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. Author manuscript; available in PMC: 2020 Oct 1.
Published in final edited form as: Prev Sci. 2019 Oct;20(7):1114–1124. doi: 10.1007/s11121-019-01026-0

Mind the Gap: Bridging the Divide Between Current Binge Drinking Prevention and the Needs of Hispanic Underage Emerging Adults

Mariya Petrova 1, Charles R Martinez Jr 2, Jennifer Jean-Jacques 3, Heather H McClure 4, Hilda Pantin 5, Guillermo Prado 6, Seth J Schwartz 7
PMCID: PMC6721994  NIHMSID: NIHMS1530387  PMID: 31140021

Abstract

In this article, we highlight the urgent public health need for prevention of heavy episodic drinking among underage Hispanic emerging adults in the United States. We outline the current state of binge drinking prevention programming and contrast it with the unique cultural, social, and developmental realities of this population using an ecodevelopmental framework (Szapocznik & Coatsworth, 1999). Finally, we advance specific recommendations for the development and delivery of culturally tailored, multisystemic binge drinking prevention programs for underage Hispanic emerging adults.

Keywords: Hispanic, emerging adult, alcohol, binge drinking, prevention, intervention


The cost of alcohol and drug misuse in the United States is estimated as more than $400 billion per year (Sacks, Gonzales, Bouchery, Tomedi, & Brewer, 2015; National Drug Intelligence Center, 2011), and three-quarters of the expenditures associated with alcohol use are due to intense drinking episodes1 ( Center for Disease Control and Prevention [CDC ], 2015). These episodes have the potential to harm users and those around them through engagement in motor vehicle accidents, violence, risky sex, alcohol poisoning, and suicide (CDC, 2018). The severity of these drinking incidents is illustrated by the finding that binge drinkers are nearly 14 times more likely to drive under the influence than other drinkers are (Naimi et al., 2003).

The present article is guided by two objectives within the framework of ecodevelopmental theory (Szapocznik & Coatsworth, 1999). First, we seek to outline the specific needs of underage emerging adults (UEAs), particularly Hispanics2, who are characterized as having among the highest levels, and experience the most severe consequences of heavy episodic drinking (e.g., drunk driving fatalities, alcohol related violence, unprotected sex while intoxicated; Caetano et al., 2017; Finer & Zolna, 2011; Rangel et al., 2006; Romano, Voas, & Lacey, 2010). Second, we aim to support the forward movement of prevention science for this population by outlining actionable steps for future binge drinking prevention research, intervention development, and dissemination. In accordance with these goals, we review the prevalence of heavy episodic drinking and its consequences among Hispanic underage binge drinkers, the current state of binge drinking preventive interventions for this population, as well as the discrepancies between available binge drinking prevention interventions and the social, cultural and developmental realities of Hispanic UEAs3. Consideration is given to micro- and macrosystemic influences, and to the interactions among them, on the well-being of this population. We conclude with implications for further research and specific suggestions for intervention development and implementation.

Population at Highest Risk: Developmental and Cultural Considerations, Needs, and Opportunities for Prevention

Of all age groups, UEAs (between 18 and 20 years old) appear to be at highest risk for binge drinking and consequent risky behaviors. For example, underage binge drinkers are disproportionately more likely to be involved in fatal car crashes – those where at least one person (not necessarily the drunk driver) is killed (Fell, Fisher, Voas, Blackman, & Tippetts, 2008). This worrisome trend can be explained by the developmental tasks of this age group, in combination with their status as legal adults who nonetheless are below the drinking age. The US Department of State (n.d.) declares that “children become adults at age 18”. This legal and social recognition, along with normal developmental processes, cues youth to explore “adult” behaviors such as drinking. However, in 1984, Congress passed the National Minimum Drinking Age Act, which required states to raise their age limits for purchase and public possession of alcohol to 21 years of age. Although later research eventually indicated that raising the minimum drinking age did lead to decreases in traffic crashes and alcohol consumption (Wagenaar & Toomey, 2002), initial evaluations of underage college students suggested shifts in where they tended to drink (George, Crowe, Abwender, & Skinner, 1989), intensification of their efforts to avoid being caught by law enforcement, and increases in risk taking (Brittain & Roberge, 1988). Having to “drink in secret,” so as not to attract the attention of authorities, may prompt youth to drink high quantities in short periods of time, which can potentiate binge drinking episodes (Sinha, 2008). Further, research using the Monitoring the Future study, comparing individuals sampled in the 1970s with those sampled in the early 2000s, indicates that more recent cohorts are characterized by steeper increases in binge drinking in the early emerging adult years (Jager, Keyes, & Schulenberg, 2015). To the extent to which underage binge drinking reflects “drinking in secret” to avoid consequences for underage alcohol consumption, the “drinking in secret” phenomenon has increased over generational time. Therefore, intervention programs are needed to prevent binge drinking and its consequences among individuals between 18 and 20.

