Mario De La Rosa, Ph.D.Mariana Sanchez, Ph.D. Candidate

ACKNOWLEDGEMENTS This study was supported by award number P20MD002288 from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities, or the National Institutes of Health

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Recent Latino Immigrant Study:Examining the Influence of Pre-Immigration Assets

on the Substance Use and HIV Risk Behavior of Recent Latino Immigrants

Background:Latino Immigrants in the U.S.

1970 1980 1990 2000 2010* 2020* 2030* 2040* 2050*

9.614.6

22.4

35.3

47.8

59.7

73.0

87.6

102.6

Census Projections

(Source: U.S. Census Bureau, 1970, 1980, 1990, and 2000 Decennial Censuses; Population Projections, July 1, 2010 to July 1, 2050)

Latino Immigrants in Miami-Dade County

• Latinos make up 62.5% of the 2.5 million people living in Miami-Dade County

• Miami-Dade County is also the only county in the Unites States with an immigrant majority (U.S. Census, 2009)

• Over the past four decades, net migration into the County has accounted for more than 75% of its population growth (Miami-Dade County, 2009)

1 m

onth

pr

ior

Time

Immigrants

U.S. Born

Imm

igra

tion

poin

t

Alc

ohol

Use

Latino Paradox

Study Objectives

• Determine how the HIV risk behavior of recent Latino immigrants are influenced by pre-immigration assets (e.g., family functioning, social capital, religious coping), early in their immigration process.

• Central hypothesis: The relationship between pre-immigration assets and post-immigration HIV risk behaviors will be mediated by post-immigration acculturation stress and substance use over a two-year time period in the U.S., while controlling for pre-immigration HIV and substance use risk behaviors.

Imm

igra

tion

to th

e U

.S.

Acculturation Stress

Substance Use

HIV Risk Behavio

r

Time

T1T0 T2

12 mo. 24 mo.

Baseline Substance Use & HIV Risk Beh.

Pre-Immigratio

n Assets

Conceptual Framework

Research AimsAim 1: Examine the influence of pre-immigration assets on post-immigration HIV risk behaviors among recent Latino immigrants over time.

Hypothesis 1: Recent Latino immigrants with higher levels of pre-immigration assets will exhibit lower levels of HIV risk behaviors over the two-year time period.

Aim 2: Examine the effects of pre-immigration assets on post-immigration acculturation stress and substance use among recent Latino immigrants over time.

Hypothesis 2: Recent Latino immigrants with higher levels of pre-immigration assets will have lower levels of post immigration acculturation stress and substance use over the two-year time period.

Research Aims

Aim 3: Examine the influence of pre-immigration assets on post-immigration HIV risk behaviors among recent Latino immigrants over time.

Hypothesis 1: The relationship between pre-immigration assets and post-immigration HIV risk behaviors will be mediated by post immigration acculturation stress and substance use over the two-year time period in the U.S. while controlling for pre-immigration HIV risk behaviors.

MethodsStudy DesignThree waves of data collection (baseline and two follow ups) spaced twelve months apart over a period of two years.

Sample• N=527 Latino immigrants • Living in Miami-Dade County (only county in the

U.S. with an immigrant majority- 51%)• 18-34 years of age• < 1 year since immigration into the U.S.• Primarily recruited through respondent driven

sampling

Data Collection ProcedureFace-to-face administered interviews using psychometrically sound instruments

Significance of the RLIS• Conducting innovative research that,

acknowledges the importance of pre-immigration factors in predicting post-immigration HIV risk behavior, an often neglected area in the literature.

• Identify important predictors of HIV and substance use behavior trajectories for Latino immigrants in the U.S.

• Enhance existing and develop new HIV and substance abuse prevention programs that identify, sustain, and incorporate assets of Latino populations into culturally grounded interventions.

Initial Findings from the RLIS:Baseline Sample DemographicsN=527 Latino immigrants representing 18 Latin American Countries

Mean age: 26.87 years

Mean time in the US: 6.77 months

Legal Status: Undocumented immigrants (30%), documented immigrants (70%)

Education: 18% of RIS participants had college degrees, 34% had attended some college, 29% had a high school or equivalent degree, and 19% had not completed high school.

Income: Mean total household income in the three months prior to immigration was $5265.11 (SD = $5148.32), which translates to an annual average household income of approximately $21,000.

