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. Author manuscript; available in PMC: 2026 Jan 29.
Published in final edited form as: J Ethn Subst Abuse. 2022 May 28;23(1):150–165. doi: 10.1080/15332640.2022.2077273

Discrimination, acculturative stress, alcohol use and their associations with alcohol-related consequences among Latino immigrant men

Vanessa N Torres a,b, Emily C Williams c,d, Rachel M Ceballos c,e, Dennis M Donovan c,f, India J Ornelas c
PMCID: PMC12849029  NIHMSID: NIHMS2127526  PMID: 35634786

Abstract

Latino immigrant men are at increased risk for unhealthy alcohol use and related consequences due to social stressors associated with immigration. We assessed the associations of, and examined whether social stressors moderated associations between, alcohol use and alcohol-related consequences in a community-based sample of Latino immigrant men in Washington (N = 187). The mean Alcohol Use Disorders Identification Test Consumption (AUDIT-C) score was 6.3 (scores ≥ 4 indicate unhealthy alcohol use). More than half of the men (61.5%) reported experiencing discrimination in at least one setting and mean acculturative stress score was 18.3 indicating moderate levels of acculturative stress. Linear regression models were fit to assess main effects (associations between both alcohol use and social stressors and alcohol-related consequences) and moderation (whether the association between alcohol use and consequences varied based on experience of social stressors using multiplicative interaction) after adjustment for potential confounders. Alcohol use (β = 0.47, 95% CI = 0.20–0.73; p = .001), discrimination (β = 0.85, 95% CI = 0.27–1.43; p = .004), and acculturative stress (β = 0.13, 95% CI = 0.02–0.24; p = .025) were all associated with increased experience of alcohol-related consequences. The association between alcohol use and alcohol-related consequences was stronger for those with high levels of acculturative stress (p = .025) but not experience of discrimination (p = .587). Findings underscore the importance of social and cultural context in alcohol use and related consequences. Efforts to reduce negative consequences of drinking may include focus on reducing exposure to discrimination and acculturative stress.

Keywords: Latino, immigrant men, alcohol use, social stressors, alcohol-related consequences

Introduction

Latino men experience more alcohol-related consequences than White men (Mulia et al., 2009; Zemore et al., 2013). Alcohol use among Latino men has been associated with higher rates of relationship problems, financial hardships, lost work opportunities, feelings of guilt or shame, and negative law enforcement interactions (Caetano & Clark, 1998; García, 2008; Mulia et al., 2009; Worby et al., 2014; Zemore et al., 2013). This is concerning because Latino men also have poor access to treatment, low treatment engagement, and low treatment completion rates (Carey et al., 2021; Pinedo et al., 2018). Disparities in alcohol-related consequences may be due in part to higher levels of unhealthy alcohol use, more specifically heavy episodic drinking among Latino than white men (Naimi et al., 2010; Zemore, 2007). However, even though heavy drinking has been identified as a risk factor for alcohol-related consequences, differences in levels of alcohol use do not fully explain higher levels of alcohol-related consequences among Latino men (Chartier & Caetano, 2009; Hilton, 1987; Midanik et al., 1996; Mulia et al., 2009; Pinedo et al., 2018; Rehm et al., 2003; Rubinsky et al., 2013; Shield et al., 2014; Stockwell et al., 1996; Witbrodt et al., 2014).

Although the literature on alcohol-related consequences among Latino men is sparse, research suggests that factors other than consumption, like social stressors, may independently contribute to alcohol-related consequences (Mulia et al., 2009). Latino immigrant men face several social stressors associated with their minority status such as racial discrimination, acculturative stress, unstable housing, and social isolation (Fleming et al., 2017; Morey, 2018; Negi, 2013; Organista et al., 2017; Valentín-Cortés et al., 2020; Worby & Organista, 2007). Experiences of acculturative stress include difficulty communicating in English, being away from loved ones, and difficulty finding a job may exacerbate alcohol-related consequences, such as financial problems and broken family relationships (Hovey & Magaña, 2000; Lueck & Wilson, 2011; Ornelas et al., 2020). Additionally, experiences of discrimination such as negative interactions with law enforcement (e.g., being more likely to get pulled over for a drinking under the influence) may contribute to greater alcohol-related consequences (Caetano et al., 2008). Altogether, findings suggest that social stressors may not only independently contribute to alcohol-related consequences but may also exacerbate the effects of alcohol use on alcohol-related consequences.