The greatest prevalence of heavy episodic drinking generally occurs during emerging adulthood – the age period between the end of high school and the assumption of adult commitments such as committed partnership and parenthood (Arnett, 2000, 2005). Furthermore, heavy episodic drinking during emerging adulthood and beyond is associated with mortality due to homicide and suicide (Pridemore & Chamlin, 2006), unprotected sex and sexually transmitted infections (Finer & Zolna, 2011), lost productivity at work (MacDonald & Sheilds, 2004), relationship difficulties (Griffin, Bang, & Botvin, 2010), and interpersonal violence (Caetano, Schafer, & Cunradi, 2017), among many other negative social consequences. Binge drinking is an important public health concern not only because of these proximal consequences, but also because of distal health problems such as several types of cancer, stroke, cardiovascular disease, and liver problems (Lieber, 2003; Boffetta, Hashibe, La Vecchia, Zatonski, & Rehm, 2006). Many of these and other consequences of binge drinking are overrepresented among Hispanics.

People of Hispanic origin comprise the nation’s largest racial/ethnic minority (56.6 million in 2015) and are younger than the total US population. Specifically, 27.5% of all Hispanic people were under the age of 21 in 2014 (USCB, 2014). Because Hispanic UEAs (age 18–20) experience the cumulative effects of three risk factors – developmental period, pre-existing risky behavior, and membership in a high-risk ethnic group – they comprise a priority group for alcohol misuse prevention (Schwartz & Petrova, in press).

The Current State of Heavy Episodic Drinking Prevention for Emerging Adults

Implementation of binge drinking prevention for UEAs and EAs in general is frequently centered in college settings. The 1970s gave rise to research on college student alcohol expectancies (Banks & Smith, 1980; Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994), where positive expectancies refer to favorable attitudes toward the effects of alcohol and serve a motivating function in the decision to drink more. By the mid 1980’s, the impact of peer influences on college drinking was evident, and it became clear that many young drinkers overestimated the extent and prevalence of binge drinking among their peers (Perkins & Berkowitz, 1986). During the mid 1980s, these findings were translated into a brief motivational intervention (Baer et al., 1992; Fromme, Kivlahan, & Marlatt, 1986) that later grew into what may be the most prominent binge drinking intervention for EAs in the US to date – the Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff, 1999).

BASICS is designed for college-attending EAs between the ages of 18 and 24 who drink heavily and experience negative health, educational, and social consequences as a result. It is built on components from three theoretical models focusing on individual behavior change: Motivational Interviewing (Miller & Rollnick, 2013), Stages of Change (Prochaska et al., 1994), and Cognitive Behavior Therapy (Dimeff et al., 1999). It is intended to trigger personal change via two 50-minute interviews. Based on the first interview and a questionnaire completed by the youth, information is gathered about student alcohol consumption patterns, personal beliefs about alcohol, understanding of social alcohol norms, and family history of alcohol use and problems. The second session occurs approximately one week after the initial interview and provides the student with personalized feedback on myths about the effects of alcohol, facts on alcohol norms, ways to reduce future risks associated with alcohol use, and options to assist in making changes. Clinicians use motivational interviewing (MI) methods to conduct the feedback sessions. MI is a cognitive-behavioral talk therapy technique that aims to help clients identify and change behaviors that may place them at risk for developing health problems. The five main principles of MI, through which conditions for change are created, are expression of empathy, avoiding arguments, supporting client self-efficacy, rolling with resistance, and developing discrepancy (Bundy, 2004). BASICS is primarily implemented on college campuses and has not been extensively evaluated with non-college EAs or with primarily Hispanic samples.

BASICS has been demonstrated to reduce frequency of drinking, quantity of drinks consumed over time, and peak quantity of alcohol consumed. As reported by multiple studies, these trends have been sustained over 6 months and over 2 years (Marlatt et al., 1998), and reductions in drinking quantity and consequences were maintained over 4 years (Baer, Kivlahan, Blume, McKnight, & Marlatt, 2001). These results were derived from testing the intervention with primarily (84%) Caucasian college students (Baer et al., 2001). Later versions of the intervention included a web-based delivery platform and utilization of peers as feedback providers (Chiauzzi et al., 2005; Larimer et al., 2001). Both versions were found to be partially efficacious. Although these studies were conducted primarily with Caucasian samples, the results of these two variations of BASICS may have particularly important implications for binge drinking prevention for Hispanic UEAs, as we discuss in greater detail below.

