Skip to main content
PMC home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2021 Sep 1.
Published in final edited form as: Addict Behav. 2020 Apr 18;108:106442. doi: 10.1016/j.addbeh.2020.106442

Alcohol Use Severity among Hispanic Emerging Adults: Examining the Roles of Bicultural Self-efficacy and Acculturation

Miguel Ángel Cano 1, Mariana Sánchez 1, Mario De La Rosa 1, Patria Rojas 1, Daisy Ramírez-Ortiz 1, Zoran Bursac 1, Alan Meca 2, Seth J Schwartz 3, Elma I Lorenzo-Blanco 4, Byron L Zamboanga 5, Luz M Garcini 6, Angelica M Roncancio 7, Consuelo Arbona 7, Diana M Sheehan 1, Marcel A de Dios 7
PMCID: PMC7282960  NIHMSID: NIHMS1590291  PMID: 32353693

Abstract

Objective:

This study aimed to (1) examine respective associations of acculturation orientations (e.g., U.S. orientation and Hispanic orientation) and domains (e.g., social groundedness and role repertoire) of bicultural self-efficacy, the perceived confidence to function effectively within the receiving culture and the heritage culture, with alcohol use severity among Hispanic emerging adults. This study also aimed to (2) examine potential moderating factors of respective associations among acculturation orientations and bicultural self-efficacy with alcohol use severity.

Method:

200 Hispanic emerging adults from Arizona (n=99) and Florida (n=101) completed a cross-sectional survey. Inclusion criteria were being ages 18–25, self-identify as Hispanic or Latina/o, and currently living in Maricopa County or Miami-Dade County. Data were analyzed using hierarchical multiple regression and moderation analyses.

Results:

Findings indicate that neither of the acculturation orientations nor role repertoire had main effects with alcohol use severity. However, higher social groundedness was associated with lower alcohol use severity. Moderation analyses indicate that the interaction between the U.S. orientation and study site and the interaction between the Hispanic orientation and social groundedness were statistically significant in relation to alcohol use severity.

Conclusions:

Considering that the U.S. orientation was associated with alcohol use severity only in Arizona highlights the need for multisite studies on acculturation. Our findings demonstrate that other sociocultural processes such as acculturation can impact bicultural self-efficacy; and that the association between bicultural self-efficacy and alcohol merits further investigation. However, more thorough assessments of bicultural self-efficacy are needed to better understand its effects on alcohol.

Keywords: alcohol, biculturalism, enculturation, Latino, young adults

The fields of developmental psychology and epidemiology indicate that emerging adulthood (ages 18–25 years) is a period in which people tend to drink most heavily in comparison to adolescents and older adults (Sussman & Arnett, 2014; Substance Abuse and Mental Health Services Administration [SAMHSA], 2018). For instance, in the United States (U.S.), emerging adults report the highest prevalence of all age groups in terms of current alcohol use (56.3%), binge drinking (36.9%), heavy drinking (9.6%), and alcohol use disorder (10.7%; SAMHSA, 2018). Compared to other racial/ethnic groups, Hispanic (inclusive of Latinos, Latinas, and Latinx) emerging adults had the second-highest prevalence of current alcohol use (50.1%), binge drinking (32.9%), and heavy drinking (8.0%), and the third-highest prevalence of alcohol use disorder (10.7%; SAMHSA, 2018). Furthermore, compared to other racial/ethnic groups, Hispanics are more likely to experience alcohol-related disparities such as higher rates of injury, chronic liver disease, and legal problems related to driving under the influence of alcohol (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2013; Sy et al., 2017; Vaeth, Wang-Schweig, & Caetano, 2017).

From a public health perspective, identifying and understanding potentially modifiable sociocultural determinants of alcohol use among Hispanic emerging adults is increasingly important in preventing the development of alcohol use disorder and in reducing alcohol-related disparities (Ver Ploeg & Perrin, 2004; Zemore et al., 2018). One sociocultural factor that has been previously studied with alcohol use is acculturation, broadly this is a “process of cultural and psychological change that takes place as a result of contact between two or more cultural groups and their individual members (Berry, 2005, p .698).” Another sociocultural factor that may merit investigation with alcohol use is bicultural self-efficacy, the perceived ability and confidence to function effectively both within the receiving culture and the heritage culture (David, Okazaki, & Saw, 2009; LaFromboise, Coleman, & Gerton, 1993). Accordingly, the first aim of this study was to examine associations of acculturation orientations and domains of bicultural self-efficacy with alcohol use severity among Hispanic emerging adults. The second aim was to examine the extent to which acculturation orientations moderate associations between domains of bicultural self-efficacy and alcohol use severity.

Acculturation

Beyond the general definition of acculturation, it should be noted that acculturation has been conceptualized as a unidimensional process in which assimilation to the receiving culture (e.g., U.S. orientation) is inevitable for immigrants and ethnic minorities and ultimately results in the loss of the heritage culture (e.g., Hispanic orientation; Gordon,1964). However, in more contemporary literature acculturation is conceptualized as an orthogonal bidimensional process whereby individuals (a) acquire the practices, values, and identity associated with the receiving culture (e.g., U.S. orientation), and (b) maintain the practices, values, and identity associated with the heritage culture (e.g., Hispanic orientation; Berry, 2017; Schwartz, Unger, Zamboanga, & Szapocznik, 2010). It should be noted that maintenance of the heritage culture is also referred to as enculturation (Castillo & Caver, 2009; Schwartz et al., 2010). Further, it has also been proposed that these processes—adoption of the receiving culture and maintenance of the heritage culture—unfold independently over time; therefore, acculturation orientations can be measured separately (Berry, 2017; Schwartz et al., 2010).

One factor that may impact acculturation among Hispanics living in the U.S. is the community of settlement—the reason being that respective communities of settlement have diverse characteristics such as attitudes toward Hispanics, sociopolitical history, ethnic density, public policies, and available resources (Cano et al., 2015). In addition, respective communities of settlement may also have a distinct context of reception—the social expectations of how immigrants and racial/ethnic minorities should interact with and acculturate toward the receiving culture (Schwartz et al., 2010; Schwartz, Unger, et al., 2014).

For some context, we briefly describe some characteristics of Maricopa County, Arizona, and Miami-Dade County, Florida which are the two communities of settlement included in the present study. In Maricopa County, approximately 31% of the population is Hispanic, 8.5% of the population is composed of immigrants from Latin America, 20% of adults report speaking Spanish at home, and 88.7% of Hispanics are of Mexican heritage (U.S. Census Bureau, 2017a, 2017b). Maricopa County has been described as a community where Hispanics often experience ethnic discrimination, hostility, and civil violations because of their real or perceived immigration status (American Civil Liberties Union of Arizona, 2019). On the other hand, in Miami-Dade County, approximately 69% of the population is Hispanic, 50% of the population is composed of immigrants from Latin America, 67% of adults report speaking Spanish at home, and 53.6% of Hispanics are of Cuban heritage (U.S. Census Bureau, 2017b, 2017c). An example the demonstrates the cultural and economic interconnectedness between Miami-Dade County and Latin America is that Miami is often referred to as the “Gateway of the Americas” (National Tour Association, 2004).

