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1.  Gender Roles and Substance Use Among Mexican American Adolescents: A Relationship Moderated by Acculturation? 
Substance Use & Misuse  2011;47(3):214-229.
This research assesses the effects of adaptive/maladaptive gender roles and acculturation in predicting substance use in a 2007 sample of 1466 Mexican American seventh-grade adolescents from Phoenix, Arizona, USA. Multiple regression analyses found significant effects for both adaptive and maladaptive gender roles, as well as several gender-specific interactions between gender roles and linguistic acculturation that predicted substance use. Limitations of the research are noted, as well as implications for understanding the impact of acculturation on how gender roles differentially affect substance use in Mexican American boys versus girls.
doi:10.3109/10826084.2011.630438
PMCID: PMC3402241  PMID: 22136419
gender roles; gender; acculturation; substance use; Mexican American adolescents
2.  Acculturation among Mexican-heritage preadolescents: A latent class analysis 
Social science research  2011;40(4):1236-1248.
This study applies advanced conceptualization and measurement to an analysis of acculturation among 1,632 Mexican-heritage preadolescents. We assessed whether – and how – multiple measures combine to form a latent acculturation construct that groups individuals into classes; and determine how many and what classes (or types) of acculturation are experienced by this sample of 5th graders. Measures included attitudinal, behavioral, and linguistic acculturation, generation status, time in the U.S., ethnic identification, and contact with the culture of origin. The analysis identified five classes of acculturation, differing in size and characterized by specific measures of acculturation: less acculturated, moderately bicultural, strongly bicultural, highly acculturated, and marginalized. Although most youths fell into the first four classes, consonant with their exposure to American society, a small minority of youths fell into the last class. Despite substantial exposure to U.S. culture and recent exposure to Mexican culture, these youth showed little affinity for either culture.
doi:10.1016/j.ssresearch.2011.02.005
PMCID: PMC3139995  PMID: 21785519
acculturation; preadolescents; Mexican
3.  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
4.  Gender Differences in Drug Resistance Skills of Youth in Guanajuato, Mexico 
The journal of primary prevention  2011;32(2):113-127.
Research is limited or absent on Mexican adolescents’ exposure to substance offers, ways of dealing with these offers, and possible gender differences in responses to offers. Extending U.S.-based research, this study examines how youth living in the Mexican state of Guanajuato employ the four drug resistance strategies—refuse, explain, avoid, and leave—that are part of the Keepin’ It REAL evidence-based drug prevention intervention. The analysis uses cross-sectional survey data from 702 students enrolled in eight alternative secondary education sites in 2007. Participants reported the drug resistance behaviors they used to deal with offers of alcohol, cigarettes, and marijuana. Using multivariate regression, findings indicate most youth had developed repertoires of drug resistance strategies that involved multiple REAL strategies and some other strategy as well. For those receiving offers, the most common strategy was to refuse the offer with a simple ‘‘no.’’ However, males used all the strategies significantly more often than females for situations involving cigarettes and marijuana as well as when using refuse and non-REAL strategies for alcohol. Possible reasons for the gender difference in use of strategies are discussed. The findings can help inform effective prevention programs based on teaching culturally appropriate drug resistance and communication skills.
doi:10.1007/s10935-011-0239-7
PMCID: PMC3132188  PMID: 21424398
Adolescents; Substance use; Substance use offers; Mexican youth; Drug resistance
5.  When to Intervene: Elementary School, Middle School or Both? Effects of keepin’ It REAL on Substance Use Trajectories of Mexican Heritage Youth 
This article presents the findings of a study exploring two questions: What age is most efficacious to expose Mexican heritage youth to drug abuse prevention interventions, and what dosage of the prevention intervention is needed? These issues are relevant to Mexican heritage youth—many from immigrant families—in particular ways due to the acculturation process and other contextual factors. The study utilized growth curve modeling to investigate the trajectory of recent substance use (alcohol, cigarettes, marijuana, inhalants) among Mexican heritage students (N = 1,670) participating in the keepin’ it REAL drug prevention program at different developmental periods: the elementary school (5th grade), middle school (7th grade), or both. The findings provide no evidence that intervening only in elementary school was effective in altering substance use trajectories from 5th to 8th grade, either for licit nor illicit substances. Implementing keepin’ it REAL in middle school alone altered the trajectories of use of all four substances for Mexican heritage youth. A double dose of prevention, in elementary and middle school proved to be equally as effective as intervening in 7th grade only, and only for marijuana and inhalants. The decrease in use of marijuana and inhalants among students in the 7th-grade-only or the 5th- and 7th-grade interventions occurred just after students received the curriculum intervention in 7th grade. These results are interpreted from an ecodevelopmental and culturally specific perspective and recommendations for prevention and future research are discussed.