To build upon existing literature we utilized the Minority Stress Model, which posits that minority stress, psychosocial stress derived from minority status, arises from negative events as well as the accumulation and intersectionality of the experiences faced by minorities in a dominant society (Meyer, 1995; Meyers et al., 2003). It may be that disparities in alcohol-related consequences can be explained by stresses induced by a hostile, anti-immigrant social environment, which often results in a lifetime of discrimination and victimization and may ultimately impact access to care (Meyers et al., 2003). Among Latino immigrant men, it is important to focus on those men with lower levels of education and income because these factors are associated with elevated stress, higher alcohol consumption, more alcohol-related consequences, and limited access to health care (Caetano et al., 2008; Documet et al., 2019; Vaeth et al., 2009; Van Oers et al., 1999). It may be that those in lower socioeconomic strata have fewer resources to respond to alcohol-related consequences (Caetano et al., 2008).

There is limited research on the effects of social stressors on alcohol-related consequences (Hunt et al., 2017). To our knowledge there are no studies that examine how social stressors may moderate the effects of alcohol use on alcohol-related consequences among Latino immigrant men. Given the limited research, it is important to identify and understand how risk factors contribute to alcohol use and consequences among Latino immigrant men in an effort to reduce alcohol disparities (López et al., 2020). Thus, the purpose of this study was to: (1) assess the associations between both alcohol use and social stressors and alcohol-related consequences, and (2) examine whether social stressors moderate associations between alcohol use and alcohol-related consequences. This study focused on a sample of Latino immigrant men with lower levels of education and income given that this population may be at particular risk for alcohol-related consequences but is yet understudied (Vaeth et al., 2009). This study will provide a more comprehensive understanding of the relationship between social stressors and alcohol-related consequences which can inform potential behavioral interventions to reduce unhealthy alcohol use and address other sources of risk.

Methods

Study sample

This study used survey data from the Vida PURA studies. This included data from both a feasibility study of a culturally adapted brief intervention to reduce unhealthy alcohol use among Latino immigrant men (conducted in 2013) (Ornelas et al., 2016) and a pilot randomized controlled trial (RCT) to evaluate the efficacy of the intervention (conducted in 2016) (Ornelas et al., 2019). Participants in the studies were recruited from a day labor worker center in Seattle, Washington. Eligible participants were men who self-identified as Latino, spoke Spanish, and were born outside the U.S. Participants in the pilot RCT were also required to meet a minimal threshold of low-risk drinking as indicated by a score of six or greater on the Alcohol Use Disorders Identification Test (AUDIT), (Babor et al., 2001). Participants in the feasibility study (N = 104) completed a baseline survey and those that had an AUDIT score ≥ 6 were offered a brief intervention to reduce their alcohol use. For the pilot RCT, screened and eligible participants completed a baseline survey (N = 121) and were randomized into an intervention or control group. The total sample size of eligible participants was 187.

Data collection procedures

Baseline surveys included measures of alcohol-related consequences, alcohol use, social stressors (acculturative stress and discrimination), and demographic characteristics. Baseline data were collected by Spanish-speaking community health workers, promotores, at a private location within the day labor center using paper surveys and tablets (feasibility study and RCT, respectively). Study participants received either $25 (feasibility study) or $30 (RCT study) for completing the baseline surveys. All Vida PURA study procedures were reviewed and approved by the Human Subjects Division at the University of Washington.