Acculturation and Alcohol

Some scholars have proposed that acculturation can play a key role in understanding racial/ethnic health disparities and merits investigation in alcohol research among racial/ethnic minorities living in the U.S. (Zemore et al., 2018). Not surprisingly, acculturation may be the cultural construct that has been studied the most in alcohol research among Hispanics. However, a meta-analysis on acculturation and alcohol use outcomes among Hispanics found that most studies have relied on unidimensional measures of acculturation (Lui & Zamboanga, 2018). Most of the studies with Hispanics that have used unidimensional measures of acculturation find that a higher U.S. orientation was associated with more alcohol use—especially among women (Alvarez, Frietze, Ramos, Field, & Zárate, 2017; Blanco et al., 2013; Lui & Zamboanga, 2018; Vaeth, Caetano, Rodriguez, 2012). An explanation for the association between a higher U.S. orientation and alcohol use is that Hispanics, particularly women, may adopt more liberal attitudes toward alcohol consumption with higher adherence to the U.S. culture (Pinedo, Zemore, Cherpitel, & Caetano, 2017).

Overall, alcohol studies among Hispanics that have conceptualized and measured acculturation as a bidimensional process have produced mixed findings. For instance, some studies that have used bidimensional measures of acculturation have found that a higher U.S. orientation is associated with more alcohol use while a higher Hispanic orientation is associated with less alcohol use (Des Rosiers, Schwartz, Zamboanga, Ham, & Huang, 2013; Martinez, Schwartz, Thier, & McClure, 2018; Sánchez, 2015). However, other studies have found that a higher U.S. orientation is associated with less alcohol use, and multiple studies have found that none of the acculturation orientations have significant associations with alcohol use outcomes (Cano, 2016; Lee, Almeida, Colby, Tavares, & Rohsenow, 2016; Montoya, Wittenburg, & Martinez, 2016; Schwartz et al., 2011).

In sum, the link between acculturation and alcohol use among Hispanics is not well understood (Vaeth et al., 2012). This association is complex and researchers have not established conclusive findings in part because studies have operationalized acculturation differently, used various measures of acculturation, and have examined acculturation with distinct alcohol use outcomes such as drinking status, quantity, frequency, and alcohol use severity (Zamboanga, Tomaso, Kondo, & Schwartz, 2014; Lui & Zamboanga, 2018). However, as this field of research moves forward, continuing to use unidimensional measures of acculturation in alcohol research is problematic because it eliminates the possibility to investigate the association between the Hispanic orientation and alcohol use outcomes.

Beyond Acculturation: Understanding Bicultural Self-efficacy

Self-efficacy, the perceived confidence to perform a desired action, is a key construct in theories of health behavior and behavior modification—including alcohol use behavior (Bandura, 1982; Kadden & Litt, 2011). Thus, one construct that may be relevant to research on sociocultural determinants of health behavior among Hispanics is bicultural self-efficacy which encompasses multiple domains of functioning such as social groundedness and role repertoire. Social groundedness represents the level of confidence an individual has in establishing social networks in both cultural groups (David et al., 2009). It is hypothesized that the ability to establish and maintain social networks in both cultures improves a person’s capacity to cope with the demands of living in a bicultural context (LaFromboise et al., 1993). Role repertoire refers to one’s level of confidence in using or learning culturally appropriate behaviors in relation to both cultural groups (David et al., 2009). It is hypothesized that a greater range of role repertoire facilitates positive interactions and reduces conflict, with both cultural groups (LaFromboise et al., 1993).

To our knowledge, no prior study has examined the association between bicultural self-efficacy and alcohol use or any other health behavior. However, researchers have suggested that higher levels of bicultural self-efficacy may help ethnic minorities, including Hispanics, enhance their coping resources and in turn experience lower sociocultural stressors (e.g., minority stress, ethnic discrimination) and better mental health (Carrera & Wei, 2014; Wei et al., 2010). Presently, most studies on bicultural self-efficacy have used multiethnic samples to examine its association with indicators of mental health. These studies have found that higher levels of social groundedness and role repertoire, as well as a composite score of bicultural self-efficacy, were associated with lower depressive symptoms and better psychological well-being (Broustovetskaia, 2015; David et al., 2009; Wei et al., 2010). However, a study that only included Hispanic college students found that higher social groundedness was associated with lower depressive symptoms, while the association between role repertoire and depressive symptoms was not statistically significant (Carrera & Wei, 2014).

Not surprisingly, both acculturation orientations are positively associated with a higher composite score of bicultural self-efficacy and with respective subscales (Carrera & Wei, 2014; David et al., 2009); however, no prior study has examined if and how acculturation orientations interact with bicultural self-efficacy. It should be noted that despite the similarities between acculturation and bicultural self-efficacy these two constructs are distinct (David et al., 2009). Having bicultural self-efficacy is more than simply reporting high degrees of adherence to both the receiving and heritage cultures—which has been referred to as a bicultural acculturation strategy (Berry, 2017; David et al., 2009). For instance, it may be the case that an individual reports high linguistic U.S. and Hispanic orientations but does not believe that he or she can communicate effectively with a respective cultural group. It has also been suggested that bicultural self-efficacy serves as a better indicator of cultural adaptation than acculturation because bicultural self-efficacy assesses individuals’ perceived competence/mastery of skills to effectively engage in interactions with people of different cultures (Basilio at al., 2014; Torres, 2013). By contrast, acculturation orientations typically focus on language and cultural practices, and thus, do not assess an individuals’ perceived competence to meet the expectations of different cultures (Basilio at al., 2014; Torres, 2013).

Examining interactions between acculturation and bicultural self-efficacy would not only deepen our understanding of bicultural self-efficacy, but it would also advance our understanding of substance use behavior among ethnic minorities. According to the cultural context model, interactions between cultural constructs (e.g., acculturation and bicultural self-efficacy) should be examined in relation to substance use behavior because conditional effects may elucidate that the effect of a cultural variable on substance use is influenced by different levels of another cultural variable (Castro & Alarcón, 2002). Further, Berry (1997) proposed a conceptual framework of acculturation and adaptation. Some key components of this framework are that acculturation can act as a moderator that influences distinct forms of adaptation. One type of adaptation in this framework is sociocultural adaptation, operationalized as a person’s “fit” within their new receiving culture and ability to respond to the demands of the social environment. This framework also proposed that individuals who develop a higher degree of sociocultural adaptation are more likely to experience better psychological adaptation (e.g., psychological and behavioral well-being; Berry, 1997). Building on this framework, we propose that acculturation will function as a moderator between indicators of sociocultural adaptation (e.g., bicultural self-efficacy domains) and an indicator of psychological adaptation (e.g., alcohol use).