doi:10.1007/s11121-010-0189-y
PMCID: PMC3042028  PMID: 21128119
Substance use prevention; Early intervention; Mexican Americans; Preadolescents; Adolescents
6.  Strategies to Resist Drug Offers Among Urban American Indian Youth of the Southwest: An Enumeration, Classification, and Analysis by Substance and Offeror 
Substance use & misuse  2011;46(11):1395-1409.
This study explores the drug resistance strategies of urban American Indian adolescents when they encounter people offering them alcohol, cigarettes, and marijuana. Data were collected in 2005 from 11 female and 9 male adolescents who self-identified as American Indian and attended two urban middle schools in the southwestern United States. In two focus groups—one at each school site—the youth described their reactions to 25 hypothetical substance offer scenarios drawn from real-life narratives of similar youth. Qualitative analysis of their 552 responses to the scenarios generated 14 categories. Half of the responses were strategies reported most often by nonnative youth (refuse, explain, leave, and avoid). Using ecodevelopmental theory, the responses were analyzed for indications of culturally specific ways of resisting substance offers, such as variation by specific substance and relationship to the person offering. Study limitations are noted along with suggestive implications for future research on culturally appropriate prevention approaches for urban American Indian youth.
doi:10.3109/10826084.2011.592433
PMCID: PMC3164593  PMID: 21810074
urban American Indian youth; drug resistance strategies; substance offers; resiliency
7.  PREFERRED DRUG RESISTANCE STRATEGIES OF URBAN AMERICAN INDIAN YOUTH OF THE SOUTHWEST* 
Journal of drug education  2011;41(2):203-234.
This study explored the drug resistance strategies that urban American Indian adolescents consider the best and worst ways to respond to offers of alcohol, cigarettes, and marijuana. Focus group data were collected from 11 female and 9 male American Indian adolescents attending urban middle schools in the southwest. The youth were presented with hypothetical substance offer scenarios and alternative ways of responding, based on real-life narratives of similar youth. They were asked to choose a preferred strategy, one that would work every time, and a rejected strategy, one they would never use. Using eco-developmental theory, patterns in the preferred and rejected strategies were analyzed to identify culturally specific and socially competent ways of resisting substance offers. The youth preferred strategies that included passive, non-verbal strategies like pretending to use the substance, as well as assertive strategies like destroying the substance. The strategies they rejected were mostly socially non-competent ones like accepting the substance or responding angrily. Patterns of preferred and rejected strategies varied depending on whether the offer came from a family member or non-relative. These patterns have suggestive implications for designing more effective prevention programs for the growing yet under-served urban American Indian youth population.
PMCID: PMC3170049  PMID: 21888001
8.  A Typology and Analysis of Drug Resistance Strategies of Rural Native Hawaiian Youth 
The journal of primary prevention  2010;31(5-6):311-319.
This study examines the drug resistance strategies described by Native Hawaiian youth residing in rural communities. Sixty-four youth from 7 middle and intermediate schools on the Island of Hawai‘i participated in a series of gender-specific focus groups. Youth responded to 15 drug-related problem situations developed and validated from prior research. A total of 509 responses reflecting primary or secondary drug resistance strategies were identified by the youth, which were qualitatively collapsed into 16 different categories. Primary drug resistance strategies were those that participants listed as a single response, or the first part of a two-part response, while secondary drug resistance strategies were those that were used in tandem with primary drug resistance strategies. Over half of the responses reflecting primary drug resistance strategies fell into three different categories (“refuse,” “explain,” or “angry refusal”), whereas over half of the responses reflecting secondary drug resistance strategies represented one category (“explain”). Significant gender differences were found in the frequency of using different strategies as well as variations in the frequency of using different strategies based on the type of drug offerer (family versus friends/peers). Implications for prevention practice are discussed.
doi:10.1007/s10935-010-0222-8
PMCID: PMC3005017  PMID: 20640939
Drug; Native Hawaiian; Culture; Prevention; Youth
9.  Parental Monitoring and Changes in Substance Use Among Latino/a and Non-Latino/a Pre-adolescents in the Southwest 
Substance use & misuse  2010;45(14):2524-2550.
