shows the sociodemographic characteristics in the total Latino sample and separately for the U.S.-born and immigrant Latinos. U.S.-born Latinos comprised 41.6% of the total sample and immigrants 58.4%. (Note that persons born in Puerto Rico are U.S. citizens; and for persons of Puerto Rican origin in this study, “immigrant,” “U.S.-born,” and “arrival into U.S.” refer to someone born on the island now residing on the mainland, someone with mainland birthplace, and transition from island to mainland residence, respectively.) Overall, Mexican Americans were by far the largest Latino subgroup at 56.5%, followed by Puerto Ricans at 10.1%, and Cubans at 4.6%. Latinos originating from other locations made up the remainder (28.8%). U.S.-born Latinos were younger (median age 33 years) than immigrants (median age 36 years).
Immigrants had significantly lower levels of education than the U.S.-born: 36% of immigrants had no high school (less than 9 years of education) compared to only 10% of U.S.-born Latinos. The marital status differences between U.S.-born and immigrants are mostly due to younger age distribution of U.S.-born Latinos; once these rates are age-adjusted they show little difference. Of immigrants, about 40% arrived during childhood or adolescence (i.e., before age 18). About half of the U.S.-born reported that both parents were born in the U.S.
U.S.-born Latinos reported high levels of English proficiency (86.4%) and immigrants much lower levels (25.7%). Immigrants had high proficiency in Spanish (79.9%), and slightly over half of the U.S. born reported good or excellent Spanish proficiency (55.8%). For the vast majority of immigrants (74.5%), Spanish was spoken with family all of the time. Among U.S.-born Latinos, there was a more uniform distribution in language spoken with family, ranging from Spanish all of the time (12.2%) to Spanish and English equally (28.4%) to English all of the time (19.8%).
shows age-adjusted lifetime and last-year prevalence of DSM-IV alcohol and drug abuse or dependence for the total Latino sample and for U.S.-born and immigrant Latinos separately. All lifetime prevalences shown in for U.S.-born Latinos are significantly higher than corresponding prevalences for immigrants. About one in five U.S.-born Latinos had a lifetime history of a substance disorder, but only about one in 20 Latino immigrants had a history of SUD. For men, 28.4% of U.S.-born Latinos have a lifetime diagnosis for substance abuse or dependence compared to only 10.0% of immigrants. The difference is even more dramatic among females: only 0.8% of immigrant Latinas have a lifetime substance abuse or dependence diagnosis compared to 10.2% of the U.S.-born. Last-year prevalences show a similar relationship, although the U.S.-born versus immigrant comparison does not always reach statistical significance because of the lower prevalences, which reflect lower numbers of observed last-year diagnoses. Indeed, in the NLAAS Latino sample, no last-year diagnoses for any type of substance-use disorders were observed among immigrant women.
All subsequent analyses were restricted to persons younger than age 65 years because no women and only 9 men aged ≥65 years were observed with lifetime SUD in the Latino sample of NLAAS. Additionally, immigrants were subdivided into age of arrival categories (see ), and the U.S. born were categorized by the nativity of their parents (i.e., at least one parent U.S.-born or both parents foreign-born). shows prevalence by parents’ nativity of U.S born and age of arrival of immigrants for men and women. Tested jointly these 6 categories were strongly associated with lifetime SUD (p < 0.001 for both men and women from age-adjusted 2 × 6 tables). Since the association of age of arrival and SUD was significantly different between women and men (p = 0.005)—immigrant women arriving after 6 years of age had near zero prevalence of SUD—we performed further analyses separately for women and men. Logistic regressions (not shown) revealed that education, income, marital status, and Latino subethnicity (i.e., Mexican, Cuban, Puerto Rican, or other) were not significantly associated with SUD in both men and women when nativity, parents’ nativity of U.S born, and age of arrival of immigrants were controlled.
We looked at five language measures as predictors of lifetime SUD: English proficiency, Spanish proficiency, preferred language of thought, language spoken with friends, and language spoken with family. After controlling for nativity, parents’ nativity of U.S born, and age of arrival of immigrants, only language spoken with family was significantly associated with SUD after a Bonferroni correction of 5 (for testing the five language measures). shows the prevalence of lifetime SUD in men and women by language spoken with family, stratified by nativity, parents’ nativity of U.S born, and age of arrival of immigrants. Given this stratification, the difference in SUD prevalence between men who tend to speak more English with their family compared to men who speak more Spanish is about two-fold (OR = 2.5 with 95% confidence interval [1.4, 4.2] and p
= 0.002 from stratified logistic regression; see Methods); among women the difference is about threefold overall (OR = 3.3 [1.8, 6.1] with p
< 0.001 from stratified logistic regression). Since SUD prevalence among immigrant women is near zero for those arriving to the U.S. after 6 years of age, we repeated the analysis with an unweighted exact Mantel-Haenszel test (Cytel Inc., 2005
) and also omitted this group; results were similar.
