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1.  Neighborhood Effects on Youth Substance Use in a Southwestern City 
This study examines neighborhood influences on alcohol, cigarette and marijuana use among a predominantly Latino middle school sample. Drawing on theories of immigrant adaptation and segmented assimilation, we test whether neighborhood immigrant, ethnic, and socioeconomic composition, violent crime, residential instability, and family structure have differential effects on substance use among youth from different ethnic and acculturation backgrounds. Data are drawn from self-reports from 3,721 7th grade students attending 35 Phoenix, Arizona middle schools. Analysis was restricted to the two largest ethnic groups, Latino students of Mexican heritage and non-Hispanic Whites. After adjusting for individual-level characteristics and school- level random effects, only one neighborhood effect was found for the sample overall, an undesirable impact of neighborhood residential instability on recent cigarette use. Sub-group analyses by individual ethnicity and acculturation showed more patterned neighborhood effects. Living in neighborhoods with high proportions of recent immigrants was protective against alcohol, cigarette, and marijuana use for Latino students at different acculturation levels, while living in predominantly Mexican heritage neighborhoods (mostly non-immigrants) was a risk factor for alcohol and marijuana use for less acculturated Latinos. There were scattered effects of neighborhood poverty and crime, which predicted more cigarette and alcohol use, respectively, but only among more acculturated Latinos. Inconsistent effects confined to bilingual and more acculturated Latinos were found for the neighborhood's proportion of single mother families and its residential instability. No neighborhood effects emerged for non-Hispanic White students. Results suggested that disadvantaged neighborhoods increase substance use among some ethnic minority youth, but immigrant enclaves appear to provide countervailing protections.
doi:10.1525/sop.2007.50.2.273
PMCID: PMC3040571  PMID: 21339890
neighborhood effects; substance use; adolescents; Mexican Americans; acculturation
2.  Puerto Rican Early Adolescents’ Self-Esteem Patterns 
This study examines self-esteem as a multidimensional construct in 1 Latino subgroup, Puerto Rican girls and boys during early adolescence, using Harter’s (1985b) Self-Perception Profile for Children. The results show that in its English and Spanish versions—the latter developed by the present research team—the Self-Perception Profile for Children has adequate reliability for use with 13- to 14-year-old Puerto Rican youth living on the mainland. Results obtained in this study of Puerto Rican early adolescents, which contrasts with the results from the combined data of “Hispanics” in the American Association of University Women (1991) survey of 3,000 youth, strongly suggests that Latino subgroups need to be studied separately. The mean levels of self-esteem found among Puerto Rican girls and boys were generally similar to those found among Harter’s sample of predominantly Anglo middle school students from the suburbs of Denver except that Puerto Rican youth did not show gender differences in overall self-esteem. Gender differences in mean levels of self-esteem in different domains were similar to those of Anglo youth, regardless of the Puerto Rican youth’s individual level of psychological or behavioral acculturation. When differences by acculturation emerged, psychological acculturation appeared to play a more protective role for girls (Hispanic- or Latino-oriented girls reported being better behaved and having greater confidence in their scholastic abilities) and behavioral acculturation operated as a risk factor for boys (boys with preference for English reported low Behavioral Conduct and Scholastic Competence scores). On the other hand, greater acculturation (both psychological and behavioral) was associated with girls’ lower confidence in their physical attractiveness. Finally, the structure of self-esteem varied by gender, and psychological and behavioral acculturation.
doi:10.1207/SJRA1003_6
PMCID: PMC3066011  PMID: 21461183
3.  DIFFERENCES BY GENDER, ETHNICITY, AND ACCULTURATION IN THE EFFICACY OF THE keepin’ it REAL MODEL PREVENTION PROGRAM* 
Journal of drug education  2007;37(2):123-144.
This study examined whether the efficacy of keepin’ it REAL, a model program for substance use prevention in schools, was moderated by gender, ethnicity, and acculturation. Gender differences in program efficacy may arise through boys’ higher risk of drug use, inadequate attention to girls’ developmental issues, or cultural factors like polarized gender expectations. Data came from a randomized trial in 35 Phoenix, Arizona, middle schools involving 4,622 mostly Latino 7th graders. Using multi-level mixed models and multiple imputation missing techniques, results for the total sample showed no gender differences in program effects on recent substance use, but the program was more effective in fostering boys’ than girls’ anti-drug norms. Subgroup analyses demonstrated several more beneficial program effects for boys than girls (less alcohol and cigarette use and stronger anti-drug norms), but only among less acculturated Latinos. There were no gender differences in program effects among more acculturated Latinos, nor among non-Latino whites.
