Alcohol Use among Mexican Youths: Is Familismo Protective for Moderate Drinking?

Abstract

The construct of familismo has been identified as a potential protective cultural value in Hispanic cultures. This paper considers familismo and alcohol use among young people in Mexico. We conducted a qualitative study using ethnographic open ended interviews with 117 first year students at a large free public university in Mexico City between April-May 2011. The findings indicate that dimensions of familismo can act as protective factors against misuse of alcohol among Mexican youths and may be protective for moderate drinking. Future research should explore the relationship of familismo to gender roles and other cultural values during adolescence. Given the enduring influence of Mexican cultural values among Mexican Americans the research has implications for prevention programs for both Mexican and Mexican American youths.

Introduction

The Hispanic population is the largest ethnic minority population in the U.S., constituting 16% of the population (Ennis, Ríos-Vargas, & Albert, 2011). Due to high immigration and fertility rates the Hispanic population is projected to comprise over 25% of the U.S. population by 2050 (US Census Bureau, 2005). Approximately two-thirds of Hispanics identify as Mexican (Ramirez & De La Cruz, 2002). With the number of Mexican immigrants to the U.S. expected to increase, the physical and mental health of current and future Mexican immigrants is of great importance to both Mexico and the U.S. (Borges, Medina-Mora, Breslau, & Aguilar-Gaxiola, 2007; Cesarman-Maus, 2003).

Since younger people are at highest risk for substance abuse and addiction, 40% of the Hispanic population in the U.S. under age 21 is vulnerable to substance abuse (Volkow, 2006). Studies show that in the U.S. Hispanic high school students are more likely to drink and to get drunk at an earlier age than non-Hispanic White or Black youths (Díaz-Martínez et al., 2008) and that Mexican Americans are more likely than those who identify as Cuban or Puerto Rican to engage in heavy drinking (Delva et al., 2005; Flores-Ortiz, 1994; Johnston, O'Malley, Bachman, & Schulenberg, 2004; Nielsen & Ford, 2001; Swaim, Wayman, & Chen, 2004). The few studies of alcohol use among Mexican American young adults focus on Mexican American college students and acculturation but the results are inconsistent and researchers recommend moving from measuring behavioral aspects of acculturation to examining cultural norms and values related to alcohol use (Corbin, Vaughan, & Fromme, 2008; Raffaelli et al., 2007; Zamboanga, 2005; Zamboanga, Raffaelli, & Horton, 2006).

Investigation of more specific cultural variables has the potential to inform prevention and intervention efforts for different groups of Hispanic/Latino youths in the U.S. The construct of familismo, or familism, is theorized as a core cultural value requiring the individual to submit to a family collective form of decision making (Smith-Morris, Morales-Campos, Alvarez, & Turner, 2012) and has been identified as a potential protective cultural value in Hispanic cultures (Balls Organista, Organista, & Kurosaki, 2003; Germán, Gonzales, & Dumka, 2009; Guilamo-Ramos, Bouris, Jaccard, Lesesne, & Ballan, 2009; Romero & Ruiz, 2007). Familismo refers to strong identification and attachment to immediate and extended family (Lugo Steidel & Contreras, 2003; Romero, Robinson, Haydel, Mendoza, & Killen, 2004) and includes dimensions of familial responsibility and obligation to be materially and emotionally supportive, perceived help and support from family to solve problems, and family as referent with behaviors and decisions made to meet familial expectations that do not dishonor the family (Germán et al., 2009; Lugo Steidel & Contreras, 2003; Sabogal, Marín, Otero-Sabogal, Marín, & Perez-Stable, 1987). Others have also identified close proximity and spending time with family as a dimension of familismo (Romero & Ruiz, 2007).