Alcohol users= (n=365); Drug users= (n=82)

Initial Findings from the RLIS: Challenges and Strategies in Recruiting, Interviewing, & Retaining Recent Latino Immigrants in Substance Abuse and HIV Epidemiologic Studies

Data collection activities of this study have provided insights in identifying, recruiting, interviewing, and retaining Latinos in community based studies:

• Utilizing a combination of translation techniques ensured the development and implementation of culturally appropriate questionnaires

• Respondent driven sampling facilitated identifying participants

• Establishing rapport and trust was critical for interviewing

• Maintaining a tracking protocol was most important for retention

Initial Findings from the RLIS: Alcohol Use among Latinos: A Comparison of Pre-Immigration, Post Immigration, & U.S. Born Latinos

Study Design Compared alcohol use of pre-immigration Latinos utilizing baseline data from the RLIS (N=527) to-

Alcohol use of post-immigration and U.S. born Latinos utilizing NSDUH report focusing on trends in alcohol use among persons 18 years of age and older between 2004 and 2009.

NSDUH Sample• Approximately 6500 Latinos ages 18-34 of South or Central

American, Dominican, and Cuban descent

Hypothesis• Regular, heavy, and binge alcohol will be lower among both

Latino male and females immigrant ages 18-25 and 26-34 prior to their immigration as compared to their U.S. born Latino and post immigration Latino counterparts.

Measures

• Past month regular alcohol use was measured as having at least one drink in the past 30 days.

• Past month heavy alcohol use was defined as drinking 5 or more drinks on the same occasion on each of five or more days in the past 30 days (SAMHSA, 2010a).

• Past month binge drinking was measured as drinking 5 or more drinks on the same occasion on at least 1 day in the past 30 days

Alcohol Use Among Pre-Immigration, Post Immigration, & U.S. Born Latinos

Alcoh

ol Use

(Ages 1

8-25)

Alcoh

ol Use

(Ages 2

6-34)

Binge

Alcoho

l (Ages

18-25

)

Binge

Alcoho

l (Ages

26-34

)

Heavy

Alcoh

ol Use

(Ages

18-25)

Heavy

Alcoh

ol Use

(Ages

26-34

)0

10

20

30

40

50

60

70

80

Pre-Immigration

NSDUH (U.S. Born)

NSDUH (Post-Im-migration)

Past Month Regular Alcohol Use By Gender

Pre-im

migrati

on (A

ges 1

8-25)

Pre-Im

migrati

on (A

ges 2

6-34)

U.S. Bo

rn (Age

s 18-2

5)

U.S. Bo

rn (Age

s 26-3

4)

Post Im

migrati

on (Ages

18-25

)

Post Im

migrati

on (Ages

26-34

)0%

10%

20%

30%

40%

50%

60%

70%

80%

% E

ngag

ing

in R

egul

ar A

lcoh

ol U

se

Past Month Heavy Alcohol UseBy Gender

Pre- immigration (Ages 18-25)

Pre-Immigration (Ages 26-34)

U.S. Born (Ages 18-25)

U.S. Born (Ages 26-34)

Post Immigration (Ages 18-25)

Post Immigration (Ages 26-34)

21.2%24.4%

18.1% 16.3%

7.4%4.4%

10.0%6% 6.8%

4% 2.6% 4.0%

Males Females

Discussion

1 m

onth

prio

r

Time

Immigrants

U.S. BornIm

mig

ratio

npo

int

Alc

ohol

Use

Why these results?Future Research DirectionsPre-immigration stresses

• Stressors associated with the loss of close ties with friends and family from the country of origin as well as formal support systems (health care providers, schools) prior to immigration

• Stressors associated with level of tangible and intangible social capital immigrants have or plan to bring with them prior to immigration (immigration status, financial resources, reasons why they immigrate, plan to bring or join family in the U.S., level of financial resources)

Psychological factors related to the post immigration experience soon after immigration

• Optimistic expectations of beginning a new life with a host of opportunities for themselves and their families.

• Leaving behind stressful life conditions such as long term unemployment, which is common among many young professionals in Latin America

• Fear of political persecution because of their political affiliations or ideology.

Social factors related to the post immigration experience soon after immigration

• Association with new non-drinking networks.• New social norms in the U.S., such as criminal penalties for driving while

intoxicated, that are enforced (Social Control theory).• Fear of deportation, particularly for undocumented immigrants.• Wanting to fit into new host culture (often impacted by the cultural milieu

of communities immigrants initially settle in after immigration)

Why these results?Future Research Directions

Limitations

• All intended analyses could not be completed due to NSDUH data on past month alcohol use for U.S. born Latino males ages 26-34 not being unavailable.