The family is one of the most important contexts for children’s development and well-being. Parents play a central role in the family, and the degree to which parents monitor their children’s behaviors has been shown to be associated with fewer risky behaviors, especially substance use. Prior research on parental monitoring and substance use, however, has several limitations. Most studies have focused on older adolescents, as well as adolescents from primarily White, Euro-American heritage. Prior studies largely have been cross-sectional and unable to test if parental monitoring decreases substance use over time. This article explicitly addresses these limitations by examining a longitudinal sample of primarily Latino youth in pre-adolescence (5th grade). Using an Ecodevelopmental framework, we hypothesized that parental monitoring will be associated with lower levels of youth substance use and more beneficial substance use intentions, norms, and attitudes. We further hypothesized that the effects of parental monitoring may differ by gender and between Latino and non-Latino youth. The data came from a school-based randomized trial of a substance use prevention program in Phoenix, AZ. To test our hypotheses, we use regression models, with adjustments for clustering and multiple imputation of missing data. The results show that parental monitoring has significant beneficial and longitudinal effects on youth’s substance use and related substance use intentions, norms, and attitudes. These beneficial effects of parental monitoring are invariant to the youth’s gender or Latino ethnicity, except in the case of marijuana use: parental monitoring is significantly more effective in reducing girls’ marijuana use.
doi:10.3109/10826081003728256
PMCID: PMC3108798  PMID: 20394523
parental monitoring; Latino/a; pre-adolescence
10.  Migration Intentions and Illicit Substance Use among Youth in Central Mexico 
Substance use & misuse  2011;46(13):1619-1627.
This study explored intentions to emigrate and substance use among youth (ages 14–24) from a central Mexico state with high emigration rates. Questionnaires were completed in 2007 by 702 students attending a probability sample of alternative secondary schools serving remote or poor communities. Linear and logistic regression analyses indicated that stronger intentions to emigrate predicted greater access to drugs, drug offers, and use of illicit drugs (marijuana, cocaine, inhalants), but not alcohol or cigarettes. Results are related to the healthy migrant theory and its applicability to youth with limited educational opportunities. The study’s limitations are noted.
doi:10.3109/10826084.2011.590957
PMCID: PMC3221015  PMID: 21955065
Mexico; migration; drugs; alcohol adolescents
11.  Gender Differences in Drug Offers of Rural Hawaiian Youths: A Mixed-Methods Analysis 
Affilia  2010;25(3):291-306.
This study examined the gender differences in drug-offer situations of Native Hawaiian youths in rural communities. Youths from seven middle or intermediate schools (N 194) on the Big Island of Hawai'i completed a survey that focused on the drug offers they had received. Multivariate and bivariate analyses indicated that the girls received significantly more drug offers than did the boys in the sample and found it more difficult to refuse drugs in such situations. Qualitative data gathered from communities in the survey's sampling frame elucidated the quantitative findings. Limitations of the study and implications for prevention practice are discussed.
PMCID: PMC2919836  PMID: 20711491
ethnic issues; family relationships; gender; peers and friends; substance use
12.  Gender Roles, Externalizing Behaviors, and Substance Use Among Mexican-American Adolescents 
A sample of 60 male and 91 female Mexican-American adolescents (age 13–18) were administered measures of positive (i.e., assertive masculinity, affective femininity) and negative (i.e., aggressive masculinity, submissive femininity) gender roles, internalizing and externalizing problem behaviors, peer substance use, and own substance use (alcohol, cigarettes, marijuana). Negative gender roles were significantly correlated with internalizing and externalizing problems for both boys and girls, with aggressive masculinity also predicting peer substance use for both genders. Assertive masculinity significantly predicted lower alcohol use in boys, and this effect was not mediated by internalizing problems, externalizing problems, or peer substance use. Negative gender roles significantly predicted higher alcohol use in girls, but this effect was almost completely mediated by internalizing problems, externalizing problems, and peer substance use. Results are discussed in terms of gender role socialization among Mexican Americans.
