Ethnic Discrimination, Acculturative Stress, and Sexual Risk Among Latinx Emerging Adults: Examining Moderation Effects of Familism Support and Ethnic Identity

Abstract

Objectives:

Ethnic discrimination and acculturative stress play an important role in sexual risk behaviors for Latinx emerging adults, who are at disproportionate risk for sexually transmitted infections. Factors such as familism support and ethnic identity may be protective, yet research is limited. This study is guided by a culturally adapted stress and coping framework to examine associations of ethnic discrimination and acculturative stress with sexual risk behaviors (i.e., multiple sex partners, alcohol or drug use before sex, and condomless sex with a primary or casual partner), and examine the moderating roles of familism support and ethnic identity among Latinx emerging adults.

Methods:

Participants were recruited from Arizona and Florida, and were primarily female (51.3%) with a mean age of 21.48 years (SD = 2.06). Using cross-sectional data from 158 sexually active Latinx emerging adults, this study employed multiple logistic regression and moderation analyses.

Results:

Higher levels of ethnic discrimination and pressure to acculturate were associated with fewer sex partners, and higher levels of pressure against acculturation were associated with increased condomless sex with a casual partner. The moderation effect of higher levels of familism support on pressure to acculturate was associated with fewer sex partners, and the moderation effect of higher levels of ethnic identity on pressure against acculturation was associated with decreased condomless sex with casual partners.

Conclusions:

Examining the results within a culturally informed theoretical framework supports that protective factors may help mitigate sexual risk factors among Latinx emerging adults experiencing acculturative stress.

High prevalence of sexual risk behaviors among emerging adults (age 18–25) in the United States remains a significant public health concern. Sexual risk behaviors—including multiple sex partners, alcohol or drug use (AOD) before sex, and condomless sex with a primary or casual partner—increase the risk for sexually transmitted infections (STIs). In fact, individuals aged 15–24 years account for half of all new STIs (Centers for Disease Control and Prevention [CDC], 2021a). Emerging adulthood is a critical developmental period impacted by risk and protective factors (Wood et al., 2018), and Latinx emerging adults (LEA) are at disproportionate risk for STIs and risky sexual behaviors (Guilamo-Ramos et al., 2020). Latinx adults and adolescents experience the second highest rate of diagnosis for HIV infection (21.5 per 100,000 population) compared with White adults and adolescents (5.3 per 100,000) (CDC, 2021b). Rates of chlamydia, gonorrhea, primary and secondary syphilis, and congenital syphilis were 1.9, 1.6, 2.2, and 3.3 times higher, respectively, among Latinx compared with rates among Whites (CDC, 2020). Substance use behaviors have been linked with high-risk sexual behaviors among LEA (Brown et al., 2016; Cano et al., 2015; Chawla & Sarkar, 2019; Moore & Chau, 2019). LEA may be even more likely to engage in condomless sex compared with non-Latinx White emerging adults (Finer & Zolna, 2011; Rangel et al., 2006; Schwartz & Petrova, 2019).

Ethnic discrimination and acculturative stress contribute to sexual risk behaviors among LEA (Lorenzo-Blanco & Unger, 2015), and can be conceptualized as complex stress factors driven by racism and xenophobia as pathways for the social determinants of health (Krieger et al., 2010; Krieger, 2011; Ramírez García, 2019; Solar & Irwin, 2010). Ethnic discrimination is inequitable treatment based on one’s racial or ethnic background (Contrada et al., 2000; Williams & Mohammed, 2009), and will hereinafter be used interchangeably with discrimination. Acculturative stress is a stress response stemming from negotiating and adjusting to perceived cultural incompatibilities when interacting with the receiving culture [i.e., U.S. culture] and the heritage culture (Rodriguez et al., 2002). Emerging literature across age and racial and ethnic groups has detected mixed and indirect effects of perceived ethnic discrimination and acculturative stress on sexual risk behaviors, supporting the need for more research (Jardin et al., 2016). Among Latinx, there is growing evidence of positive associations between ethnic discrimination and sexual risk behaviors (Ayala et al., 2012; Díaz et al., 2004; Ontiniano Verissimo et al., 2020; Rosenthal et al., 2014) and between acculturative stress and sexual risk behaviors (Jardin et al., 2016; Martinez-Donate et al., 2018; Rivera et al., 2015). However, research on direct associations between ethnic discrimination and acculturative stress with sexual risk behaviors among LEA is lacking (Martinez-Donate et al., 2018; Martin-Storey & Benner, 2019; Piña-Watson et al., 2021; Rivera et al., 2015). Beyond ethnic discrimination, familism (family) support (hereinafter used interchangeably with familism) and ethnic identity may play an important role in sexual risk behaviors among LEA.

Familism (Crockett et al., 2007) and ethnic identity (Piña-Watson et al., 2021; Umaña-Taylor & Updergraff, 2007) can be protective for Latinx (Crockett et al., 2022; Ramírez García, 2019). However, research on potential relationships between such protective factors and sexual risk behaviors (Piña-Watson et al., 2021)—and the role of protective factors within the context of social determinants of health for Latinx—is scarce (Cerdeña et al., 2021). The present study examines (a) the direct association between ethnic discrimination, acculturative stress and sexual risk behaviors (i.e., multiple sex partners, AOD use before sex, and condomless sex with a primary or casual partner) and (b) familism support and ethnic identity as hypothesized protective factors that may moderate these associations. Understanding the moderation of protective factors on sexual risk behaviors can inform important prevention strategies relevant to LEA.

