Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos

*Richard C. Cervantes and Elias Koutantos*

### **Abstract**

The problem of substance abuse impacts the Hispanic/Latino youth population. In some cases, subpopulations of the Hispanic/Latino population suffer higher rates of substance use than do other groups. While the science of prevention in the general population and the rigorous study of substances abuse prevention programs have flourished over the past few decades, there continues to be a limited body of knowledge regarding substance abuse prevention that is culturally specific or tailored to Hispanic/Latinos. One promising area is the study of risk and protective factors which finds that acculturation stress, among others, plays a key role in the development of substance use and other behavioral problems among youth. Stress experiences related to discrimination, immigration, parent–child cultural differences all play a role in disrupting normative development and subsequent risk-taking behavior. Culturally focused prevention models such as *Familia Adelante* show promise in helping reduce acculturation-based risk and increasing individual and family resilience. This chapter will address many of the aforementioned issues and will provide direction for future prevention research for Hispanic/Latinos.

**Keywords:** Hispanic, substance abuse, prevention, acculturation, stress

#### **1. Introduction**

This chapter will provide an overview of substance use prevention for Hispanic/ Latino youth. Based on US Census Bureau data Hispanics are the youngest major racial or ethnic group in the United States [1]. About one-third or 17.9 million of the nation's Hispanic population is younger than 18 and about a quarter or 14.6 million of all Hispanics are millennials (ages 18–33 in 2014). Researchers and practitioners alike recognize the advantages of implementing prevention programming that averts the need for more intensive and costly drug treatments. Advances in prevention science have been highlighted in reports from the Institute of Medicine and National Institute on Drug Abuse (NIDA) among others. The question is whether such advances in scientifically based prevention efforts can also extend to Hispanic/ Latino youth including those who are immigrants or non-English speaking. A second question is whether theoretical models used to develop and study drug prevention programs are adequate in terms of addressing core cultural values beliefs and traditions among Hispanic/Latinos. Have prominent and widely used prevention interventions been adapted studied and proven effective with Hispanic/Latino youth? Are culturally tailored evidence-based programs available?

According to the review of literature conducted by Cuijpers [2], prevention programs have different goals, including the following: (a) increasing knowledge about drugs, (b) reducing the use, (c) delaying the onset of first use, (d) reducing abuse, and (e) minimizing the harm caused by the use. Prevention can be understood as any activity designed to avoid substance abuse and reduce its health and social consequences. This broad term can include actions aimed to reduce supply (e.g., based on the principle that the decreased availability of substances reduces the opportunities for abuse and dependence) and actions aimed to reduce demand (i.e., health promotion and disease prevention). In addition, the National Institute on Drug Abuse (NIDA), based on a growing body of prevention science, offers principles concerning prevention which range from the importance of addressing risk and protective factors to implementing and enforcing family and community policies prohibiting substance use [3]. Unfortunately, the NIDA principles do not specifically address the importance of cultural risk or protective factors that may impact substance use among Hispanics. Principle 12 does offer some broad recommendation regarding culture, citing that when communities adapt programs to match their needs, they should still do their best to maintain as close to the original intervention as possible and maintain high fidelity, although this principle is related to program adaptation.

#### **2. Scope of the problem for Hispanic/Latino youth**

Hispanic adolescents experience health disparities related to substance use, emotional problems, and high-risk sexual behavior. By the 12th grade, Latino students report the highest rates of 30-day use of marijuana, inhalants, ecstasy, cocaine, crack, salvia, Vicodin, methamphetamine, crystal methamphetamine, over-thecounter cough medicines, and tobacco through use of hookah [4]. Additionally, over one-quarter of Latino adolescents report alcohol use in the last 30 days as well as reports of the highest rates of binge and heavy drinking [5]. Suicide ideation is elevated among Latino adolescents as 1 in 7 (16.7%) Latino adolescents report suicidal ideation and 1in 10 (10.2%) report having attempted suicide [6]. In 2012, Latina adolescents had higher rates of teenage pregnancy than any other racial and ethnic minority, with 43.6 births per 1000 females, ages 15–19 years old [7].

The fastest-growing drug problem in the United States is prescription drugs, and it is profoundly affecting the lives of teenagers. According to NIDA DrugFacts, prescription drug misuse and abuse is when someone takes a medication inappropriately (e.g., without a prescription). According to National Survey on Drug Use and Health (NSDUH) data on youth and young adults, more than 5700 youth in 2014 reported using prescription pain relievers without a doctor's guidance for the first time.

A common misperception is that prescription drugs are safer or less harmful to one's body than other kinds of drugs. However, there are a range of short- and long-term health consequences for each type of prescription drugs used inappropriately. When concerning opioids, which act on the same parts of the brain as heroin, the consequences of inappropriate use can cause drowsiness, nausea, constipation, and depending on the amount taken, slowed breathing and even respiratory failure [8]. In terms of trends in tobacco use and electronic cigarettes among youth, older students, Hispanics, and Whites are more likely to use e-cigarettes than younger students and Blacks. In the young adult population, males, Hispanics, Whites, and those with lower education are more likely to use e-cigarettes than females, Blacks, and those with higher levels of education [9]. Flavored products marketed as e-cigarettes have gained popularity among youth and adults, while health consequence data continues to highlight the negative health impact of these products.

*Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos DOI: http://dx.doi.org/10.5772/intechopen.90399*

### **3. Risk and protective factors**

Factors that drive the substance use behaviors of Hispanic youth may be quite similar to those found in the general population of youth, yet there are unique challenges, stressors, and other risk factors that play a role in the development of substance use among Hispanic/Latino youth [10]. Cultural values and language shifts, pre- and post-migration trauma, ethnic identified problems, and parent–child "acculturation gaps" are implicated in the onset of substance use in this growing population. A body of research on family stress, adaptation, and resilience by McCubbin and colleagues has established that stressors that impact minority groups, including Hispanics, can negatively impact and disrupt the family system [11]. In turn, how the family actively deals with their stressful conditions can strengthen family members, their relationships, and the family unit. Highly stressful conditions can overwhelm family functioning.