Hispanic Underage Emerging Adults: Developmental and Cultural Characteristics and Synergy with Current Prevention Strategies

Although BASICS and other college drinking interventions have been shown to be efficacious with largely White college student samples, we do not know whether such an individual-focused intervention would work with collectivistic Hispanic cultural systems or with non-college attending youth. We adopt an ecodevelopmental theoretical framework to present areas of divergence between existing binge drinking prevention programs and the cultural and social realities of Hispanic UEAs, as well as to bring forth recommendations for future research, intervention development, and implementation. We believe that ecodevelopmental theory fits well with the change processes experienced by Hispanic UEAs, and it is widely utilized in interventions with Hispanic and other minority populations (e.g. Prado et al., 2011).

Ecodevelopmental theory (Szapocznik & Coatsworth, 1999) posits that individual risk is influenced by the risk in one’s social environments, as well as by interactions among risks across levels of social context. The theory postulates that understanding risk and protection for problem behaviors requires understanding not only of human development, but also of the social systems within which development occurs. The theory consists of three primary components: (1) social ecological theory, (2) developmental theory, and (3) interactions among social systems.

The first element (social ecological theory) organizes the multiple systems to which a person belongs according to their level of influence on the individual. In the context of binge drinking prevention for Hispanic UEAs, for example, we focus on the microsystem with a focus on parents and peers and the macro-system, capturing issues of discrimination, cultural values, ethnic pride and access to binge drinking prevention programming. Research has consistently demonstrated the importance of incorporating these determinants into the next generation of prevention programs for Hispanic youth. Indeed, evidence suggests that interventions that include general developmental influences, but are tailored toward the cultural circumstances of the target group, are likely to produce the largest and most lasting effects (see Castro, Barrera, & Holleran Steiker, 2010; Castro et al., 2017, for reviews).

The second theoretical element (developmental theory) emphasizes the changing nature of human well-being. It suggests that individuals’ behaviors are not only a function of the present state of social influences in their lives, but also a result of previously existing dynamics within their support systems. In the case of Hispanic UEAs, such influences include heritage culture values and gender roles, experiences of discrimination, and acculturation to U.S. society (as well as retention of one’s cultural heritage; Salas-Wright & Schwartz, in press).

Finally, the last element of ecodevelopmental theory is social interactions, which suggests that risk and protection can be triggered by individuals’ interactions with their social contexts, as well as interactions among the various contextual levels and domains. For example, adolescents and UEAs are affected not only by their direct relationships with parents and peers, but also by the quality of relationships between their parents and peers (Coatsworth, Pantin, McBride, Briones, Kurtines, & Szapocznik, 2002).

Microsystemic Influences

Parenting.

Generally, emerging adulthood is a developmental period characterized by semi-autonomy. Specifically, most individuals in this age group are at least partially financially supported by their families of origin, and many continue living at home until their early to mid-twenties (Arnett, 2011). A growing body of research indicates that, rather than being supplanted by peer influences, parenting remains a strong determinant of EA alcohol use (Ichiyama et al., 2009; Wood et al., 2004). More specifically, ineffective monitoring, perceived parental permissiveness of drinking, and parental modeling of alcohol use have been shown to predict increases in alcohol use and related negative consequences among 18–20 year olds (Wood at al., 2004; Beck, Boyle, & Boekeloo, 2004; Urberg, Goldstein, & Toro, 2005). On the other hand, parental protective factors such as greater emotional and instrumental support, family cohesion, and positive parenting contribute to lower levels of UEA drinking (Ichiyama et al., 2009; Fairlie, Wood, & Laird, 2012). Wood and colleagues (2004) suggest that heavy episodic drinking was lower among UEAs who perceived their parents to be disapproving of drinking (Wood et al., 2004). Finally, successful general and alcohol-specific communication between parents and their UEA children have been associated with reduced peer-influenced drinking behaviors (Ichiyama et al., 2009; Wood et al., 2004; Reid & Carey, 2015).

