Cultural Stress and Multiple Risk Outcomes in Hispanic Adolescents

Background.Hispanic adolescents report the highest rates of crack, heroin and methamphetamine use when compared to all other ethnic categories (Monitoring the Future, 2008).  Over one-quarter of Hispanic adolescents also report using alcohol in the last 30 days (Pemberton et al., 2008) and exhibit high rates of HIV risk (Prado et al., 2006). Culturally specific stressors have been implicated in these outcomes, yet little research has examined how these stressors may have a differential and/or additive effect when considered simultaneously.

Methods. The current study examined the relation between cultural stress and multiple risk behaviors in a sample of Hispanic adolescents (n=1087), 11-19 years old, from an NIMH funded study (5R44MH073180-03) that implemented random selection to recruit participants. Latent class analysis (LCA) was used to identify subgroups of Hispanic adolescents based on combinations of risk behaviors. Risk behaviors were operationalized using categorical measures of: alcohol use, alcohol risk, tobacco risk, marijuana use, marijuana risk, other drug use, and teenage pregnancy. Cultural stress was operationalized using the Hispanic Stress Inventory-Adolescent Version, which includes 8 validated cultural stress domains: family economic, educational, acculturative gap, immigration, discrimination, family immigration, community gang, and family drug stress. Once classes were identified, general linear models (GLM) examined mean differences by class on the 8 domains of cultural stress.

Results. In the sample, 55% were female and the mean age was 14.81 years. Nearly half (47%) of the sample was Mexican origin. Fit statistics revealed a 5 class structure best represented the data: (1) heavy alcohol and marijuana users and moderate drug use; (2) low marijuana use, no alcohol or drug use; (3) low alcohol use, less than in class 1; (4) heavy drug and tobacco use and teenage pregnancy; and (5) no risk takers. The no risk takers were the largest group (75%) and the heavy drug users was the smallest group (1%). The effect sizes generated from the GLM analyses revealed the largest mean differences between the no risk group and heavy alcohol and marijuana users and the heavy drug users on acculturative gap, family immigration, community gang, and family drug stress domains.

Discussion. This study is one of the first to document the impact of cultural stressors on multiple behavioral health outcomes simultaneously in Latino immigrants. There is a strong public health impact, as it will inform “bundled” intervention approaches that address multiple behavioral health risk outcomes. Bundling approaches have been proven effective in addressing the complex needs of hard-to-reach populations that do not frequently seek services (Jennette, 2008)—as such is typically the case with Hispanic adolescents.