent), past month marijuana use (1.7 vs. 5.1 percent), past year any illicit drug use (6.0 vs. 11.5 percent), and past month any illicit drug use (2.9 vs. 6.6 percent). [5] Rates of substance use were associated with the length of time immigrants had been in the United States, those in the U.S. for 5 or more years were more likely to be drinkers, to use marijuana, an illicit drug, or tobacco. [6] The substance use patterns of immigrants from 16 selected countries showed wide variations. It demonstrated that comparisons of broad regions, e.g. Asia or Central America is likely to mask differences within the region. [7] Past month alcohol use rates among immigrants from the United Kingdom (67.5 percent) and Canada (64.5 percent) were significantly higher than the rate among U.S.-born adults (52.4 percent). Immigrants born in the Philippines (24.1 percent), Vietnam (26.4 percent), India (26.6 percent), and China (28.4%) had rates significantly below rates among immigrants from other selected Asian countries (Japan, 62.1 percent; Korea, 53.2%) and among U.S.-born adults. [8] None of the 16 countries studied showed adult immigrant populations with past month tobacco use rates higher than the U.S. rate (32.8%). Among the Latin American countries studied, rates ranged from 12.1% among immigrants from Jamaica to 31.0% among immigrants from Puerto Rico. Similarly, there was wide variation among Asian countries, with Korean-born immigrants having a rate of 30.2%, while the lowest rates were found among those born in China (10.1%), India (10.2%), and the Philippines (13.5%). [9] Immigrants from several countries had rates of past month illicit drug use that were similar to the U.S.-born rate of 6.6%. These included Japan, Puerto Rico, Korea, Jamaica, Poland, Germany, and the United Kingdom. Low rates of illicit drug use were found among immigrants from China, Cuba, the Philippines, and India. The data is presented in 17 figures and 20 tables.

Pantin H; Schwartz SJ; Sullivan S; Coatsworth JD; Szapocznik J. Preventing substance abuse in Hispanic immigrant adolescents: An eco-developmental, parent-centered approach. Hispanic Journal of Behavioral Sciences 25(4): 469-500, 2003. (38 refs.)

This article discusses the challenges that Hispanic immigrant families face and reviews the potential negative consequences of these challenges for Hispanic adolescents. The article outlines the theoretical background, goals, and intervention components of Familias Unidas, a substance-abuse-prevention program for poor immigrant Hispanic adolescents and their parents. Familias Unidas is an ecodevelopmentally based, parent-centered intervention delivered by way of parent participatory-learning groups, parent-adolescent discussion circles, and periodic home visits. Through participation in Familias Unidas, parents acquire skills for communicating with and supporting their adolescents, managing adolescent behavior problems, and becoming actively involved in their adolescents' social and academic lives, all of which are protective against substance abuse. This article delineates the key intervention principles of Familias Unidas that increase parental involvement and collaboration within the adolescents' family, school, and peer worlds and, as a result, improve adolescents' functioning in these areas.

Pena JB; Wyman P; Brown C; Matthieu M; Olivares T; Hartel D et al. Immigration generation status and its association with suicide attempts, substance use, and depressive symptoms among Latino adolescents in the USA. Prevention Science 9(4): 299-310, 2008. (41 refs.)

This study investigated the relation between suicide attempts and immigrant generation status using the Latino subset of the National Longitudinal Study of Adolescent Health, a school-based, nationally representative sample. This study also examined whether generation status predicted risk factors associated with elevated suicide behaviors, namely illicit substance use, problematic alcohol use, and depressive symptoms. Finally, hypothesizing that elevated depressive symptoms and substance use mediate the relation between immigrant generation status and suicide attempts among Latino adolescents, a path model was tested. Our findings revealed immigrant generation status was a determinant for suicide attempts, problematic alcohol use, repeated marijuana use, and repeated other drug use for Latino adolescents. US-born Latinos with immigrant parents (i.e., second-generation youth) were 2.87 (95% CI, 1.34, 6.14) times more likely to attempt suicide, 2.27 (95% CI, 1.53, 3.35) times more likely to engage in problematic alcohol use, 2.56 (95% CI, 1.62, 4.05) times more likely to engage in repeated marijuana use, and 2.28 (95% CI, 1.25, 4.17) times more likely to engage in repeated other drug use than were foreign-born youth (i.e., first-generation youth). Later-generations of US-born Latino youth with US-born parents were 3.57 (95% CI, 1.53-8.34) times more likely to attempt suicide, 3.34 (95% CI, 2.18-5.11) times more likely to engage in problematic alcohol use, 3.90 (95% CI, 2.46, 6.20) times more likely to engage in repeated marijuana use, and 2.80 (95% CI, 1.46, 5.34) times more likely to engage in repeated other drug use than were first-generation youth. Results from the path analysis indicated that repeated other drug use may mediate the effect of generation status on suicide attempts.