National demographic trends indicate that Hispanics represent an increasing proportion of EAs in the US (Ennis, Rios-Vargas, & Albert, 2011) and that 75% of Hispanic EAs live at home until at least age 21 – often for cultural and economic reasons. Existing research indicates that, much like their non-Hispanic White counterparts, Hispanic EAs seek some degree of independence from family, but they are more likely to base their definitions of adulthood on role transitions (such as home ownership, education, or parenting), especially transitions regarding their role in relation to their family (supporting a household, caring for children, etc.) (Syed & Mitchell, 2013). Family in Hispanic culture is not only a social construct – rather, it is a cultural value. Specifically, familismo refers to interdependency among family members (Cuellar, Arnold, & Gonzalez, 1995), and respeto emphasizes a young person’s duty to respect their parents and older mentors (Garcia, 1996). Hispanic parents are not only guardians but also the keepers of these cultural values. That is, parents are charged with maintaining the tight-knit structure and importance of the family context. This role is especially poignant and challenging for immigrant parents who have to (a) guide their youth in a culture they do not know well and (b) navigate their changing role in their relationship with their EA children, while continuing to instill values from their country of origin. It is not uncommon for Hispanic immigrant families to experience increased levels of conflict due to parent-youth discrepancies in cultural practices, values, and identities (Martinez, 2006; Schwartz et al., 2016). These incongruences have been shown to compromise family functioning and lead to alcohol misuse in Latino youth.

A substantial body of research has demonstrated parents’ impact on Hispanic adolescent outcomes such as drug and alcohol use, risky sex, and other key health behaviors, and has translated these findings into efficacious family-centered interventions (e.g., Prado & Pantin, 2011). However, literature on the impact of parents on Hispanic EA alcohol use (especially binge drinking) and related health behaviors is scant. Although there has been an increased recognition of emerging adulthood as a distinct developmental period, currently there are no interventions in the published literature (as of March 2018) that incorporate developmentally suitable parenting as a primary intervention component for substance misuse prevention for Hispanic UEAs or EAs. The most prevalent approach to binge drinking prevention for EAs – brief alcohol screening and intervention – is largely individual-centered, and its degree of match with youth from collectivistic, family-oriented cultural backgrounds is not known. Although currently validated approaches claim to be applicable across ethnic groups (Blue Prints for Healthy Youth Development, 2018), they have not been tested with exclusively Hispanic samples – nor with samples consisting of both college and non-college participants.

Peers.

Although the debate about whether parents or peers are more influential in shaping a young person’s norms, beliefs and behaviors is ongoing, it is inarguable that peers play an increasingly important role as youth transition from childhood to adulthood (DeGarmo & Martinez, 2006; Steinberg & Monahan, 2007). The influence of peers and the characteristics of youth social networks on adolescent development, and on risky health behaviors such as binge drinking, is well documented, and these peer influences continue well into emerging adulthood (Alexander et al., 2001; Ennett et al. 1994). In fact, young people’s perceptions of the level and frequency of their peers’ alcohol use, in contrast to their peers’ actual drinking levels, are the most examined and well supported modifiable mechanisms in the college drinking literature (Reid & Aiken, 2013; Rai et al., 2003, Toumbourou et al., 2007; Windle, 2000).

Peer influences may be particularly pertinent to minority youth, such as Hispanic UEAs, for multiple reasons. First, in emerging adulthood, peers are generally the most proximal source of information regarding norms for “acceptable” behavior. In the face of minority status and discrimination, Hispanic UEAs may gravitate even more strongly towards “dominant” US culture behaviors and values in an attempt to “blend in” (Kasinitz, Mollenkopf, Waters, & Holdaway, 2008). Second, in families where parents are unable to provide culturally syntonic guidance, youth may rely more heavily on peers to gain understanding of the host culture and make sense of the two cultural worlds they are navigating (Smokowski & Bacallao, 2011).

The prominent role of peers in emerging adulthood has been leveraged in some intervention programs. As mentioned above, a version of BASICS utilized the power of peers beyond youth-reported peer norms. For example, in a study by Larimer and colleagues (2001), college students assigned to the BASICS intervention condition received a 1-hour individual feedback session based on the information the participant provided at the baseline assessment. Sessions were facilitated by a member of the research team or by trained undergraduate peers and were designed to provide information about specific skills to encourage moderate drinking. Results indicated that, among students who received their feedback from college aged peers, significantly greater reductions in typical blood alcohol concentrations were observed compared to students who received their individual sessions from professional staff members. Although this utilization of peers in delivering an adult-driven feedback process speaks to the importance of peer influences, it certainly does not take full advantage of the power that peers exert on EA behaviors, nor does it capitalize on the developmental specificities of friendships during emerging adulthood. The power of peer influences has yet to be harnessed in binge drinking prevention interventions for EAs in general, or for Hispanic UEAs in particular.