PMCID: PMC3838635  PMID: 17977237
4.  Ethnic Pride, Traditional Family Values, and Acculturation in Early Cigarette and Alcohol Use Among Latino Adolescents 
A structural equations model examined the influence of three cultural variables of ethnic pride, traditional family values and acculturation, along with the mediating variables of avoidance self-efficacy and perceptions of the “benefits” of cigarette smoking, on cigarette and alcohol use in a sample of Latino middle school students in the Southwest. Girls (N = 585) and boys (N = 360) were analyzed separately. In both groups, higher ethnic pride and traditional family values exerted indirect effects on less cigarette smoking and alcohol use when mediated through greater self-efficacy and less endorsement of the “benefits” of cigarette smoking. Among the girls, greater ethnic pride also had a direct effect on less cigarette and alcohol use. Also, greater acculturation directly predicted more cigarette and alcohol use among the girls, but not among the boys. However, differences between the boys and girls were generally nonsignificant as revealed by multiple group latent variable models. These results offer implications for incorporating cultural variables into the design of culturally relevant prevention interventions that discourage cigarette and alcohol use among Latino adolescents.
doi:10.1007/s10935-009-0174-z
PMCID: PMC2818880  PMID: 19415497
Ethnic pride; Acculturation; Traditional family values; Latino adolescents; Alcohol use; Tobacco use; Gender differences
5.  Do healthy behaviors decline with greater acculturation?: Implications for the Latino mortality paradox 
Social science & medicine (1982)  2005;61(6):1243-1255.
Relative to non-Latino whites, Latinos in the United States have a lower socioeconomic status (SES) profile, but a lower all-cause mortality rate. Because lower SES is associated with poorer overall health, a great deal of controversy surrounds the Latino mortality paradox. We employed a secondary data analysis of the 1991 National Health Interview Survey to test the health behavior and acculturation hypotheses, which have been proposed to explain this paradox. These hypotheses posit that: (1) Latinos have more favorable health behaviors and risk factor profiles than non-Latino whites, and (2) Health behaviors and risk factors become more unfavorable with greater acculturation. Specific health behaviors and risk factors studied were: smoking, alcohol use, leisure-time exercise activity, and body mass index (BMI). Consistent with the health behaviors hypothesis, Latinos relative to non-Latino whites were less likely to smoke and drink alcohol, controlling for sociodemographic factors. Latinos, however, were less likely to engage in any exercise activity, and were more likely to have a high BMI compared with non-Latino whites, after controlling for age and SES. Results provided partial support for the acculturation hypothesis. After adjusting for age and SES, higher acculturation was associated with three unhealthy behaviors (a greater likelihood of high alcohol intake, current smoking, a high BMI), but improvement in a fourth (greater likelihood of recent exercise). Gender-specific analyses indicated that the observed differences between Latinos and non-Latino whites, as well as the effects of acculturation on health behaviors, varied across men and women. Results suggest that the health behaviors and acculturation hypotheses may help to at least partially explain the Latino mortality paradox. The mechanisms accounting for the relationship between acculturation and risky behaviors have yet to be identified.
doi:10.1016/j.socscimed.2005.01.016
PMCID: PMC3587355  PMID: 15970234
Latino mortality paradox; Smoking; Alcohol use; Exercise; Body mass index; USA
6.  Perceived Ethnic Discrimination versus Acculturation Stress: Influences on Substance Use among Latino Youth in the Southwest* 
Using a predominately Mexican-origin Latino sample of 5th grade students from the Southwestern United States, this study examined the relative effects of perceived discrimination and acculturation stress on substance use, and it assessed whether these effects were moderated by linguistic acculturation or time in the United States. Although rates of substance use were generally low in the sample, given the young age of the participants, over half (59%) of the sample perceived some discrimination, and almost half (47%) experienced some acculturation stress. Spanish-dominant and bilingual youth perceived more discrimination than English-dominant youth, whereas youth who have been in the United States five or fewer years perceived more discrimination than youth with more time in the United States. Youth who were Spanish-dominant or were recent arrivals experienced the most acculturation stress, with levels declining as linguistic acculturation and time in the United States increased. Multiple regression estimates indicated that perceived discrimination was associated with larger amounts and higher frequency of recent substance use and an array of substance use attitudes, such as stronger intentions to use substances, espousal of pro-drug norms, more positive substance use expectancies, and peer approval of substance use. Although acculturation stress was not associated with substance use, it was positively associated with several substance use attitudes, which are known antecedents of actual use. With a few exceptions, linguistic acculturation and time in the United States did not moderate the effects of perceived discrimination or acculturation stress.
