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Substance Abuse Resource Guide: Hispanic/Latino Americans

From the Director of CSAP...

Produced by the National Clearinghouse for Alcohol and Drug Information, Andrea B. Miller and Cara McVeigh, editors.

For further information on substance abuse, call 301-468-2600, 800-729-6686, or TDD 800-487-4889. Or visit us on our World Wide Web site at http://ncadi.samhsa.gov.

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Contents

Section 1: Prevention Material
Section 2: Studies, Articles, & Reports
Section 3: Groups, Organizations, & Programs
Section 4: Internet Access Sites

This fact sheet for Hispanic/Latinos presents nine ways they can prevent substance abuse problems in themselves and in others. Pointers include: (1) Be a good role model, especially for young people. Help them find ways to resolve their problems without resorting to violence or substance use; and (2) Help new neighbors, perhaps recent immigrants, cope with the difficulties of the English language and the American culture. Life stresses, such as a major move, can be a precursor to substance abuse.

Busy and colorful, this poster features the anti-crime hero, McGruff the Crime Dog. Children can search for 45 hidden pictures in the illustration.

This educational coloring book in Spanish teaches children to say no to drugs. Safety is emphasized, with information such as "¡Nunca recibas dinero o caramelos de personas que no conoces!" and "Si alguien te ofrece drogas, cuéntaselo a tus padres."

A hard-working family in a rural community experiences some alcohol-related problems. The 17-year-old son suffers the consequences of exercising poor judgment involving alcohol. He is arrested for public drunkenness, is suspended from the wrestling team, breaks up with his girlfriend, and sees a counselor. Thus, he and his family learn a lesson about alcohol's negative effects. Sub-plots touch on teen pregnancy, adult and teenage alcohol problems, and exposure to pesticides in a migrant community. Available as a fotonovela booklet (56 pages), or as 6 episodes in a radionovela or videotape format (2 hours, 12 minutes).

This fotonovela describes the dangers of tobacco through the responses of a group of young women who are looking at an eye-catching cigarette advertisement. The women dismantle the myths and discuss the dangers of smoking.

This mini fotonovela is a scene between three babies talking about the awful smoke that they have to breathe from their families' cigarette smoke. One baby has a cold and says he has a lot more colds because smoke hurts his lungs and makes him get sick more often. At the end, the brochure mentions the dangers of secondhand smoke.

This publication provides the basic facts about smoking and its proven relationship with many diseases and disabilities. The booklet helps the reader decide to quit smoking and lists sources of further information.

This illustrated consumer education booklet presents the basic facts about the dangers of cigarette smoking. The health hazards and negative consequences of nicotine addiction are outlined, along with suggestions for smoking cessation.

This booklet explains the dangers of secondhand or passive smoking and the health risks it presents to nonsmokers. People with health problems, pregnant women, and young children are most vulnerable to the dangers of secondhand smoke. Smokers are urged to quit for their own health and the health of others around them.

This booklet focuses on cocaine, and explains the dangers associated with its use. The booklet debunks the myths surrounding cocaine use, describes the pattern of use, and uses text and illustration to explain how it affects the body and mind.

This booklet illustrates the often unfortunate consequences alcohol has on the children of alcohol abusers. Two theories about child abuse and alcohol are proposed: alcohol may cause abuse and neglect, and alcohol use may provide an excuse for abuse. The booklet provides an overview of the problem and suggests some intervention strategies and solutions.

This consumer education booklet describes the harmful effects and consequences of substance abuse and how illegal substances affect the mind and body. The booklet covers the reasons why people begin to use drugs and includes a chart that explains the type of drugs, its name and slang, and the possible side effects. The booklet concludes with information on the physical, emotional, and social problems associated with addiction and offers suggestions for addiction care.

This bilingual booklet gives several examples of community drug prevention programs and offers suggestions for what steps citizens can take to keep their neighborhoods drug-free. Schools are asked to set up "drug-free school zones," health care providers are encouraged to sponsor drug education programs, and families are urged to keep the lines of communication open. All community systems are advised to work together. A list of government and nongovernment sources is included for further information.

This colorful handbook outlines what children at four key stages of development should know about drugs and suggests family activities to reinforce children's motivation to avoid alcohol and drugs.

Written in simple language, this booklet addresses issues around alcohol. It explains to parents how alcohol affects the body, how to tell if children have been drinking, why children start to drink, and how to help children refuse alcohol. A resource list is included.

This program in Spanish describes the services of the National Clearinghouse for Alcohol and Drug Information. Former Surgeon General Antonia Novello speaks about the importance of substance abuse prevention for youth. Other health professionals and community representatives participate in a discussion about the most effective ways to prevent substance abuse problems among youth.

This poster beautifully illustrates a pregnant woman holding her stomach. The viewer can see the fetus and the all-important umbilical cord. To the left of the woman are the words (in English and Spanish): Any use of alcohol or other drugs may affect the health of your unborn baby.

This illustrated, two-sided HIV and AIDS prevention brochure is printed in English and Spanish. It explains why sharing needles is dangerous and gives directions for cleaning works.

This brochure "AIDS and Babies" explains the ways that the virus is contracted, how to protect yourself, ways of not contracting AIDS, how to get tested, and what to do if your results are positive. It also discusses whether the baby can get it, what to do if you are pregnant, and other information.

This educational slide show looks at alcohol's role in Latino culture, from Pre-Colombian times to the present and then uses slides of specific advertisements and promotions to show how marketers have subverted Latino culture in an attempt to embed their products in the lifestyles of Latinos. A supplementary fact sheet, discussion questions, community action ideas, and resource list are included.