This study also addresses limitations in sexual risk behavior research among LEA by examining multiple sex partnerships (Kapadia et al., 2012), condomless sex, and AOD use before sex—all of which increase risk of HIV infection and other STIs (Copen, 2017; Deardorff et al., 2013; Ramírez-Ortiz, 2020; Stone et al., 2012)—among a sample of LEA aged 18–25 years. Guided by a stress and coping framework adapted to the Latinx community (Estrada, 2009; Walters et al., 2002), predictor variables (ethnic discrimination, acculturative stress) are hypothesized as “stress” or risk factors, and moderators (familism support and ethnic identity) are hypothesized as “coping” or protective factors for sexual risk behaviors (Cerdeña et al., 2021; Crockett et al., 2022; Estrada, 2009; Orozco-Figueroa, 2021; Sotero, 2006). This model is predicated on a social determinants of health framework (Krieger et al., 2010; Krieger, 2011; Ramírez García, 2019) in response to increasing calls for researchers and institutions to identify important risk and protective factors and address racial health inequities (Boyd et al., 2021; Cerdeña et al., 2021; Orozco-Figueroa, 2021; Ramírez García, 2019).

Association Between Ethnic Discrimination, Acculturative Stress, and Sexual Risk Behaviors

Ethnic discrimination is pervasive in the United States (Daniller, 2021; Lee et al., 2019), and racism is a serious public health threat (CDC, 2021c; Paine et al., 2021). Discrimination against Latinx, regardless of nativity, increased in recent years (Gutierrez et al., 2019), capitalizing on pre-existing Latinx racialization (Canizales & Agius Vallejo, 2021). Adverse impacts on Latinx physical and mental health (Andrade et al., 2021; Paradies et al., 2015; Paulus et al., 2019) include sexual risk behaviors (Ayala et al., 2012; Martinez-Donate et al., 2018; Ontiniano Verissimo et al., 2020). Accordant with research showing positive associations between discrimination and sexual risk across communities of color (Fields et al., 2013; Grollman, 2017), studies of discrimination that include large Latinx samples (Rosenthal et al., 2014) or Latinx-only samples have primarily revealed positive associations with sexual risk behaviors (e.g., substance use before or during sex, condomless sex in the past 3 months, in the past 12 months, and over the lifetime; Ayala et al., 2012; Díaz et al., 2004; Ontiniano Verissimo et al., 2020;), with the exception of one study which revealed negative associations (Piña-Watson et al., 2021). Studies that examine direct relationships between discrimination and sexual risk behaviors among Latinx-only samples are few, yet increasing. These studies have focused on gay men and men who have sex with men (Ayala et al., 2012; Díaz et al., 2004), Caribbean LEA in New York (Ontiniano Verissimo et al., 2020), and Mexican descent emerging adults in Texas (Piña-Watson et al., 2021). There are currently few published studies that examine direct associations between ethnic discrimination and sexual risk behaviors among LEA representing a broader range of heritages (e.g., Mexican, Caribbean, Central and South American) across more than one site in the United States.

Ethnic discrimination is both positively correlated and associated with acculturative stress among Latinx (Lee & Ahn, 2012; Torres et al., 2012). In tandem with research showing associations between acculturative stress and sexual risk across communities of color, including Latinx (Jardin et al., 2016; Yang et al., 2018), cross-sectional studies of acculturative stress that include Latinx samples (Jardin et al., 2016) or Latinx-only samples (Martinez-Donate et al., 2018; Rivera et al., 2015) have revealed positive associations with sexual risk behaviors. More specifically, these studies revealed a direct association between acculturative stress and sexual risk behaviors (i.e., various behaviors including past 12-month condom usage with steady or casual partners) among a Latinx-only male Mexican migrant sample (Martinez-Donate et al., 2018), and a direct association between acculturative stress and condomless sex among LEA (Rivera et al., 2015). Studies that examine direct associations between acculturative stress and sexual risk behaviors among LEA are limited.

Protective Factors

Although ethnic discrimination and acculturative stress have been associated with sexual risk behaviors among LEA (e.g., Ontiniano Verissimo et al., 2020; Rivera et al., 2015), protective factors can mitigate these relationships (Guilamo-Ramos et al., 2009; Ma et al., 2014). For Latinx, they may include familism support and ethnic identity (Castro et al., 2009; Crockett et al., 2022; Evans et al., 2020; Germán et al., 2009; Moise et al., 2019; Stein et al., 2017). Promising evidence shows protective effects of familism support and ethnic identity in sexual risk prevention strategies among LEA (Evans et al., 2020; Moise et al., 2019).