Present Study

Based on the review of the existing literature, the following hypotheses were proposed. Hypothesis one, regarding acculturation, a higher U.S. orientation will be associated with higher alcohol use severity and a higher Hispanic orientation will be associated with lower alcohol use severity. Post hoc analyses will be conducted to examine if gender and community of settlement (e.g., Arizona vs. Florida) moderate respective associations between acculturation orientations and alcohol use severity. Hypothesis two, higher levels of each respective domain of bicultural self-efficacy (e.g., social groundedness and role repertoire) will be associated with lower alcohol use severity. Acculturation orientations will be tested as moderators in each respective association between bicultural self-efficacy domains and alcohol use severity. However, given the scarcity of literature on bicultural self-efficacy, specific hypotheses regarding potential moderating effects were not advanced. Lastly, a post hoc analysis will be conducted to examine if the community of settlement moderates each respective association between domains of bicultural self-efficacy and alcohol use severity.

Methods

Procedure and Participants

The present analyses used data from a cross-sectional study with a sample of 200 participants from the Project on Health among Emerging Adult Latinos (Project HEAL). A quota sampling design was used to enroll participants in Maricopa County, Arizona and Miami-Dade County, Florida. The target quota for Arizona was 100 participants and within Arizona we aimed to enroll 15 non-college student women, 15 non-college student men, 35 college student women, and 35 college student men. The same target quotas were applied in Florida. Prospective participants were recruited (1) in-person by distributing flyers, (2) posting flyers with tear-off tabs, (3) social media, and (4) by emailing an announcement that described the study aims and procedures to organizations and individuals who may have had access to the target sample. It should be noted that at each respective study site most participants who were not current college students were recruited in-person by research personnel with experience in recruiting Hispanic participants for research studies.

Prospective participants interested in the study contacted coordinators of Project HEAL and they were screened to determine whether they were eligible to enroll in the study. Inclusion criteria for participants included being ages 18 to 25, self-identify as Hispanic or Latina/o, able to read English, and currently living in Maricopa County, Arizona or Miami-Dade County, Florida. Exclusion criteria were currently being pregnant or breastfeeding. Participants provided informed consent to participate in the study by using an electronic informed consent form. Data were collected between August 2018 and February 2019 via a confidential online survey using Qualtrics. The survey took approximately 50 minutes to complete and participants were compensated with a $30 electronic Amazon gift card. This study was approved by the Florida International University Institutional Review Board.

Measures

Demographic Variables.

The following sociodemographic variables were included: age, gender, (0 = male, 1 = female), study site (0 = Florida, 1 = Arizona), partner status (0 = single, 1 = has a partner), nativity (0 = immigrant, 1 = non-immigrant), Hispanic heritage group (0 = other Hispanic heritage, 1 = Mexican heritage), student status (0 = current college student, 1 = non-college student), employment status (0 = unemployed, 1 = employed), and financial strain (1 = has more money than needed, 2 = just enough money for needs, 3 = not enough money to meet needs). Existing literature suggests that these sociodemographic variables are linked with alcohol use behavior (Alegría et al., 2007; SAMHSA, 2018); thus, we included them in the regression analyses to control for potential confounding effects.

Acculturation.

Two linguistic acculturation orientations were measured using the Brief Acculturation Rating Scale for Mexican Americans-II (Brief ARSMA-II; Bauman, 2005). The four-item Anglo orientation subscale of the Brief ARSMA-II was used to measure the U.S. orientation. A sample item of this subscale is, “I enjoy English language movies.” The six-item Hispanic orientation subscale of the Brief ARSMA-II was used to measure the Hispanic orientation. A sample item of this subscale is, “I enjoy speaking Spanish.” Both subscales use a five-point Likert-type scale (1 = not at all, 5 = extremely often or almost always). Higher mean scores indicate higher levels of U.S. orientation and Hispanic orientation, respectively. Cronbach’s alpha reliability coefficients for the Anglo orientation subscale and Hispanic orientation subscale in this study were (α = .79) and (α = .91), respectively.

Bicultural Self-efficacy.

The Bicultural Self-efficacy Scale measures six domains of perceived bicultural self-efficacy, social groundedness, role repertoire, communication ability, positive attitudes, cultural knowledge, and bicultural beliefs (David et al., 2009); however, due to time limitations the present study only measured two domains—social groundedness and role repertoire. The social groundedness subscale consists of seven self-report items and a sample item is, “I have an extensive network of mainstream Americans as well as an extensive network of people from the same heritage culture as myself.” The role repertoire subscale consists of three self-report items and a sample item is, “I am confident that I can learn new aspects of both the mainstream American culture and my heritage culture.” Both subscales use a nine-point Likert-type scale (1 = strongly disagree, 9 = strongly agree). Higher sum scores indicate higher levels of bicultural self-efficacy for each respective subscale. Cronbach’s reliability coefficients for social groundedness and role repertoire in this study were (α = .92) and (α = .77), respectively.

Alcohol Use Severity.

Self-reported alcohol use severity was measured using the Alcohol Use Disorder Identification Test (AUDIT; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), which consists of 10 self-report items with varied response choices on a Likert-type scale ranging from zero to four. Summed scores range from zero to 40 with higher scores indicating higher alcohol use severity. A sample item is “Has a relative or friend or a doctor or another health worker been concerned about your drinking or suggested you cut down?” Cronbach’s reliability coefficient for the AUDIT was (α = .90).

Statistical Analysis Plan

All analyses were performed with SPSS v25. Descriptive statistics including means, standard deviations were generated for all continuous variables and frequencies and proportions were generated for all categorical variables. Univariate comparisons of the mentioned variables by study site were carried out with the chi-square test for categorical variables, and a t-test for continuous variables. Bivariate correlations between study variables were assessed using a Pearson correlation coefficient.

Main effects of the predictor variables on alcohol use severity were estimated using hierarchical multiple regression (HMR). Predictor variables were entered into the HMR model in a specified order so that each predictor contributed to the explanatory variance of the outcome variable (i.e., alcohol use severity) after controlling for the variance explained by the previous variables (Cohen, Cohen, West, & Aiken, 2003). Predictor variables were grouped and entered into the HMR model in the following order: (1) demographic variables were entered in the first block, (2) acculturation orientations were entered in the second block, and (3) domains of bicultural self-efficacy were entered in the third and final block to determine the extent to which they uniquely predicted alcohol use severity above and beyond the other predictors.