doi:10.1080/1533256X.2010.497033
PMCID: PMC2963473  PMID: 21031145
externalizing/internalizing; gender roles; Mexican-American adolescents; substance use
13.  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
14.  Acculturation Status and Substance Use Prevention with Mexican and Mexican-American Youth 
SUMMARY
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.
doi:10.1300/J160v5n01_05
PMCID: PMC3110070  PMID: 21660128
Acculturation; substance abuse; protective factors; Mexican; Latino; youth; prevention
15.  The Development and Initial Validation of the Hawaiian Youth Drug Offers Survey (HYDOS) 
Ethnicity & health  2010;15(1):73-92.
This study describes the development and preliminary validation of a survey focused on the most salient situations where drugs and/or alcohol are offered to Native Hawaiian youth in rural communities. The study used a 5-phase approach to test development and validation. In Phase 1 (Item Generation), survey items were created from a series of focus groups with middle school aged youth (N = 47). In Phase 2 (Item Refinement and Selection), items were edited and reduced to 62 drug offer situations that were selected for inclusion in the survey. In Phase 3 (Item Reduction), items were administered to 249 youth from 7 middle or intermediate schools in Hawai‘i. Exploratory factor analysis of the Native Hawaiian subsample (n = 194) indicated the presence of three factors accounting for 63% of the variance: Peer Pressure (23%), Family Offers and Context (21%), and Unanticipated Drug Offers (19%). The survey items differentiated between Hawaiian and non-Hawaiian youth respondents, supporting the validity of the questionnaire. The hypothesized relationship between cultural connectedness and drug offer exposure was not confirmed. Internal consistency of the measure was high.
doi:10.1080/13557850903418828
PMCID: PMC2888708  PMID: 20013440
Test development; validity; Native Hawaiian; youth; drugs
16.  Drug Resistance Strategies and Substance Use among Adolescents in Monterrey, Mexico 
The journal of primary prevention  2008;29(2):167-192.
This study examined drug resistance strategies and substance use among adolescents from Monterrey, Mexico. The focus was strategies that U.S. adolescents use most often to resist using substances, including refuse (saying no), explain (declining with an explanation), avoid (staying away from situations where drugs are offered), and leave (exiting situations where drugs are offered). Using self-administered questionnaire data from a convenience sample of 327 Mexican students enrolled at two secondary schools (preparatorias), we tested whether frequent use of particular drug resistance strategies predicted actual substance use. Multiple regression results showed that different strategies were effective for different substances, that some effects were mediated by number of offers received, and that certain effects were stronger for females than for males. Students using the refuse strategy reported less cigarette use and less binge drinking; those using the avoid strategy reported less alcohol and cigarette use; and those using the leave strategy reported less binge drinking and, for females only, less marijuana use. Use of the explain strategy was not significantly related to substance use after controlling for use of other strategies. Findings are discussed in terms of Mexican cultural values and their implications for the design of prevention programs for Mexican youth.
doi:10.1007/s10935-008-0128-x
PMCID: PMC3076702  PMID: 18365314
Adolescents; Substance use; Substance use offers; Mexican youth; Drug resistance
17.  Hopelessness, Family Stress, and Depression among Mexican-heritage Mothers in the Southwest 
Health & social work  2011;36(1):7-18.
This article reports on the findings of a study conducted with a sample of 136 Mexican-heritage mothers residing in a large southwestern metropolitan area. From a risk-and-resiliency perspective, hopelessness was approached as a culturally specific response to family stress and other challenges encountered by Mexican immigrants. Although Mexican-heritage women and other Latinas have higher prevalence rates of psychiatric disorders than their male counterparts, they experience disparity in accessing mental health services. Multiple regression analysis was used to explore the relationships among hopelessness, depression, social support, and other variables. Culturally rooted resiliency and a sense of optimism connected to immigration appear to shelter Mexican-heritage mothers from hopelessness and depression. A very large households and nonworking status were found to elevate the risk of hopelessness. Because poverty and acculturation levels were not related to hopelessness or depression, further culturally specific research distinguishing hopelessness from depression is recommended. Given that hopelessness sometimes presents itself independently from depression, implications for practice include the need to refine mental health assessment tools to capitalize on the resiliency among immigrant mothers and avoid misdiagnosis.