Familism Support as a Protective Factor

Familism is a constellation of collectivist Latinx family values that center on relationships, roles, and responsibilities among immediate and extended family (Aceves et al., 2020; Germán et al., 2009; Knight et al., 2009; Ramírez-Ortiz et al., 2020; Piña-Watson et al., 2021). While familism plays an important role across many racial and ethnic groups, it is a key cultural construct that was developed originally and most widely studied among Latinx, who report higher levels of familism compared with other racial and ethnic groups (Campos et al., 2014; Crockett et al., 2022). Limited research shows mixed results vis-à-vis moderating effects of familism as a whole concept and its embedded values (e.g., family support, involvement, parental support). Familism was associated with reduced sexual risk behaviors among Latinx adolescent girls (Guilamo-Ramos et al., 2009). Family involvement was specifically associated with a reduced number of lifetime sexual partners among a sample of majority Mexican-origin youth in the southwestern United States (Van Campen & Romero, 2012) and reduced substance use overall among a sample of Latinx adolescents (Castro et al., 2009). There is substantial evidence of positive associations between substance use and sexual risk across young adult and other Latinx sub-groups (Brown et al., 2016; Cano et al., 2015; Chawla & Sarkar, 2019; Dolezal et al., 2000; Moore & Chau, 2019); however, few studies demonstrated associations between familism and substance use during sex. One such study found that drinking before sex was strongly associated with condomless sex among formerly incarcerated Latinx men (Muñoz-Laboy et al., 2017). A related study of emerging adults across racial groups (16% Latinx) found that familism itself did not separately predict decreased substance use or sexual risk, yet quality of family relationships was associated with decreased substance abuse and sexual risk (i.e., intention to practice safer sex) (Maliszewski & Brown, 2014). Familism was also positively associated with condom use for Latinx men who have sex with men (Shrader et al., 2021). Limited studies examine protective effects of familism on associations between ethnic discrimination and acculturative stress on sexual risk behaviors among Latinx of any age group.

Ethnic Identity as a Protective Factor

Ethnic identity is a multidimensional concept that refers to one’s identification with values and practices associated with one’s ethnicity (Aceves et al., 2020; Andrade et al., 2021; Phinney, 1992; Umaña-Taylor & Updergraff, 2007). While protective effects of ethnic identity have been more commonly examined among Latinx adolescents (Crockett et al., 2022), fewer studies have included Latinx young and emerging adults (Iturbide et al., 2009). These studies showed mixed results on moderating effects of ethnic identity as a whole concept and its embedded dimensions (e.g., confirmation, commitment, pride, salience, development). Limited research specific to LEA showed that ethnicity-based coping increased likelihood of risky sexual behaviors (including multiple sex partners, condomless sex, and sex with a casual partner) and alcohol use among college students of Mexican descent who reported experiencing discrimination (Piña-Watson et al., 2021). Few existing studies examine protective effects of ethnic identity on associations between ethnic discrimination and acculturative stress on sexual risk behaviors among LEA across a broader range of Latinx heritage groups (e.g., Mexican, Caribbean, Central and South American).

Present Study

The present study examined associations among ethnic discrimination and acculturative stress with sexual risk behaviors. Additionally, we examined how these effects varied as a function of moderating effects of familism support and ethnic identity. Based on limited yet emerging evidence and guided by a stress-coping framework adapted to Latinx (Figure 1; Estrada, 2009; Walters et al., 2002), we hypothesized:

1. Both ethnic discrimination and acculturative stress would be positively associated with sexual risk behaviors.

2. These associations would be stronger among LEA with lower levels of familism support than those with higher levels.

3. They would also be stronger among LEA with lower levels of ethnic identity than those with higher levels.

Figure 1:

Culturally Adapted Stress-Coping Model Applied to Sexual Risk Behavior Among Latinx Emerging Adults. Model adapted from and etiological model of historical trauma theory model applied to Mexican Americans in United States (Estrada, 2009), which as originally adapted from an Indigenist Stress-Coping Model Adapted from “Substance Use Among American Indians and Alaska Natives: Incorporating Culture in an ‘Indigenist’ Stress-Coping Paradigm,” by K. L. Walters, J.M. Simoni, and T. Evans-Campbell, 2002, Public Health Reports, 117 Suppl 1, p. S106 (https://pubmed.ncbi.nlm.nih.gov/12435834/). Copyright 2002 by SAGE Publications.

Methods

Participants and Data Collection

Data are from the Project on Health among Emerging Adult Latinos (Project HEAL), a cross-sectional study comprising 200 LEA recruited between August 2018 and February 2019. The project assessed social, psychological, and cultural impacts on alcohol and nicotine use, sexual behaviors, and mental health. Participants were stratified by gender and college student status via quota sampling. Eligibility criteria included (a) identifying as Latino or Hispanic, (b) age 18–25 years old, (c) residing in Miami-Dade County, Florida, or Maricopa County, Arizona, at the time of data collection, and (d) reading in English. The present study only included 158 participants who self-reported lifetime sexual activity. Excluding the remaining 42 lifetime sexually inactive participants avoids inflation for those categorized as not at risk.