Measures

Alcohol-related consequences

Alcohol-related consequences were measured using a 15-item Short Inventory of Problems (SIP) questionnaire (Miller et al., 1995). Participants reported whether they had ever experienced any of the fifteen problems related to drinking (e.g. been unhappy, not eaten properly, have failed to do what is expected of them, have done impulsive things that they regret later, money problems) with no (0)/yes (1) responses. Scores from all fifteen items were summed to calculate a total SIP score ranging from 0 to 15, with higher values indicating more alcohol-related consequences (α = .93) (Miller et al., 1995). The SIP measure was composed of five subscales with three items each. Additionally, in preliminary analyses we calculated scores for each of the five subscales: physical (i.e. my physical health and appearance have been harmed and I have not eaten properly), interpersonal (i.e. my family has been hurt by my drinking, a friendship or close relationship has been damaged by my drinking, and my drinking has damaged my social life, popularity or reputation), intrapersonal (i.e. I have been unhappy because of my drinking, I have felt guilty or ashamed, and my drinking has gotten in the way of my growth as a person), impulse control (i.e. I have taken foolish risks when I have been drinking, when drinking I have done impulsive things that I regretted later, and I have had an accident while drinking or intoxicated) and social responsibility (i.e. I have failed to do what is expected of me, I have had money problems, and I have spent too much or lost a lot of money because of my drinking).

Alcohol use

The Alcohol Use Disorders Identification Test Consumption (AUDIT-C) score was used to assess alcohol use. The AUDIT-C is a 3-item alcohol screen based on quantity and frequency questions used to identify unhealthy alcohol use (Bush et al., 1998). Each item is scored 0–4, resulting in a total score ranging from 0–12, with higher scores indicating higher levels of alcohol-related risk (e.g. consumption, unhealthy alcohol use severity, and alcohol abuse or dependence) (α = .74) (Bradley et al., 2007; Rubinsky et al., 2013). For men, AUDIT-C scores of 4 or greater indicate positive screen for unhealthy alcohol use (Bush et al., 1998; Frank et al., 2008; Rubinsky et al., 2013).

Social stressors

Social stressors included discrimination and acculturative stress. Our measure of discrimination was based on items used in the Multicultural Discrimination Module in the California Health Interview Survey (CHIS), and included questions related to discrimination in different settings (Ornelas et al., 2011; Shariff-Marco et al., 2009). We used a continuous variable by summing the discrimination items together (0–5), indicating the number of settings participants reported being “treated unfairly or discriminated against” since arriving to the U.S. (options included work, stores/restaurants, medical care, police/courts, and other settings). To measure acculturative stress, we used ten items from the Migrant Farmworker Stress Inventory (Hovey & Magaña, 2000). We selected the items based on our previous studies and input from community advisors about which stressors were most relevant for Latino immigrant men (Ornelas et al., 2016, 2019). Participants were asked to rate how stressful they found the experience described in each statement (e.g., difficulty communicating in English, unable to purchase desired items, difficulty accessing healthcare, working long hours, being away from loved ones, difficulty finding a job). Responses were rated on a five-point scale (“Have Not Experienced” to “Extremely Stressful”). We summed responses for a total score ranging from 0–40, with higher scores indicating more acculturative stress (α = .81) .

Participant characteristics

We also included age in years, years living in the U.S., marital status (single/divorced/widowed, or married/cohabitating), weekly income (less than $300, or $300 or more), education level (primary or less, or high school graduate or more), and living situation (homeless/temporary housing, or house/apartment). Previous research indicates that these characteristics are associated with alcohol use and related consequences (Galvan & Caetano, 2003; Lee et al., 2013; Negi, 2013; Ornelas et al., 2016; Worby & Organista, 2013).

Analysis

Means and percentages were calculated to describe alcohol-related consequences, alcohol use, social stressors, and participant characteristics. Bivariate analyses assessed the association between participant characteristics, alcohol use, social stressors and alcohol-related consequences using chi-square tests of independence for categorical measures and Pearson’s correlation for continuous measures.

Linear regression models were fit to assess main effects, the associations between both alcohol use and social stressors (i.e. discrimination and acculturative stress) and alcohol-related consequences. To assess whether the association between alcohol use and consequences varied based on experience of social stressors, we conducted a linear regression model using multiplicative interaction. All models were adjusted for participant characteristics including years living in the U.S., weekly income, education level, and living situation, because of their association alcohol use and related consequences. Estimates of main effects and interaction terms were reported with 95% confidence intervals (CI). We used the effects Johnson-Neyman technique using a Microsoft Excel 2013 macro-enabled workbook (.xlsm) to explore significant interactions (Carden et al., 2017). All other analyses were conducted using Stata MP Edition, v14.