Familismo has been well-researched among different Hispanic/Latino populations in the U.S. and shown to impact both attitudinal and behavioral norms (Guilamo-Ramos et al., 2009; Rodriguez & Kosloski, 1998; Sabogal et al., 1987). Studies show that higher rates of familismo dimensions including family pride, filial piety, and family support act as protective factors for substance use among Mexican American youths and are associated with fewer risky behaviors. A comparison of the levels of alcohol use among U.S.-born and immigrant Latino adolescents living in Southeast Florida found familismo was associated with a decreased tendency towards deviant behaviors such a stealing or breaking the law (Gil, Wagner, & Vega, 2000). Among Mexican American adolescents, familismo has been identified as a core protective factor that buffers against the effects of acculturation stress (Balls Organista et al., 2003; Marsiglia et al., 2009). Exploring the drinking behaviors of Mexican young people can help explain how cultural drinking norms that may be protective are maintained or modified in different social and cultural contexts such as the U.S.

In Mexico alcohol is the most commonly used substance (Degenhardt et al., 2008) and young people may be at increased risk for alcohol misuse because of traditional patterns of drinking. Historically alcohol is not consumed frequently but when people do drink, they tend to consume large quantities of alcohol in a single episode (Medina-Mora, 2007). However, studies of alcohol use among young people in Mexico indicate both consumption of large quantities in a single occasion and increasingly frequent use. A majority of male and female adolescents report having consumed alcohol before age 18 and there is growing concern about increasing rates of drinking and alcohol misuse among young people (Latimer et al., 2004; Marsiglia, Kulis, Rodriguez, Becerra, & Castillo, 2009; Medina-Mora, Borges, & Villatoro, 2000). In the most recent 2011 National Survey of Addictions (NSA), a household survey examining the prevalence of alcohol and drug use in Mexico, 42.9% of youths aged 12-17 reported ever using alcohol with 31.8% of males and 28.1% of females reporting drinking in the last 30 days (INEGI, 2012). Other studies show higher rates among young adults. A study of 17-25 year old university students from private and public schools in Mexico City, found 83% of students reported drinking in the past year with 31%, mainly males, drinking 5+ drinks per drinking occasion (Mora-Ríos & Natera, 2001). Similarly, in a 2005 survey of 24,921 entering first year university students in Mexico City, 75% of males and 66% of females reported drinking in the past year (Díaz-Martínez et al., 2008). In 2008, 28.9% of first year entering students drank 2+ times a month with 17.5% of males and 14.4% of females reporting an AUDIT score of 6+, indicating harmful and hazardous drinking (Strunin et al., 2013). Although these studies suggest traditional patterns of alcohol are changing, the ways in which cultural norms or values contribute to these patterns are unknown. Cultural values may act as either protective or risk factors for substance use and behavior may be shaped by culture-specific norms and environmental factors (Strunin et al., 2013; Voisine, Parsai, Marsiglia, Kulis, & Nieri, 2008).

This paper considers whether dimensions of familismo act as protective factors against misuse of alcohol and are protective for moderate drinking among young people in Mexico. The study is from phase one of a project investigating patterns of alcohol use, including alcohol related risk behavior and protective factors that may modify or prevent the likelihood of risk taking. The themes of (1) attachment/duty/ties, (2) family as referent/expected role, (3) reconciling/negotiating expectations and (4) trust identified in the findings illustrate how cultural values such as familismo are shaped over time and affect beliefs and behaviors about alcohol use among young people in Mexico. These findings can also help inform studies and prevention efforts among Mexican American young people.

Methods

We conducted a qualitative study using ethnographic open ended interviews with 117 first year students at a large free public university in Mexico City in which many students are the first in their family to attend university. The ethnographic interviews explored drinking behaviors and identified alcohol-related risk and protective factors. The ethnographic interview was designed to elicit young peoples' alcohol beliefs and patterns of use and encouraged explicit explanations. The interviews constitute phase one of a two phase study about alcohol-related risk and protective factors among Mexican students. The term “ethnographic interviewing” is based on the anthropological method of describing the local point of view and social organization, the culture of a people, and results in studying systems of meaning and rules (Hahn, 1995). Ethnographic interviewing permits the researcher to understand the world as seen by the respondent within the context of the respondent's everyday life.