In contrast to the field of binge drinking prevention, numerous programs involving HIV prevention have integrated a focus on peer networks into intervention approaches with adolescents. HIV-related interventions have successfully lowered or prevented both risky sexual behaviors and substance use among the peer leaders who were directly trained, and among the youth to whom these peer leaders disseminated the intervention, with no adverse effects (Mackesy-Amiti et al., 2010, Weeks et al., 2009). Such peer-led interventions can serve as a model for programs designed to prevent/reduce binge drinking among Latino (and other) UEAs.

For instance, Mackesy-Amiti and colleagues (2010) evaluated a three-week peer-educator training consisting of six sessions targeting injection-drug risks, sexual risks, and refusal skills among adolescents and EAs ages 15–30. The peer-educator training was followed by community-based outreach where the peer educators were asked to spread the training to their peers. The intervention significantly reduced injection episodes between baseline and six months post-baseline among peer educators. For another example, Weeks and colleagues (2009) tested an approach that involved training active drug injectors and crack cocaine users as “Peer Health Advocates” to deliver an HIV, hepatitis, and STI prevention intervention to hard-to-reach members of their social networks and other community members. The program was designed to diffuse risk and harm reduction and health promotion via modeling of preventive practices and spreading of materials and information by the peer health educators. The study compared change in behaviors and attitudes between baseline and 6-months follow up for the 112 primarily African American and Latino health educators, 223 of their drug-network affiliates, and 118 other study recruits. Findings indicated significant correlations between the peer health educator follow up efficacy score (public health educator beliefs about their own effectiveness as educators) and other participants’ reported reduction in prior 30-day unprotected sex, number of sex partners, and drug use as a result of having interacted with a peer health educator. The peer health advocates were thus effective in diffusing the preventive messages to their social networks – and they were most effective when they viewed themselves as competent educators. Self-efficacy training may therefore be important when training youth as intervention deliverers.

In the school-based adolescent substance use prevention literature, Valente and colleagues (2007) found increased program effects when a social network approach was utilized in the selection of teen peer leaders and their audiences (who would then receive the peer-led intervention). Unlike BASICS, which used adult-selected students to provide normative feedback to fellow college students, Valente et al.’s study illustrated that using peer-nominated youth, and pairing them with the youth who selected them to perform follow up activities, was the most effective way to structure the program. Although this example comes from the adolescent literature, it also seems developmentally well suited for UEAs. Arnett and colleagues (2007) suggest that selective association in friendships may be much more pronounced in emerging adulthood than in adolescence. Specifically, acquaintances and distant friends are much less likely to be influential in EAs’ lives than they are in the lives of adolescents – meaning that specific peers selected as close friends exert greater influence in emerging adulthood than in adolescence. Further, Collins and colleagues (2006) provide evidence for the increased intimacy in EA friendships – they tend to be characterized by increased emotional depth, complexity, and discussions of personal importance. These developmental differences between adolescent and EA friendships suggest that pairing influential EAs with their close friends to carry out prevention activities may be especially important. Using close friends to deliver peer-led intervention content may therefore be especially effective in emerging adulthood. Although BASICS has included important advances in capitalizing on peer influences, the techniques employed within the intervention are likely not complex enough to fully harness the prevention potential of close friends in emerging adulthood.

Macrosystemic Influences

Culture, Discrimination, and Gender.

While individual-based intervention components such as those included in BASICS (e.g. recognition of one’s alcohol consumption pattern, personal beliefs about alcohol, understanding of social alcohol norms, ways to reduce future risks associated with alcohol use) certainly seem relevant for Hispanic UEAs, a heavy episodic drinking intervention for this population must also consider the effects of culture on individual health behaviors. Specifically, it is essential to understand the immigrant population’s heritage culture, locate it within the larger receiving context, and consider the effects of the interactions between the two cultures on individual and family health outcomes. That is, the cultural determinants of health within a given population must be considered and incorporated into interventions intended for that population (Castro et al., 2010; Castro et al., 2017).

One key example of a salient cultural process is discrimination. Experiences of discriminatory treatment in the US is a well-documented occurrence among Latino immigrants (Salas-Wright, Robles, Vaughn, Córdova, & Pérez-Figueroa, 2015). Discrimination refers to differential treatment based on one’s membership in a minority ethnic, cultural, or social group (Williams & Mohammed, 2009). In turn, a substantial body of research suggests that perceived discrimination increases risk for substance use (e.g., Schwartz et al., 2015; Unger, Schwartz, Huh, Soto, & Baezconde-Garbanati, 2014), whereas heritage-culture retention (as a way of coping with and lessening the effects of discrimination) may inhibit escalation of substance use during late adolescence and emerging adulthood (Unger et al., 2014). Thus, engaging Hispanic UEAs not only in culturally tailored interventions, but also in programs that address healthy ways of coping with discrimination, likely helps to build skills for effectively navigating the changing nature of processes and relationships during emerging adulthood. In turn, such skills are important for solidifying Hispanic UEA engagement in activities and relationships reflective of their cultural values and practices, as well as those of the larger US society.