Results

The characteristics of participants are presented in Table 1. The mean age of the sample was 47 years old and years lived in the United States was eighteen years on average. Most participants had a low weekly income, low levels of education, and many were homeless or living in temporary housing (42%).

Table 1.

Sample characteristics (N = 187).

N/Mean % (SD)
Participant Characteristics
Age (years) 47.0 (11.5)
Years living in the United States 18.2 (11.6)
Weekly income
Less than $300 107 58.5
$300 or more 76 41.5
Education level
Primary or less 99 52.9
High school graduate or more 88 47.1
Living situation
Homeless or temporary housing 78 41.7
House/apartment 109 58.3
Alcohol Use
AUDiT-C 6.3 (3.4)
Social Stressors
Discrimination (0–5) 1.3 (1.3)
Acculturative stress score (0–40) 18.3 (7.2)
Alcohol-related Consequences
Physical problems (0–3) 1.5 (1.2)
interpersonal problems (0–3) 1.3 (1.3)
intrapersonal problems (0–3) 1.5 (1.3)
impulse control problems (0–3) 1.4 (1.1)
Social responsibility problems (0–3) 1.6 (1.3)
Total SiP score (0–15) 7.2 (5.5)
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*

Not all categories add up to 187 due to missing data for some variables.

Participants experienced an average of 7 alcohol-related consequences (0–15). The most commonly reported alcohol-related consequences included social responsibility problems with a mean score of 1.6 problems, as well as intrapersonal and physical problems with mean scores of 1.5 problems. The mean AUDIT-C score was 6.3 (scores ≥ 4 indicate unhealthy alcohol use). More than half of the men (61.5%) reported experiencing discrimination in at least one setting and mean acculturative stress score was 18.3 indicating moderate levels of acculturative stress (i.e., their experiences related to immigration, communication, poverty, health care, work and feeling of belonging were somewhat or extremely stressful).

As seen in Table 2, the simple main effects presented in Model 1 indicate that alcohol use (β = 0.49, 95% CI = 0.23–0.75; p < .001), discrimination (β = 0.89, 95% CI = 0.29–1.48; p = .004), and acculturative stress (β = 0.12, 95% CI = 0.01–0.24; p = .028), R2 = .28 were all associated with increased experience of alcohol-related consequences. Model 2 provides the estimates for the interaction effects. Associations between alcohol use and consequences did not vary based on experience of discrimination (p = .587 for Wald test) but did vary based on experience of acculturative stress (p = .025). As seen in Figure 2 in only acculturative stress moderated the relationship between alcohol use and alcoholrelated consequences. The association between alcohol use and alcohol-related consequences was stronger among those with high levels of acculturative stress such that for each 1-unit increase in the acculturative stress score, the association between alcohol use and alcohol-related consequences was .04 units higher (95% CI = 0.01–0.07) (Hunt et al., 2017). The interaction term was added to the regression model, which accounted for a significant increase in the variance of alcohol-related consequences R2 = .31 (see Table 2). Post-hoc power analyses revealed that N = 290 is the estimated sample size for a multiple linear regression with two interaction terms and a power of 0.80. Therefore, we do not have enough sample to detect a significant interaction between discrimination and alcohol use.

Table 2.

Regression models estimating associations with alcohol-related consequences (N = 187).

Predictors β (95% CI)
Model 1 a R2 = 0.2835
Alcohol Use
 AUDIT-C score 0.49*** (0.23, 0.75)
Social Stressors
 Discrimination 0.89** (0.29, 1.48)
 Acculturative stress 0.12* (0.01, 0.24)
Participant characteristics
 Years living in the United States 0.01 (−0.06, 0.08)
 Weekly income (less than $300) 1.41 (−0.22, 3.04)
 Education (primary or less) 0.68 (−0.95, 2.32)
 Living situation (homeless or temporary housing) 1.17 (−0.41, 2.32)
Model 2 b R2 = 0.3068
Alcohol Use × Social Stressors
 Interactions
 Alcohol use × Discrimination −0.05 (−0.22, 0.13)
 Alcohol use × Acculturative stress 0.04* (0.01, 0.07)
Participant characteristics
 Years living in the United States −0.00 (−0.07, 0.07)
 Weekly income (less than $300) 1.49 (−0.08, 3.05)
 Education (primary or less) 0.82 (−0.78, 2.41)
 Living situation (homeless or temporary housing) 1.21 (−0.36, 2.79)
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*

p<.05;

**

p<.01;

***

p<.001.