This video is based on the book, Marketing Disease to Hispanics, written by the Center for Science in the Public Interest. The video explores how Hispanic and Latino communities are bombarded with billboards promoting cigarettes and alcohol. Professionals from the field of public policy and advocacy are interviewed. Efforts of everyday citizens and special advocacy commissions to decrease and/or rid their communities of powerful advertising from tobacco and alcohol companies are also highlighted.

This study guide provides background information about the alcohol and tobacco advertisers' damaging effects on the Hispanic population. Also included are discussion questions, suggested activities, and available resources.

This video is about a high school student and the decisions she must make regarding her pregnancy. Mary smokes and drinks beer. Her mother, unsuccesful in dissuading her, asks an adult friend who is a nurse to help. She shows Mary babies born with disabilities because of the mothers' use of various drugs. Mary realizes that her actions could mean life or death for her unborn baby. The accompanying discussion guide provides background information about teen pregnancy and developmental disabilities resulting from maternal use of illegal and legal drugs. It includes a synopsis of the video, key points and objectives, general and video-specific discussion starters, activities, glossary, and a list of resources.

Pasos Adelante is a demonstration project that promotes resiliency in preschool-age children and their parents. Parents currently in treatment for substance abuse participate with their children. The objectives are to increase motor, language and communications skills in the children, and to increase the parenting skills of the participating parents.

Prevention and Treatment

Because of its distinct cultural values and orientations, the Hispanic/Latino community benefits from a culturally sensitive prevention program that incorporates both formal and informal systems of support. This inclusive approach acknowledges the variety of factors that influence substance abuse and the social context in which it occurs. An integrated program that capitalizes on the strengths and resources of the community it serves is both culturally relevant and cost-effective. Furthermore, without this partnership between the community and external resources, the benefits of the comprehensive prevention program are less likely to continue once external funding ceases. Collaboration with Hispanic/ Latino natural support systems involves several steps: (1) assess the natural support systems; (2) identify appropriate natural support providers and map their location in the community; (3) build a relationship with identified natural support systems; and (4) program collaborative activities with natural support systems, including sharing resources, building knowledge and consulting, doing outreach and community education, and counseling.

This Center for Substance Abuse Prevention monograph, part of a series on cultural competence, examines issues of the Hispanic/Latino family, culture, and society as they relate to the design and evaluation of substance abuse problem prevention programs. Part I reviews concepts of substance abuse prevention, demography on Hispanic/Latinos, and existing research on substance abuse problems in this population. Part II presents family-based intervention models that have been implemented in Hispanic/Latino communities. Part III presents family-oriented, community-based, and school-based intervention models.

As an introduction to a series on the array of issues in the implementation and evaluation of substance abuse prevention programs, this volume integrates two types of competence for prevention program practitioners: program evaluation competence and cultural competence. The chapters in this document provide conceptual frameworks and practical suggestions for evaluators working with various ethnic groups.

This paper conducts a review of the demographic and health status data for Hispanic communities and relates them to the role of culture in health care. The authors recommend that promotion programs for Hispanic communities should focus on specific community data (morbidity rather than mortality), understand the impact of culture and language (cultural competency training and staffing), develop strong outreach components (establish community advisory boards, identify credible community spokespersons and incorporate community residents as health educators), and work in partnership (sharing funds and resources) with community-based organizations.

This chapter presents a generic model that may be used to guide scientific drug abuse research with Hispanics. This model serves not as a final version but rather as a template that may prompt variations that will be applicable to various Hispanic populations in the United States. This paper also presents a discussion of theoretical and methodological issues that should be considered in future drug abuse research with Hispanics. To address the unique issues posed by modern drug abuse prevention and treatment with ethnic minority populations, a composite and staged approach to scientific research appears necessary. Such a staged approach for culturally sensitive research likely would entail three important phases in a single study: ethnographic exploratory analysis; effective translation of these data to valid scales; and model-building and testing. The use of a three-phased approach when conducted within a single study may help to generate better specified and more culturally accurate models describing the processes that promote drug abuse among members of various U.S. Hispanic populations.

This chapter discusses how outcomes have evolved for two substance abuse prevention demonstrations in South Texas for 8- to 14-year-old youth of Mexican descent living in the United States. Lack of data and models for guiding the development of prevention programs for Hispanics are identified. The problems of Hispanic youth are placed in historical and sociocultural contexts, and how these problems interact with problems of adolescent development are discussed.

A rap contest methodology for smoking prevention was tested with 10- to 14-year-olds in a predominantly minority school district. Contests occurred after initial assemblies where students heard and viewed taped peer antismoking rap messages. Winning students received $25. Pre- and post-testing indicated high preference ratings for the intervention.

Hispanic A.A. groups in Los Angeles operate with two different models, one involving "terapia dura" (rough therapy) and the other employing less confrontive methods. Terapia dura adapts expressions of the machismo value complex to produce social alternatives for young male immigrants from Central America. In the less confrontational version, machismo is muted. Hispanic A.A. groups make little provision for the problem of women, and gays are stigmatized. Members' economic status, ethnicity, and level of acculturation condition the style and content of meetings and strategies for group survival.

This paper evaluates and contrasts the effectiveness of two culturally sensitive AIDS education programs developed by the UCLA AIDS Nursing Network and delivered to 213 impoverished Latina homeless drug-addicted women in Los Angeles. The Comprehensive Health Seeking and Coping Paradigm guided the program, which was implemented by specially trained nurses and outreach workers. A quasi-experimental design was employed where women were randomized by site into specialized (n=82) and traditional (n=131) programs. Repeated-measures ANOVAs and log-linear models were used to evaluate improvement over a 2-week period for women in both groups and to identify interactions with program type. Two-week posttest analyses assessed program effectiveness, controlling for baseline values of the measure in question, nonequivalency between groups at baseline, and selected demographic characteristics, including acculturation. Results indicated that women in both AIDS education programs improved significantly in cognitive, behavioral, and psychologic outcomes.