PMCID: PMC2821707  PMID: 20099450
7.  Influences of School Latino Composition and Linguistic Acculturation on a Prevention Program for Youth* 
Social work research  2010;34(1):6-19.
This study examined how ethnic composition and linguistic acculturation within schools affected the efficacy of a youth substance use prevention model program. Data come from a randomized trial of the keepin' it REAL program, using a predominantly Mexican American sample of middle school students in Phoenix, Arizona. Schools were randomly assigned to a control group or to one of three culturally tailored intervention versions. We hypothesized that school ethnic and linguistic acculturation composition (percent Latino, percent non-English speaking at home) and individual level of linguistic acculturation jointly would moderate the efficacy of the prevention program, as indicated by students' alcohol, marijuana, and cigarette use. Using multilevel linear modeling and multiple imputation techniques to manage clustered data and attrition, results showed that desired program effects varied by the linguistic acculturation level of the school, the program version, and individual acculturation level. The Latino intervention version was more efficacious in schools with larger percentages of non-English speaking families, but only among less linguistically acculturated Latino students. There were no significant school level program effects connected to the percentage of Latino students at school, the other versions of the program, or among more linguistically acculturated students.
PMCID: PMC2922772  PMID: 20721310
8.  Gender Differences in the Effect of Linguistic Acculturation on Substance Use Among Mexican-Origin Youth in the Southwest United States 
This study tested for gender differences in the impact of linguistic acculturation on pro-drug norms, substance use intentions, and actual substance use among youth of Mexican heritage in a large metropolitan area in the Southwest United States. The authors analyzed baseline survey data provided by 2,487 middle school students of Mexican heritage who were part of a larger, multiethnic randomized efficacy trial of a drug abuse prevention program. Using multi-group structural equation modeling, the authors found that linguistic acculturation was positively and directly related to adherence to pro-drug norms, substance use intentions, and recent alcohol use, controlling for age, poor grades, and socioeconomic status. In addition, linguistic acculturation had an indirect effect on substance use intentions and recent alcohol use through pro-drug norms. The direct effect of linguistic acculturation on pro-drug norms was stronger for girls than for boys, as was its indirect effect on substance use intentions.
doi:10.1080/15332640903539252
PMCID: PMC2903967  PMID: 20390972
acculturation; gender differences; Mexican American youth; substance use; substance use norms
9.  Gender Identity, Ethnicity, Acculturation, and Drug Use: Exploring Differences among Adolescents in the Southwest 
Journal of community psychology  2003;31(2):167-188.
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.
doi:10.1002/jcop.10041
PMCID: PMC3045088  PMID: 21359134
10.  Correlates of self worth and body size dissatisfaction among obese Latino youth 
Body image  2011;8(2):173-178.
The current study examined self-worth and body size dissatisfaction, and their association with maternal acculturation among obese Latino youth enrolled in a community-based obesity intervention program. Upon entry to the program, a sample of 113 participants reported global self-worth comparable to general population norms, but lower athletic competence and perception of physical appearance. Interestingly, body size dissatisfaction was more prevalent among younger respondents. Youth body size dissatisfaction was associated with less acculturated mothers and higher maternal dissatisfaction with their child's body size. By contrast, although global self-worth was significantly related to body dissatisfaction, it was not influenced by mothers’ acculturation or dissatisfaction with their own or their child’s body size. Obesity intervention programs targeted to Latino youth need to address self-worth concerns among the youth as well as addressing maternal dissatisfaction with their children’s body size.
doi:10.1016/j.bodyim.2010.12.002
PMCID: PMC3072832  PMID: 21354881
self-worth; body size dissatisfaction; acculturation; obese Latino youth
11.  God Forbid! Substance Use Among Religious and Nonreligious Youth 
Among a predominately Mexican and Mexican American sample of preadolescents, religiosity protected against lifetime alcohol, cigarette, and marijuana use and recent alcohol and cigarette use when religious affiliation was controlled. When religiosity was controlled, however, adolescents with no religious affiliation and adolescents who were religiously affiliated reported similar substance use outcomes. Interaction effects demonstrated that the protective effect of greater religiosity operated more strongly in some religions than in others for selected outcomes. Overall, the impact of religiosity on reported drug use did not differ significantly for more and less acculturated Latino youth.
doi:10.1037/0002-9432.75.4.585
PMCID: PMC3043382  PMID: 16262516
adolescents; drug use; religiosity; Mexican American; acculturation
12.  Prevalence of physical symptoms and their association with race/ethnicity and acculturation in the United States 
General Hospital Psychiatry  2012;34(4):323-331.
