This document summarizes a study that used latent class analysis to examine patterns of substance abuse and sexual risk behaviors among youth in the Dominican Republic and how these patterns relate to their involvement with US culture. The analysis identified three latent classes - a low risk class, a binge drinking and risky sex class, and a high risk class. Higher levels of US cultural involvement, such as having friends who lived in the US, were associated with greater odds of being in the high risk class. The findings suggest that aspects of US culture may increase health risks for Latino youth both in the US and abroad.

1. U.S. Cultural Involvement and its
Association with Co-Occurring Substance
Abuse and Sexual Risk Behaviors Among
Youth in the Dominican Republic: A Latent
Class Regression Analysis
Elián P. Cabrera-Nguyen, MSW
Juan B. Peña, Ph.D., LCSW Society for Prevention Research | June 3, 2011

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. 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. 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. 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. 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. Methods

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. 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. 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. 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. 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. Sample Characteristics
Variable Weighted Percentage Unweighted Frequency
Gender
Female 57.0 5205
Male 43.0 3241
Region
Urban 67.7 5718
Non-Urban 32.3 2728
Family structure
Dual parent household 52.0 4391
Non dual parent household 48.0 4055
Parental Education
No parent completed high school 45.8 3834
A parent completed high school 30.9 2601
A parent completed college 23.3 1979
Lived in US
Never 90.9 7642
Less than 1 year 6.2 510
More than 1 year 2.9 231
At least 5 friends lived in US
No 82.4 6914
Yes 17.6 1457
Age Weighted Mean (SD)
16 (1.5)

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. 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. Results

17. Latent Class Extraction

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. 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. Conditional Indicator Conditional Response Probabilities
BD-RS Class High Risk Low Risk
response (0.29)a Class
(0.05)a
Class
(0.66)a
probabilities Binge drinking, past 30 days
0 days 62.90 17.90 82.10
for 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 1.40
latent class 6 to 9 days
10 to 19 days
1.90
1.10
4.90
8.30
0.50
0.40
model 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. Conditional Response Probabilities

22. Conditional Response Probabilities

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. LR
US 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 bold
2. Reference is no parent(s) finished high school
* p< .05 **p<.01 p<.001

24. Latent Class Proportions Across Models
Baseline Model 1 Model 2
BD-RS 0.29 0.30 0.31
HR 0.05 0.04 0.05
LR 0.66 0.66 0.64
Entropy 0.90 0.90 0.91

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 & English
Age 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. 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. 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. 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.

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