Hispanics are a distinct cultural group, and the fastest growing minority in the United States today, representing some 22 million persons or 9 percent of the total population. Research and policy issues related to the prevention and treatment of HIV disease and drug abuse in America's Latino/Hispanic communities are discussed. Three critical policy issues are examined: setting future research priorities; strategies for community involvement in research; and strategies for increasing Hispanic researcher involvement.

A participatory community project in the US-Mexico border town of Ciudad Juarez, aimed at helping women who are sex partners of male injection drug users to reduce behaviors that increase their risk for HIV infection, is described and evaluated. The design and implementation of the project were influenced by Paulo Freire's pedagogy in the Latin American tradition of popular education, by Bandura's self-efficacy concepts, and by David Warner's "barefoot doctor" community health care methodology. Using these approaches, the participants were directly involved in the development of teaching materials, and curriculum content and implementation of the project. The program was evaluated quantitatively using NIDA's AIDS Intake and Follow-up Assessment (AIA/AFA) questionnaires, and qualitatively using open ended interviews. While the AIA/AFA questionnaires detected small changes in the frequency of condom use among the participants, ethnographic interviews detected significant changes in the nature of the behaviors that were placing the women at risk. The changes seem to stem from an increase in the degree of self-esteem, self-efficacy, and awareness of the social, economic, and political constraints of their lives. These results demonstrate the need for qualitative measures to be incorporated in the evaluation of community based health education programs. A series of recommendations is presented to facilitate further development and replication of the program in similar populations.

This article reviews the clinical research conducted with U.S. Hispanics and discusses priorities for alcohol treatment research in this ethnic group. Specific areas in which research is needed include epidemiological descriptions of client characteristics, access and utilization of alcohol treatment, the structure of alcohol programs, pathways to treatment, alcohol dependence and treatment effectiveness, and treatment matching in alcohol treatment. Methodological requirements, research funding strategies, and professional training needed for implementing the research needs identified in the article are also discussed. A concerted effort by funding institutions is needed to emphasize the importance of this research, and an increased commitment of funds for research and professional training is necessary. Such funds should be earmarked for research with minorities and training for minority professionals.

The problem of gang violence poses a significant threat to the mental health of Chicano children. Although there has been considerable media attention given to the increase in gang violence, the mental health literature is sparse with clinical information on the assessment and treatment of Chicano gang-involved youth. The sparsity of information has been related to public apathy toward these youth, and negative and stereotypic views of these youth as antisocial. This article examines family systems dynamics and adolescent developmental variables that contribute to gang participation. Specific treatment modalities are discussed and the importance of a multimodal approach is emphasized. Two cases are presented: one addresses family systems and cultural identity factors of gang participation; the other highlights the importance of a multimodal treatment approach as well as extended family involvement in treatment. Finally, recommendations are made for mental health professionals to advocate the needs of Chicano gang-involved youth in both mental health and correctional settings.

Prevalence and Patterns of Use

This study identified differences in gender between and among fourth, fifth, and sixth grade Mexican-American students for use of four specific "minor" substances: cigarettes, beer, wine/li- quor, and marijuana. Minor substances are believed to serve as a "gateway" to more intense and frequent use of minor and major substances. Students (n = 2,216; males 52 percent and females 48 percent) were surveyed to ascertain information pertaining to their substance use. The chi-square statistic found significant gender differences at the fourth and fifth grade level for use of minor substances. Patterns of initiation of minor substance use by gender and grade are discussed in the context of substance use stage theory. Overall, results support the need for further research emphasizing within-group variations in the substance use of singular ethnic groups.

To examine tobacco use patterns and its sociobehavioral correlates among Hispanic in-school youth, a tobacco use and knowledge survey was administered to 660 children from fourth through sixth grade classes, of which 69 percent (n=453) were of Hispanic origin. Male Hispanics were more exposed to previous tobacco use (38 percent vs. 20 percent), p < .01), reported more current smoking, had more smoking friends, received more cigarette offers, and wanted to try a cigarette compared to females (all p < .05). Also, more previous alcohol use was noted in the previous tobacco users, indicating its potential as a "gateway drug." Multivariate analyses showed that being offered cigarettes was the strongest environmental indicator of previous tobacco usage, followed by having adult smokers in the house, and having smoking friends. All may cause Hispanic youth to initiate smoking, which suggests the need to address peer and social influences in school-based substance abuse programs.

This report provides the most current data available on the nature of drug use among minorities. Basic population statistics are presented from the Census Bureau and projections are given from racial/ethnic minorities in the United States to help professionals determine the relative size of racial/ethnic groups and compare demographic factors, such as family income. An overview is provided of drug use patterns for the total U.S. population and for racial/ethnic groups using data obtained from the National Household Survey on Drug Abuse. Prevalence estimates on past-month, past-year, and lifetime use of illicit drugs, alcohol, and cigarettes are included. Drug use and drug-related behaviors among minority youth are examined. Data are presented on risk behaviors such as dropping out of school, driving under the influence of alcohol or drugs, and engaging in high-risk sexual behaviors. Data are discussed on women of childbearing age and on drug use during pregnancy. The health consequences of drug use also are examined. Drug use and crime are addressed, including data on the drug use history of inmates and on the percentage of inmates who committed offenses under the influence of drugs, to get money for drugs, or both.