Figure 2.

Figure 2.

Open in a new tab

Moderation model estimating associates between alcohol use, acculturative stress, and alcohol-related consequences.

The Johnson–Neyman technique was utilized to identify significant interaction effects (Johnson & Fay, 1950). This approach searches for values of the moderator variables that lead to significant associations between the predictor variable and the dependent variable (Spiller et al., 2013). Figure 1 shows the Johnson-Neyman graph for the model estimating moderation effects. The effect of alcohol use on alcohol-related consequences was significantly different than zero for values of acculturative stress higher than 13 points. In other words, alcohol use is associated with having more alcohol-related consequences for those with an acculturative stress score of 13 or higher.

Figure 1.

Figure 1.

Open in a new tab

The Johnson-Neyman graph for the model relating alcohol-related consequences (SIP score) to alcohol use (AUDIT-C), acculturative stress and their interaction.

Discussion

In this sample of Latino immigrant men, unhealthy alcohol use was common, as were experiences of discrimination, acculturative stress, and alcohol-related consequences. Alcohol use and social stressors (discrimination and acculturation) were both independently associated with increased experience of alcohol-related consequences, the association between alcohol use and consequences was stronger for those who experienced higher levels of acculturative stress than those with lower levels.

Our study supports previous research indicating that the most prevalent alcohol-related consequences experienced by Latinos include social responsibility (e.g. failing to meet expectations, problems with money), intrapersonal (e.g. feelings of guilt or shame), and physical health (e.g. physical health or appearance) problems (Caetano & Clark, 1998; Vaeth et al., 2009). The moderate prevalence of social stressors reported by our study participants, which include experiences of discrimination and significant levels of acculturative stress were consistent with recent studies (Bacio et al., 2014; Galvan et al., 2015; Glass et al., 2020; Hill et al., 2019; Negi, 2013; Organista et al., 2020).

Overall, findings that higher levels of alcohol use and social stressors (i.e. discrimination and acculturative stress) were associated with more alcohol-related consequences are consistent with findings from a previous national study in which experience of social stressors were directly related to alcohol-related consequences, independent of their association with alcohol use (Mulia et al., 2009). Only one other study has documented an association between acculturative stress and alcohol-related consequences among Latinos (Lee et al., 2013). More research is needed to identify and understand the mechanisms by which social stressors contribute to alcohol-related consequences in this population. This is especially critical during a contentious political climate, where policies and anti-immigrant rhetoric continue to criminalize and marginalize Latino immigrant men, which may exacerbate existing disparities in alcohol-related consequences (Negi et al., 2020; Organista et al., 2020).

We found that discrimination was significantly associated with alcohol-related consequences. Given that 61% of the sample reported experiencing discrimination in one or more settings, these findings are particularly concerning. Prior research on discrimination and alcohol use has focused on discrimination as a motive for drinking, without addressing the potential impact on consequences of alcohol use. For example, previous studies have found that Latino immigrant men that engage in unhealthy alcohol use to cope or escape negative feelings from experiencing discrimination, are at increased risk for alcohol-related consequences (Cooper et al., 1995; Wray et al., 2016). However, our findings suggest that consequences may depend on other factors not directly related to the quantity and pattern of drinking of an individual, such as living under more law enforcement scrutiny due to discrimination, putting men at a higher risk for experiencing consequences regardless of the levels of alcohol use (Vaeth et al., 2009). Previous research has shown that Latino immigrant men are more likely to experience negative law enforcement interactions, including being charged with driving while intoxicated, being involved in alcohol-related motor-vehicle accidents and being detained or deported by immigration officials (Caetano et al., 2008; Ornelas et al., 2020). Previous studies have also shown that Latino day laborers, specifically, are at increased risk for victimization and violence due to their working conditions and legal status (Negi et al., 2020; Organista et al., 2020). Future studies should investigate how discrimination of different types or in different settings impacts alcohol use and related consequences.