A multi-pronged approach was used to recruit an equal amount of total potential participants across sites (99 in Arizona and 101 in Florida), including social media, listservs, distribution of flyers, and word-of-mouth. Most participants were recruited in-person by college student leadership, research staff, the Principal Investigator, and other university research personnel with experience recruiting Latinx. Research staff screened potential participants by email (most students used their university email address), and those deemed eligible were emailed a unique link to provide informed consent. Upon providing consent, participants were directed to a self-administered Qualtrics survey. Participants were advised to complete the survey in a private space. Survey completion lasted approximately 50 minutes and incentives were $30 Amazon e-gift cards. Most alpha coefficients were adequate or good for all measures, decreasing likelihood of bots and fraudulent survey responses. Institutional Review Board approval was given. Additional details can be found elsewhere (Cano et al., 2020).

Of the 158 participants (Table 1), the mean age was 21.5 (SD = 2.06), with females accounting for nearly half of the total sample (n = 81, 51.3%). Most participants had just enough money for their needs (n=88, 55.7%). Participants living in Arizona accounted for slightly more than half of participants (n = 84, 53.2%). Many participants reported light skin tone (n = 125, 79.1%) and were born in the United States (n = 106, 68.4%). Approximately half identified as Mexican origin (n = 82, 51.9%), and the majority identified as heterosexual (n = 133, 84.2%).

Table 1.

Demographic Characteristics of Latinx Emerging Adults Who Had Been Sexually Active in their Lifetimes from the 2018–2019 Project on Health among Emerging Adult Latinos Survey (N = 158)

Participant characteristics	n/M	(%/SD)
Age (18–25 years)	21.48	2.06
Gender
Male	77	48.7
Female	81	51.3
Socioeconomic status
More money than you need	10	6.3
Just enough money for your needs	88	55.7
Not enough money to meet your needs	60	38.0
Site
Florida	74	46.8
Arizona	84	53.2
Skin color
Light	125	79.1
Dark	33	20.9
Nativity
Immigrant	49	31.6
U.S. native	106	68.4
Hispanic heritage
Mexican	82	51.9
Other Hispanics	76	48.1
Sexual minority status
Heterosexual	133	84.2
Sexual Minority	25	15.8
Familism support (1–5)	4.33	0.67
Multigroup ethnic identity measure (1–5)	3.92	0.76
Ethnic discrimination (1–5)	3.35	0.87
Pressure to acculturate (0–5)	2.02	1.28
Pressure against acculturation (0–5)	1.31	1.24

Measures

Demographic Characteristics

These included age, gender (0 = male, 1 = female), skin color (0 = light, 1 = dark), nativity status (0 = immigrant, 1 = U.S. born), Hispanic heritage (0 = Mexican, 1 = Other Hispanics), and sexual minority status (0 = heterosexual, 1 = sexual minority).

Independent Variables

Ethnic Discrimination.

Ethnic discrimination was assessed using 9 items from the perceived discrimination sub-scale of the Scale of Ethnic Experience (SEE; α = .90; Malcarne et al., 2006). The SEE is a self-report measure of multiple cognitive constructs related to ethnicity across ethnic groups. Sample questions include, “My ethnic group does not have the same opportunities as other ethnic groups”, and, “In my life, I have experienced prejudice because of my ethnicity” (Malcarne et al., 2006, p. 154). Response options were displayed on a Likert scale (1 = strongly disagree, 5 = strongly agree).

Pressure to Acculturate and Pressure Against Acculturation.

Project HEAL used two sub-scales (totaling 11 items) of the Multidimensional Acculturative Stress Inventory (MASI; Rodriguez et al., 2002), which measures acculturative stress among people of Mexican and other Latino origins who live in the United States. Pressure to acculturate was measured using 7 items (α = .91). and pressure against acculturation was measured using 4 items (α = .87). Sample questions include, “People look down upon me if I practice Latino customs”, “I don’t feel accepted by whites” (pressure to acculturate), “People look down on me if I practice American customs”, and, “I feel uncomfortable because my family members do not know Latino ways of doing things” (pressure against acculturation) (Rodriguez et al., 2002, p. 455). Response options were displayed on a Likert scale (0 = this did not occur in the past year, 5 = extremely stressful).

Outcome Variables

All four outcomes were dichotomized and evaluated separately, with 0 indicating participants had not engaged in sexual risk behavior and 1 indicating they had. Multiple sexual partners was dichotomized by 0 = 0–1 person and 1 = 2–6 or more people.

Multiple Sex Partners.

Multiple sex partners was assessed by the question: “In the past 3 months, with how many people did you have sexual intercourse (this includes vaginal and/or anal sex)?” (Kann et al., 2018).

Alcohol or Other Drugs (AOD) Use Before Sex.

AOD use before sex was assessed by the question: “In the past 3 months, did you drink alcohol or use drugs before you had sexual intercourse (this includes vaginal and/or anal sex)?” (Kann et al., 2018).

Engagement in Condomless Sex with Primary Partner.

Engagement in condomless sex with a primary partner was ascertained with this question: “In the past 3 months, did you use a condom every time you had vaginal and/or anal sex with your primary partner (someone with whom you feel the most committed such as boyfriend/girlfriend, spouse, significant other, or life partner)?” (Kann et al., 2018).