When discussing culture, it is also essential to consider the role of gender and of variations in interpretation of mental health concerns, both within Hispanic cultures and in the context of the efficacy of preventive interventions with Hispanic EAs or UEAs specifically. Within many Hispanic cultural systems, traditional gender roles assign breadwinning and protection tasks to men, and assign nurturance and domestic tasks to women (Galanti, 2003). The process of adjusting to the United States may be gendered as well – men’s roles are fairly similar between the two sets of cultural systems, but women’s roles are quite different. Regarding alcohol use, then, women in many traditional Hispanic cultural contexts may be discouraged from drinking, whereas alcohol use is an expression of machismo among men. Accordingly, women may have more “acculturating” to do once in the United States, and Hispanic women who are more Americanized may be at especially high risk for heavy episodic drinking (Rote & Brown, 2013).

There is also some evidence that men and women may respond differently to alcohol prevention interventions. For example, Neighbors et al. (2010) found that college women, but not men, reduced their drinking in response to a personal normative feedback intervention. The study was designed to evaluate the efficacy of general versus gender-specific personalized normative feedback for heavy-drinking college students. A two-year randomized controlled trial was conducted with 818 freshmen who reported one or more binge drinking episodes at baseline. The sample was 57.6% women and 42% non-Caucasian. After a random assignment to 4 experimental conditions (gender-specifc vs gender non-specific and a single vs. biannual administration of the intervention) and one control condition. Results indicated that for women, but not for men, gender-specific biannual personalized normative feedback was associated with reductions in alcohol-related problems over time compared to the control condition. It is not known whether this same pattern of results would emerge for Hispanic UEAs specifically.

A randomized controlled trial was conducted by Chiauzzi and colleagues (2005) comparing an online version of BASICS for college binge drinkers to an alcohol education website at baseline, postintervention, and 3-month follow-up. The sample consisted of 265 predominantly Causacian students (73% White, 7.5% Hispanic). Findings indicated that women and persistent heavy binge drinkers were most likely to benefit from the online version of the intervention. If replicated consistently within Hispanic UEA populations, such gender differences would suggest the need for different components – if not different interventions entirely – for young Hispanic men versus women (Barrera, Castro, & Holleran Steiker, 2011).

Social Contextual Variation in Pathways Towards Binge Drinking.

Obtaining higher education or beginning one’s career is a central developmental task in emerging adulthood. However, at present, binge drinking prevention is available only to those who pursue higher education – which does not include the majority of Hispanic EAs. In 2014, only 35 percent of Hispanics between the ages of 18 and 24 were enrolled in two- or four-year colleges (Krogstad, 2016). Also, in 2014, a National Journal poll indicated that 66 percent of Hispanic EAs who entered the workforce or the military rather than pursuing higher education cited having to support their families as a reason for not enrolling in college – again highlighting the importance of family in Hispanic culture. Perhaps as a result, in 2014, only 15% of Hispanics aged 25–29 had a bachelor’s degree, and Hispanics were the US ethnic group least likely to enroll in a four-year college, attend an academically selective college, or enroll full-time. Four-year colleges with large numbers of full-time students living on campus are often those that have the most demand, infrastructure, and funding for widespread alcohol prevention programming (Krogstad, 2016). Hispanic UEAs are therefore quite unlikely to receive binge drinking prevention programming. Ascertaining which types of programs are efficacious or effective for non-college-attending UEAs, and making those programs accessible to non-college young adults, and especially ethnic minority UEAs, represents a major public health priority. Meeting this need requires us to move beyond a primary focus on college drinking preventive interventions.