Using PROCESS v3.2 for SPSS (Hayes, 2017), moderation analyses were conducted with 50,000 bootstraps to examine the extent to which potential moderating variables influenced the direction and/or strength of respective associations with alcohol use severity. PROCESS tested moderation by (1) performing a multiple regression to replicate the variance explained by all the predictor variables included in the HMR model, (2) estimating interaction terms between focal predictors (e.g., acculturation orientations) and moderating variables (e.g., study site), and (3) estimating conditional effects for each respective interaction term in relation to alcohol use severity. All moderation analyses controlled for all variables in the HMR model that were not included in respective interaction terms.

Results

Descriptive Analyses

The mean participant age was 21.30 (SD = 2.09) and approximately half the sample was composed of women (n = 102, 51.0%) and participants from Arizona (n = 99, 49.5%). Approximately one-third of participants were immigrants (n = 60, 30.0%) and non-college students (n = 61, 30.5%). Regarding Hispanic heritage groups, participants identified as Mexican (n = 88, 44.0%), Cuban (n = 33, 16.5%), Colombian (n = 24, 12.0%), non-Colombian South American (n = 21, 12.5%), Central American (n = 20, 10.0%), Puerto Rican (n = 9, 4.5%), and Dominican (n = 4, 2.0%). With regard to language, seven participants (3.5%) reported that they did not speak Spanish. Lastly, some participants reported being non-drinkers (n = 49, 24.5%) and based on an AUDIT total score of eight points or higher, some participants met criteria for hazardous alcohol use (n = 45, 22.5%). Frequencies, proportions, means, and standard deviations for all study variables are presented by study site in Table 1. Bivariate correlations for all study variables are presented in Table 2.

Table 1.

Descriptive Statistics for Study Variables (n = 200)

Variable Arizona
99 (49.5)		 Florida
101 (50.5)
n (%) n (%) χ2
Gender .50
 Female 53 (53.5) 49 (48.5)
 Male 46 (46.5) 52 (51.5)
Partner Status 1.05
 Single 67 (67.7) 75 (74.3)
 Has Partner 32 (32.3) 26 (25.7)
Nativity 23.48**
 Immigrant 14 (14.1) 46 (45.5)
 Non-immigrant 85 (85.9) 55 (54.5)
Hispanic Heritage 146.21**
 Mexican 86 (86.9) 2 (2.0)
 Other Hispanic Heritage 13 (13.1) 99 (98.0)
Student Status .06
 Current College Student 68 (68.7) 71 (70.3)
 Non-College Student 31 (31.3) 30 (29.7)
Employment Status 31.43**
 Employed 94 (94.9) 63 (62.4)
 Unemployed 5 (5.1) 38 (37.6)
M (SD) M (SD) t-value
Age 21.67 (1.91) 20.94 (2.20) −2.49*
Financial Strain 2.34 (.61) 2.26 (.58) −1.03
Hispanic Orientation 3.23 (.99) 3.45 (3.45) 1.56
U.S. Orientation 4.72 (.44) 4.44 (.64) −3.62**
Social Groundedness 42.98 (11.38) 47.58 (9.15) 3.14*
Role Repertoire 21.20 (4.07) 21.33 (3.85) .23
Alcohol Use Severity 6.85 (6.48) 3.19 (4.84) −4.52**
Open in a new tab
*

p < .05,

**

p < .01

Table 2.

Bivariate Correlations for Study Variables (n = 200)

Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14
1. Age -
2. Gender −.05 -
3. Study Site .17* .05 -
4. Partner Status .24** .01 .07 -
5. Nativity .08 .14* .34** −.01 -
6. Hispanic Heritage .23** .02 .86** .06 .32** -
7. Student Status .30** −.01 .02 .01 −.11 .01 -
8. Employment Status .27** .05 .40** .09 .16* .37** .24** -
9. Financial Strain −.02 .10 .07 .03 .02 .06 −19** .02 -
10. Hispanic Orientation .02 .09 −.11 −.14* −.27** −.10 .28** .02 −15* -
11. U.S. Orientation .02 .07 .25** .07 .30** .23** −.29** .01 .12 −.50** -
12. Social Groundedness .05 −.16* −.22** −.15 −.07 −.17* .16* −.06 −.12 .09 −.01 -
13. Role Repertoire .11 −.08 −.02 .03 .14 .02 −.14* .14* −.02 −.06 .24** .44** -
14. Alcohol Use Severity .16* −.05 .31** −.01 .12 .23** −.03 .21** .10 −.13 .02 −.22** −.07 -
Open in a new tab
*

p < .05,

**

p < .01

Hierarchical Multiple Regression

Table 3 presents the regression coefficients from the HMR model. Results indicate that 19.3% of the variance of alcohol use severity was explained by all predictor variables entered into the HMR model. The first predictor block included demographic variables and explained 14.1% of variability in alcohol use severity, R2 = 14.1, F(9, 190) = 3.29, p = .001. The second block added the two acculturation orientations which explained 2.5% of variability in alcohol use severity ΔR2 = 2.5, F(2, 188) = 2.78, p > .05. The third and final block added the social groundedness and role repertoire domains of bicultural self-efficacy, which explained 2.7% of the variability in alcohol use severity ΔR2 = 2.7, F(2, 186) = 3.10, p < .05. Standardized coefficients from the final regression model indicate that age (β = .17, p = .03), study site (β = .39, p = .004), and the social groundedness domain of bicultural self-efficacy (β = −.19, p = .02) had statistically significant associations with alcohol use severity.

Table 3.

Hierarchical Multiple Regression Model Predicting Alcohol Use Severity (n = 200)

Model 1 Model 2 Model 3
Variable b SE β b SE β b SE β
Block 1
Age .42 .22 .15* .47 .22 .16* .48 .22 .17*
Gender −.81 .82 −.07 −.50 .82 −.04 −.81 .83 −.07
Study Site 4.86 1.60 41** 5.16 1.59 43*** 4.62 1.59 .39**
Partner Status −.95 .92 −.07 −1.16 .92 −.09 −1.53 .92 −.12
Nativity .08 .96 .01 −.04 .98 −.00 −.11 .98 −.01
Hispanic Heritage −2.33 1.59 −.19 −2.32 1.57 −.19 −2.32 1.56 −.19
Student Status −1.11 .97 −.09 −1.45 1.03 −.11 −.93 1.05 −.07
Employment Status 1.54 1.12 .11 1.51 1.11 .10 1.61 1.11 .11
Financial Strain .75 .70 .08 .64 .70 .06 .54 .69 .05
Block 2
Hispanic Orientation −.97 .49 −.16* −.90 .49 −.15
U.S. Orientation −1.74 .89 −.16* −1.47 .91 −.14
Block 1
Social Groundedness −.11 .05 −.19*
Role Repertoire .07 .12 .05
Open in a new tab

Note: b = unstandardized coefficient, SE = standard error, β = standardized coefficient,

*

p ≤ .05,

**

p ≤ .01,

***

≤ .001

R2 = 14.1 for Block 1, ΔR2 change = 2.5 for Block 2, ΔR2 change = 2.7 for Block 3.