Acculturative stressors are a class of adverse conditions that can generate interpersonal, cultural and familial challenges. For example, cultural conflict following immigration can reverberate across generations. Such stressors may comprise chronic adversity that includes clashes between personal and family goals; an increase in individualistic views; a reduced sense of the importance of religion; increased intra-family conflicts; gender role conflict; and increased marital conflict. Families with more acculturative stress and who lack a strong social support system or resilience (i.e., family and friends, spiritual resources, access to public social services) or personal resources (i.e., self-esteem) can show a greater decline in family cohesion.

### **4. Immigration and acculturation-related hardships confronted by Hispanic/Latino youth**

The physical and emotional demands of immigrating to the United States are well documented [12]. New data shows a 117% increase in unaccompanied children ages 12 and under caught at the US-Mexico border in fiscal year 2014 compared to fiscal year 2013. By comparison, the number of apprehensions of children 13–17 years old has by increased 12% in the past year [13]. Parental deportation is an increasingly common hardship experienced by the Hispanic youth. Nearly 33,000 noncitizen youth are in DHS custody each day, representing an over 50% increase from 2001. Chaudry and colleagues found most children of deported undocumented workers remained in the United States with their other parent or relative [14]. The negative consequences of forced family separation because of deportation on child well-being are documented [15–18]. Children most at risk for negative behavioral or psychological changes are those who witnessed their parents' arrest; children separated from their parents longer than 30 days; and children whose primary caregiver was deported [19].

The term *acculturative stress* refers to the distress that individuals experience as a result of tension between maintaining the behaviors and characteristics of their country of origin and concurrently adopting those from the majority culture [20]. Acculturative stressors are not unique to Latino populations and may include pressure from learning a new language, balancing differences in cultural values, and adjusting to new employment expectations [21, 22]. Stress itself is conceptualized as a behavioral and emotional reaction to acute or chronic life-changing events and occurs when the demands of the events exceed the individuals' perceived personal and social resources to deal with these changes [23]. The stress-illness paradigm offers one way to conceptualize the relationship between social stress and health [24, 25].

Research studies on acculturation and health status have been mixed, with some studies showing a positive relation between acculturation and health, while others demonstrate an inverse effect on health outcomes [26]. Furthermore, there is often considerable variation in these outcomes depending on factors such as country of origin, age, gender, years lived in the United States, education, and income [27]. For example, some research shows differences in health outcomes across a number of Latino/a subpopulations, with some subgroups experiencing higher morbidity and mortality rates, diabetes and hypertension, psychiatric disorders, and substance use disorders [27–32]. One potential factor driving these different outcomes is experiences of acculturative stress.

Recent work by the authors suggests that acculturation "gaps" between adolescents and their parents can impact healthy emotional development. An additional adversity often faced by Hispanic families involves family member separations due to immigration, such as when parents come to the United States first and children are separated for years. The reunification process can be stressful and painful rather than smooth and joyous. The work by Perreira and colleagues emphasizes how adversity and resilient responses are embedded in social contexts. From an adversities' perspective, this involves loss of social position and class status, loss of vital extended family resources, loss of peer networks and community support, and economic and social segregation and marginalization. Unfamiliar social contexts, language barriers, and humiliation when confronted by racism and discrimination can further erode individual and family coping and resilience.

Studies also indicate that US-born and more acculturated Mexican origin youth exhibit higher rates of externalizing behavior when compared to their less acculturated, Mexican-born peers. Markers of acculturation are consistently associated with externalizing outcomes like conduct problems, juvenile arrest, and substance use. US-born youth report less investment in education and lower academic aspirations than their Mexican-born peers [33]. Among immigrants, greater length of residence in the United States is associated with lowered academic motivation [34, 35]. Despite the stressful period of adjustment to a new set of cultural and linguistic changes, immigrants show resilience and better behavioral health compared to US-born Latino youth. The immigrant paradox primarily results from the progressive loss of traditional culture and associated negative health consequences associated with increasing generations or time in the United States [36].

Research examining the effects of both acculturation and stress find that stress partially mediates the relationship between acculturation and negative health behaviors. Stress impedes health by limiting access to salutogenic health behaviors and through maladaptive coping [37]. Hispanics under elevated stressor exposure are more likely to deny the stressor or to use maladaptive coping behaviors such as risky sex and substance abuse [38, 39].

Among youth, immigration, and acculturation-related stressors have also been found to predict greater drug use and risky sexual behavior [40, 41]. Recently, Cervantes and colleagues identified eight culturally based stress risk domains commonly experienced by Latino adolescents, ranging from acculturation gaps to family immigration-related stress [42]. Higher scores of cultural stress in these life domains were significantly related to both internalizing and externalizing behavioral health problems in Latino adolescents including polysubstance use [10, 42]. Effective interventions targeting immigration-related stress among Hispanics must promote healthy coping strategies for acculturation- and immigration-based stressors [43].

The implications of immigration and acculturation stressors are likely accentuated in new Hispanic settlement communities. New settlement areas are often

*Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos DOI: http://dx.doi.org/10.5772/intechopen.90399*

hostile towards immigrants, creating a culture of fear where there is a heightened sense of anxiety that likely underlies social interaction and exaggerates possible stressor exposure. Birman and colleagues provide evidence that these hostile contextual conditions can affect the acculturation process and point to contextual factors such as immigrant density, acceptance of cultural diversity, and presence of social capital as core contextual issues [44].