Rahman MM; Luong NT; Divan HA; Jesser C; Golz SD; Thirumalai K et al. Prevalence and predictors of smoking behavior among Vietnamese men living in California. Nicotine & Tobacco Research 7(1): 103-109, 2005. (22 refs.)

Vietnamese populations in Vietnam and the United States have a high prevalence of smoking. The associations among behavioral risk factors, acculturation, and smoking among the Vietnamese population living in the United States are not well documented. The present study aimed to identify the factors associated with smoking behavior among Vietnamese men living in Santa Clara County, Californiaornia. A cross-sectional random-digit-dialed telephone survey was conducted. The sampling frame consisted of 27 Vietnamese surnames from the Santa Clara County telephone directory. A total of 660 adult respondents were interviewed to collect information on general health status, alcohol and tobacco use, HIV/AIDS, sexual behavior, injury control, hypertension, cholesterol screening, and acculturation. Of the 660 adults interviewed, 364 (55.2%) were male and 296 (44.8%) were female. Among males, 31.9% were current smokers, and among females, only one woman reported smoking. Univariate analyses revealed that having less than a college education, having poor English language skills, using Vietnamese at home and with friends, being less acculturated, not having a routine physical or blood cholesterol check, and being a binge drinker were significantly associated with an increased likelihood of smoking. Multivariate analysis revealed two independently associated factors: Respondents who were more acculturated were less likely to smoke (OR=0.38, 95% CI=0.18-0.83), and those not having cholesterol checked were more likely to smoke (OR=2.48, 95% CI=1.30-4.71). Acculturation level was inversely associated with smoking among Vietnamese adult men in Santa Clara County. Other health risk behaviors coexisted with smoking behavior and should be considered in prevention programs.

Ramirez JR; Crano WD; Quist R; Burgoon M; Alvaro EM; Grandpre J. Acculturation, familism, parental monitoring, and knowledge as predictors of marijuana and inhalant use in adolescents. Psychology of Addictive Behaviors 18(1): 3-11, 2004. (37 refs.)

The authors investigated relationships between marijuana and inhalant use and several cultural and demographic factors in Anglo American and Hispanic American adolescents (N = 1,094). Outcome measures assessed lifetime and 30-day marijuana and inhalant use. Predictors and covariates used in logistic regression analyses were region, grade, gender, knowledge, acculturation, familism, and parental monitoring. Hispanic Americans exhibited higher usage across all measures. In this group, high acculturation was associated with low marijuana, but high inhalant, use. Across all participants, positive family relations and parental monitoring were strongly associated with attenuated marijuana use but only among those most knowledgeable about drugs. Familism and monitoring were not associated with diminished usage among the less knowledgeable. For inhalants, monitoring combined with high knowledge or high familism was associated with diminished usage.

Rodriguez RA; Henderson CE; Rowe CL; Burnett KF; Dakof GA; Liddle HA. Acculturation and drug use among dually diagnosed Hispanic adolescents. Journal of Ethnicity in Substance Abuse 6(2): 97-113, 2007

With drug abuse among Hispanic youth on the rise, examining cultural factors such as acculturation may provide insight into understanding and addressing this problem. This study examined the relationship between acculturation and severity of drug use among a sample of severely impaired Hispanic adolescents referred for residential substance abuse treatment. As recent studies with clinical samples have found, it was hypothesized that lower levels of acculturation would be associated with higher levels of substance use. Results indicated that youth born outside the United States reported greater frequency of drug use at intake into treatment than those born in the United States, supporting the hypothesis.

Rohrbach LA; Trinidad DR; Unger JB; Weiss JW. Acculturation as a risk factor for smoking among Asian American adolescents: Is the association confounded by nationality? Journal of Ethnicity in Substance Abuse 3(1): 65-79, 2004

Acculturation to the United States is associated with tobacco use among Asian American adolescents. Previous studies have not controlled for the possible confounding effects of national origin. This study analyzed data from statewide surveys of 2093 Asian-American 10th grade California adolescents. Logistic regression analyses evaluated the independent effects of nationality and acculturation on past-month smoking. Consistent with previous studies, acculturation was a risk factor for smoking. When nationality was added to the model, acculturation became no significant and nationality became significant. Differences in smoking prevalence across groups were due to low smoking rates among Vietnamese-American and Chinese-American students and higher rates among Korean-American and Japanese-American students. Within each national subgroup, acculturation was not associated significantly with smoking. Research on acculturation and smoking among Asian-American adolescents should consider national origin.