Moderation Analyses

Moderation analyses conducted to test hypothesis one indicated that the study site moderated the association between U.S. orientation and alcohol use severity (β = −.36, p = .03). This moderation effect added 2.1% to the variance explained by the HMR model. Conditional effects indicate that higher U.S. orientation was associated with lower levels of alcohol use severity among participants in Arizona (β = −.36, p = .001); however, no statistically significant association was found among participants in Florida (β = −.01, p > .05). This moderating effect is depicted in Figure 1. Study site did not moderate the association between the Hispanic orientation and alcohol use severity and gender did not moderate respective associations between acculturation orientations and alcohol use severity.

Figure 1.

Figure 1.

Open in a new tab

Two-way interaction with study site moderating the association between U.S. orientation and alcohol use severity.

Moderation analyses conducted to test hypothesis two indicated that Hispanic orientation moderated the association between the social groundedness domain of bicultural self-efficacy and alcohol use severity (β = .17, p = .01). This moderation effect added 2.8% to the variance explained by the HMR model. Conditional effects indicate that, across participants, increases in social groundedness were associated with the steepest decline in alcohol use severity (β = −.39, p < .001) at low levels of Hispanic orientation (1 SD below the mean). A similar but weaker conditional effect (β = −.16, p = .04) was found at mean levels of Hispanic orientation. The conditional effect of social groundedness on alcohol use severity was not significant at high levels of Hispanic orientation (1 SD above the mean). This moderating effect is depicted in Figure 2. The interaction between social groundedness and the U.S. orientation was not statistically significant, nor were any of the interactions between acculturation orientations and the role repertoire domain of bicultural self-efficacy. Lastly, study site did not moderate respective associations between domains of bicultural self-efficacy and alcohol use severity.

Figure 2.

Figure 2.

Open in a new tab

Two-way interaction with Hispanic orientation moderating the association between the social groundedness domain of bicultural self-efficacy and alcohol use severity.

Discussion

Acculturation and Alcohol: What Did We Learn?

Although most studies on acculturation among Hispanics find that a higher U.S. orientation is linked with higher alcohol use—our null findings on the main effects of acculturation orientations are not entirely unexpected. Our null findings are consistent with other studies that specifically examined alcohol use severity among Hispanic emerging adults and used bidimensional measures of acculturation (Cano, 2016; Schwartz et al., 2011). Findings from a meta-analysis may offer an explanation for our null findings, Lui and Zamboanga (2018) found that acculturation is a strong predictor of drinking status, but may exert a relatively small effect on alcohol use severity. The acculturation measure used in our study, the Brief ARSMA-II, may have also been a factor. A study that used two acculturation measures, the original ARSMA-II and the Bicultural Involvement Questionnaire-Short Version (BIQ-S), found that none of the ARSMA-II subscale scores were associated with risk of alcohol use; however, the Hispanic orientation subscale score of the BIQ-S was associated with risk of alcohol use (Martinez et al., 2018). Again, it should be noted that the present study used the Brief ARSMA-II, not the original ARSMA-II. However, these two measures are highly correlated; thus, indicating concurrent validity (Bauman, 2005).

One of our moderation analysis indicated that gender did not moderate the association between acculturation orientations and alcohol use severity. One explanation for this null finding is that historically, men have reported higher rates for various alcohol use outcomes compared to women, but those differences are narrowing—particularly among emerging adults (Delker, Brown, & Hasin, 2016). In addition, it has been suggested that attitudes toward alcohol may now be very similar between male and female Hispanic emerging adults, and thus, acculturation may not have the same pronounced effect on drinking attitudes and alcohol use outcomes among Hispanic women (Montoya et al., 2016). Some post-hoc analyses of our data indicate that there were no statistically significant differences by gender in relation to acculturation orientations or alcohol use severity which may lend some support to this potential explanation.

Another moderation analysis indicated that the study site functioned as a moderator between higher levels of U.S. orientation and alcohol use severity. On average, participants in Florida had a lower level of alcohol use severity than participants in Arizona; however, the conditional effect for Florida was not statistically significant because the rate of change in alcohol use severity across participants was low. By contrast, participants in Arizona had the steepest decline in alcohol use severity as levels of U.S. orientation increased across participants. The association we found between the U.S. orientation and alcohol use is the same found in another study that used the ARSMA-II with Hispanic emerging adults living in Texas (Montoya et al., 2016). The social environment in Maricopa County, Arizona likely played a role in the moderating effect that was found in our study. While Maricopa County has been characterized as a community that discriminates against Hispanics, Torres (2012) suggested that a higher U.S. orientation may facilitate Hispanics’ ability to communicate effectively in English to help them counteract the effects of negative interactions such as ethnic discrimination. To some degree, the idea presented by Torres (2012) has some empirical support because one study found that a higher U.S. orientation was associated with lower perceived ethnic discrimination (Cano et al., 2015). To date, few studies on acculturation and alcohol have examined the social environment. Our findings highlight the notion that context matters, and thus more multisite studies are needed to examine the extent to which communities of settlement may influence associations between acculturation and alcohol use outcomes.

Bicultural Self-efficacy and Alcohol

It is possible that higher social groundedness was associated with lower alcohol use severity because it is acting as a coping resource against sociocultural stressors (e.g., ethnic discrimination) that are linked with more alcohol use (Carrera & Wei, 2014; Cano et al., 2015; Wei et al., 2010). For example, one study found that higher social groundedness mitigated the effects of ethnic discrimination/minority stress on depressive symptoms (Chao, Mallinckrodt, & Wei, 2012; Wei et al., 2010). A question that merits investigation in future studies is whether social groundedness (and other domains of bicultural self-efficacy) function as protective factors that mitigate the effects of sociocultural stressors on alcohol use outcomes. Higher levels of social groundedness may also facilitate the ability to develop wider social networks that enhance social support (Lubben, 1988). This may be important because according to the Stress Buffering Model, higher levels of social support can help an individual cope with stressors more effectively; thus, mitigating the effect of stress on maladaptive outcomes such as substance use (Cohen, 2004). For instance, a study with Hispanic immigrants found that higher levels of social support mitigated the effect of immigration stress in relation to alcohol use severity (Cano et al., 2017).

