U.S. Cultural Involvement and itsAssociation with Co-Occurring SubstanceAbuse and Sexual Risk Behaviors AmongYouth in the ...
Suggested citation!     Cabrera-Nguyen, E. P., & Peña, J.B. (2011, June). US cultural involvement and its      relationshi...
Acknowledgements!   This study is the result of a collaborative effort among   US and DR-based institutions and individual...
Purpose of Study!   Explore substance abuse and sexual risk behavior   profiles among adolescents in the Dominican Republi...
Why study substance abuse and sexual risk             behavior patterns among DR youth?!     Substance abuse and sexual ri...
The “Hispanic Immigrant Paradox”!   Evidence suggests that a US nativity and being more    “Americanized” increases Latino...
Methods
Sample!     We used a novel approach to control for selection bias as an      explanation for the Latino immigrant paradox...
Measures!   U.S. cultural involvement (USCI):    !   Non-Hispanic domain of Bidimensional        Acculturation Scale (BAS)...
Two Latent Factors from BAS!   English Proficiency: 6 items, good EFA model fit   (CFI = .99, TLI = .98). Factor loadings ...
USCI Indicators!   Time lived in the US:    !   never (reference group)    !   < 1 year    !   > 1 year!   Five or more be...
Demographic covariates!   Urban residence!   Parental education   !   Parent(s) did not complete high school (reference)  ...
Sample CharacteristicsVariable                               Weighted Percentage   Unweighted FrequencyGender    Female   ...
Latent Class Indicators!   Items from 2009 Youth Risk Behavior Survey (YRBS)    !   Binge drinking, past 30 days   !   Lif...
Statistical Analysis!   Determined baseline latent class model!   Single-step multinomial logistic regression of 4 USCI   ...
Results
Latent Class Extraction
Three Class Solution!   Bayesian Information Criterion (BIC) & Sample-Size   Adjusted BIC (SS-BIC) increased with 4th clas...
Class Labels & Latent Class Assignment!     Three distinct classes (Entropy = 0.90):      !      Low risk for all behavior...
Conditional     Indicator                                         Conditional Response Probabilities                      ...
Conditional Response Probabilities
Conditional Response Probabilities
Multinomial Logistic Regression Results of                 Odds Ratios for Latent Class Assignment                        ...
Latent Class Proportions Across Models           Baseline   Model 1   Model 2BD-RS       0.29       0.30      0.31HR      ...
Latent class regression model      with latent and manifest covariates (and direct effects)                        Binge  ...
Relationship of USCI to Substance Abuse &           Sexual Risk Behavior Classes!   Odds of being HR versus LR were greate...
Conclusions!     Robust relationship of USCI with LC assignment consistent with      “acculturation” related theories for ...
Limitations!     Latent class analysis creates potential for reification of classes!     Cross-sectional design prevents c...
References1. Connell CM, Gilreath TD, Hansen NB. A multiprocess latent class analysis of the co-occurrence of substance us...
9. Torres LR, Peña JB, Westhoff WW, Zayas LH. A cross-national comparison of adolescent alcohol and drug usebehaviors: U.S...
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U.S. Cultural Involvement and its Association with Co- Occurring Substance Abuse and Sexual Risk Behaviors among Youth in the Dominican Republic

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We examined the relationship of US cultural involvement with substance abuse and sexual risk behavior profiles in our nationally representative sample of public high school students in the Dominican Republic. We used a novel methodological approach to control for selection bias while evaluating explanations for the "Hispanic" immigrant paradox. A latent class regression analysis with manifest and latent covariates found that US cultural involvement indicators were independent and robust predictors of increased risk for co-occurring substance abuse and sexual risk behaviors. Implications for prevention efforts targeting risk behaviors among Latino/a adolescents in the US and abroad are considered.