Objective
Physical symptoms are common and a leading reason for primary care visits, however data are lacking on their prevalence among racial/ethnic minorities in the United States. This study aimed to compare the prevalence of physical symptoms among White, Latino, and Asian Americans, and examine the association of symptoms and acculturation.
Methods
We analyzed data from the National Latino and Asian American Study, a nationally-representative survey of 4864 White, Latino, and Asian Americans adults. We compared the age- and gender-adjusted prevalence of fourteen physical symptoms among the racial/ethnic groups and estimated the association between indicators of acculturation (English proficiency, nativity, generational status, and proportion of lifetime in the United States) and symptoms among Latino and Asian Americans.
Results
After adjusting for age and gender, the mean number of symptoms was similar for Whites (1.00) and Latinos (0.95) but significantly lower among Asian-Americans (0.60, p < 0.01 versus Whites). Similar percentages of Whites (15.4%) and Latinos (13.0%) reported 3 or more symptoms, whereas significantly fewer Asian-Americans (7.7%, p<0.05 versus Whites) did. In models adjusted for sociodemographic variables and clinical status (psychological distress, medical conditions, and disability), acculturation was significantly associated with physical symptoms among both Latino and Asian Americans, such that the most acculturated individuals had the most physical symptoms.
Conclusions
The prevalence of physical symptoms differs across racial/ethnic groups, with Asian Americans reporting fewer symptoms than Whites. Consistent with a ‘healthy immigrant’ effect, increased acculturation was strongly associated with greater symptom burden among both Latino and Asian Americans.
doi:10.1016/j.genhosppsych.2012.02.007
PMCID: PMC3383871  PMID: 22460006
Acculturation; Asian Americans; Epidemiology; Hispanic Americans; Signs and Symptoms
13.  Experimenting with cigarettes and physical activity among Mexican origin youth: a cross sectional analysis of the interdependent associations among sensation seeking, acculturation, and gender 
BMC Public Health  2012;12:332.
Background
Sensation seeking tendencies tend to manifest during adolescence and are associated with both health-compromising behaviors and health-enhancing behaviors. The purpose of this study is to evaluate the relationship between sensation seeking and physical activity, a health-enhancing behavior, and between sensation seeking and experimenting with cigarettes, a health compromising-behavior, among a cohort of Mexican origin adolescents residing in the United States with different levels of acculturation.
Methods
In 2009, 1,154 Mexican origin youth (50.5% girls, mean age 14.3 years (SD = 1.04)) provided data on smoking behavior, physical activity, linguistic acculturation, and sensation seeking. We conducted Pearson’s χ2 tests to examine the associations between categorical demographic characteristics (i.e. gender, age, country of birth and parental educational attainment) and both cigarette experimentation and physical activity and Student’s t-tests to examine mean differences on the continuous variables (i.e. sensation seeking subscale) by the behaviors. We examined mean differences in the demographic characteristics, acculturation, and both behaviors for each of the sensation seeking subscales using analysis of variance (ANOVA). To examine relationships between the sensation seeking subscales, gender, and both behaviors, at different levels of acculturation we completed unconditional logistic regression analyses stratified by level of acculturation.
Results
Overall, 23.3% had experimented with cigarettes and 29.0% reported being physically active for at least 60 minutes/day on at least 5 days/week. Experimenting with cigarettes and being physically active were more prevalent among boys than girls. Among girls, higher levels of sensation seeking tendencies were associated with higher levels of acculturation and experimentation with cigarettes, but not with physical activity. Among boys, higher levels of sensation seeking tendencies were associated with higher levels of acculturation, experimenting with cigarettes and being physically active.