Sample Selection

The sample was a stratified, purposeful sample of 117 18-24 year old students (60 male and 57 female drinkers) in four consumption groups: 15 male and 12 female heavy drinkers, 15 male and 15 female each of regular, occasional, and non drinkers. The sample is large enough for both detailed complexity and depth and to make meaningful comparisons. The goal of purposeful sampling strategies is to understand a phenomenon, not to represent a population (Patton, 2002). Students were identified from quantity and frequency of alcohol use questions in a general wellness survey conducted by the university Medical Services prior to the beginning of the school year. The ethnographic interviews revealed six drinking groups: excessive drinkers drank 10+ drinks 1-2+ times a week (21 students; 13 males, 8 females); heavy drinkers drank 5-8 drinks 2-3 times a week (27; 15 males, 12 females); regular drinkers drank 1-4 drinks 2-8 times a month (23; 8 males, 15 females); occasional drinkers drank 1-4 drinks once a month or less (28; 14 males, 14 females); abstainers did not drink in the past 6 months (10; 4 males, 6 females); non drinkers did not drink (8; 6 males, 2 females). Almost all youths lived with one or both parents, a few lived with a sibling or extended family member because their parents were deceased or did not live in Mexico City, and a few lived with non-family or alone. No occasional, abstainers or non drinkers lived alone.

Question Development

To help assure collection of comparable qualitative data, an interview guide listed specific questions and topics to be covered in a particular order in the interview. Questions were drawn from previous research about alcohol use among Italian young people and from a national cross-sectional survey about early age of onset among young people in the U.S. The procedures used to obtain self-reported drinking data included using a quantity-frequency index, a specific settings approach and beverage-specific questions. To assess familismo dimensions of family identification, attachment, familial support, and familial expectations attitudinal and behavioral questions included relationships and time spent with parents and other nuclear and extended family members, conflict with parents and other family, advice seeking from family members.

The interviews were conducted by eight interviewers trained in qualitative interviewing techniques by the PI. Language appropriateness and understandability was an important aspect of the training. All interviewers participated in a pre-test of the final questions.

Interview Procedure

The interviews were audio recorded and checked by the study coordinator in Mexico City to ensure fidelity with the interview script. The interviews were translated into English by a subcontractor and back-translated by the study coordinator. The study was approved by the university IRB for the PI in the U.S. and the IRB in Mexico City.

Analytic Procedures

Each interview was evaluated by a set of thematic codes developed inductively from the interview scripts by two qualitative analysts and the PI. Coding organizes the text and involves identifying issues and themes of relevance in the text. Codes represent a category or theme found in the data and the codes were attached to corresponding segments of text. To improve inter-rater reliability, the analysts and the PI each coded four interviews, reviewed the codes, and when it was clear that all understood the coding scheme, four coders coded the interviews. In order to ensure that each interview was coded correctly, each of the four coders recoded eight interviews of another coder and the project coordinator checked the coding for consistency. The PI and coders discussed any coding differences and resolved any problem cases. The findings from excessive, heavy, regular, occasional, abstainers and non drinkers were analyzed to explore whether or not linkages existed between and/or among particular themes using HyperRESEARCH software (HyperRESEARCH, 2009), a text retrieval program geared toward in-depth exploration of data.

Results

Youths' descriptions and explanations about their relationships with family and their own alcohol use reflect cultural norms about both family and alcohol use that intersect with dimensions of familismo including familial attachment and identification, proximity, familial expectations and family as referent. The concept of familial trust, both trust of and being trusted by family members, permeated discussions of youths' discussions about relationships.