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U.S. Cultural Involvement and its Association with Co- Occurring Substance Abuse and Sexual Risk Behaviors among Youth in the Dominican Republic

  1. 1. U.S. Cultural Involvement and itsAssociation with Co-Occurring SubstanceAbuse and Sexual Risk Behaviors AmongYouth in the Dominican Republic: A LatentClass Regression AnalysisElián P. Cabrera-Nguyen, MSWJuan B. Peña, Ph.D., LCSW Society for Prevention Research | June 3, 2011
  2. 2. Suggested citation!   Cabrera-Nguyen, E. P., & Peña, J.B. (2011, June). US cultural involvement and its relationship to co-occurring substance abuse and sexual risk behaviors among youth in the Dominican Republic. Paper presented at the annual conference of the Society for Prevention Research, Washington, D.C.!   Keywords: Acculturation, Hispanic populations, immigration, HIV risk behavior, substance abuse, latent class analysis, immigrant paradox
  3. 3. Acknowledgements!   This study is the result of a collaborative effort among US and DR-based institutions and individuals including: !   DR Ministry of Education !   Autonomous University of Santo Domingo !   Fundación Familia Sana !   Center for Latino Family Research, Washington University in St. Louis!   This research was supported by NIMH Grant No. R03- MH085203, PI: Juan B. Peña, Ph.D., LCSW
  4. 4. Purpose of Study!   Explore substance abuse and sexual risk behavior profiles among adolescents in the Dominican Republic!   Examine how US cultural involvement relates to risk behavior profiles among DR youth!   Situate findings within existing theory to inform future prevention efforts with DR youth and US Latino/a adolescents.
  5. 5. Why study substance abuse and sexual risk behavior patterns among DR youth?!   Substance abuse and sexual risk behaviors often co-occur among adolescents, placing them at increased risk for HIV!   Incidence of HIV among youth due to co-occurring substance abuse and sexual risk behaviors is a public health concern in the US and much of the world. Co- occuring substance abuse and risky sex among youth in DR requires further study.!   US Latino/a adolescents have higher substance abuse and sexual risk behavior rates compared to other ethnic groups & their foreign counterparts—HIV/AIDS is a leading cause of death!   Dominicans are one of the fastest-growing yet least studied Latino/a groups in the US, and nearly 30% are below 18 years of age
  6. 6. The “Hispanic Immigrant Paradox”!   Evidence suggests that a US nativity and being more “Americanized” increases Latino/a adolescents’ risk for substance use, sexual risk behaviors, and a range of negative outcomes compared to their less “Americanized” foreign-born counterparts! Peña and colleagues (2008) classified hypotheses about the Latino immigrant paradox into 3 broad categories: !   Protective Culture Model !   Intergenerational Acculturation Conflict Model !   Resilient Immigrant Model
  7. 7. Methods
  8. 8. Sample!   We used a novel approach to control for selection bias as an explanation for the Latino immigrant paradox: !   Examined how US cultural involvement related to risk behaviors among youth in the DR—outside of the US context. Possibly via mechanisms related to “cultural globalization”.!   Strata consisted of the DR’s 18 national educational regions!   PSUs were public high schools (n = 80)!   Sample of youths (N = 8,446) weighted to adjust for grade, gender, and educational region.
  9. 9. Measures!   U.S. cultural involvement (USCI): !   Non-Hispanic domain of Bidimensional Acculturation Scale (BAS) !   Two items from our study questionnaire!   Substance use and sexual risk behavior !   Items from 2009 Youth Risk Behavior Survey (YRBS)!   Demographic covariates
  10. 10. Two Latent Factors from BAS!   English Proficiency: 6 items, good EFA model fit (CFI = .99, TLI = .98). Factor loadings ranged from .74 to .90!   Use of US Electronic Media and Language: 6 items, good EFA model fit (CFI = .96, TLI = .95). Factor loadings ranged from .67 to .86
  11. 11. USCI Indicators!   Time lived in the US: !   never (reference group) !   < 1 year !   > 1 year!   Five or more best friends lived in US at least one month
  12. 12. Demographic covariates!   Urban residence!   Parental education !   Parent(s) did not complete high school (reference) !   At least 1 parent completed high school !   At least 1 parent completed college!   Dual parent household!   Gender!   Age