Summary, Recommendations, and Call for Action

Research strongly points to intensive drinking episodes as representing among the most problematic and costly alcohol-related behaviors in the US. Hispanic UEAs are disproportionately affected by the consequences of heavy episodic drinking, and thus constitute a high-priority group for binge drinking prevention. The current state of binge drinking prevention for UEAs, however, seems to be missing the mark regarding this large and growing ethnic group. The challenge is two-fold and requires us to re-think the design of binge drinking prevention interventions for Latino UEAs as well as the avenues for program implementation. Table 1 summarizes the evidence based elements potentially relevant to Latino UEA binge drinking prevention program design. The most widely used program, BASICS, is put in place primarily in four-year residential colleges and universities, but in 2016, only 47% of Hispanic high school graduates ages 18 to 24 were enrolled in college (Pew Research Center, 2017), with only half of these youth attending four-year universities (Krogstad, 2016; Pew Research Center, 2016). This large gap between supply of and demand for binge drinking prevention interventions could be addressed effectively by high school- or pediatric care-based prevention initiatives and by engagement of post-secondary educational institutions and industries with large Latino populations. The 2014 Bureau of Labor Statistics report highlighted the industries with the highest concentration of Hispanic workers: 27.3 % of the workers in construction were Hispanic, 23.1% in agriculture were Latino, and leisure and hospitality employed 22.3% Latino workers (Bureau of Labor Statistics, 2015). Additionally, The 2015 CBHSQ report outlined that the second highest rate of past month heavy alcohol use among full-time workers aged 18–64 was found in the construction industry and the accommodations and food services industry had the highest rates of past year substance use disorder (Bush & Lipari, 2015). Thus, to effectively support the health of Hispanic UEAs post high school, businesses in these high risk industries must be incentivized, whether through taxes or available NIH research grant support, to (1) collaborate with scientists and conduct local evaluations on alcohol use and (2) implement employee heavy drinking prevention and wellness promotion programs with built-in evaluations.

Table 1.

Summary of Ecodevelopmental Influences on Emerging Adult Binge Drinking

Systemic Level of Influence Evidence Based Elements for Latino UEA Binge Drinking (BD) Prevention
 Macro System Cultural Processes:
 BD Risk Factors:
  • Perceived discrimination (e.g., Schwartz et al., 2015; Unger, Schwartz, Huh, Soto, & Baezconde-Garbanati, 2014)
 BD Protective Factors:
  • Heritage-culture retention as a way of coping with and lessening the effects of discrimination ( Unger et al., 2014)
Gender Influences:
 BD Risk Factors:
  • The gendered acculturation process of Hispanic women in the US ( Rote & Brown, 2013)
 BD Protective Factors:
  • Personal normative feedback intervention effective for women ( Neighbors et al. 2010)
  • Women most likely to benefit from online prevention delivery (Chiauzzi et al., 2005; Barrera, Castro, & Holleran Steiker, 2011)
Social Contextual Factors:
 BD Risk Factors:
  • Majority of Hispanic UEA do not attend two- or four-year colleges, yet binge drinking prevention is available only to those who pursue higher education ( Krogstad, 2016)
  • Construction and leisure and hospitality industries employ large percentage of Latino workers and have some of the most elevated rates of heavy alcohol use and substance use disorders (Bureau of Labor Statistics, 2015; Bush & Lipari, 2015)
 Microsystem Parenting
 BD Risk Factors:
  • Ineffective monitoring, perceived parental permissiveness of drinking, and parental modeling of alcohol use (Wood at al., 2004; Beck, Boyle, & Boekeloo, 2004; Chassin, Curran, Hussong, & Colder, 1996; Urberg, Goldstein, & Toro, 2005)
  • Increased levels of conflict due to parent-youth discrepancies in cultural practices, values, and identities (Martinez, 2006; Schwartz et al., 2016)
   BD Protective Factors:
  • Greater emotional and instrumental support, family cohesion, and positive parenting, general and alcohol-specific communication between parents and their UEA (Wood et al., 2004, Ichiyama et al., 2009; Fairlie, Wood, & Laird, 2012)
Peer Influences
 BD Risk Factors
  • Perceptions of elevated level and frequency of peers’ alcohol use, in contrast to peers’ actual drinking levels (Reid & Aiken, 2013; Rai et al., 2003, Toumbourou et al., 2007; Windle, 2000)
 BD Protective Factors:
  • Youth nominated peers are safe and effective intervention dissemination agents (Larimer et al., 2001, Mackesy-Amiti et al., 2010, Weeks et al., 2009, Valente et al., 2007)
 Mezosystem Parent-Peer Interaction
Protective Factors:
  • Positive interactions between parents and the peers of their children ( Coatsworth, Pantin, McBride, Briones, Kurtines, & Szapocznik, 2002)
   Note: Findings are from adolescent literature and are potentially generalizable to EAs

Although some of the components of BASICS and other college drinking prevention programs are likely applicable to Hispanic UEAs, prior research points to the importance of culturally tailoring prevention programs (see Castro et al., 2017). Hispanic UEAs are often pulled in multiple directions by obligations to family, developmental necessity for both friendships and romantic relationships, socioeconomic realities, and incompatibilities between their cultural heritage and the larger US cultural system, among other issues. This presence of multiple cultural and social influences calls for a multisystemic approach to binge drinking prevention to actively engage and transform not only UEAs but also the systems around them.