Romano EO; Tippetts AS; Voas RB. Language, income, education, and alcohol-related fatal motor vehicle crashes. Journal of Ethnicity in Substance Abuse 5(2): 119-37, 2006

This paper investigates the role of race/ethnicity, language skills (a proxy for acculturation among Hispanic in Arizona, California, New Mexico, and Texas), income, and education level on alcohol-related fatal motor vehicle crashes. Using the Fatality Analysis Reporting System (FARS), we confirmed previous state-based studies showing that high income and education levels have a protective influence on alcohol-related fatal motor vehicle crashes. We also confirmed that language proficiency/acculturation tends to increase the vulnerability of Hispanic women to alcohol-related fatalities. Differences in alcohol-related fatality rates across Hispanic subgroups are observed. Future reductions in alcohol-related traffic fatalities may require prevention policies that take into account existent variations in acculturation, income, and education among racial/ethnic groups and subgroups.

Romero RA; Messer K; West JH; White MM; Trinidad DR. Smoking trends among Filipino adults in California, 1990-2002. Preventive Medicine 46(4): 336-339, 2008. (15 refs.)

Objectives. Filipinos comprise about 18% of the Asian/Pacific Islander American (APIA) population and are increasing. Few studies have examined Filipino current smoking prevalence rates (CSPR) and none have described trends over time. Methods. Trends in CSPR were estimated for Filipinos and non-Hispanic whites (NHW) from 1990-2002 from the California Tobacco Surveys (N > 42,000/year). Results. CSPR for Filipino males declined: 23.7% (95% CI: 18.7, 28.7) in 1990 to 18.7% (15.3, 22.1) in 2002 (p < 0.05). The decline in CSPR for Filipino women was non-significant (p = 0.24),9.8% (5.5, 14.1) in 1990 and 7.7% (5.3, 10.1) in 2002. During the same period, CSPR among NHW males declined: 24.4% (23.8, 25.0) in 1990 to 18.8% (18.1, 19.4) in 2002 (p < 0.01). For female NEW, CSPR were 21.3% (20.5, 22.0) in 1990 and 15.0% (14.4, 15.6) in 2002 (p < 0.01). Adjusted logistic regression for Filipinos suggest that English language use is associated with current smoking among females (p < 0.01) and that, overall, 18-29 year-olds were more likely to be current smokers than those 45+ years old (p < 0.01). Conclusion. Trends for male Filipino current smokers declined similarly to male NEW from 1990-2002; female rates were lower but did not decline. Future smoking prevention and cessation programs would benefit by taking into account important differences in smoking rates between genders and age groups.

Ross AJ; Heim D; Bakshi N; Davies JB; Flatley KJ; Hunter SC. Drug issues affecting Chinese, Indian and Pakistani people living in Greater Glasgow. Drugs: Education, Prevention and Policy 11(1): 49-65, 2004. (41 refs.)

This paper describes research on drug issues affecting Chinese, Indian and Pakistani people living in Greater Glasgow. There were two strands: (i) a questionnaire-based survey of young people and focus groups; (ii) interviews with young people and adults. The primary aims were to gather prevalence data and to investigate perceptions about current service provision. A methodological discussion also takes place as to the relationship between the quantitative and qualitative data gathered. Results show that use and misuse of drugs is reportedly present and increasing among young people in the three ethnic groups, with cannabis being the most prevalent drug. However, prevalence is still generally reported at lower levels than reported for the general population. Predictors of consumption include gender (male consumption higher), non-importance of religion, and higher consumption among friends from the same (self-identified) ethnic group. Service provision was felt to be insensitive to issues affecting Chinese, Indian and Pakistani groups. Specific issues (religious, cultural, social) that need to be addressed by service providers are outlined. A general conclusion is that choices should be available, and stereotypes and general assumptions should be avoided.

Safer AM; Piane G. Analysis of acculturation, sex, and heavy alcohol use in Latino college students. Psychological Reports 101(2): 565-573, 2007. (22 refs.)

24% of 917 students at California State University Long Beach who completed an alcohol use survey in 2002 (73% response) identified themselves as Latino. Because measures of acculturation reported in most adult studies positively correlated with alcohol use and sex, it was hypothesized that these associations might also apply to Latino college students. With increasing levels of acculturation, women but not men in this Latino college sample reported significantly greater occurrence of heavy drinking, positive attitudes about drinking, and perception that most of their friends use alcoholic beverages.