In the current study, the role repertoire domain of bicultural self-efficacy was not associated with alcohol use severity. Given the limited research on bicultural self-efficacy, particularly on specific domains of bicultural self-efficacy, it is difficult to develop explanations for our null findings that are based on existing literature. However, researchers have suggested that respective domains of bicultural self-efficacy develop at varying rates and some domains might not fully develop until bicultural self-efficacy is achieved in other domains (LaFromboise et al., 1993). Thus, it may be the case that bicultural self-efficacy in the role repertoire domain has not reached an optimal level to function as a protective factor against alcohol use severity. LaFromboise and colleagues (1993) also suggest that some domains of bicultural self-efficacy may be more important than others in relation to distinct indicators of psychosocial adjustment. A study that lends support to this explanation found that out of six bicultural self-efficacy domains, only the social groundedness and cultural knowledge domains were associated with lower depressive symptoms (Wei et al., 2014). Lastly, the psychometric properties of the role repertoire subscale may have been a factor. Although the role repertoire subscale had adequate internal consistency in our sample the initial validation study reported suboptimal internal consistency and another study found low internal consistency which raises concern about the psychometric properties of this subscale (Wei et al., 2010).

A moderation analysis indicated that the Hispanic orientation moderated the association between social groundedness and alcohol use severity. Although the conditional effect of social groundedness on alcohol use severity was most favorable at high levels of Hispanic orientation, the slope of this condition was not statistically significant because the rate of change in alcohol use severity observed across participants was low. By contrast, the worst condition was at low levels of Hispanic orientation; however, the slope for this conditional effect was statistically significant because it had the steepest decline in alcohol use severity as levels of social groundedness increased across participants. A plausible explanation for this finding is that social groundedness may help individuals counteract adverse effects associated with a low Hispanic orientation. For instance, some studies have found that a low Hispanic orientation is associated with higher perceived marginalization from the family which in turn may increase levels of alcohol use severity (Cano et al., 2015, Cano, 2016).

Moderation analyses also indicated that acculturation orientations did not moderate the association between the role repertoire domain of bicultural self-efficacy and alcohol use severity. Again, these null findings may stem from the psychometric properties of the role repertoire subscale or it may be the case that the role repertoire domain does not have a direct association with alcohol use severity—future studies with longitudinal data should consider testing if role repertoire is associated with alcohol use outcomes indirectly. Also, study site did not moderate respective associations between bicultural self-efficacy domains and alcohol use severity. It may be the case that the perceived context of reception of each respective community of settlement may be a more salient factor, rather than objective differences by study site, that function as a moderating factor (Schwartz, Zamboanga, et al., 2014). However, this does not mean that communities of settlement do not impact bicultural self-efficacy because one notable difference was that social groundedness was significantly higher in Florida than in Arizona. As research on this topic advances, researchers should consider including measures of perceived context of reception and using longitudinal study designs with larger immigrant samples to examine if bicultural self-efficacy increases over-time as a function of distinct communities of settlement.

Limitations

The following limitations should be considered when interpreting the findings of this study. First, the present study utilized self-report measures that are susceptible to participant misrepresentation and error. Second, our assessment of acculturation was limited to linguistic acculturation and only two domains of bicultural self-efficacy were examined out of a possible six. Third, due to the cross-sectional design, the causal or directional ordering of associations found cannot be inferred. Lastly, generalizability may be limited due to the non-probability sampling technique that was utilized in the current study. Namely, most participants were current college students and U.S.-born. Also, the sample size adequacy limited the ability to examine subgroup variations attributable to different Hispanic heritage groups. Future studies should attempt to recruit more diverse samples that are more representative of the broader Hispanic population living in the U.S. because key variables in our study such as acculturation have been found to have different effects on alcohol use among distinct Hispanic subgroups (Blanco et al., 2013; Caetano, Ramisetty-Mikler, & Rodriguez, 2009).

Conclusion

Despite these limitations, the present study highlights that distinct communities of settlement can modify associations between specific acculturation orientations and substance use behavior. This finding underscores the need for more multisite studies on acculturation and alcohol use. Bicultural self-efficacy is a novel construct in alcohol research and our findings suggest that this construct is relevant in alcohol research with Hispanic populations. However, our findings need to be replicated and more studies are needed with more diverse Hispanic samples (e.g., ages, nativity) and inclusion of other bicultural self-efficacy domains. Based on the interaction we found between acculturation and bicultural self-efficacy—future studies should continue to examine how other sociocultural processes may influence bicultural self-efficacy in relation to substance use behavior.

Highlights.

  • Neither acculturation orientation nor the role repertoire domain of bicultural self-efficacy had a main effect with alcohol use severity.

  • Higher levels of the social groundedness domain of bicultural self-efficacy were associated with lower alcohol use severity.

  • Study site moderated the association between the U.S. orientation and alcohol use severity.

  • The Hispanic orientation moderated the association between social groundedness and alcohol use severity.

Acknowledgments:

Preparation of this article was supported by the National Institute on Alcohol Abuse and Alcoholism [K01 AA025992] and the National Institute on Minority Health and Health Disparities [U54 MD002266, U54 MD012393, K01 MD013770]. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health. The authors would like to acknowledge Carlos Estrada and Irma Beatriz Vega de Luna for their work in recruiting participants.

Role of funding sources

Covered time and effort to work on the article.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Author Disclosures: All authors declare that they have no conflicts of interest and do not have any financial disclosures to report.