Conclusions
Our results suggest that interventions designed to prevent smoking among Mexican origin youth may need to address social aspects associated with acculturation, paying close attention to gendered manifestations of sensation seeking.
doi:10.1186/1471-2458-12-332
PMCID: PMC3441442  PMID: 22559717
Smoking behavior; Physical activity; Acculturation; Sensation seeking; Gender; Mexican origin youth
14.  Overweight in Young Latino Children 
Archives of medical research  2008;39(5):511-518.
Background
Acculturation status is associated with overweight and obesity among Latino adults, but the relationship between maternal acculturation and overweight in Latino children is inconsistent and has not been adequately studied.
Methods
We analyzed 3-year follow-up data from 185 Latina mothers and children who were recruited at San Francisco General Hospital. Outcome measure was the child’s body mass index at age 3 years, adjusted for age and sex and categorized as healthy (<85%) or overweight (≥85%). Independent variables were maternal acculturation status, child health status, and child nutritional factors.
Results
At age 3 years, 43% of children were overweight. In multivariate logistic regression analyses, childhood overweight was associated with maternal acculturation status (adjusted odds ratio [OR] 1.99, 95% confidence interval [95% CI] 1.07–3.69) and maternal obesity (OR 3.71, 95% CI 1.40–9.84). Childhood overweight was also more likely among children who were reported to eat well or very well (OR 3.33, 95% CI 1.46–7.58) and children whose weight was perceived as too high (OR 11.88, 95% CI 2.37–59.60), as compared to children who were reported to eat poorly/not well and children whose weight was perceived as normal, respectively.
Conclusions
Interventions to reduce the high rates of overweight among young Latino children should address the importance of maternal acculturation and obesity as well as maternal perceptions of children’s weight and eating habits.
doi:10.1016/j.arcmed.2008.02.008
PMCID: PMC2519869  PMID: 18514096
Obesity; Overweight; Child; Preschool; Hispanic Americans; Mexican Americans
15.  Majority Rules? The Effects of School Ethnic Composition on Substance Use by Mexican Heritage Adolescents* 
Sociological focus  2004;37(4):371-392.
This article examines key aspects of the school environment — its composition by ethnicity and acculturation — as important social contexts for understanding Mexican immigrant and Mexican American adolescents' drug use norms and behaviors. Results are presented based on surveys completed by Mexican-background students from 35 Phoenix. Arizona middle schools, whose enrollment ranged from a numerical minority to an overwhelming majority. Multivariate mixed models tested for the influence of school ethnic composition measures on substance use outcomes, while accounting for individual level predictors and for the nesting of data at the school level. The proportional representation of Latinos in the school was not a factor in an individual's drug use norms or drug use for the sample overall. Once students were broken down by acculturation status, however, ethnic composition had an effect. Less acculturated Mexican heritage students in schools with higher proportions of Latino students reported less substance use and less adherence to pro-drug norms. Further investigation using other measures of ethnic composition suggested that these effects were attributable to the larger presence of less acculturated Latinos in the school rather than more acculturated Latino students. These school-level effects support the individual-level results indicating that less acculturated Mexican American students face less daunting substance use risks. The results suggest that ethnic group size, but not necessarily numerical predominance, matters and that within-group differences influence the effect of a particular ethnic group's presence in the school. In other words, the majority does not always rule. These findings are interpreted using the concepts of segmented assimilation and school level social capital.
PMCID: PMC3113510  PMID: 21686029
16.  HIV risk behaviors and sociodemographic features of HIV-infected Latinos residing in a new Latino settlement area in the Southeastern United States 
AIDS care  2013;25(10):1298-1307.