Saint-Jean G; Crandall LA. Psychosocial mediators of the impact of acculturation on substance abuse among Hispanic youth: Findings from the Florida youth substance abuse survey. Journal of Child & Adolescent Substance Abuse 17(4): 133-152, 2008. (38 refs.)

The objective of the study was to identify and evaluate factors that are associated with differences in substance abuse between non-acculturated and acculturated Hispanic youth. We employed t-test and logistic regression to analyze self-reported survey data from 8,200 self-described Hispanic students. The outcome variable was past 30-day use of marijuana and the key independent variable was language used at home (English/Spanish). The covariates were 32 psychosocial risk and protective factors for drug use. All the risk factor scores that were significantly different for the two groups had higher means, indicating greater risk, for English-speakers, while all the seven protective factors that were significantly different had higher mean scores, indicating greater protection, for the Spanish speakers. In multivariate analysis, the odds ratios for language used at home range from 1.60 (p < 0.00) for the basic model to 1.05 (p = 0.62) for models that incorporated the psychosocial factors. Findings confirm literature reports suggesting that language used at home is a strong predictor of adolescent substance use. This effect may be mediated principally through the family and peer/individual psychosocial domains.

Santisteban DA; Mena MP; Suarez-Morales L. Using treatment development methods to enhance the family-based treatment of Hispanic adolescents. IN: Liddle HA; Rowe CL, eds. Adolescent Substance Abuse: Research and Clinical Advances. Cambridge: Cambridge University Press, 2006. pp. 449-470. (76 refs.)

This is one of two chapters in Part V dealing with culturally based treatment development for adolescent substance abusers. Prior to the authors' description of their involvement in generating integrative family therapy approaches for Hispanic adolescents, they address the short-comings of current efforts to promote cultural competence. The chapter addresses the cultural related variables and processes, acculturation and its relationship to externalizing behaviors, to parenting practices, and to immigration experiences. The process of the development of the model is highlighted, with discussion of efforts to incorporate the relevant literature, the use of pilot cases, the creation of thematic modules, and a flexible manual design.

2006, Project Cork

Shelley D; Fahs M; Scheinmann R; Swain S; Qu JJ; Burton D. Acculturation and tobacco use among Chinese Americans. American Journal of Public Health 94(2): 300-307, 2004. (35 refs.)

Objectives: We examined the relationship between acculturation and tobacco use behaviors among Chinese Americans. Methods: Using a Chinese-language instrument based on validated questions from several national surveys, we conducted in-person, household-based interviews with 712 representative adults aged 18-74 years. Results: Observed smoking prevalence was 29% for men and 4% for women. Predictors of smoking cessation included being 35 years and older and having a high level of tobacco-related knowledge. Acculturation was positively associated with a history of never smoking, as was being younger than 35 years and having a high level of tobacco-related knowledge. Conclusions: Acculturation was positively associated with never smoking among men but not with smoking cessation. However, knowledge of tobacco-related health risks was associated with both. Results indicate a need for language-specific educational interventions.

Song YJ; Hofstetter CR; Hovell MF; Paik HY; Park HR; Lee J; Irvin V. Acculturation and health risk behaviors among Californians of Korean descent. Preventive Medicine 39(1): 147-156, 2004. (30 refs.)

Background. This study examined the effects of acculturation on health behaviors among Korean-Americans in California compared to Koreans in Seoul. Methods. Telephone interviews were conducted with 2,830 Korean-American adults in California (completion rate exceeding 86%) and 500 Korean adults in Seoul (completion of about 50%). Results. Among Korean-Americans, acculturated women were more likely to smoke and drink while acculturated men were more likely to become obese. All Korean-American men reported significantly decreased rates of smoking and drinking compared to Koreans in Seoul. Among both men and women in California, acculturation was associated with high consumption of American foods, and low consumption of traditional Korean foods. Conclusions. These results indicate that more acculturated Korean-Americans were exposed to greater health risk than those who were less acculturated.

Steenbeek A; Tyndall M; Rothenberg R; Sheps S. Determinants of sexually transmitted infections among Canadian Inuit adolescent populations. Public Health Nursing 23(6): 531-534, 2006. (8 refs.)