Attachment and Identification: Familial Relationships

In the familismo literature, the dimensions of attachment and identification are characterized by family support and family closeness, and by proximity, the amount of time family members spend with one another (Lugo Steidel & Contreras, 2003; Romero et al., 2004; Sabogal et al., 1987). Some authors also describe these dimensions as being obligatory in nature (Lugo Steidel & Contreras, 2003). Most young people in all drinking groups reported having “good” relationships with parents describing them as “close,” “open,” “caring” relationships in which there was “comfort” and “confidence” to express opinions and be heard, but excessive and heavy drinkers talked the least about such open and trusting relationships with their parents. Although youths in all groups reported “not good” relationships with parents referring to “distant”, “closed” and “not deep” relationships most wanted closer ties with parents. Only excessive and heavy drinkers in not good relationships with parents did not want closer ties but these youths did acknowledge a duty to be involved with their parents and a caring for their parents. Luisa, a heavy drinker did not want closes ties with her parents, “because if we are a little bit distant we get along, but if we are too close we crash and we start to argue” but also describes a duty to check up on her father, “with my father the relationship is almost null, it's, it's just to know if he's alright, and things like that.” Importantly, all the youths, regardless of their relationship with parents, reported at least one good relationship with other nuclear or extended family describing “support,” “closeness” and particularly “trust” with siblings, grandparents, aunts, uncles, or cousins.

Proximity: Time with Family

The familismo dimension of proximity is defined as the amount of time family members spend with each other and includes eating meals together as a family, doing fun things, having family discussions, and spending time with extended and nuclear families. Youths in all groups had at least one meal a day with one or more family members, and weekend meals frequently included extended family. The major reasons family members did not eat meals together were conflicting work and school schedules. Although everyone ate meals with family, females in all groups and male occasional drinkers reported most family meal time. Youths in all drinking groups also reported spending free time with family. Females spent the most free time with family and female occasional drinkers talked most about preferring to do so. Although few male excessive and heavy drinkers preferred to spend free time with family, as with familial relationships, they described an obligation to family. Paco, an excessive drinker explained, “we have the family Sundays, we don't go out and all. Sundays, it's just family but other than that we don't see each other that often.” This sense of obligation expressed by excessive and heavy drinkers suggests an interconnectedness between the two dimensions of attachment and identification and proximity.

Family as Referent: Familial Expectations

The family as referent dimension of familismo refers to guidance and approval (Germán et al., 2009; Sabogal et al., 1987) whereby an individual's behavior reflects upon the whole family. The individual is expected to sacrifice individual needs for the family and owes it to the family to be good and do well (Lugo Steidel & Contreras, 2003; Romero et al., 2004). Youths knew their parents and other family members expected them to fulfill a particular familial role and to not behave in a manner that reflected poorly on the family. They also knew that challenging expectations or behaving in a manner that did not reflect their expected role would result in conflict with family. The explanations of excessive and heavy drinkers about challenging expectations, being in conflict with family, and feigning expected behavior suggest resistance to family as referent.

Confirming Expectations

Youths met familial expectations in two ways. Most youths conformed by behaving in ways that met expectations and thereby confirmed their expected familial role. They received confirmation from parents and expressed respect for parents and gratitude for parental support and trust:

How is my relationship with my parents? The truth is I am a family girl. I spend a lot of time when I'm not in school, on vacations time. I spend a lot of time with them. I speak to them a lot about what I do and don't do in my day. I trust them very much and they trust me as well. (Patricia, abstainer)

I have to be grateful that they've supported me, and they have trust. I can't disappoint them, because they've given me the trust. (Isabella, regular drinker)

Another way youths conformed was by concealing unacceptable behavior. Male excessive and heavy drinkers concealed their drinking by pretending not to drink thereby conforming with expectations, confirming their familial role, exhibiting respect for the family and being worthy of trust from family:

I've never liked [to drink] with family, I don't want them to know that I'm at the front of the line if there is some alcohol… I have always shown some respect with my family about that because they've asked me, because they know I'm older and they ask me “don't you want a beer?” and I'm like, although I want to have it and all, I always say no, just a glass of water. (Ignacio, excessive drinker)

Challenging and Reconciling Expectations

Youths who openly challenged familial expectations about alcohol use by drinking and partying described conflict with parents and other family members. Excessive and heavy drinkers reported most conflict:

Well for example, sometimes, since my mom doesn't like that I drink, there were times that even when I didn't drink she thought I did, so that was like very, I don't know, like I got home and she asked “what did you drink?” and even if I didn't drink anything she didn't believe me. Or there were times that I went out with my friends, like without drinking but she thought I was going to drink, so sometimes I got pissed that she didn't believe me. (Marco, excessive drinker)

Well, yes once my grandma scolded me really badly because I didn't go home and yes, since then I have been more careful.