PMCID: PMC3074347  PMID: 21446605
depression; hopelessness; Latina mothers; women’s health
18.  Promoting Reduced and Discontinued Substance Use among Adolescent Substance Users: Effectiveness of a Universal Prevention Program 
Efforts to address youth substance use have focused on prevention among non-users and treatment among severe users with less attention given to youth occupying the middle ground who have used substances but not yet progressed to serious abuse or addiction. Using a sample from 35 middle schools of 1,364 youth who reported using substances, this study examined the effectiveness of a universal youth substance use prevention program, the SAMHSA Model Program keepin’ it REAL, in promoting reduced or recently discontinued alcohol, cigarette, and marijuana use. Discrete-time event history methods modeled the rates of reduced and recently discontinued use across four waves of data. Each substance (alcohol, cigarettes, and marijuana) was modeled separately. Beginning at the second wave, participants who reported use at wave 1 were considered at risk of reducing or discontinuing use. Since the data sampled students in schools, multi-level models accounted for the nesting of data at the school level. Results indicated that prevention program participation influenced the rates of reduced and recently discontinued use only for alcohol, controlling for baseline use severity, age, grades, socioeconomic status, ethnicity and gender. Among youth who reported use of alcohol in wave 1 (N= 1,028), the rate of reducing use for program participants was 72% higher than the rate for control students. The rate of discontinuing use was 66% higher than the rate for control students. Among youth who reported use of one or more of the three substances in wave 1 (N = 1,364), the rate of discontinuing all use was 61% higher for program participants than for control students. Limitations and implications of these findings and plans for further research are discussed.
doi:10.1007/s11121-006-0052-3
PMCID: PMC3055561  PMID: 17096196
Universal prevention; Substance use reduction; substance users; Adolescents
19.  Ethnic pride, biculturalism, and drug use norms of urban American Indian adolescents 
Social work research  2001;26(2):101-112.
This study examines how strength of ethnic identity, multiethnic identity, and other indicators of biculturalism relate to the drug use norms of urban American Indian middle school students. The article distinguishes categories of norms that may affect drug use. Regression analysis of self-reports by 434 American Indian seventh graders attending middle schools in a large southwestern U.S. city indicated that students who had a more intense sense of ethnic pride adhered more strongly to certain antidrug norms than those who did not. Whereas American Indian students with better grades in school held consistently stronger antidrug norms, there were few differences by gender, socioeconomic status, or age. These results have implications in social work practice for better understanding and strengthening the protective aspects of American Indian culture in drug prevention efforts.
PMCID: PMC3051189  PMID: 21399737
adolescents; American Indians; biculturalism; drug use
20.  Social Contexts of Drug Offers Among American Indian Youth and Their Relationship to Substance Use: An Exploratory Study 
In this exploratory study the authors examined the social contexts of American Indian youths’ encounters with drug offers and their relationship to substance use. Using an inventory of drug use-related problem situations developed specifically for American Indian youth, questionnaires were completed by 71 American Indian youth at public middle schools in a Southwest metropolitan area. Regression analyses highlight the importance of situational and relational contexts in understanding substance use among the youth in this sample. Exposure to drug offers through parents, other adults, cousins, friends and other peers was associated with different types of substance use. Exposure through parents was particularly salient in predicting the drug use of female respondents. The study underscores the need for development of culturally grounded prevention programs in schools, reservations, and nonreservation communities.
doi:10.1037/1099-9809.12.1.30
PMCID: PMC3046425  PMID: 16594853
American Indians; youth; adolescence; substance use; drug offers
21.  Neighborhood Effects on the Efficacy of a Program to Prevent Youth Alcohol Use 
Substance use & misuse  2007;42(1):65-87.