The health status of Canadian Inuit is considerably lower than that of their ancestors. The introduction of previously unknown diseases (e.g., tuberculosis), substance abuse (e.g., alcohol), and Western customs have permanently altered this population. As a result of Western assimilation, many Inuit have distanced themselves from their land and severed their ancestral ties. Consequently, many are now mired in a state of widespread poverty and malnutrition and have severe health problems (e.g., addictions) and communicable diseases, such as sexually transmitted infections (STIs). The purpose of this case report is to provide an overview of the STI crisis that exists among Canadian Inuit. More specifically, this case study is intended to assist public health nurses working in Inuit communities in understanding how certain determinants (e.g., Westernization, culture) may influence STI transmission among Inuit youth and, how to incorporate these determinants into nursing practice. Inuit adolescents have been subjected to intense acculturation pressures that do not exist for other adolescent populations. These pressures are creating problems for youth in their transition from childhood and adulthood; they also impact on the struggle to establish their own identity, caught between two opposing cultures: their native culture and the wider Canadian one.

Tang H; Shimizu R; Chen MS. English language proficiency and smoking prevalence among California's Asian Americans. Cancer 104(12, Supplement S): 2982-2988, 2005. (33 refs.)

The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females.

Tong EK; Nguyen TT; Vittinghoff E; Perez-Stable EJ. Smoking behaviors among immigrant Asian americans: Rules for smoke-free homes. American Journal of Preventive Medicine 35(1): 64-67, 2008. (20 refs.)

Background: Higher acculturation is associated with Asian-American smoking prevalence decreasing in men and increasing in women. Asian immigrants in California are significantly more likely than their counterparts in Asia to have quit smoking. Smoke-free environments may mediate this acculturation effect because such environments are not widespread in Asia. Methods: In 2006, Asian-American current and former smokers were analyzed using the 2003 California Health Inter-view Survey. A multivariate logistic regression analysis examined how the interaction between having a smoke-free-home rule and immigrating to the U.S. is associated with status as a former smoker and lighter smoking. Results: For recent Asian immigrants (< 10 years in the U.S.) and longer-term residents (born/>= 10 years in the U.S.), having a smoke-free-home rule was associated with status as a former smoker (OR 14.19, 95% CI = 4.46, 45.12; OR 3.25, 95% CI = 1.79, 5.90, respectively). This association was stronger for recent immigrants (p=0.02). Having a smoke-free-home rule was associated with lighter smoking only for longer-term residents (OR 5.37, 95% CI = 2.79, 10.31). Conclusions: For Asian Americans, smoke-free-home rules are associated with status as a former smoker, particularly among recent immigrants, and lighter smoking in long-term residents. Interventions encouraging Asian Americans to adopt smoke-free-home rules should be evaluated.

Tonin SL; Burrow-Sanchez JJ; Harrison RS; Kircher JC. The influence of attitudes, acculturation, and gender on substance use for Mexican American middle school students. Addictive Behaviors 33(7): 949-954, 2008. (7 refs.)

The present study tested if current drug use was related to acculturation (measured by language spoken at home), gender, or youth attitudes towards drugs in a large sample of 8th grade, predominantly Mexican American, Hispanic youth. The data were obtained via self-report survey from 2964 Hispanic youth in 108 schools. Hierarchical linear modeling (HLM) was used to test if acculturation, gender, or youth attitudes towards drugs predicted past 30-day use of alcohol, inhalant, or marijuana use and assess school-level influences. Acculturation and gender interacted with attitudes towards drugs to predict current alcohol use. Gender interacted with attitudes towards drugs to predict current alcohol and inhalant use. Having positive attitudes towards drugs was related to increased substance use for all three drug types. Hispanic eighth grade girls had significantly higher use rates than boys for both alcohol and inhalants. Additional research is needed to better understand the influence of acculturation on substance use among Hispanic youth.

Torres LR; Pena JB; Westhoff WW; Zayas LH. Across-national comparison of adolescent alcohol and drug use behaviors: U. S. Hispanics and youth in the Dominican Republic. Journal of Drug Issues 38(1): 149-170, 2008. (31 refs.)

The prevalence of substance use behaviors during adolescence is an important concern in the United States and internationally. Of particular importance to the U.S. is our ability to compare prevalence estimates and trends with those of neighboring countries, particularly those that feed our immigrant population and have a circulatory migration pattern with us. One of the fastest-growing Hispanic groups is Dominicans, who are also a young group, with a third of Dominicans in the United States under age 18. However cross-national comparisons of the substance use rates of youth in the U. S. and the Dominican Republic have not been done. Our study represents, to our knowledge, the first such comparison. We conducted a secondary data analysis comparing data from the U.S. Center for Disease Control and Prevention's (CDC) 1997 Youth Risk Behavior Survey (YRBS), a biennial survey in the U.S., to data from a survey conducted by the Ministry of Education of the Dominican Republic in 1997. The Dominican Republic survey used a similar sampling methodology and the Spanish version of the YRBS, piloted and modified to ensure linguistic and cultural appropriateness. Youth in the United States in general, and U.S. Hispanic youth in particular, consistently reported higher lifetime and recent use of alcohol, marijuana, and cocaine than youth in the Dominican Republic. Our study supports other cross-national comparisons that have found rates of substance use for youth in Latin America lower than those for youth in the United States. Cross-national comparisons of this nature help each individual country inform its social policies around prevention. They may also allow us to examine the impact of immigration, acculturation, and return migration processes on adolescent substance use in both countries.