A telephone survey was conducted to compare the extent of smokeless tobacco consumption by Anglo-Americans and Mexican-Americans. Using systematic random sampling, 1 out of every 25 phone numbers was selected from the Grant County, NM, telephone directory. Two hundred and ten individuals were interviewed. All of the female respondents, including 46 Mexican-Americans and 81 Anglo-Americans, indicated that they did not use smokeless tobacco. Twenty-five percent of the 51 Anglo-American males and 26 percent of the 30 Mexican-American males identified themselves as consumers of smokeless tobacco. A chi-square analysis revealed no significance difference between the number of Mexican-Americans and Anglo-Americans among the male self-identified users of smokeless tobacco.

Based on an epidemiological sample field survey of community households in Puerto Rico, this study estimates the frequency of illicit drug use and clinically defined drug abuse and/or dependence syndromes. Results are compared with those from surveys on the U.S. mainland. Suspected risk factors are studied as well, with a special focus on childhood misbehavior. Trained lay interviewers administered a Spanish Diagnostic Interview Schedule to 912 respondents ages 17 to 68 years who were selected by multistage probability sampling of island households. An estimated 8.2 percent of the population had a history of illicit drug use and 1.2 percent qualified for a standardized lifetime diagnosis of drug abuse, dependence, or both. An estimated 18.4 percent of the male drug users and 7.7 percent of the female drug users met the criteria for drug abuse and/or dependence. A history of drug use was related to the diagnoses of alcohol abuse and/ or dependence and antisocial personality, but few persons who had used illicit drugs at least once in their lifetime reported a history of receiving treatment for alcohol, drug, or mental health problems. The data were consistent with a suspected association between level of childhood misbehavior and occurrence of illicit drug use, even after statistical control for potentially confounding variables.

Hispanic HANES was used to examine whether family structure is related to substance abuse among Mexican, Puerto Rican, and Cuban American adolescents. Mexican adolescents living in female headed households have higher rates of drinking, drug use, and overall risk-taking behaviors than those living with both parents. Puerto Rican adolescents living in female-headed households have higher rates of overall risk-taking behaviors than those living with both parents. Family structure is unrelated to Cuban adolescent risk-taking behavior. There is no evidence that gender modifies the effect of family structure for adolescent risk-taking behaviors.

This study examined initiation into drug use during grade school years in a sample of Cuban-American, black, and white non-Hispanic students in the greater Miami, FL, area. Findings indicate that first use of alcohol occurs in fifth grade and cigarettes in sixth grade for all subgroups except white non-Hispanics who start in the fifth grade. White non-Hispanics had the highest life-time levels of alcohol and cigarette use. Foreign-born Cuban Americans had a lower lifetime prevalence of alcohol and cigarette use than U.S.-born Cuban Americans. Higher acculturation level was related to first use of alcohol. One important implication of this study is that alcohol intervention should begin no later than third grade and smoking interventions no later than fourth grade.

The Hispanic population of the United States is one of the fastest growing ethnic subpopulations in the country. The 1980 census reported that 14.6 million persons of Hispanic descent reside in the United States, making this group the second largest minority in the country (6. 4 percent of the total population). The U.S. Census Bureau (1987) projects that this population will continue to grow by 45.9 percent through the year 2000. Given the dramatic growth rate and the youthfulness of the Mexican American and Puerto Rican populations, the importance of understanding the drug use and abuse patterns of these groups is self-evident. The need for national epidemiological studies of substance use among the Hispanic population and its subpopulations is high. This chapter begins by briefly reviewing general studies of drug use epidemiology, then considers studies specifically devoted to Hispanic substance use, and finally, discusses problems in interpreting Hispanic substance use epidemiology results.

The investigations examined drug usage-based and culture-based differences in young Puerto Ricans living in New York (100 nonusers and 192 drug users), Americans living in New York (100 nonusers and 99 drug users), and Puerto Ricans living in Puerto Rico (100 nonusers and 98 drug users). The Associative Group Analysis method was used to measure cultural change in three dimensions: dominant perceptions, priorities, and evaluations. The findings show that the Puerto Rican drug user and nonuser groups in New York differed significantly in their paths of acculturation. The nonusers were shown to progress successfully in learning American meanings and adopting American perspectives and cultural norms. The drug users were attracted to dominant American priorities (e.g., wealth and freedom) but showed little progress in adopting deeper American cultural meanings necessary for effective coping.

This report examines the reasons some minorities have more medical problems than others. Acculturation seems to increase drinking among successive generations of Hispanics, particularly for Mexican-American women. The authors discuss genetic and environmental factors that may put minorities at risk for or protect them from alcohol problems, and review research on screening to identify those at risk for alcoholism or alcohol abuse. Obtaining adequate treatment and prevention services is of concern. Although access to treatment is sometimes difficult for minorities, those who do enter treatment programs have success rates equal to those of whites.

Data from the Hispanic Health and Nutrition Examination Survey were used to examine the influence of acculturation on alcohol consumption among Puerto Rican, Cuban-American, and Mexican-American women in the United States. Acculturation was found to be positively related to frequency of consumption and probability of being a drinker among all three groups. A positive relationship was also evident for total drinks consumed and volume (drinks per occasion) among Cuban-American women and total drinks consumed among Mexican-American women.

Analysis of data from a nationally representative sample of Hispanic youth ages 12-17 and their parents investigated the impact of a number of variables on youths' drug-using behavior. The significance of youth, household, and parental characteristics were tested using measures of youth drug use as dependent variables in regression models. Parents' attitudes and use of licit and illicit drugs were found to play an important role in their children's drug use behavior. The results also provide some support for the hypothesis that Hispanic children whose parents are more acculturated into American society are at higher risk of using drugs. Youths of Mexican origin, youths living outside large metropolitan areas, and females were found to be more likely to use drugs. The results provide supportive evidence that drug prevention education programs must be family oriented to be effective with Hispanic youths.