Interviewer: Has any other member of your family talked to you about your drinking habits?

Hmm, my brother, he tells me I should stop drinking so much. (Ivonne, heavy drinker)

Some youths in conflict with parents because of their drinking wanted to reconcile by changing their alcohol use to reflect expectations. By reconciling their behavior they believed they would regain good relationships with and trust of their parents. Cecilia, a heavy drinker, talked of changing her alcohol use to repair her relationship with her mother:

Yes, lately I have been acting different mostly with my mom about everything. Because there was a time when, as I said, I was drinking often and she got upset ‘look how you are, look at the time, it's unbelievable.’ It's been different because of that. Before, months ago, it was good. Maybe, I would be better off if I change that a bit.

Juan, an occasional drinker, explained about his damaged relationship with his father:

Well, for a while I was partying a lot, I already mentioned that before and my dad did get disappointed with me, so now, well his first reaction is to judge me a lot, and maybe gaining his trust has taken me a long time and that bothers me a lot.”

Discussion

The Hispanic value of familismo is described as a core value in Mexican culture (Lugo Steidel & Contreras, 2003; Sabogal et al., 1987; Smith-Morris et al., 2012; Zinn, 1982). Our study indicates that dimensions of familismo may be protective against misuse of alcohol and protective for moderate drinking. In this study aspects of attachment and identification, proximity and family as referent were strong among regular, occasional, abstainers and non drinkers but weak among heavy and excessive drinkers. Trust was a major factor in youths' relationships with parents and other family and attachment and identification were strongest among youths reporting trusting relationships with parents. Among excessive and heavy drinkers, most described good but not trusting relationships with parents, males concealed their drinking to demonstrate confirmation of and conformity with expectations, and both males and females openly challenged familial expectations and were in conflict with parents because of their alcohol use. Other studies on the nature of parental trust and youth behavior, including substance use, also show the importance of trust and quality of relationships with parents. In Finland a longitudinal study examining predictors of risky drinking found an association between lack of trust with parents during adolescence and excessive alcohol use but the association was not significant after controlling for other factors including the quality of relationships with parents (Huurre et al., 2010). In a study of secrecy among adolescents in the Netherlands parental trust was negatively correlated with secrecy from parents and positively correlated with good parental communication and support (Frijns, Finkenauer, Vermulst, & Engels, 2005). Similarly, a study of 14 year olds in Sweden found youths' poor relationships with parents and less disclosure to parents correlated with youths' beliefs that their parents did not trust them (Kerr, Stattin, & Trost, 1999). A study of high school students in the U.S. found an association between students' perceptions of a lack of a trusting parent-child relationship and secrecy of peer and personal issues. Trust in their parents was strongly associated with disclosure (Smetana, Metzger, Gettman, & Campione-Barr, 2006).

When discussing trust of and for parents, young people in our study also referred to respect for parents and family. Respect for elders, jerarquismo, is described as another important value in Mexican culture through which children are taught to understand the “hierarchical social structures” of the family (Villa, Cuellar, Gamel, & Yeo, 1993). Excessive and heavy drinkers in this study appear to be resisting traditional norms of parental respect and authority. Other research found similarly that heavy drinkers break with the cultural tradition of moderate drinking (Strunin et al., 2010).

There are limitations to this study. The participants were interviewed during the second semester of their first year of university, six months after the administration of the mandated wellness survey. However they were of legal drinking age and likely provided reliable information about their drinking behaviors. Surveys of Mexican youths in the same age group as participants in this study indicate similar alcohol consumption (Latimer et al., 2004; Marsiglia et al., 2009; Medina-Mora et al., 2000).