shows results of the analyses used to evaluate the hypotheses that quality of relationships with family and friends will differ between Latinos with and without SUD. Here differences in family scale scores (support, harmony, pride, cohesion, and conflict) and friend scale scores (support and harmony) among those with and without a diagnosis of lifetime SUD are stratified by sex and adjusted for age. Scale scores were normalized to have mean zero and standard deviation one in the population represented by the sample. Note that positive scores on these scales indicate, respectively, more support, more harmony, more pride, more cohesion (all positive attributes), and more conflict (a negative attribute). Men and women with SUD reported significantly less family harmony, less pride, less cohesion and more conflict than those of the same sex without SUD. Women with SUD reported significantly more family support than those without SUD; the male difference for family support was small and nonsignificant. Among men, differences in friend scale scores were nonsignificant between those with and without SUD. However, women with SUD reported significantly higher friend support and lower friend harmony than women without SUD. This latter finding of differential directions of the association of SUD with the two friend scales is not surprising upon closer examination of the scales; they are negatively correlated (r = −0.27; p < 0.001), and both scales are likely representative of the overall frequency and intensity of the respondent’s relationships with friends; e.g., persons who gave positive responses to “How much can you open up to your friends if you need to talk about your worries?” (an item of the friend support scale) also reported that their friends make too many demands on them (an item of the friend harmony scale).
The five family scales were correlated in the pattern one would expect (with only one exception): support, harmony, pride, and cohesion all had positive pairwise correlations (the exception being support and harmony, which had a small negative correlation), and each of these four scales were negatively correlated with the family conflict scale. In order to see if the associations seen in still remained after controlling for parents’ nativity of the U.S. born, age of arrival of immigrants, family language use, and other demographic variables, we first ran factor analyses on the family and friend scales separately with both sexes combined to extract the first principal factors for each set of scales. Linear regression models were then fit (see ) with these factors as outcome variables (after normalizing the factors to have mean 0 and SD 1). Factor analysis for the family scales yielded a first principal factor with loadings as follows: support 0.28, harmony 0.21, pride 0.85, cohesion 0.81, and conflict −0.56. Clearly, this factor represents a positive family relationship. Factor analysis for the friend scales yielded a first principal factor with loadings proportional to 1 for the friend support scales and −1 for the friend harmony scale. As discussed earlier, this friend scales factor is reflective of the frequency and intensity of interactions with friends, whether positive or negative. Factor analyses run on the men and women separately yielded almost identical results. Linear regressions were also run on the individual scales (data not shown), and results were similar to that of the regressions for the principal factors, but were less powerful.
The first two data columns in show results of regressions for the first principal factor of the family scales, separately for men and women. Men with SUD have significantly lower values of the family scales factor compared to men without SUD (−0.35 SD) after controlling for other covariates. Tested jointly, differences among categories of parents’ nativity for U.S.-born men and age of arrival categories for immigrant men were marginally non significant (p = 0.06). Divorced, separated, or widowed men and never married men had significantly lower scores (joint test: p = 0.004). Interestingly, family language use was not significantly predictive for the family scales factor. No other covariates were significant among men in this and other models (other regression models, not shown, tested additional measures such as those shown in ). For women, parents’ nativity and immigrants’ age at arrival were significantly associated with the family scales factor (joint test: p < 0.001). SUD, however, was not significantly associated with the family scales factor in women. As with men, marital status was significant (p = 0.03) and family language use non significant.
The third and fourth columns in show regression results for the first principal factor of the friend scales. The model for men shows no significant association between the friend scales factor and SUD. For women, however, SUD is highly associated with the friend scales factor; on average the friend scales factor among women with SUD is about one half of a standard deviation higher than the factor among women without SUD. For women, education is also a highly significant predictor of the friend scales factor (p < 0.001) with more highly educated women having higher values on the factor (i.e., more contact with friends whether positive or negative).
In , we explore the relationship between the family and friend scales factors and last-year SUD. It is important to note that because family and friend scales factors characterize respondents’ current relationships, it would be inappropriate to use these scales to predict lifetime SUD; the onset of SUD may have occurred years before the date of the survey interview and current relationships may not be reflective of relationships prior to or coincident with SUD onset (or a prior time period with SUD). Additionally, because the prevalence of last-year SUD is relatively low, precluding multivariate analyses, the results in must be considered exploratory. In , persons are classified by whether their values on the family and friend factors are less than or equal to the median of the factor or greater than the median, and last-year SUD prevalence is shown by this classification. Also analyses are stratified by parents’ nativity for U.S. born and age of arrival of immigrants (for men) since these categories were shown to have significant (or nearly significant in the case of men) associations with the factors () and with SUD prevalence (). Consistent with relationships shown earlier, men with lower scores on the family scales factor had significantly higher past-year SUD rates (p
= 0.002) when stratified by parents’ nativity for the U.S. born and age of arrival for immigrants. For U.S.-born women, there was no significant association between past-year SUD rates and the family scales factor. For the friend scales factor in women, however, the association with past-year SUD prevalence was dramatic (p
< 0.001); essentially all women who had past-year SUD had a value of the friend scales factor that was above the median value of the factor. Since numbers in some of cells in this table were small, we repeated the statistical tests of significance using unweighted exact Mantel-Haenszel statistics (Cytel Inc., 2005
) and obtained similar results.