The Southeastern United States (US) has a rapidly growing Latino population, yet little is known about HIV-infected Latinos in the region. To help inform future prevention studies, we compared sociodemographic, clinical, and behavioral characteristics between immigrant and US-born HIV-infected Latinos using face-to-face interviews conducted at three clinics in North Carolina. Questions encompassed HIV testing, acculturation, sexual- and substance-related behaviors, and migration history. Behavioral data were compared with 451 black and white clinic patients. Differences were tested using Pearson’s and Kruskal–Wallis tests. Participants (n = 127) were primarily male (74%) and immigrants (82%). Most immigrants were Mexican (67%), had low acculturation scores (92%), and were diagnosed a median of 8 years (IQR 0–12) following immigration. Compared with US-born Latinos, immigrants had lower CD4 counts at clinic entry (median 187 vs. 371 cells/mm3) and were less likely to have graduated high school (49% vs. 78%) or have insurance (9% vs. 52%; all P < 0.05). Most immigrants identified as heterosexual (60%) and reported fewer lifetime partners than US-born Latinos (median 6 vs. 20; P = 0.001). Immigrant men were less likely to report sex with men than US-born men (43% vs. 81%; P = 0.005). Immigrant men also had similar risk behaviors to black men, and US-born Latino men exhibited behaviors that were more similar to white men in our clinic. At the time of survey, >90% of participants were receiving antiretroviral therapy (ART) and most had achieved HIV RNA <50 copies/mL (62% immigrants vs. 76% US-born; P = 0.32). In conclusion, Latino immigrants were more likely to present with advanced disease, identify as heterosexual, and report different risk behaviors than US-born Latinos, yet receipt and response to ART were similar between the two groups. Prevention strategies should prioritize finding innovative methods to reach Latino immigrants for routine early testing regardless of risk stratification and include programs targeted toward the different needs of immigrant and US-born Latinos.
doi:10.1080/09540121.2013.764964
PMCID: PMC4125118  PMID: 23384328
Hispanic; HIV; CD4 lymphocyte count; Southeast United States; immigrants
17.  The Effects of Parental Acculturation and Parenting Practices on the Substance Use of Mexican-Heritage Adolescents from Southwestern Mexican Neighborhoods 
A sample of 189 Mexican-heritage seventh grade adolescents reported their substance use, while one of the child’s parents reported parent’s acculturation and communication, involvement, and positive parenting with his or her child. Higher levels of parental acculturation predicted greater marijuana use, whereas parent communication predicted lower cigarette and marijuana use among girls. A significant parent acculturation by parent communication interaction for cigarette use was due to parent communication being highly negatively associated with marijuana use for high acculturated parents, with attenuated effects for low acculturated parents. A significant child gender by parent acculturation by parent positive parenting interaction was found. For girls, positive parenting had a stronger association with lower cigarette use for high acculturated parents. For boys, positive parenting had a stronger association with reduced cigarette use for low acculturated parents. Discussion focuses on how acculturation and gender impact family processes among Mexican-heritage adolescents.
doi:10.1080/15332640.2014.905215
PMCID: PMC4206522  PMID: 25176121
acculturation; Mexican American adolescents; parenting; substance use
18.  Acculturation, Gender, Depression, and Cigarette Smoking Among U.S. Hispanic Youth: The Mediating Role of Perceived Discrimination 
Journal of youth and adolescence  2011;40(11):1519-1533.
Hispanic youth are at risk for experiencing depressive symptoms and smoking cigarettes, and risk for depressive symptoms and cigarette use increase as Hispanic youth acculturate to U.S. culture. The mechanism by which acculturation leads to symptoms of depression and cigarette smoking is not well understood. The present study examined whether perceived discrimination explained the associations of acculturation with depressive symptoms and cigarette smoking among 1,124 Hispanic youth (54% female). Youth in Southern California completed surveys in 9th–11th grade. Separate analyses by gender showed that perceived discrimination explained the relationship between acculturation and depressive symptoms for girls only. There was also evidence that discrimination explained the relationship between acculturation and cigarette smoking among girls, but the effect was only marginally significant. Acculturation was associated with depressive symptoms and smoking among girls only. Perceived discrimination predicted depressive symptoms in both genders, and discrimination was positively associated with cigarette smoking for girls but not boys. These results support the notion that, although Hispanic boys and girls experience acculturation and discrimination, their mental health and smoking behaviors are differentially affected by these experiences. Moreover, the results indicate that acculturation, gender, and discrimination are important factors to consider when addressing Hispanic youth’s mental health and substance use behaviors.
doi:10.1007/s10964-011-9633-y
PMCID: PMC3753367  PMID: 21293915
Acculturation; Gender; Perceived discrimination; Depression; Cigarette smoking; Hispanic youth
19.  Bullying Victimization as a Mediator of Associations between Cultural/familial Variables, Substance use and Depressive symptoms among Hispanic Youth 
Ethnicity & health  2013;18(4):415-432.
Objectives
This article examines the antecedents and consequences of bullying victimization among a sample of Hispanic high school students. Although cultural and familial variables have been examined as potential risk or protective factors for substance use and depression, previous studies have not examined the role of peer victimization in these processes. We evaluated a conceptual model in which cultural and familial factors influenced the risk of victimization, which in turn influenced the risk of substance use and depression.