Among 1,208 Puerto Rican women in Boston and Hartford responsible for adolescents, the age-adjusted prevalence of current smokers was 29.4 percent higher than rates for all adult women. Nonsmoking status was associated with higher educational attainment, presence of a spouse or partner, and regular church attendance.

Mental health status of island Puerto Ricans and three groups from the Los Angeles Epidemiologic Catchment Area Study (Mexican American immigrants, U.S.-born Mexican Americans, and non-Hispanic whites) were compared. The research sample included a total of 1,513 Puerto Ricans and 2,219 adults from the Los Angeles area. Subjects were interviewed using the Diagnostic Interview Schedule (DIS) with a focus on affective disorders, alcohol abuse/dependence, somatization, phobic disorder, and psychotic disorder. The following results of the study were seen: (1) Mexican American immigrants had the fewest mental health problems; (2) Puerto Ricans had more somatization disorder; and (3) U.S.-born Mexican Americans or non-Hispanic whites had more affective and alcohol disorders. It is concluded that the heterogeneity of the group studied may account for mixed results in studies of mental health of American Hispanics.

The relationships between alcohol consumption, alcohol dependence, the reasons for drinking, and secondary depression were studied. The research sample included 372 persons with a history of alcohol abuse or dependence taken from a randomly selected community sample of 2,393 persons. The data were derived from the Los Angeles Epidemiologic Catchment Area study. The community sample included 1,244 Mexican Americans and 1,149 non-Hispanic whites born in the United States who responded to an interview. The following results of the study were seen: (1) lifetime alcohol abuse/de- pendence was related to increased risk of major depression by a factor of 2 to 7; (2) recent secondary depression was seen in 2 to 18 percent of those diagnosed with alcohol abuse/dependence; (3) increased risk of secondary depression was related to low income, female gender, low acculturation levels, drinking for reasons other than relaxation, drinking to forget by Mexican-American alcoholics, and current abstinence by alcoholics born in Mexico. It is suggested that ethnicity and cultural attributes of Mexican Americans play a role in the development of secondary depression associated with alcoholism.

The authors examined substance abuse rates among subgroups of Mexican-American students by comparing substance use rates of Mexican-American adolescents born in the United States to those of Mexican-American students born in Mexico and those of Caucasian students attending the same schools. A total of 3,404 9th- and 11th-grade students were surveyed using the California Substance Use Survey (Skager, Austin, & Firth, 1991; Skager, Firth, & Maddahian, 1989). It was found that Mexican females abstain the most from drug and alcohol use. Mexican males also reported lower drug and alcohol use than their Mexican-American and Caucasian counterparts, who had similar rates of alcohol use. In terms of prevention and intervention, Caucasian ninth graders reported the highest percentages receiving a substance abuse prevention program for at least part of a semester. Mexican-American students, however, were more likely to report not having received any prevention programming in school. Implications for assessment and prevention are discussed.

This paper presents preliminary findings of two studies conducted with Chicana/Latino secondary and university students. Ninety-four women were surveyed concerning alcohol and drug use, behavioral efficacy, knowledge of HIV infection, and sexual practices. In addition, two focus groups were conducted in the high school and four in the university. The focus groups examined the women's perception of the role of cultural values and family communication in their ability to prevent high-risk behaviors (alcohol and drug use, unsafe sexual practices). The implications of the findings are discussed in terms of Chicano scholarship, health promotion, and methodological issues in research with Latinos.

The theoretical argument of the paper is as follows: Traditional values may defer many Latinos from drug use, but they operate to ostracize adolescent girls from cholo (street) families. Those girls may be propelled into drug using youth gangs or similar peer groups, where they are further channeled to the more deviant subcliques. This pivotal experience initiates a drug-oriented adult lifestyle. Gender norms mean that the typical male career path to and from the gang is different. Data bearing on this argument are presented, and research and intervention implications are explored.

Drug use and psychosocial profile of young Central American immigrants in Washington, DC, were compared to the National Household Survey of Latinos. The immigrants showed (1) more exposure to alcohol and illicit drugs; (2) interrelated marijuana, cocaine, PCP, and hallucinogenic drug use; and (3) a positive association between psychosocial competency and ratio of perceived supports/threats. Drug involvement intensity was negatively associated with psychosocial competence and positively with instrumental drug use, CAGE scores, and problems. Crisis scores and drug involvement were related only in the high support/threat group. Supportive environments may be more effective than threats in preventing drug use.

Data are presented on recent findings from theory-driven research studies on the etiology of drug use among minority youth. Information regarding methodological problems and other barriers affecting the lack and quality of research in this field also is presented. Issues under discussion include cultural identification, acculturation, integrating mainstream and subcultural explanations of drug use, social network theory, interactional theory, self-report validity, survey techniques, and data collection.

Latino adolescents in two urban New England areas were surveyed to assess risk of human immunodeficiency virus (HIV) transmission. Probability of HIV infection during the previous 6 months was estimated from self-reported sexual contacts, condom usage rates, and number of partners. Teens were also asked to show condoms in their possession to the interviewer to validate self-reports of condom use. Overall, 8 percent of the 586 respondents were classified as high risk for HIV infection (estimated infection probability greater than .0001), 34 percent were at moderate risk, and the remaining 58 percent were classified as not at risk (no sexual activity or needle sharing). Teens who said they had purchased condoms or claimed to have used them recently were more likely than others to have condoms in their possession at the time of the interview. These estimates suggest that a small percentage of Latino adolescents may be at substantial risk for HIV infection over periods as short as 6 months, that self-reports of recent condom use are strongly related to condom possession, and that questionnaire items regarding condom use at last intercourse are poor surrogates for HIV risk.