Engagement in Condomless Sex with a Casual Partner.

Engagement in condomless sex with a casual partner was ascertained with this question: “In the past 3 months, did you use a condom every time you had vaginal and/or anal sex with a casual partner (someone with whom you do not feel committed to or know very well)?” The preceding condomless sex variables were developed by Project HEAL investigators (Ramírez-Ortiz et al., 2020).

Moderator Variables

Familism Support.

Project HEAL used a 6-item familism support subscale of the Mexican American Cultural Values Scale of Adolescents and Adults (α = .90; Knight et al., 2009), which measures Mexican American and other Latino culturally linked values during early adolescence and adulthood. Sample questions include “Parents should teach their children that the family always comes first” and “It is always important to be united as a family,” (Knight et al., 2009, pp. 459–460) with response options displayed on a Likert scale (1 = not at all, 5 = completely).

Ethnic Identity.

Ethnic identity was assessed using 6-items from the Multi-Group Ethnic Identity Measure-Revised (α = .91; Phinney & Ong, 2007). Sample questions include “I have often done things that will help me understand my ethnic background better” and “I feel a strong attachment towards my own ethnic group,” (Phinney & Ong, 2007, p. 276) with response options displayed on a Likert scale (1 = strongly disagree, 5 = strongly agree).

Analysis

We used R Studio V.1.2.5042 to conduct descriptive and inferential analyses and SPSS V.26 to construct the correlation matrix. The analytic approach proceeded in six steps. First, a descriptive analysis was calculated to obtain frequencies and percentages for categorical variables and means and standard deviations for continuous variables. Second, variance inflation factor (VIF) scores were computed to detect and rule out multicollinearity between independent variables. Third, bivariate regression analyses were conducted to determine the significance of associations between each of the three independent variables (i.e., ethnic discrimination, pressure to acculturate, and pressure against acculturation) and all four outcome variables (i.e., multiple sex partners, AOD use before sex, condomless sex with primary partner, and condomless sex with a casual partner). Fourth, logistic regression was used to estimate odds ratios and 95% confidence intervals for each model. Age, gender, Hispanic heritage, sexual minority status, nativity status, ethnic identity, and familism support were added to each of the logistic regression models to adjust for potential confounding. Finally, moderation terms between each of the three independent variables and familism support and ethnic identity were included to detect any moderating effects of the independent variables on sexual risk behaviors. All inferential analyses used a <0.05 alpha to test for statistical significance.

Results

Descriptive Statistics and Preliminary Analyses of Outcome Variables

Table 1 presents means and standard deviations of independent and moderator variables. Mean familism support scores were 4.33 (SD = 0.67), while ethnic identity scores were 3.92 (SD = 0.67). The mean score for ethnic discrimination was 3.35 (SD = 0.87). The mean score for pressure to acculturate was 2.02 (SD = 1.28), and for pressure against acculturation was 1.31 (SD = 1.24). Table 2 presents frequencies and percentages of dichotomized outcome variables, revealing that fewer than half of all participants reported sexual risk behaviors overall. Approximately one-third of the sample reported having 2–6 sex partners (n = 46, 29.7%), while more than one-third reported using AOD before sex (n = 59, 37.2%). Less than half of participants had condomless sex with their primary partners (n = 69, 44.5%), while just below one-fifth reported condomless sex with casual partners (n = 27, 17.5%).

Table 2.

Sexual Risk Behaviors of Latinx Emerging Adults Who Had Been Sexually Active in their Lifetimes from the 2018–2019 Project on Health among Emerging Adult Latinos Survey (N = 158)

Participant characteristics	n	(%)
No. of sex partners
0–1 person	109	69.0
2–6 or more people	49	31.0
Alcohol/drugs before sex
No	99	62.7
Yes	59	37.2
Condomless sex with primary partner
Yes/Not at risk	86	55.5
No/At risk	69	44.5
Condomless sex with casual partner
Yes/Not at risk	127	82.5
No/At risk	27	17.5

Multiple Regression and Moderation Analyses

Table 3 displays results for logistic regression models estimating the probability of engaging in sexual risk behaviors by levels of ethnic discrimination, pressure to acculturate, and pressure against acculturation, holding all other variables constant. Participants who reported higher levels of ethnic discrimination had 60.8% lower odds of reporting multiple sex partners compared to those who had not experienced ethnic discrimination (OR = 0.402, 95% CI [0.232, 0.668]). Participants who reported higher levels of pressure to acculturate had 45.0% lower odds of reporting higher numbers of sex partners compared to those who did not (OR = 0.550, 95% CI [0.338, 0.868]). Adding familism support as a moderation term on this association yielded statistical significance (p = 0.043; see Fig. 2), indicating that participants who reported both higher levels of pressure to acculturate and higher levels of familism support had lower odds of reporting higher numbers of sex partners relative to those who reported lower levels of both factors. Participants who reported higher levels of pressure against acculturation had 83.4 % higher odds of reporting condomless sex with a casual partner compared to those who did not (OR = 1.834, 95% CI [1.196, 2.887]). Adding ethnic identity as a moderation term on this association yielded statistical significance (p = 0.031; see Fig. 3), indicating that participants who reported both higher levels of pressure to acculturate and higher levels of ethnic identity had lower odds of reporting condomless sex with a casual partner relative to those who reported lower levels of both factors.