Design
Data were collected as part of a longitudinal survey study of 9th and 10th grade Hispanic/Latino students in Southern California (n=1167). The student bodies were at least 70% Hispanic/Latino with a range of socioeconomic characteristics represented. We used linear and logistic regression models to test hypothesized relationships between cultural and familial factors and depression and substance and a meditational model to assess whether bullying victimization mediated these associations.
Results
Acculturative stress and family cohesion were significantly associated with bullying victimization. Family cohesion was associated with depression and substance use. Social support was associated with alcohol use. Acculturative stress was associated with higher depression. The associations between acculturative stress and depression, family cohesion and depression, and family cohesion and cigarette use were mediated by bullying victimization.
Conclusion
These findings provide valuable information to the growing, but still limited, literature about the cultural barriers and strengths that are intrinsic to the transition from adolescence to emerging adulthood among Hispanic youth. Our findings are consistent with a mediational model in which cultural/familial factors influence the risk of peer victimization, which in turn influences depressive symptoms and smoking, suggesting the potential positive benefits of school based programs that facilitate the development of coping skills for students experiencing cultural and familial stressors.
doi:10.1080/13557858.2012.754407
PMCID: PMC3723765  PMID: 23297708
Hispanic; acculturation; family cohesion; bullying victimization; depression; substance use
20.  Decomposing associations between acculturation and drinking in Mexican Americans 
Background
Acculturation to life in the United States is a known predictor of Hispanic drinking behavior. We compare the ability of 2 theoretical models of this effect – sociocultural theory and general stress theory – to account for associations between acculturation and drinking in a sample of Mexican Americans. Limitations of previous evaluations of these theoretical models are addressed by using a broader range of hypothesized cognitive mediators and a more direct measure of acculturative stress. In addition, we explore nonlinearities as possible underpinnings of attenuated acculturation effects among males.
Methods
Respondents (N = 2,595, current drinker N = 1,351) were interviewed as part of 2 recent multistage probability samples in a study of drinking behavior among Mexican Americans in the United States. The ability of norms, drinking motives, alcohol expectancies, and acculturation stress to account for relations between acculturation and drinking outcomes (volume and heavy drinking days) were assessed with a hierarchical linear regression strategy. Nonlinear trends were assessed by modeling quadratic effects of acculturation and acculturation stress on cognitive mediators and drinking outcomes.
Results
Consistent with previous findings, acculturation effects on drinking outcomes were stronger for females than males. Among females, only drinking motives explained acculturation associations with volume or heavy drinking days. Among males, acculturation was linked to increases in norms, and norms were positive predictors of drinking outcomes. However, adjusted effects of acculturation were non-existent or trending in a negative direction, which counter-acted this indirect normative influence. Acculturation stress did not explain positive associations between acculturation and drinking.
Conclusions
Stress and alcohol outcome expectancies play little role in the positive linear association between acculturation and drinking outcomes, but drinking motives appears to at least partially account for this effect. Consistent with recent reports, these results challenge stress models of linear acculturation effects on drinking outcomes and provide (partial) support for sociocultural models. Inconsistent mediation patterns – rather than nonlinearities – represented a more plausible statistical description of why acculturation-drinking associations are weakened among males.
doi:10.1111/j.1530-0277.2011.01712.x
PMCID: PMC3349785  PMID: 22316139
Mexican Americans; Acculturation
21.  The Influence of Linguistic Acculturation and Gender on the Initiation of Substance Use Among Mexican Heritage Preadolescents in the Borderlands 
The Journal of early adolescence  2011;31(2):271-299.
This article examined the impact of linguistic acculturation and gender on the substance use initiation of a sample of 1,473 Mexican heritage preadolescents attending 30 public schools in Phoenix, Arizona. It was hypothesized that linguistic acculturation operates differently as a risk or protective factor for young children than for older youth. The study used discrete-time event history methods to model the rate at which nonusing children initiate substance use. Alcohol, cigarettes, marijuana, and inhalants were studied separately while inhalant use was examined more closely. Results suggested that while linguistic acculturation is a risk factor for Mexican heritage preadolescents, this association depended on gender, the linguistic acculturation context (family, friends, or media), and the type of substance. For inhalants, higher linguistic acculturation with friends was inversely associated with drug initiation both for boys and girls. Implications for preventive science and future intervention research are discussed.
doi:10.1177/0272431610363157
PMCID: PMC3108799  PMID: 21660121
acculturation; bilingual/bicultural; Hispanic/Latino/Latina; substance use/alcohol and drug use
22.  School Context and Individual Acculturation: How School Composition Affects Latino Students’ Acculturation* 
Sociological inquiry  2012;82(3):460-484.