As part of a peer counseling program, 71 parents in a predominately Central American neighborhood in Washington, DC, were interviewed to determine their attitudes toward the use of alcohol by their sons and daughters. Parents overwhelmingly considered their own drinking behavior to influence their children's drinking behavior, but generally would not permit their children to drink. However, they said they would do little if they discovered that their children were drinking without their permission. Recommendations are made for including attention to these parental inconsistencies in Latino youth-oriented alcohol prevention or intervention programs.

This study examined the relationship between language spoken and smoking (at least once a month) among New York City Hispanic-Latino adolescents, using a large sample of specific Hispanic-Latino subgroups (Puerto Rican, Dominican, Colombian, and Ecuadorian youth) and controlling for social and environmental factors. The sample included 3,129 Hispanic-Latino students in 47 New York City public and parochial schools. Of the total sample, 43 percent were Puerto Rican, 20 percent Dominican, 7 percent Colombian, and 7 percent Ecuadorian. The students completed questionnaires to assess social and environmental influences on their smoking and determine what languages they spoke (English and Spanish) with parents and friends. Self-reported smoking data were collected by means of the bogus pipeline to enhance the veracity of self-reports. In the logistic regression model, including background, social influence, and language use variables, 101 students were smokers.

The authors examined demographic and social influence predictors of adolescent drinking among New York City Latino adolescents, including specific Latino subgroups (i.e., Puerto Rican, Dominican, Colombian, and Ecuadorian). Sixth- and seventh-grade students (n=3,129) who identified themselves as Latino or Hispanic on the survey questionnaire comprised our Latino sample. The survey included self-reported frequency of alcohol use, demographic items, and measures and social influences for drinking. Logistic-regression analyses revealed that social influences (how many friends drink, attitudes of parents and friends toward respondent's drinking) are strong predictors of current drinking (defined as drinking at least once a month) for the overall sample of Latino youth, as well as for Puerto Rican youth and Dominican youth. Findings are discussed in terms of their implications for prevention.

This paper presents a critical review of epidemiologic studies of the use and misuse of alcohol on Hispanic women. Although there is a wide variation in alcohol use among different Hispanic groups, there is some uniformity. The findings of most studies point toward the fact that drinking and drunkeness, as well as "excessive drinking," is predominately a male activity. Abstention rates are high among Hispanic women, and a pattern of infrequent "light" drinking and low prevalence rates of alcoholism is usually observed in most groups of Hispanic women. The role of societal mores and culture in shaping these patterns of alcohol use is discussed. Recommendations for needed future research with Hispanic women are also made.

Six papers were presented in the course of a 2-day symposium on Latinas and Substance Use. The presenters included established as well as evolving female investigators within the fields of indigenous peoples' psychology, sociology, and ethnography. Methodology used in the studies ranged from epidemiological telephone surveys to ethnographic observations. Topics of investigations included depth of HIV knowledge among adolescent Latinas, prevalence of protective practices of Latinos when engaging in high-risk behaviors, and childhood experiences of Latinas who exhibit extremely deviant behaviors. All of the studies had as a primary background substance-using practices primarily related to alcohol use and abuse. The papers presented in one way or another substantiate and support this perspective.

The literature on alcohol consumption and farmworkers is virtually nonexistent. This case study provides information on drinking patterns and problems in a Mexican farmworker community in Northern California. The focus is on Mexican farmworker women's perspectives on drinking in a specific social context: A migrant farmworker housing center. Male responses are provided as a basis for comparison and contrast. The study examines issues related to driving under the influence, public versus private space, and the centrality of considerations regarding children/youth in setting acceptable parameters for drinking. Data collection consisted of observations and 29 interviews of men (13) and women (16) farmworkers over a 6-month period in 1991. Researchers found that most of the women in the camp abstained from drinking. They defined male drinking as a problem when (1) youth were allowed and encouraged to drink; (2) an increase of individuals driving under the influence in the housing center became evident; and (3) drinkers served as poor role models for youth.

Although drinking by black and Hispanic women in the United States differs from that of white women in terms of prevalence rates and incidence of alcohol-related problems, factors such as age and employment status have similar effects on drinking in each group. However, influences on drinking among minority women are complex and must be thought of as an interaction of cultural, personal, and historical factors. This interplay is being delineated in ethnic studies.

Factors affecting the drinking patterns of 183 pregnant African-American, Hispanic, and white adolescents were investigated, including the influence of peers, sexual partners, family members, and mentors. Among participants who drank alcohol prior to their pregnancies, 87 percent quit or cut back on their drinking behaviors. Those adolescents who lived in environments where their partners, peers, and relatives were drinking and using drugs were more likely to have consumed alcohol in the previous month, while adolescents who identified mentors and/or parents who provided high levels of support were less likely to consume alcohol. Finally, distinct patterns of both drinking and life circumstances among the African-American, Hispanic, and white adolescents were revealed. The implications of these findings for future research and intervention with pregnant adolescents are discussed.

Data from the first two waves of a longitudinal study are reported on the relationships between self-rejection/ derogation and substance use among a multiracial/ethnic sample of adolescents (n=4,983). Significant increases were found for all three groups between Waves 1 and 2. African Americans had the lowest rates of alcohol, cigarette, and illicit drug use at both time periods. Peer factors, rejection/derogation, and race/ethnicity were significant predictors of alcohol and cigarette use but not of illicit drug use. Peer factors were more powerful predictors of substance use than rejection/derogation. Interaction analyses indicated peer and rejection/derogation factors were independent predictors of substance use.