Table 3: Logistic Regression Model Results.

Adjusted Effects of Ethnic Discrimination, Pressure to Acculturate, and Pressure Against Acculturation on Multiple Sex Partners Alcohol/Drug Use Before Sex, Condomless Sex with Primary Partner, and Condomless Sex with Casual Partner within the Last Three Months Among Latinx Emerging Adults in Florida and Arizona who have been Sexually Active in their Lifetimes from the 2018–2019 Project on Health among Emerging Adult Latinos Survey (N = 158)

Independent variable	No. of sex partners OR (95% CI)	Alcohol/Drugs before sex OR (95% CI)	Condomless sex with primary partner OR (95% CI)	Condomless sex with casual partner OR (95% CI)
Ethnic discrimination	0.402*** (0.232, 0.668)	1.437 (0.927, 2.269)	1.104 (0.718, 1.710)	1.021 (0.597, 1.779)
Pressure to acculturate	0.550** (0.338, 0.868)	1.110 (0.753, 1.648)	1.229 (0.837, 1.820)	1.536 (0.934, 2.589)
Pressure against acculturation	0.821 (0.550, 1.201)	0.980 (0.688, 1.384)	1.241 (0.883, 1.760)	1.834*** (1.196, 2.887)

Note: OR = odds ratio; CI = confidence interval

All models were adjusted for gender, age, skin color, nativity, Hispanic heritage, and sexual minority status, familism support, and multigroup ethnic identity measure.

Continuous variables including age, familism support, multigroup ethnic identity measure, ethnic discrimination, pressure to acculturate and pressure against acculturation were standardized for ease of interpretation.

^**p < 0.05;

^***p < 0.01

Figure 2.

Effect of Familism Support Score on Association Between Pressure to Acculturate and Multiple Sex Partners

Figure 3.

Effect of Multigroup Ethnic Identity Measure (MEIM) Scores on Association Between Pressure Against Acculturation and Condomless Sex with Casual Partner(s)

Discussion

This study is among the first to examine associations between ethnic discrimination and acculturative stress on sexual risk behaviors (i.e., multiple sex partners, AOD use before sex, and condomless sex with a primary or casual partner), and familism support and ethnic identity as moderators on these associations among LEA. We hypothesized both ethnic discrimination and acculturative stress would be positively associated with sexual risk behaviors, and that these associations would be stronger among LEA with lower levels of familism support and ethnic identity than those with higher.

Our findings suggest a nuanced relationship between ethnic discrimination, acculturative stress, ethnic identity, familism support, and sexual risk behaviors. Contrary to our hypothesis, higher levels of ethnic discrimination and pressure to acculturate were both associated with fewer sex partners in the study sample. This finding contrasts with studies suggesting a positive association between discrimination and acculturative stress and sexual risk behaviors among LEA (Ayala et al., 2012; Díaz et al., 2004; Jardin et al., 2016; Martinez-Donate et al., 2018; Ontiniano Verissimo et al., 2020; Piña-Watson et al., 2021; Rivera et al., 2015). We offer several possible explanations. First, ethnic discrimination is positively associated with depression and generalized anxiety symptoms among participants in this sample (Cano et al., 2021), and acculturative stress is positively associated with depressive symptoms among Latinx college students (Cano et al., 2014). This majority college student sample (Cano et al., 2020) could also be impacted by evidence that perceived discrimination positively predicted academic distress (Cheng et al., 2020) and that acculturative stress was associated with family cultural conflict, which in turn was associated with increased depression among LEA college students (Cheng, 2022). Posttraumatic stress symptoms were found to mediate negative association between perceived discrimination and multiple sexual partners among Latinx adolescents (Flores et al., 2010). However, the potential mediating role of mental health symptomatology is not included in our analysis. Second, our analysis may lack important variables linked to increased sexual risk behaviors, such as social capital among emerging adults. This sample may have less social capital, and thereby fewer opportunities for sexual activity and engaging in sex risk behaviors (Cordova et al., 2022). Third, religiosity is negatively associated with fewer sex partners among LEA (Edwards et al., 2008; Haglund & Fehring, 2010), but was not included in our analysis. Finally, this majority sample of lighter-skinned, heterosexual, U.S. born, English-speaking LEA (Table 1)—of which only 29.7% reported multiple sex partners—are potentially less vulnerable to ethnic discrimination, acculturative stress, and sexual risk behaviors (Table 2; López & Hogan, 2021).

Consistent with our hypothesis and prior studies that analyzed associations between acculturative stress and condomless sex (Martinez-Donate et al., 2018; Rivera et al., 2015), higher levels of pressure against acculturation were associated with increased condomless sex with a casual partner. Furthermore, the moderation effect of higher levels of familism support on pressure to acculturate was associated with fewer sex partners (Van Campen & Romero, 2012). While we found that the moderation effect of higher levels of ethnic identity with pressure against acculturation was associated with a lower probability of reporting condomless sex with casual partners, we found no prior studies with this association. The dearth of research examining these associations between specific predictors reveals a need for greater analytic specificity. It also highlights a need to unpack these nuanced relationships with theoretical frameworks that can illuminate nuanced origins and impacts of social determinants of health on heterogeneous Latinx subgroups.