Understanding how schools—a key context for children—shape students’ cultural trajectories is important since these trajectories are tied to youth development and achievement. This study assessed how the size of the school’s group of acculturated Latino and non-Latino students influenced the acculturation of 1,720 Latino 5th-grade students from urban public schools in the Southwest United States. A longitudinal secondary data analysis revealed that controlling for wave 1 acculturation, youths in schools with larger proportions of linguistically acculturated students were more acculturated at wave 2 than youths in schools with smaller proportions of such students. This effect was independent of Latino students’ baseline acculturation level and was found even in schools with minority proportions of more acculturated students.
doi:10.1111/j.1475-682X.2012.00423.x
PMCID: PMC3519394  PMID: 23239897
23.  Acculturation, Coping Styles, and Health Risk Behaviors Among HIV Positive Latinas 
AIDS and behavior  2010;14(2):401-409.
This study examined the relationships among acculturation, coping styles, substance use, sexual risk behavior, and medication non-adherence among 219 Latinas living with HIV/AIDS in Los Angeles, CA. Coping styles were hypothesized to mediate the link between acculturation and health risk behaviors for HIV positive Latinas. Structural equation modeling revealed that greater acculturation was related to less positive coping and more negative coping. In turn, negative coping was associated with more health risk behaviors and more non-adherence. Positive coping was associated with less substance use as reflected in use of cigarettes and alcohol and less non-adherence. Coping styles mediated the relationship between acculturation and health risk behaviors. Findings echo previous works examining the Hispanic Health Paradox wherein more acculturated Latinos exhibit increased risk behavior and maladaptive coping styles. HIV/AIDS interventions need to be mindful of cultural differences within Hispanic populations and be tailored to address these differences.
doi:10.1007/s10461-009-9618-y
PMCID: PMC2835805  PMID: 19847637
Acculturation; Coping styles; Latinas; HIV/AIDS; Hispanic
24.  Acculturation and the Prevalence of Diabetes in US Latino Adults, National Health and Nutrition Examination Survey 2007–2010 
Introduction
US Latinos are growing at the fastest rate of any racial/ethnic group in the United States and have the highest lifetime risk of diabetes. Acculturation may increase the risk of diabetes among all Latinos, but this hypothesis has not been studied in a nationally representative sample. The objective of this study was to test the hypothesis that acculturation was associated with an increased risk of diabetes in such a sample.
Methods
We conducted a cross-sectional analysis including 3,165 Latino participants in the 2007–2010 National Health and Nutrition Examination Survey. Participants with doctor-diagnosed diabetes and participants without diagnosed diabetes who had glycated hemoglobin (HbA1C) values of 6.5% or higher were classified as having diabetes. An acculturation score, ranging from 0 (lowest) to 3 (highest), was calculated by giving 1 point for each of 3 characteristics: being born in the United States, speaking predominantly English, and living in the United States for 20 years or more. Logistic regression was used to determine the association between acculturation and diabetes.
Results
The prevalence of diabetes among Latinos in our sample was 12.4%. After adjusting for sociodemographic factors, the likelihood of diabetes (95% confidence interval [CI]) increased with level of acculturation— 1.71 (95% CI, 1.31–2.23), 1.63 (95% CI, 1.11–2.39), and 2.05 (95% CI, 1.27–3.29) for scores of 1, 2, and 3, respectively. This association persisted after further adjustment for body mass index (BMI), total dietary calories, and physical inactivity.
Conclusion
Acculturation was associated with a higher risk of diabetes among US Latinos, and this risk was only partly explained by BMI and weight-related behaviors. Future research should examine the bio-behavioral mechanisms that underlie the relationship between acculturation and diabetes in Latinos.
doi:10.5888/pcd11.140142
PMCID: PMC4193061  PMID: 25299982
25.  Correlates of susceptibility to smoking among Mexican origin youth residing in Houston, Texas: A cross-sectional analysis 
BMC Public Health  2008;8:337.
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.
doi:10.1186/1471-2458-8-337
PMCID: PMC2569937  PMID: 18822130

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