Trinidad DR; Unger JB; Chou CP; Johnson A. Emotional intelligence and acculturation to the United States: Interactions on the perceived social consequences of smoking in early adolescents. Substance Use & Misuse 40(11): 1697-1706, 2005. (19 refs.)

High emotional intelligence (El) is associated with decreased adolescent smoking. Acculturation to the United States is a risk factor for adolescent smoking. High El may buffer the relationship between acculturation to the United States and perceptions of the social consequences of smoking (PSC). Emotional intelligence is the ability to: accurately perceive, appraise, and express emotion; access and/or generate feelings in facilitating thought; understand emotion and emotional knowledge; and regulate emotions. Emotional intelligence (measured by the Multifactor Emotional Intelligence Scale, Adolescent Version), acculturation, and PSC were assessed in 2001 from 416 Southern California sixth graders (47% boys; mean age = 11.3 yrs; 32% Hispanic Latino, 29% Asian/Pacific Islander, 13% White, 19% Multiethnic, 6% Other). There was a significant EI x US acculturation interaction(p < 0.01) suggesting that those with high El perceived more social consequences associated with smoking. As the U.S. population becomes increasingly diversified, identifying protective variables and designing effective prevention programs for adolescents of diverse ethnic and cultural backgrounds becomes important.

Turner RJ; Lloyd DA; Taylor J. Stress burden, drug dependence and the nativity paradox among US Hispanics. Drug and Alcohol Dependence 83(1): 79-89, 2006. (62 refs.)

It seems well established that exposure to social stress, including acculturation stress, increases risk for psychiatric and substance problems, and that the disadvantaged experience higher levels of such exposure. Such evidence points to the expectation that immigrant minority groups must be at elevated risk relative to their native-born counterparts. That the opposite appears to be true for various immigrant groups within the U.S. constitutes what has been referred to as the nativity health paradox. This paper examines the association between nativity and drug dependence among the distinctive and understudied Hispanic population of South Florida and attempts to evaluate competing explanations for the apparent advantage of immigrant populations. Based on data on a representative sample young adults of Cuban and other Hispanic backgrounds (n = 888), we found the paradox to be limited to women and confirmed the finding of prior research that acculturation plays a major role in explaining this difference in risk. We also found cumulative exposure to major and potentially traumatic events to be lower rather than higher among immigrants, to be a strong predictor of drug dependence and to contribute importantly toward accounting for observed nativity differences among women. Taken together. cumulative stress exposure and degree of acculturation explained 40% of the nativity difference. Finally, our results suggest that social support matters for risk primarily because such support more effectively acts to reduce exposure to social stress among foreign-born young Hispanic women.

Valencia EY; Johnson V. Acculturation among Latino youth and the risk for substance use: Issues of definition and measurement. Journal of Drug Issues 38(1): 37-68, 2008. (65 refs.)

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 s 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.

Verney SP; Kipp BJ. Acculturation and alcohol treatment in ethnic minority populations assessment issues and implications. Alcoholism Treatment Quarterly 25(4): 47-61, 2007

The roles of culture and ethnicity are crucial for understanding the relevance of personal and social factors involved in the drinking patterns of individuals. Research has shown that acculturative stress is associated with poorer health outcomes and may be linked to problematic drinking. This article briefly outlines issues including the construct of acculturation, measuring acculturation, and understanding the implications that it has with alcohol use in ethnic minorities. A study is presented that illustrates the association between acculturation and drinking patterns in older White and Hispanic veterans. Greater levels of past drinking were associated with more acculturation into the mainstream U.S. society for the Hispanic veterans. For the White veterans, greater levels of past drinking were associated with greater perceived discrimination and less comfort in mainstream U.S. society. Based on the literature, implications for clinical treatment are presented. Clinicians are called upon to understand the worldview of their clients and engage in culturally sensitive alcohol treatments.

Volkow ND. Hispanic drug abuse research: Challenges and opportunities. (editorial). Drug and Alcohol Dependence 84(Supplement 1): s4-s7, 2006. (48 refs.)

Wallby T; Hjern A. Parental region of birth, socio-economic status and infants' exposure to second-hand smoke. Acta Paediatrica 97(11): 1542-1545, 2008. (18 refs.)