The adapted stress and coping framework (Figure 1; Estrada, 2009; Walters et al., 2002) and intersectionality (Bowleg, 2021; Crenshaw, 1991; Hill Collins, 2019; Poteat, 2021) theoretically situate our results, by contextualizing ethnic discrimination and acculturative stress as “stress” (Cano, 2014; 2021; Cheng, 2020; 2022) and familism support and ethnic identity as “coping” or protective factors (Krieger et al., 2010; Krieger, 2011), within historical foundations of the social determinants of health (Cerdeña et al., 2021; Orozco-Figueroa, 2021). Settler colonialism’s production (e.g., Indigenous genocide, African enslavement; Cerdeña et al., 2021; Orozco-Figueroa, 2021) and legacy of racialization (Canizales & Agius Vallejo, 2021), political violence, and migration-related multigenerational stressors, drive social, health, and economic inequities across Latin America and the United States. Intergenerational traumas (Cerdeña et al., 2021; Chavez-Dueñas et al., 2019)—or psychological harms resulting from historically oppressive systems and events that impact the health and well-being of subsequent generations (Cerdeña et al., 2021; Chavez-Dueñas et al., 2019; Estrada, 2009; Orozco-Figueroa, 2021)—can result. Intergenerational resilience—or multilevel (e.g., individuals, communities) transmission of strengths (e.g., cultural values, practices, relationships), despite adversities, to subsequent generations (Cerdeña et al, 2021)—coexists through familism and ethnic identity as protective factors (Cerdeña et al., 2021; Guilamo-Ramos et al., 2020; Orozco-Figueroa, 2021). Intergenerational traumas and resiliencies are unique to social locations (e.g., race, gender, class) (Cerdeña et al., 2021; Estrada, 2009; Orozco-Figueroa, 2021). Intersectional theory describes complex, interconnected and historically-rooted systems of oppression (e.g., associated with race, gender, and social class), and can help articulate the relationship between social location and unique experiences of ethnic discrimination and/or acculturative stress across heterogeneous Latinx subgroups (Bowleg, 2021; Cole, 2009; Crenshaw, 1991; DeBlaere et al., 2018; Hill Collins, 2019; Poteat, 2021).

Applying these frameworks helps identify key clinical and policy interventions (Cerdeña et al., 2021; Guilamo-Ramos et al., 2020; López & Hogan, 2021; Orozco-Figueroa, 2021). Researchers call for inclusion of acculturative stress prevention (Jardin et al., 2016) and familism and ethnic identity as protective factors (Guilamo-Ramos et al., 2009; Ma et al., 2014) in sexual health prevention strategies (Evans et al., 2020; Moise et al., 2019). Our findings suggest that familism support and ethnic identity are targeted intervention points in sexual risk prevention efforts for LEA who experience acculturative stress. Clinical practice strategies could include assessment questions and treatment plans that account for discrimination and acculturation-related stressors, as well as familism and ethnic identity as potential protective factors (Fernandez & Beltrán, 2022). Tailoring sexual and reproductive health interventions for LEA can increase effectiveness of interventions (Guilamo-Ramos et al., 2020). Meta-analyses have identified significant gaps in availability of culturally-relevant sexual health interventions for Latinx youth (Cardoza et al., 2012) and evidence that they produce increased condom usage compared to nontailored interventions (Evans et al., 2020).

Using culturally-informed, historically-situated theoretical frameworks (Krieger et al., 2010; Krieger, 2011; Ramírez García, 2019) can drive more equitable policy interventions, such as funding community development projects and programs that center culturally-relevant protective factors for LEA (Fernandez & Beltrán, 2022). These frameworks highlight structural factors influencing predictors while accounting for Latinx heterogeneity. They thereby strengthen practice and policy (Cerdeña et al., 2021; López & Hogan, 2021), which contributes to dismantling racism (Boyd et al., 2021; López & Hogan, 2021) and health inequities (Bowleg, 2021) through identifying, articulating, and disseminating evidence and approaches that name their root causes (Bowleg, 2021; Boyd et al., 2021).