References

  1. American Civil Liberties Union of Arizona. (2019). Immigrants’ rights. Retrieved from www.acluaz.org/en/node/95
  2. Alegría M, Mulvaney-Day N, Torres M, Polo A, Cao Z, & Canino G (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97, 68–75. doi: 10.2105/AJPH.2006.087205 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Alvarez MJ, Frietze G, Ramos C, Field C, & Zárate MA (2017). A quantitative analysis of Latino acculturation and alcohol use: Myth versus reality. Alcoholism: Clinical and Experimental Research, 41, 1246–1256. doi: 10.1111/acer.13420 [DOI] [PubMed] [Google Scholar]
  4. Basilio CD, Knight GP, O’Donnell M, Roosa MW, Gonzales NA, Umaña-Taylor AJ, & Torres M (2014). The Mexican American Biculturalism Scale: Bicultural comfort, facility, and advantages for adolescents and adults. Psychological Assessment, 26, 539–554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Babor TF, Higgins-Biddle JC, Saunders JB, & Monteiro MG (2001). The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care (2nd ed.). Geneva, CH: World Health Organization. [Google Scholar]
  6. Bandura A (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122–147. doi: 10.1037/0003-066X.37.2.122 [DOI] [Google Scholar]
  7. Bauman S (2005). The reliability and validity of the Brief Acculturation Rating Scale for Mexican Americans-II for children and adolescents. Hispanic Journal of Behavioral Sciences, 27, 426–441. doi: 10.1177/0739986305281423 [DOI] [Google Scholar]
  8. Berry JW (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46, 5–34. doi: 10.1111/j.1464-0597.1997.tb01087.x [DOI] [Google Scholar]
  9. Berry JW (2005). Acculturation: Living successfully in two cultures. International Journal of Intercultural Relations, 29, 697–712. doi: 10.1016/j.ijintrel.2005.07.013 [DOI] [Google Scholar]
  10. Berry JW (2017). Theories and models of acculturation In Schwartz SJ & Unger JB (Eds.), The Oxford handbook of acculturation and health (pp. 15–28). New York, NY: Oxford University Press. [Google Scholar]
  11. Blanco C, Morcillo C, Alegría M, Dedios MC, Fernández-Navarro P, Regincos R, & Wang S (2013). Acculturation and drug use disorders among Hispanics in the U.S. Journal of Psychiatric Research, 47, 226–232. doi: 10.1016/j.jpsychires.2012.09.019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Broustovetskaia A (2015). The role of bicultural self-efficacy and cognitive-affective factors on psychological well-being (Doctoral dissertation). Retrieved from https://docs.lib.purdue.edu/cgi/viewcontent.cgi?article=2386&context=open_access_dissertations
  13. Caetano R, Ramisetty-Mikler S, & Rodriguez LA (2009). The Hispanic Americans Baseline Alcohol Survey (HABLAS): The association between birthplace, acculturation and alcohol abuse and dependence across Hispanic national groups. Drug and Alcohol Dependence, 99, 215–221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Cano MA, de Dios MA, Castro Y, Vaughan EL, Castillo LG, Lorenzo-Blanco EI, … & Correa-Fernandez V (2015). Alcohol use severity and depressive symptoms among late adolescent Hispanics: Testing associations of acculturation and enculturation in a bicultural transaction model. Addictive Behaviors, 49, 78–82. doi: 10.1016/j.addbeh.2015.06.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Cano MA (2016). Intracultural accusations of assimilation and alcohol use severity among Hispanic emerging adults: Moderating effects of acculturation, enculturation, and gender. Psychology of Addictive Behaviors, 30, 850–856. doi: 10.1037/adb0000206 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Cano MA, Sánchez M, Trepka MJ, Dillon FR, Sheehan DM, Rojas P, … & De La Rosa M (2017). Immigration stress and alcohol use severity among recently immigrated Hispanic adults: Examining moderating effects of gender, immigration status, and social support. Journal of Clinical Psychology, 73, 294–307. doi: 10.1002/jclp.22330 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Cano MA, Schwartz SJ, Castillo LG, Romero AJ, Huang S, Lorenzo-Blanco EI, … & Lizzi KM (2015). Depressive symptoms and externalizing behaviors among Hispanic immigrant adolescents: Examining longitudinal effects of cultural stress. Journal of Adolescence, 42, 31–39. doi: 10.1016/j.adolescence.2015.03.017 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Carrera SG, & Wei M (2014). Bicultural competence, acculturative family distancing, and future depression in Latino/a college students: A moderated mediation model. Journal of Counseling Psychology, 61, 427–436. doi: 10.1037/cou0000023 [DOI] [PubMed] [Google Scholar]
  19. Castillo LG, & Caver KA (2009). Expanding the concept of acculturation in Mexican American rehabilitation psychology research and practice. Rehabilitation Psychology, 54, 351–362. [DOI] [PubMed] [Google Scholar]
  20. Castro FG, & Alarcón EH (2002). Integrating cultural variables into drug abuse prevention and treatment with racial/ethnic minorities. Journal of Drug Issues, 32, 783–810. doi: 10.1177/002204260203200304 [DOI] [Google Scholar]
  21. Chao RCL, Mallinckrodt B, & Wei M (2012). Co-occurring presenting problems in African American college clients reporting racial discrimination distress. Professional Psychology: Research and Practice, 43, 199–207. doi: 10.1037/a0027861 [DOI] [Google Scholar]
  22. Cohen J, Cohen P, West SG, & Aiken LS (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. [Google Scholar]
  23. Cohen S (2004). Social relationships and health. American Psychologist, 59, 676–684. doi: 10.1037/0003-066X.59.8.676 [DOI] [PubMed] [Google Scholar]
  24. David EJR, Okazaki S, & Saw A (2009). Bicultural self-efficacy among college students: Initial scale development and mental health correlates. Journal of Counseling Psychology, 56, 211–226. doi: 10.1037/a0015419 [DOI] [Google Scholar]
  25. Delker E, Brown Q, & Hasin DS (2016). Alcohol consumption in demographic subpopulations: An epidemiologic overview. Alcohol research: Current reviews, 38, 7–15 [PMC free article] [PubMed] [Google Scholar]
  26. Des Rosiers SE, Schwartz SJ, Zamboanga BL, Ham LS, & Huang S (2013). A cultural and social cognitive model of differences in acculturation orientations, alcohol expectancies, and alcohol‐related risk behaviors among Hispanic college students. Journal of Clinical Psychology, 69, 319–340. doi: 10.1002/jclp.21859 [DOI] [PubMed] [Google Scholar]
  27. Gordon MM (1964). Assimilation in American life. New York, NY: Oxford University Press. [Google Scholar]
  28. Hayes AF (2017). Introduction to mediation, moderation, and conditional analysis, second edition: A regression-based approach. New York, NY: The Guilford Press. [Google Scholar]
  29. Kadden RM, & Litt MD (2011). The role of self-efficacy in the treatment of substance use disorders. Addictive Behaviors, 36, 1120–1126. doi: 10.1016/j.addbeh.2011.07.032 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. LaFromboise T, Coleman HL, & Gerton J (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin, 114, 395–412. doi: 10.1037/0033-2909.114.3.395 [DOI] [PubMed] [Google Scholar]