Aim: To investigate the impact of parental region of birth on the risk of exposure to second-hand smoke for infants. Methods: The smoking habits, according to child health records, of parents of 14,431 infants in Uppsala county, Sweden, born during 1997-2001, were investigated with logistic regression in the presence of socio-economic and demographic confounders from national registers. Results: Fathers born outside of Sweden smoked more often than Swedish-born fathers irrespective of region of birth (adjusted odds ratios [ORs] 1.77-3-02). Mothers born in Africa (adjusted OR 0.29, 95% CI 0.15-0.58) and Asia (adjusted OR 0.53, 95% CI 0.40-0.70) smoked less often than Swedish-born mothers. Single parenthood, low income and mother's age <= 24 years increased the risk for parental smoking. Conclusion: The present study indicates that the risk of smoking in immigrant parents of infants is influenced by the smoking patterns in the region of birth. Smoke cessation interventions targeting fathers are particularly important in immigrant-dense neighbourhoods in Sweden.

Warner LA; Valdez A; Vega WA; de la Rosa M; Turner RJ; Canino G. Hispanic drug abuse in an evolving cultural context: An agenda for research. Drug and Alcohol Dependence 84(Supplement 1): s8-s16, 2006. (92 refs.)

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

Warner TD; Krebs CR; Fishbein DH. Perceiving the risk of substance use: The roles of nativity, acculturation, and family support among Hispanic children. Journal of Drug Issues 38(1): 119-147, 2008. (45 refs.)

The prevalence of substance use behavior and the personal characteristics and social and cultural factors that influence substance use among children have been studied extensively. However, much less attention has been directed at the attitudes towards, and particularly the perceived risks of, using substances, and even less research has focused on Hispanic youth, whose rates of substance use have been increasing. Understanding what factors are associated with perceived risk is important because there is evidence that perceived risk is associated with subsequent substance use. The current study uses longitudinal data collected from 553 children in the Cicero Youth Development (CYD) Project to identify individual and environmental factors associated with the perceived risk of substance use. We pay particular attention to dimensions of nativity and acculturation in an effort to determine whether there are differences in risk perception between U. S.-born Hispanic children and their foreign-born counterparts. Results indicate that a number of factors are associated with perceived risk, including family support, parent-child communication, peer substance use, and child temperament. Additionally, U.S.-born Hispanics perceive substances as less risky than immigrants, and among immigrants, length of time in the U.S. is negatively associated with perceiving great risk in substance use. Implications for policy and prevention strategies are discussed.

Weiss JW, Garbanati JA. Effects of acculturation and social norms on adolescent smoking among Asian-American subgroups. Journal of Ethnicity in Substance Abuse 5(2): 75-90, 2006

This study provides new information about how acculturation and perceived social norms affect adolescents smoking among four Asian-American subgroups. Results showed differences in smoking prevalence rates across subgroups, with Koreans having the highest rates of smoking, while Chinese have the lowest rates. In contrast to the large gender disparity in the ancestral countries, smoking rates were equal for Asian-American boys and girls. Acculturation was significantly associated with an increased risk for lifetime smoking for Asian-American girls, but not for boys. Perceived social norms regarding peer smoking were significantly associated with smoking behaviors for both genders and for all subgroups.

Wexler LM. Inupiat youth suicide and culture loss: Changing community conversations for prevention. Social Science & Medicine 63(11): 2938-2948, 2006. (45 refs.)

Inupiat living in Northwest Alaska have one of the highest youth suicide rates in the world. Other circumpolar peoples share this disturbing distinction. This demographic and ethnic health disparity has spurred research that investigates acculturation stress as a cause of Inuit youth suicide. Despite this body of knowledge, few studies describe how local people connect suicide to culture loss, even though this understanding is crucial for developing effective prevention and intervention strategies. This article describes how Inupiat understand and talk about youth suicide and suicide prevention within public settings. I have used participatory action research (PAR) to illuminate the meanings and processes that surround youth suicide. In meetings focused on suicide prevention, local people clearly link self-destruction with historical oppression, loss of the Inupiaq culture and current manifestations of these realities in alcoholism, abuse and neglect. This narrative typically focuses on young people and the Inupiaq community's current failure to lead them to a bright future. The article describes these understandings and offers suggestions to expand them in order to create new possibilities for community-based prevention and the promotion of wellness in circumpolar communities.

Wilkinson AV; Waters AJ; Vasudevan V; Bondy ML; Prokhorov AV; Spitz MR. Correlates of susceptibility to smoking among Mexican origin youth residing in Houston, Texas: A cross-sectional analysis:. BMC Public Health 8(e-article 337), 2008. (60 refs.)