This study examines how neighborhood characteristics affect program efficacy. Data come from a randomized trial of a substance use prevention program called keepin’ it REAL, which was administered to a predominantly Mexican American sample of 4,622 middle school students in Phoenix, Arizona, beginning in 1998. Multilevel models and multiple imputation techniques address clustered data and attrition. Among less linguistically acculturated Latinos, living in poorer neighborhoods and those with many single-mother families decreased program effectiveness in combating alcohol use. High neighborhood immigrant composition increased program effectiveness. Unexpectedly, the program was also more effective in neighborhoods with higher rates of crime. There were no significant effects on program efficacy for the more linguistically acculturated Latinos and non-Hispanic White students. Findings are discussed in light of theories of neighborhood social disorganization, immigrant adaptation, and social isolation.
doi:10.1080/10826080601094264
PMCID: PMC3046879  PMID: 17366126
substance use; adolescents; neighborhoods; neighborhood effects; Latinos; Mexican Americans; acculturation; prevention; program efficacy; social control; social cohesion; social capital; treatment
22.  The Effect of Neighborhood Context on the Drug Use of American Indian Youth of the Southwest 
SUMMARY
This study examined neighborhood effects on the drug use of American Indian youth of the Southwest. We compared these effects with American Indian and non-American Indian youth in order to examine the universality of neighborhood disorganization as a risk factor for drug use. Neighborhood level variables included unemployment, poverty, education, and violent crime rate. Results indicated that American Indian youth were not as adversely affected by these neighborhood factors. American Indian youth may possess cultural characteristics that protect them from the adverse effects of neighborhood disorganization, including close familial relationships and ethnic pride. Culturally competent practice with American Indian youth may best be implemented through the enhancement of relational and cultural strengths as described in the literature.
PMCID: PMC3045036  PMID: 18192210
American Indians; drugs; substance abuse; neighborhoods
23.  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
24.  Sense of Belonging in School as a Protective Factor Against Drug Abuse Among Native American Urban Adolescents 
This article presents the results of a study conducted with 243 Native American students who were part of a multi-ethnic sample of adolescents attending middle school in a large urban center in the Southwest region of the United States. Native adolescents who felt a stronger sense of belonging in their school were found to report a lower lifetime use of alcohol and cigarettes, lower cigarette and marijuana use in the previous month, lower frequency of current use of these substances, fewer substances ever used, and a later age of initiation into drug use than other Native students. Research implications are discussed in relationship to school environment, culturally-grounded prevention curricula, and school social work practice.
doi:10.1300/J160v03n02_03
PMCID: PMC3045112  PMID: 21359140
Native Americans; adolescents; drug use; school belonging
25.  Gender identity and substance use among students in two high schools in Monterrey, Mexico 
Drug and alcohol dependence  2008;95(3):258-268.
This study explored relationships between several hypothesized dimensions of gender identity and substance use outcomes within a non-probability sample of adolescents in Monterrey, Mexico. Based on Mexican concepts of machismo and marianismo, four gender identity constructs were measured: aggressive masculinity, assertive masculinity, affective femininity and submissive femininity. The study assessed how well these gender identity measures predicted substance use behaviors, substance use intentions, expectancies, and normative approval, and exposure and vulnerability to substance offers. Data were drawn from questionnaires completed by 327 students from 2 Monterrey secondary schools. Multivariate ordered logistic and linear regression analyses, adjusted for school level effects, indicated that aggressive masculinity was associated with higher risk of drug use on most outcomes, while affective femininity was associated with lower risk on selected outcomes. Assertive masculinity was associated with only one of the outcomes examined and submissive femininity with none of them. Most gender identity effects persisted after controlling for biological sex, academic performance, age, and other gender identity measures. For two of the outcomes, the gender identity measures had significantly stronger effects for males than for females. The findings are interpreted in light of males’ higher risk for drug use and changes in gender roles and gendered behavior that are now occurring in Mexico as in the U.S.
doi:10.1016/j.drugalcdep.2008.01.019
PMCID: PMC3044649  PMID: 18329826
Gender identity; Substance use; Gender gap; Adolescents; Youth; Mexico

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