  13. 13. Sample CharacteristicsVariable Weighted Percentage Unweighted FrequencyGender Female 57.0 5205 Male 43.0 3241Region Urban 67.7 5718 Non-Urban 32.3 2728Family structure Dual parent household 52.0 4391 Non dual parent household 48.0 4055Parental Education No parent completed high school 45.8 3834 A parent completed high school 30.9 2601 A parent completed college 23.3 1979Lived in US Never 90.9 7642 Less than 1 year 6.2 510 More than 1 year 2.9 231At least 5 friends lived in US No 82.4 6914 Yes 17.6 1457Age Weighted Mean (SD) 16 (1.5)
  14. 14. Latent Class Indicators!   Items from 2009 Youth Risk Behavior Survey (YRBS) !   Binge drinking, past 30 days !   Lifetime marijuana use !   Lifetime inhalant use !   Lifetime number of sex partners !   No condom use during last sexual intercourse
  15. 15. Statistical Analysis!   Determined baseline latent class model!   Single-step multinomial logistic regression of 4 USCI predictors on latent classes!   Single-step multinomial logistic regression of USCI predictors on latent classes adjusted for demographic covariates with direct effects
  16. 16. Results
  17. 17. Latent Class Extraction
  18. 18. Three Class Solution!   Bayesian Information Criterion (BIC) & Sample-Size Adjusted BIC (SS-BIC) increased with 4th class, only Akaike Information Criterion (AIC) decreased!   Estimator = MLR!   Checked model identification, possible local maxima: !   1000 sets of random starting values !   replication using Latent GOLD
  19. 19. Class Labels & Latent Class Assignment!   Three distinct classes (Entropy = 0.90): !   Low risk for all behaviors (LR) !   Binge drinkers with risky sex behavior, no drugs (BD-RS) !   High risk for all behaviors (HR)!   Average latent class probabilities for most likely latent class membership (row) by latent class (column) BD-RS HR LR BD-RS (0.29) 0.92 0.05 0.03 HR (0.05) 0.17 0.80 0.03 LR (0.66) 0.01 0.01 0.98
  20. 20. Conditional Indicator Conditional Response Probabilities BD-RS Class High Risk Low Riskresponse (0.29)a Class (0.05)a Class (0.66)aprobabilities Binge drinking, past 30 days 0 days 62.90 17.90 82.10for baseline 1 day 2 days 23.70 6.50 25.20 19.90 12.00 3.10 3 to 5 days 3.30 14.60 1.40latent class 6 to 9 days 10 to 19 days 1.90 1.10 4.90 8.30 0.50 0.40model 20 days or more Any lifetime marijuana use 0.60 9.00 0.40 no 99.80 73.80 99.80 yes 0.20 26.20 0.20 Lifetime inhalant use never 94.50 74.50 93.60 1 or 2 times 4.20 11.50 4.60 3 or more times 1.30 14.00 1.80 Number of lifetime sex partners 0 0 6.40 97.70 1 54.00 9.50 0.00 2 21.30 9.00 0.00 3 11.40 7.00 0.50 4 4.60 12.80 0.50 5 2.60 11.80 0.10 6 or more 6.00 43.40 1.30 No condom last time had sex 38.90 31.40 0.60 a Percentage in each class based on estimated model
  21. 21. Conditional Response Probabilities
  22. 22. Conditional Response Probabilities
  23. 23. Multinomial Logistic Regression Results of Odds Ratios for Latent Class Assignment Model 1: OR (95% CI) Model 2: OR (95% CI) BD-RS vs. LR HR vs. LR BD-RS vs. LR HR vs. LRUS Media, English 1.05 (0.99, 1.12) 1.33 (1.12, 1.59)** 1.05 (0.99, 1.10) 1.29 (1.08, 1.56)*English Proficiency 0.94 (0.91, 0.97)*** 0.84 (0.78, 0.91)*** 0.98 (0.95, 1.00) 0.89 (0.82, 0.96)*5+ friends lived US 1.10 (0.93, 1.30) 4.51 (3.06, 6.65)*** 1.10 (0.92, 1.33) 4.12 (2.74, 6.19)***Lived in US < 1 yr1 1.41 (1.15, 1.72)** 7.21 (4.46, 11.64)*** 1.38 (1.11, 1.71)* 6.68 (3.81, 11.70)***Lived in US > 1 yr1 1.79 (1.36,2.35)*** 9.87 (5.29, 18.42)*** 1.51 (1.11, 2.06)* 8.48 (4.08, 17.63)***Urban residence 0.91 (0.77, 1.08) 1.04 (0.66, 1.64)Dual parent home 0.75 (0.83, 0.68)*** 0.75 (0.52, 1.08)Parent—high school2 1.17 (1.03, 1.32)* 1.35 (0.96, 1.90)Parent—college2 0.81 (0.69, 0.95)* 1.09 (0.75, 1.56)Age 1.84 (1.70, 1.99)*** 2.30 (1.77, 2.98)***Female 0.24 (0.21, 0.28)*** 0.13 (0.08, 0.21)***1.  Reference is never lived in US Continuous latent factors in bold2.  Reference is no parent(s) finished high school* p< .05 **p<.01 p<.001
  24. 24. Latent Class Proportions Across Models Baseline Model 1 Model 2BD-RS 0.29 0.30 0.31HR 0.05 0.04 0.05LR 0.66 0.66 0.64Entropy 0.90 0.90 0.91
  25. 25. Latent class regression model with latent and manifest covariates (and direct effects) Binge Inhalant Multiple sex Condom Pot use Drinking use partners use C ≥5 A parent Lived Lived Dual A parent US Media & EnglishAge friends finished Gender in US < in US > Urban parent finished Language Proficiency2 lived in high 1 year 1 year home college Use1 US school 1. Standardized factor loadings range from .63 to .85, p < .001. Variance= 2.40 2. Standardized factor loadings range from .75 to .91, p<.001. Variance = 8.15.