Limitations and Future Directions

Our study limitations first include the use of cross-sectional data, which precluded our ability to test for temporality between associated variables of interest. While this study provides evidence of associations between ethnic discrimination and acculturative stress and sexual risk behaviors, as well as protective effects of familism support and ethnic identity on certain sexual risk behaviors, a longitudinal study design would enable observation of individual-level change in experiences at multiple time points. Furthermore, while emerging adulthood is a crucial period for heightened sexual risk behaviors (Guilamo-Ramos et al., 2020; Wood et al., 2018), this age group experiences evolving identity formation (Côté, 2006; Schwartz et al., 2005), which may implicate an evolving relationship with familism support and ethnic identity. Thus, longitudinal data could provide a more comprehensive understanding of whether and to what extent these factors are protective throughout emerging adulthood. Second, the use of self-reported measures to collect data on behavioral outcome variables commonly risks recall and social desirability biases. Data were collected about past 3-month sexual risk behaviors using an online survey methodology in which confidentiality was safeguarded to reduce the impact of these biases. Third, this analysis lacks inclusion of important variables that are linked with increased sexual risk behaviors, such as social capital. Future studies could control for social capital to determine potential impacts on sexual risk behaviors among LEA (Cordova et al., 2022). Fourth, it should also be noted that while ethnic discrimination and acculturative stress have unique theoretical integrity as predictor variables, components of ethnic discrimination and acculturative stress scales may have overlapping construct validity. Future research could involve measurement development with LEA, guided by theoretical frameworks such as the adapted stress and coping framework and intersectionality that account for such nuances and distinctions between these two measures. Furthermore, these measures could be developed with Latinx subgroups, and examine whether and to what extent differences exist in experience of ethnic discrimination or acculturative stress by variables such as skin color, nativity, or language.

Constraints on Generality

While our non-probability sample of LEA represented ethnic subgroup diversity similar to the overall Latinx population in the United States, our sample size limited our ability to test for ethnic subgroup variation. Furthermore, though the sample was split fairly evenly across binary gender categories, most participants were U.S.-born college students and identified as lighter-skinned and heterosexual, which also limits generalizability. Fewer than one-fifth to one-half of our sample reported sexual risk behaviors overall, and all reported above-average familism support and ethnic identity scores. Overall, our sample may have been less susceptible to ethnic discrimination and acculturative stress relative to those with fewer social and economic privileges (Araújo & Borrel, 2006; Arce et al., 1987; Chavez-Dueñas et al., 2019; Montalvo & Codina, 2001; Telzer & Vazquez Garcia, 2009). Given these sampling limitations, we controlled for age, gender, skin color, nativity, Latinx (Hispanic) heritage, and sexual minority status in our statistical models to recognize the intersectionality of this heterogeneous population. Future research could examine differences among Latinx subgroups across intersectional identities to better identify risk and protective factors and account for diverse impacts on health, through specific subgroup comparison, measurement, and intervention development. In addition, a Spanish language survey was not offered due to inadequate funding, which limited survey eligibility to monolingual English and bilingual speakers only. Including a Spanish language survey could capture greater cultural diversity in future work. Finally, physical location may impact results. The sample was split evenly between urban Florida and Arizona sites only. Latinx represent 69.1% of Miami-Dade County (U.S. Department of Commerce [USDOC], n.d. -d)—more than 2.5 times their proportion of Florida state (26.8%) (USDOC, n.d. -b), while they represent nearly the same proportion of Maricopa County (32%) (USDOC, n.d. -c) compared with Arizona state (32.3%) (USDOC, n.d. -a). Differences in Latinx demographics, as well as political and social opportunities that could be linked with perceived discrimination and acculturative stress may vary across U.S. cities (Sanchez et al., 2014; Schwartz et al., 2014; Stepick & Stepick, 2002) and rural areas. To increase generalizability, this study could be replicated across multiple sites that include rural areas.

Conclusions

Sexual risk behaviors are a significant public health concern for LEA in the United States (Guilamo-Ramos et al., 2020). While previous research provides evidence of the impacts of ethnic discrimination and acculturative stress on sexual risk behaviors among Latinx (Ayala et al., 2012; Díaz et al., 2004; Jardin et al., 2016; Martinez-Donate et al., 2018; Ontiniano Verissimo et al., 2020; Rivera et al., 2015), research examining potential protective factors has been limited. Mainstream health research largely emphasizes individual risk factors yet minimizes cultural, structural, and historical contexts as determinants of health (Boyd et al., 2021). In response, leading health scholars and institutions have called for a deeper examination of the social determinants of the health for Latinx, in order to not only account for important risk and protective factors (Cerdeña et al., 2021; Orozco-Figueroa, 2021; Ramírez García, 2019) but to also better understand how Latinx heterogeneity may impact experiences with ethnic discrimination and pressure to acculturate and potentially influence health outcomes. This study’s findings suggest that protective factors may help mitigate sexual risk behaviors among LEA who experience acculturative stress. Results may implicate the important protective role of familism support and ethnic identity, as well as the importance of using intersectional and culturally-congruent theoretical frameworks in the design and development of measures and interventions to address sexual risk behaviors among this population. Furthermore, using theoretical frameworks that are culturally informed and situated within the social determinants of health, while accounting for intersectional heterogeneity, can provide researchers, practitioners, and policymakers with more effective, sustainable social and behavioral strategies that advance racial equity and social justice in sexual risk prevention and health promotion among LEA (López & Hogan, 2021).

Public Significance Statement:

Ethnic discrimination and acculturative stress can be linked with sexual risk behaviors among Latinx emerging adults. This study found that while ethnic discrimination and pressure to acculturate were linked with fewer sex partners, pressure against acculturation was linked to increased condomless sex with a casual partner. Family support and ethnic identity can be protective in the prevention of sexual risk behaviors among Latinx emerging adults who experience acculturative stress.