The Latino population is one of the fastest growing populations in the country and, relative to other groups, it is a population that must cope with a number of immigration-related stressors. As a result, Latino adolescents may be at special risk for emotional distress and drug use. This paper reviews issues around emotional distress and drug use in Latino adolescents. In a survey of primarily 9th and 10th grade immigrant Mexican students, emotional distress was assessed using three abbreviated scales of depression, hostility, and anxiety based on the Hopkins Symptom checklist. A history of suicide attempts was also assessed. Frequency and quantity of 10 substances including alcohol, cigarettes, and drugs also were assessed. Most types of drug use were significantly correlated with emotional distress and positive history of suicide attempt. A high frequency of alcohol use and inhalant use were associated with emotional distress and a positive history of suicide attempts. Hostility was most strongly correlated with drug use. It is suggested that hostility as well as moderate to high depression symptom levels be considered risk factors for drug use and suicidality in Latino adolescents. It is also recommended that emotional distress be explicitly addressed in the treatment of drug abuse and other problem behaviors in Latino adolescents.

Codependence treatment of poor Hispanics is discussed, with a focus on cross-cultural perspective and codependence. Headings within this review of the literature include: (1) concept of codependence; (2) Hispanic family values; (3) codependence versus family values; (4) therapeutic consequences of conflict; (5) socioculturally sensitive therapy; (6) culture-migration dialogue; (7) cultural reframing; and ( 8) behavioral focus. It is concluded that interventions and service delivery systems should be sensitive to the cultural needs of people of different ethnocultural backgrounds. Many of the changes the client and the family are expected to achieve are in direct conflict with important Hispanic family values, particularly familism. Case examples are provided.

The purpose of this article is twofold. The first is to outline key events in the history of Hispanic MMPI research. Since 1949, researchers have documented the MMPI performance of Hispanic-Americans in a variety of clinical and nonclinical settings. The second purpose is to present a comprehensive bibliography of Hispanic MMPI research by setting. A total of 86 studies are listed in this bibliography.

The drinking patterns of 412 homeless and marginally housed adults in New York State are described and compared with 5,952 domiciled adults. The homeless and marginally housed persons interviewed were randomly selected from a representative group of public shelters and low-price hotels in New York City and upstate New York. They showed transience in their sleeping arrangements; in recent months many had slept with friends or in public places. They are disproportionately male (71 percent), ages 18-34 (61 percent), and black or Hispanic (74 percent). Many of the homeless and marginally housed are abstainers (40 percent, as opposed to 26 percent in the State as a whole), but a startling 13 percent drink more than 20 drinks a day, as opposed to less than 1 percent in the State as a whole. They also reported high rates of alcohol dependence signs such as blackouts or loss of control. Among the homeless and marginally housed, heavy drinking is higher among men than women and higher among blacks than whites or Hispanics. For homeless and marginally housed men, those with the poorest sleeping arrangements (e.g., in public places) have higher rates of heavy drinking. A causal model supports the hypothesis that, for a minority of the homeless, drinking is a contributory cause of their homelessness.

The association of alcohol consumption and casualties was analyzed among Hispanic emergency room patients to determine whether level of acculturation and accompanying changes in drinking patterns influence risk of alcohol-related injuries. A sample of patients admitted to a county hospital emergency room during a l-year period was breathalyzed and interviewed (n= 1,102). Of these, 112 identified themselves as Hispanic. Hispanic males were more likely than non-Hispanic male to have positive breathalyzer readings, to report drinking prior to the event, and to attribute a causal association of drinking with the event. These findings were most pronounced among those in the moderate and high acculturation groups.

A sample of Mexican Americans was studied for the prevalence of alcoholism and the use of medical services. The research sample included all patients 18 years and older in a family health center in South Texas. They were asked to respond to a health screening interview and to the Short Michigan Alcoholism Screening Test (SMAST). The following results of the study were seen: (1) alcoholism was more prevalent among males than females; (2) the prevalence among Mexican Americans was similar to that among other ethnic groups; (3) equal percentages were identified in a primary care clinic and in a walk-in clinic; and (4) alcoholic patients reported more unemployment and poorer health than nonalcoholic patients. It is concluded that alcoholism can be identified in a variety of outpatient settings and that employment status and not ethnic group may serve as an indicator for alcoholism screening.

This study reports early adolescent prevalence and risk factor data in four ethnic groups of sixth and seventh-grade students (n=6,760) residing in the greater Miami area: blacks, non-Hispanic whites, Cubans, and other Hispanics. Risk profiles include a comparative assessment of risk factor distribution and predictive value for each ethnic/racial subsample. Baseline questionnaire data from a 3-year epidemiologic study of early adolescent development and drug use were used to conduct bivariate and multivariate risk factor analyses. The study found 5 percent illicit drug use, 4 percent lifetime inhalant use, 37 percent alcohol use, and 21 percent tobacco use, with important intergroup differences. Monotonic relationships were found between 10 risk factors and alcohol and illicit drug use. Individual risk factors were distributed disproportionately, and sensitivity and patterning of risk factors varied widely by ethnic/racial subsample. While the cumulative factors bear a monotonic relationship to drug use, ethnic/racial differences in risk factors profiles, especially for blacks, suggest differential predictive value based on cultural differences.

This study modeled associations of quantity and frequency of alcohol use with depressive symptoms (negative affect, lack of positive affect, somatic disturbance, interpersonal problems) in two household surveys of Mexican Americans (Ns=1,313 and 3,577). Multivariate analyses controlled cultural (immigration, acculturation) and demographic (age, income, household size, marital status, employment status) characteristics, and assessed interactions of these classes of predictors. Alcohol use was consistently related to depression. In some analyses, cultural characteristics accounted for associations of alcohol use with depression. Associations of drinking with depression tended not to be robust across samples.