  26. 26. Relationship of USCI to Substance Abuse & Sexual Risk Behavior Classes!   Odds of being HR versus LR were greater by a factor of 4.12 for youths with at least 5 friends who had lived in the US compared to youths with < 5 friends who had lived in the US.!   One unit increase in Use of U.S. Electronic Media and English was associated with a 29% increase in the odds of assignment to HR versus the LR.!   Even after inclusion of direct effects of gender on latent class indicators, the odds of being HR vs LR were 87% greater for males versus females.
  27. 27. Conclusions!   Robust relationship of USCI with LC assignment consistent with “acculturation” related theories for the immigrant paradox while controlling for selection bias!   This finding is consistent with parallel analysis that found USCI substantially increases suicide behavior among youth in the DR.!   Findings suggest more research is needed to understand the mechanisms by which US culture increases risk for Latino/a youth as well as the salubrious aspects of Latino/a cultures—both in the US and abroad!   Results highlight need for culturally congruent prevention efforts targeting Latino/a youth in the US and abroad that are tailored to gender
  28. 28. Limitations!   Latent class analysis creates potential for reification of classes!   Cross-sectional design prevents causal inference!   Limited sociodemographic covariates!   Computational burden is severe!   Our novel methodological approach does not account for reverse selection; however, Use of US Electronic Media and English predicted HR class assignment independent of “time lived in US”—an effect we would not necessarily expect if reverse selection explained assignment to HR class.
  29. 29. References1. Connell CM, Gilreath TD, Hansen NB. A multiprocess latent class analysis of the co-occurrence of substance use and sexual riskbehavior among adolescents. J Stud Alcohol Drugs. 2009;70(6):943-951.2. Eaton DK, Kann L, Kinchen S, et al. Youth risk behavior surveillance -- United States, 2007. MMWR SURVEILLANCE SUMM.2008;57(-4):1-131.3. Flores G, Brotanek J. The healthy immigrant effect: A greater understanding might help us improve the health of all children.Arch Pediatr Adolesc Med. 2005;159:295-297.4. Hair EC, Park MJ, Ling TJ, Moore KA. Risky behaviors in late adolescence: Co-occurrence, predictors, and consequences. Journalof Adolescent Health. 2009;45(3):253-261.5. Langer LM, Tubman JG. Risky sexual behavior among substance-abusing adolescents: Psychosocial and contextual factors. Am JOrthopsychiatry. 1997;67(2):315-322.6. Marín G, Gamba R. A new measurement of acculturation for Hispanics: The Bidimensional Acculturation Scale for Hispanics(BAS). Hispanic journal of behavioral sciences. 1996;18(3):297-316.7. Peña J, Wyman P, Brown C, et al. Immigration generation status and its association with suicide attempts, substance use, anddepressive symptoms among Latino adolescents in the USA. Prevention science. 2008;9(4):299-310. 10.1007/s11121-008-0105-x.8. Prado G, Schwartz SJ, Pattatucci-Aragon A, et al. The prevention of HIV transmission in Hispanic adolescents Drug AlcoholDepend. 2006;84 Suppl 1:S43-53. 10.1016/j.drugalcdep.2006.05.006.
  30. 30. 9. Torres LR, Peña JB, Westhoff WW, Zayas LH. A cross-national comparison of adolescent alcohol and drug usebehaviors: U.S. Hispanics and youth in the Dominican Republic. J Drug Iss. 2008;38(1):149-170.10. Westhoff WW, McDermott RJ, Holcomb DR. HIV risk behaviors: A comparison of U.S. Hispanic and DominicanRepublic youth AIDS Educ Prev. 1996;8(2):106-114.11. World Health Organization. Alcohol Use and Sexual Risk Behaviour: A Cross-Cultural Study in Eight Countries. Geneva:WHO Press; 2005.

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