• Participant-level demographic differences in income and education levels between the RLIS and NSDUH samples could also explain differences in alcohol patterns between groups. For instance:

• RLIS sample reported higher higher education • NSDUH sample reported higher income

• Issues with recall of alcohol use both for the RLIS and NSDUH sample.

• Nonrandom nature of RLIS sample

Initial Findings: The Influence of Religious Coping on the Acculturative Stress of Recent Latino ImmigrantsAim:

Examine the association between pre-immigration religious coping styles (internal and external religious coping) and post-immigration acculturation stress among recent adult Latino immigrants.

Hypothesis: After controlling for socioeconomic status and legal status (legal or illegal immigrant), participants with higher levels of religious coping will experience lower rates of acculturative stress.

Acculturation: Acculturation is the exchange of cultural features that results when groups of individuals having different cultures come into continuous first hand contact; the original cultural patterns of either or both groups may be altered, but the groups remain distinct.

Acculturation stress: a form of psychological or social stressors encountered by an individual due to an incongruence of beliefs, values, and other cultural norms between their country of origin and the country to which they have immigrated.

Examples of social stressors: legal status stress language barriers difficulties assimilating to beliefs, values, norms of the

dominant culture perceived feelings of inferiority and discrimination

Background:Acculturative Stress

Background:Religious Coping

Tix & Frazier (1998) define religious coping as “The use of cognitive and behavioral techniques, in the face of stressful life events, that arise out of one’s religion/spirituality.”

Religious coping can be beneficial by providing belief framework which:

facilitates cognitive restructuring of the meaning of an event social support of a religious community sense of control over stressful situations

Various forms of religious coping mechanisms: internal (cognitive) religious coping external (behavioral) religious coping

Religious Coping among Latinos• When controlling for education and other SES disparities, Latino’s

use religious coping more frequently than do Non-Latino Whites.

• Less acculturated Latinos use religious coping strategies more frequently than those with higher levels of acculturation.

• Finch and Vega (2003) investigated the effect of social support on acculturation stress with a sample of 3012 participants of Mexican-origin.

• Lowest rates of acculturative stress were displayed by participants with the highest religious support seeking behaviors.

• Ellison and colleagues (2009) reported that religious involvement appeared to exacerbate the effects of acculturative stress on depressive symptoms of Mexican-origin adults.

MeasuresReligious Coping: Ways of Religious Coping Scale (Boudreaux et al., 1995). This instrument is a 40-item questionnaire measuring internal and external religious coping cognitions and behaviors. Total scale (Cronbach’s α = .95), internal scale (α =.97), and external scale (α =.93).

Acculturative Stress: The immigration stress subscale of the Hispanic Stress Inventory Scale –Immigrant Version (Cervantes, Padilla, & Salgado de Snyder, 1990). The instrument is in a 5 point Likert scale format and the subscale used contains 18 questions. (Cronbach’s α = .85).

Socio-economic status (SES): Measured by creating a total SES index score by multiplying participant’s total household income during the 3 months after immigration and level of education (1 = less than high school, 2 = high school, 3 = some training / college after high school, 4 = bachelor’s degree, 5 = graduate / professional studies).

Legal status: Participants were asked to report their current legal status in the U.S. A total of fourteen possible categories were provided. These categories were then recoded into a dichotomous variable of legal (1) or illegal (0) immigration status.

Measures

Results:A Path Model of Acculturative Stress

Internal Religious Coping

External Religious Coping

Immigration Status

Acculturation Stress

Socioeconomic Status

-.10*

-.47**

-.23**

-.27**.03 .19** .05

-.01

.66**

*p < .05, **p < .01

Discussion

• Dramatic loss of valuable religious resources, soon after immigration could make recent immigrants more vulnerable to experiencing acculturative stress.

• Negative religious coping passively leaving the responsibility for resolving crisis

entirely up to divine intervention feelings of divine abandonment and anger found to have negative impacts on mental health by

fostering feelings of guilt and shame; eroding feelings of competence and worth, and hopefulness; and distracting persons from more productive coping responses.

Limitations

• No random sampling• Self report measures• Cross-sectional research design

Significance• Improve prevention/intervention skills and strategies

necessary to assist recent Latino immigrants in mediating the negative aspects of the acculturation process (i.e., acculturative stress).

• Gaining better insight into these coping mechanisms would provide valuable knowledge in targeting cognitions and behaviors that may need to be addressed when providing prevention and other intervention services to Latino immigrants

• Development of culturally appropriate interventions that incorporate issues of religiosity when applicable into the clinical process