An investigation was carried out on the relation of assertiveness to use of alcohol among 3,129 Hispanic junior high school students. Data were obtained through questionnaires administered in 47 public and parochial schools in New York City to 5,501 students. An 18-item modified version of the Gambrill-Richey Assertiveness Inventory was used. Factor analysis of the inventory identified five assertiveness factors of substance awareness, mastery of cognitive skills, individual rights, dating, and social skills. Significant gender differences were observed. Multiple regression analysis showed that substance awareness was negatively associated with alcohol use while dating, social skills, and individual rights factors were positively associated with alcohol use. Acculturation with peers was also a significant predictor of alcohol use or abuse. The findings provide a basis for design of alcohol prevention programs that specifically focus on Hispanic youth.

The authors present prevalence data on four specific mental disorders among 452 Cuban immigrants who arrived in the Mariel crisis and 500 Haitians who arrived in the United States at the same time. Only among the Cubans was the standard inverse relationship between socioeconomic status and rate of mental disorder observed.

This paper seeks to extend previous research on stress buffer effects of alcohol use with data from tri-ethnic community sample of 1,784 respondents. Differences in buffer effects between Anglos, blacks, and Mexican Americans were examined for possible racial/ethnic variation in the role or function of alcohol vis-a-vis life stress and depressive symptoms. Both acute life events and chronic financial stress were examined to clarify the conditions under which buffer effects were most and least salient in these groups. The findings indicate that alcohol buffer effects were most pronounced among males with regard to life event stress and depression. Ethnic differences in buffer effects were suggested among males for life events, though statistical controls for demographic factors, fatalism, and religiosity accounted for these differences. The implications of these findings are examined, and the paper generally highlights the need to view alcohol use and alcohol buffer effects in the context of more general coping orientations.

Alcohol expectancies of Hispanics and non-Hispanic whites were analyzed, with a focus on the role of drinking status and acculturation. The research sampled 1,740 San Francisco residents by telephone interviews, including 1,204 Hispanics and 536 non-Hispanic whites. Results of the study showed: (1) a main effect from ethnicity on the responses to the Emotional and Behavioral Impairment and Social Extroversion Scales; (2) differences in results between drinkers and abstainers; and (3) no differences in expectations held by Mexican-American and Central American respondents. The findings support the need for a more comprehensive analysis of ethnic differences between Hispanic and non-Hispanic groups.

Ethnic differences in vulnerability to parental alcoholism and life stress were compared in Hispanic and non-Hispanic Caucasian adolescents. The research sample included 69 Hispanic and 237 Caucasian male and female adolescents from a total of 161 families with at least one alcoholic parent and 145 families with no alcoholic parent. Respondents completed questionnaires relating to life stress, social support, and alcohol use. The parents reported on the adolescents' psychological symptoms and their own substance use. The study found that parental alcoholism and life stress were related to almost all indicators of adolescents' psychological distress and alcohol use. In addition, results showed some evidence that Caucasian adolescents were more vulnerable to the effects of life stress and parental alcoholism than Hispanics. Neither social support nor the higher substance use of Caucasian parents provided a good explanation for this differential vulnerability. It is suggested that resilience factors associated with Hispanic culture may result in less psychological distress and alcohol use than is otherwise associated with life stress and parental alcoholism.

This study explored potential psychosocial risk factors associated with completed suicide among Latino adolescents (n=14) in Miami, FL, between January 1988-June 1989. Data were drawn from medical examiner's records, family interviews, and a questionnaire completed by school counselors of the victims. T-tests were used to determine the significance of differences on the psychosocial risk variables explored between victims and controls. Alcohol was detected in three autopsies, two of whom had traces of other drugs also. Results indicate that victims had experienced significantly more school, personality, behavioral, and family stressors than had the controls.

A model for drug use is presented that incorporates many potential risk and protective factors. Protective factors may operate in both direct (main effect) and interactive (as moderators or buffers of risk) forces on drug use. This model was tested using data on Latino and white teenagers, and 14 factors related to drug use were selected and assigned empirically to either a multiple protective (PFI) or risk factor (RFI) default. Bivariate and regression analyses of the relationships of the RFI, PFI and their interaction on frequency and/or quantity of cigarette, alcohol, cannabis, cocaine and drug use revealed that both defaultes and their interaction contributed significantly to frequency and quality of drug use among all groups.

Alcoholism in relation to aging in Hispanic cultures is discussed. Topics include alcohol use among Hispanic older persons, Hispanic cultural factors and alcoholism, Hispanic world views and perceptions of health, and clinical assessment of alcoholism in Hispanics. Among the factors believed to contribute to alcoholism in Hispanic cultures are machismo (the concept of manly strength and dominance that includes the attitude that a man should be able to drink without showing the effects), stress of transition from the native culture to the mainstream U.S. culture, an ethnic tradition of male drinking in Hispanic cultures, and poverty. The need for culturally sensitive assessment tools is addressed.

The authors review empirical studies addressing acculturation across a variety of psychosocial variables. Two methodological weaknesses in the studies were (1) lack of a satisfactory scale to assess acculturation; and (2) excessive reliance on self-reports for information perceived as personal to Hispanics. They present recommendations to improve further research.

The authors identify psychological characteristics of 49 male and 8 female immigrant Latin American youth who were primarily responsible for their own lives. The subjects' capacities to adapt to their different environments and the conditions in which they live are discussed for their implications for social and substance abuse prevention programs.

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