Background: Survey data suggest that in Texas Latino youth exhibit higher rates of susceptibility to smoking than youth from other ethnic groups. In this analysis we examined the relationship between susceptibility to smoking and well-known risk factors associated with smoking initiation among a cohort of 11 to 13 year old Mexican origin youth residing in Houston, Texas. Methods: We analyzed cross-sectional survey data from 1,187 participants who reported they had never smoked, even a puff of a cigarette. The survey assessed peer and family social influence, school and neighborhood characteristics, level of family acculturation and socioeconomic status, and attitudes toward smoking. Bivariate associations, Student's t-tests, and logistic regression analysis were used to examine predictors of susceptibility. Results: Overall, 22.1% of the never-smokers were susceptible to smoking. Boys were more likely to be susceptible than girls (25.6% vs. 18.9%), and susceptible children were slightly older than non-susceptible children (12.1 vs. 11.8 years). In addition, multivariate analyses revealed that positive expectations about smoking exerted the strongest influence on susceptibility status (odds ratio = 4.85). Multivariate analyses further revealed that compared to non-susceptible participants, susceptibles were more likely to report peer influences supportive of smoking, lower subjective social status and more detentions at school, more temptations to try smoking and to have a mother and a brother who smokes. Conclusion: Our findings suggest that interventions that target positive expectations about smoking may be useful in this population. Furthermore, because youth encounter smoking-initiation risk factors in different social environments, our results underscore the continued need for both family- and school-based primary prevention programs to adequately combat their influence. The results also can be used to inform the development of culturally sensitive programs for Mexican origin youth.

Zamboanga BL; Raffaelli M; Horton NJ. Acculturation status and heavy alcohol use among Mexican American college students: Investigating the moderating role of gender. Addictive Behaviors 31(12): 2188-2198, 2006. (31 refs.)

We examined whether gender moderates the association between acculturation and heavy alcohol use. The sample consisted of 126 Mexican American college students (Mean age = 24.7 years; 57% female) who completed self-report measures of heavy alcohol use, acculturation status (global acculturation and ethnic identity), and relevant control variables (age, peer alcohol use). Multivariable regression revealed that higher levels of ethnic identity were associated with greater frequency of heavy alcohol among men. Conversely, neither measure of acculturation was associated with heavy alcohol use among women. These findings suggest that interventions for Latino/a students should consider the role of culturally relevant variables in heavy alcohol use, particularly for men. They also have implications regarding how acculturation is operationalized in alcohol studies, and suggest directions for future research.

Zemore SE. Acculturation and alcohol among Latino adults in the United States: A comprehensive review. Alcoholism: Clinical and Experimental Research 31(12): 1968-1990, 2007. (88 refs.)

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. Conclusion 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.

Zemore SE. Re-examining whether and why acculturation relates to drinking outcomes in a rigorous, national survey of Latinos. Alcoholism: Clinical and Experimental Research 29(12): 2144-2153, 2005. (32 refs.)

BACKGROUND: Fundamental limitations have hampered conclusions surrounding acculturation's effects among Latinos. This research re-examines associations between acculturation and alcohol use, addressing the most troubling of these limitations. The research also explores mediators of the association, and the dimensional structure of acculturation. METHODS: Linear regressions and scale analyses were used to analyze data from Latino adults in the U.S. (825 women, 761 men) sampled in the 1995 National Alcohol Survey. Analyses used a standard, reliable acculturation scale and well-validated drinking measures; systematically accounted for demographic covariates; and analyzed men and women separately. RESULTS: As expected, higher acculturation was positively associated with a higher probability of drinking (vs. abstinence) among women, and higher average volumes and more frequent drunkenness among female drinkers. Acculturation was unrelated to alcohol use among men. Also as expected, mediational analyses of average volume supported expectations that gender-specific drinking norms would mediate acculturation's effects (though norms did not explain acculturation's associations with either drinking status or frequency of drunkenness). Analyses investigating depressive symptoms showed no support for the acculturation-stress model. Factor analyses of the acculturation scale supported the hypothesized distinctions between linguistic acculturation, attitudinal acculturation, and the social environment of acculturation. Further, items implying more intimate exposure to Anglo culture (i.e., language use) were most strongly related to drinking outcomes among women, supporting the normative interpretation of acculturation's effects on drinking. CONCLUSIONS: Results underline acculturation's influence on alcohol consumption among Latina women, and highlight the role of drinking norms in mediating this association. Results also suggest a multidimensional view of acculturation. The article recommends further research on drinking norms and other potential mediators of acculturation's effects among Latina women.