We support the use of some of the major elements of BASICS if integrated into more multisystemic program. Targets such as increased awareness of one’s alcohol consumption pattern, personal beliefs and social norms regarding alcohol, family history of alcohol use and problems, knowledge of alcohol norms and effects, and help seeking may be beneficial but not sufficient for Hispanic UEAs. We recommend that these alcohol-specific aims be embedded within larger goals such as increased understanding of emerging adulthood as a key developmental time for identity exploration and formation, and heightened awareness of heritage-culture challenges (e.g. machismo) and assets (familismo) and how those unfold in the context of a receiving country (e.g. discrimination, acculturation). We place strong emphasis on preparing Hispanic UEAs to transmit knowledge and skills to their peers and families, who represent the main sources of both support and risk for UEA alcohol misuse and binge drinking.

We also recommend that peers and parents be intervened with directly to strengthen each specific microsystem, and thus to provide a healthier overall environment for sustained success among Hicpanic UEAs. Literature points to key elements that must be present in a family-based binge drinking preventive intervention for Hispanic UEAs: providing knowledge of the changes and processes occurring during emerging adulthood; delivering developmentally appropriate general and alcohol/binge drinking specific parenting; and increasing awareness of macrosystemic influences such as heritage culture, gender, acculturation, and discrimination on the family system. Recommendations for the ingredients of a peer-based binge drinking prevention component are challenging to specify because little is known about the demographic composition of Hispanic UEAs’ close peer networks. Some of the individual change components of BASICS regarding alcohol and binge drinking will likely also be applicable to the close friends of underage Hispanic drinkers, even if these friends are not Hispanic themselves..

In accordance with ecodevelopmental theory, the interactions among contextual systems must be considered. In addition to the parents-UEAs and peers-UEAs interactions, it is essential to facilitate positive connections between peers and parents, as adult mentors (such as parents) are consistently found to be the most powerful protective factor in the adolescent and young adult literature (Schwartz & Petrova, in press). Such an approach may increase the efficacy and reach of binge drinking prevention interventions for Hispanic UEAs by promoting synergy between important social contexts in young people’s lives. Peers would also gain access to additional adult mentors – i.e., their friends’ parents.

Finally, due to the association of binge drinking with other health risk behaviors (e.g. homicide and suicide (Pridemore & Chamlin, 2006), unprotected sex and sexually transmitted infections (Finer & Zolna, 2011), lost work productivity (MacDonald & Sheilds, 2004), relationship challenges (Griffin, Bang, & Botvin, 2010), and interpersonal violence (Caetano, Schafer, & Cunradi, 2017)) interventions will likely have to be tailored to the specific needs of each population. This approach will require an assessment prior to program implementation to identify which behaviors associated with binge drinking are most relevant to the youth to be receiving an intervention.

Acknowledgments

Funding: Not applicable

Footnotes

Publisher's Disclaimer: This Author Accepted Manuscript is a PDF file of a an unedited peer-reviewed manuscript that has been accepted for publication but has not been copyedited or corrected. The official version of record that is published in the journal is kept up to date and so may therefore differ from this version.

Compliance with Ethical Standards

Disclosure of Potential Conflicts of Interest: The authors report no conflicts of interest.

Research Involving Human Participants and/or Animals: Not applicable

Informed Consent: This was not an empirical study and no human subjects were recruited.

Ethical Approval: This was not an empirical study and no human subjects were recruited.

1

There is a lack of definitional agreement in the field regarding how intense drinking episodes should be regarded and labeled, and this lack of agreement leads to some ambiguities in measurement of these episodes. Some leading writers operationalize heavy episodic drinking (HED) as the frequency of consuming five or more drinks on a single occasion (Mulia, Ye, Greenfield, & Zemore, 2009; Kilmer, 2013), whereas the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) use a similar definition to denote binge drinking (BD). For the purpose of capturing the phenomenon of problematic intensive drinking throughout this article, we will use both terms interchangeably.

2

The terms “Hispanic” and “Latino” are used interchangeably.

3

The term “underage emerging adults (UAEs)” is used in reference to emerging adults between the ages of 18 and 20 and the term”emerging adults (EAs)” is utilized to mark the full developmental period of emerging adulthood (between 18 and 25 years of age).

Contributor Information

Mariya Petrova, University of Miami.

Charles R. Martinez, Jr., University of Texas

Jennifer Jean-Jacques, University of Miami.

Heather H. McClure, University of Oregon

Hilda Pantin, University of Miami.

Guillermo Prado, University of Miami.

Seth J. Schwartz, University of Miami

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