  31. Lee CS, Almeida J, Colby SM, Tavares T, & Rohsenow DJ (2016). Acculturation, hazardous drinking and depressive symptomatology among Hispanics enrolled in a clinical trial. Addiction Research and Theory, 24, 69–79. doi: 10.3109/16066359.2015.1072517 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Lubben J (1988). Assessing social networks among elderly populations. Family and Community Health, 11, 42–52. doi: 10.1097/00003727-198811000-00008 [DOI] [Google Scholar]
  33. Lui PP & Zamboanga BL (2018). A critical review and meta‐analysis of the associations between acculturation and alcohol use outcomes among Hispanic Americans. Alcoholism: Clinical and Experimental Research, 42, 1841–1862. doi: 10.1111/acer.13845 [DOI] [PubMed] [Google Scholar]
  34. Martinez CR, Schwartz SJ, Thier M, & McClure HH (2018). A tale of two measures: Concordance between the ARSMA-II and the BIQ acculturation scales among Latino immigrant families. Psychological Assessment, 30, 459–473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Montoya JA, Wittenburg D, & Martinez V (2016). Alcohol use among Hispanic college students along the US/Mexico border. The American Journal of Drug and Alcohol Abuse, 42, 707–714. doi: 10.1080/00952990.2016.1185433 [DOI] [PubMed] [Google Scholar]
  36. National Institute on Alcohol Abuse and Alcoholism. (2017). Strategic plan 2017–2021. Retrieved from www.niaaa.nih.gov/about-niaaa/strategic-plan-2017-2021
  37. National Tour Association. (2004). Miami—the gateway to the Americas. Retrieved from https://ntaonline.com/miami-the-gateway-to-the-americas/
  38. Pinedo M, Zemore S, Cherpitel C, & Caetano R (2017). Acculturation and alcohol use: The role of environmental contexts In Schwartz SJ & Unger JB (Eds.), The Oxford handbook of acculturation and health (pp. 239–261). New York, NY: Oxford University Press. [Google Scholar]
  39. Sánchez J (2015). Alcohol use among Latino migrant workers in South Florida. Drug and Alcohol Dependence, 151, 241–249. doi: 10.1016/j.drugalcdep.2015.03.025 [DOI] [PubMed] [Google Scholar]
  40. Schwartz SJ, Unger JB, Lorenzo-Blanco EI, Des Rosiers SE, Villamar JA, Soto DW, … & Szapocznik J (2014). Perceived context of reception among recent Hispanic immigrants: Conceptualization, instrument development, and preliminary validation. Cultural Diversity and Ethnic Minority Psychology, 20, 1–15. doi: 10.1037/a0033391 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Schwartz SJ, Unger JB, Zamboanga BL, & Szapocznik J (2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 65, 237–251. doi: 10.1037/a0019330 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Schwartz SJ, Weisskirch RS, Zamboanga BL, Castillo LG, Ham LS, Huynh QL, … & Davis MJ (2011). Dimensions of acculturation: Associations with health risk behaviors among college students from immigrant families. Journal of Counseling Psychology, 58, 27–41. doi: 10.1037/a0021356 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Schwartz SJ, Zamboanga BL, Tomaso CC, Kondo KK, Unger JB, Weisskirch RS, … & Brittian AS (2014). Association of acculturation with drinking games among Hispanic college students. American Journal of Drug and Alcohol Abuse, 40, 359–366. doi: 10.3109/00952990.2014.910521 [DOI] [PubMed] [Google Scholar]
  44. Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Retrieved from www.samhsa.gov/data/report/2017-nsduh-annual-national-report
  45. Sussman S, & Arnett JJ (2014). Emerging adulthood: Developmental period facilitative of the addictions. Evaluation and the Health Professions, 37, 147–155. doi: 10.1177/0163278714521812 [DOI] [PubMed] [Google Scholar]
  46. Sy AM, Ching R, Olivares G, Vinas C, Chang R, & Bergasa NV (2017). Hispanic ethnicity is associated with increased morbidity and mortality in patients with alcoholic liver disease. Annals of Hepatology, 16, 169–171. doi: 10.5604/16652681.1226956 [DOI] [PubMed] [Google Scholar]
  47. Torres L, Driscoll MW, & Voell M (2012). Discrimination, acculturation, acculturative stress, and Latino psychological distress: A moderated mediational model. Cultural Diversity and Ethnic Minority Psychology, 18, 17–25. doi: 10.1037/a0026710 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Torres L (2013). Initial development and validation of the Mexican Intercultural Competence Scale. Journal of Latina/o Psychology, 1, 171–181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. U.S. Census Bureau (2017a). American Community Survey 1-year estimates, Maricopa County, AZ: Retrieved from http://censusreporter.org/profiles/05000US04013-maricopa-county-az/ [Google Scholar]
  50. U.S. Census Bureau (2017b). 2013–2017 American Community Survey 5-Year Estimates. Retrieved from https://factfinder.census.gov
  51. U.S. Census Bureau (2017c). American Community Survey 1-year estimates, Miami-Dade County, FL: Retrieved from http://censusreporter.org/profiles/05000US12086-miami-dade-county-fl/ [Google Scholar]
  52. U.S. Department of Health and Human Services. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Retrieved from www.surgeongeneral.gov/library/2016alcoholdrugshealth/index.html [PubMed]
  53. Vaeth PA, Caetano R, & Rodriguez LA (2012). The Hispanic Americans Baseline Alcohol Survey (HABLAS): The association between acculturation, birthplace and alcohol consumption across Hispanic national groups. Addictive Behaviors, 37, 1029–1037. doi: 10.1016/j.addbeh.2012.04.015 [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Vaeth PA, Wang‐Schweig M, & Caetano R (2017). Drinking, alcohol use disorder, and treatment access and utilization among U.S. racial/ethnic groups. Alcoholism: Clinical and Experimental Research, 41, 6–19. doi: 10.1111/acer.13285 [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Ver Ploeg M & Perrin E (2004). Eliminating health disparities. Measurement and data needs. Washington, DC: National Research Council, National Academies Press. [PubMed] [Google Scholar]
  56. Wei M, Liao KYH, Chao RCL, Mallinckrodt B, Tsai PC, & Botello-Zamarron R (2010). Minority stress, perceived bicultural competence, and depressive symptoms among ethnic minority college students. Journal of Counseling Psychology, 57, 411–422. doi: 10.1037/a0020790 [DOI] [Google Scholar]
  57. Zamboanga BL, Schwartz SJ, Jarvis LH, & Van Tyne K (2009). Acculturation and substance use among Hispanic early adolescents: Investigating the mediating roles of acculturative stress and self-esteem. The Journal of Primary Prevention, 30, 315–333. doi: 10.1007/s10935-009-0182-z [DOI] [PubMed] [Google Scholar]
  58. Zamboanga BL, Tomaso CC, Kondo KK, & Schwartz SJ (2014). Surveying the literature on acculturation and alcohol use among Hispanic college students: We’re not all on the same page. Substance Use and Misuse, 49, 1074–1078. doi: 10.3109/10826084.2014.887731 [DOI] [PubMed] [Google Scholar]
  59. Zamboanga BL, Tomaso CC, & Lui PP (2017) Acculturation and alcohol use among Hispanic and Asian American college students: What do we know and where could we go? In Schwartz SJ & Unger JB (Eds.). The Oxford Handbook of Acculturation and Health (pp. 263–280). New York, NY: Oxford University Press. [Google Scholar]
  60. Zemore SE, Karriker-Jaffe KJ, Mulia N, Kerr WC, Ehlers CL, Cook WK, … & Greenfield TK (2018). The future of research on alcohol-related disparities across U. S. racial/ethnic groups: A plan of attack. Journal of Studies on Alcohol and Drugs, 79, 7–21. doi: 10.15288/jsad.2018.79.7 [DOI] [PMC free article] [PubMed] [Google Scholar]

RESOURCES