Another key finding is the moderating role of acculturative stress which was found to exacerbate the effects of alcohol use on alcohol-related consequences, such that the effect of alcohol use and alcohol-related consequences was stronger for those higher levels of acculturative stress. This finding provides evidence that acculturative stress experiences may negatively affect alcohol-related consequences. To our knowledge this is the first study to assess this relationship among Latino immigrant men with low levels of education and income. Only one other study examined acculturative stress as a moderator of the relationship between alcohol use and alcohol-related consequences among 175 international students at a large Midwestern university (Hunt et al., 2017). Consistent with our findings Hunt et al. (2017) found that high levels of acculturative stress were associated with a stronger relationship between drinking behaviors (i.e., alcohol use) and alcohol-related consequences. Our findings are also consistent with a growing body of literature that indicates that immigration-related stressors contribute to poor health among low-income Latino immigrants (Valentín-Cortés et al., 2020). In summary, it is important to consider the effect of acculturative stress on alcohol-related consequences.

Limitations

There are some important limitations to this study. First, the data were cross-sectional, and therefore no causal interpretations can be made. Secondly, our interpretations were limited to our study sample which was recruited for a randomized controlled trial to reduce unhealthy alcohol use from a day labor center; therefore, we cannot generalize to other Latino immigrant populations. Third, there may be bias due to participant recall or social desirability. Participants may underreport alcohol use due to the timeframe (seasonal variability) or the way in which questions were asked, or forgetfulness as a result of heavy drinking, (Sobell & Sobell, 2003). Consequently, alcohol-related consequences may have been underreported for similar reasons.

Conclusions

Despite these limitations, this is one of the first studies to investigate the relationship between alcohol use, social stressors and alcohol-related consequences among a community-based sample of Latino immigrant men. Our findings underscore the importance of considering factors related to social and cultural context of Latino immigrant men in order to better understand the impact of their alcohol use (Castañeda et al., 2015; Mulia et al., 2009; Negi, 2013). Future research is needed to better understand patterns of alcohol-related consequences among this population and investigate whether different kinds of discrimination or experiencing discrimination in different settings impacts both alcohol use and risk of experiencing alcohol-related consequences. In addition, researchers should follow increasing recommendations to highlight immigration as a social determinant of health (Cabral & Cuevas, 2020; Castañeda et al., 2015; Held et al., 2020). Studies should assess the extent to which immigration and acculturation related stressors, such as housing, legal status, and family structure which may also contribute to alcohol use and consequences (Cabral & Cuevas, 2020; Ornelas et al., 2020).

There are also several implications for practice. Latino immigrant men need improved access to health and social services, including alcohol treatment that is culturally and linguistically appropriate (Doshi et al., 2020; Yamanis et al., 2020). Behavioral interventions to reduce unhealthy alcohol use need to address multiple sources of risk (i.e. discrimination, economic factors, immigration) to effectively change behavior (Mulia et al., 2009; Negi et al., 2020). Health care, social service agencies, and government institutions should focus on shifting policies and practices in order to dismantle systems of oppression that can result in discrimination, victimization and criminalization of this highly vulnerable population and thus, help reduce alcohol disparities (Glass et al., 2020; Negi et al., 2020).

Acknowledgements

We acknowledge the efforts of the entire research team as well as the support of our community partners Casa Latina. We further acknowledge the contributions of all the participants. Additionally, we want to acknowledge Dr. Eunice Wong and Dr. Bing Han for their guidance and support in conducting additional analyses.

Funding

This study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) under Grants 1R34AA022696–01A1 and 3R34AA022696–02S1; National Cancer Institute (NCI) under Grant T32CA092408; and Agency for Healthcare Research and Quality (AHRQ) and Maxicare by grant number T32HS000046.

Footnotes

Declaration of potential conflicts of interests

All authors declare that they have no conflicts of interest.

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