The study has a number of implications. In our study dimensions of familismo were interconnected and difficult to disentangle. In the literature the concept of familismo includes dedication to a constant set of values and beliefs (Germán et al., 2009, Sabogal et al., 1987) and a means to form an identity (Sabogal et al., 1987). Our findings suggest that although familismo has potency among Mexican youths, some aspects have greater influence and seemingly more legitimacy than others. In other studies the dimensions of attachment and identification are treated independently from proximity (Germán et al., 2009; Romero & Ruiz, 2007; Sabogal et al., 1987) but our findings indicate that these dimensions are inseparable and may be more or less relevant for different drinking behaviors. A recent ethnographic study of Mexican immigrants in the U.S. and their families in Mexico found similarly that different factors including multiple and competing core values influence how familismo is expressed in different contexts (Smith-Morris et al., 2012). Previous research also proposes familismo as multidimensional and that using a familismo score, collapsing across the different dimensions, obscures dimensions that are predictive of outcomes by including those that are not predictive of behaviors (Guilamo-Ramos et al., 2009). The breaking with cultural traditions suggests how cultural values are used or manipulated by members of the society and how cultural values change over time.

In this study, trust was an important factor in youths' relationships with parents with excessive and heavy drinkers referring to lack of trust. Writing about trust, Corsín Jiménez (2011), drawing on Gluckman (1972), shows that divisions and disruptures in relationships help unite and integrate what is trustworthy, that trust is “a self-eclipsing relationship through which people replace themselves into new relationships” (Corsín Jiménez, 2011). This conceptual model of trust focusing on its role in ongoing and new relationships can be well applied to familismo and whether and how the cultural values of trust and respect are expressions of familismo in Mexico warrant further study.

We found that more females than males in all drinking groups behaved in aspects of the theorized familismo core cultural value. Other studies also indicate that familismo dimensions vary by gender. In a study of risky sexual behavior, subjugation to the family was protective for females but not associated with a decrease in risky behavior among males (Guilamo-Ramos et al., 2009) and a study of familismo and parental monitoring found more male than female family proximity (Romero & Ruiz, 2007). Findings from two studies, qualitative and quantitative, on gender socialization in Latino families in the U.S. found that sons and daughters experienced different gender socialization with females reporting more limits than males (Raffaelli & Ontai, 2004). Future research should explore dimensions of familismo and gender socialization.

In Mexico moderate alcohol use among adolescents is not considered a deviant or problem behavior because there is a level of social acceptance of alcohol use and a more Mediterranean approach to alcohol consumption (Felix-Ortiz, Villatoro Velazquez, Medina-Mora, & Newcomb, 2001; Villatoro et al., 1998). An evaluation of substance use intervention strategies among Mexican American school children proposed these values about alcohol were as a reason for the finding of lower rates for alcohol intervention strategies compared to cigarettes and marijuana (Marsiglia et al. 2009). Studies of familismo and acculturation among Mexican American youths show the influence of familismo. Irrespective of time in the U.S. and family income the importance of family did not change and Mexican cultural identity played an important role in psychological adjustment and well-being (Balls Organista et al., 2003; Marsiglia et al., 2009; Zambrana, Silva-Palacios, & Powell, 1992). Our findings indicate that dimensions of attachment and identification, proximity, and family as referent may be protective for moderate drinking among Mexican youths. Furthermore, despite being in conflict with parents because of their drinking, excessive and heavy drinkers' acknowledgment of an obligation to parents and family, and their concealment of unacceptable alcohol use, may reflect aspects of familismo dimensions of attachment and identification and family as referent. Studies are needed to clarify whether these and other aspects of familismo are relevant among heavy and excessive drinkers and their utility for prevention efforts. That cultural values are not immutable is illustrated by youths' confirming and conforming some dimensions of familismo but challenging and rejecting others.

The research has implications for prevention programs for both Mexican and Mexican American youths. Investigating familial and cultural variables in the Mexican context can inform us about key factors associated with drinking practices among Mexican young people and also inform future research and programmatic efforts for Mexican American young people. This line of research allows us to examine if drinking can be predicted in part by identifiable social and family characteristics including risk and protective factors within cultural contexts.