文章基本信息

标题：The Influence of Perceived Risk to Health and Immigration-Related Characteristics on Substance Use Among Latino and Other Immigrants
本地全文：下载
作者：Victoria D. Ojeda ; Thomas L. Patterson ; Steffanie A. Strathdee 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：5
页码：862-868
DOI：10.2105/AJPH.2006.108142
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined whether immigration-related characteristics and perceptions of risk surrounding substance use were independently associated with lifetime use of cigarettes and various illicit substances among immigrant and native-born Latino and non-Latino White adults in the United States. Methods. Data were from the 2002 National Survey on Drug Use and Health. Analyses were limited to Latinos and non-Latino Whites 18 years and older. We used cross-tabulations and multivariate logistic regression to test relations between risk perceptions, immigration characteristics, and substance use. Results. More than two thirds of all respondents perceived moderate or great risk to health and well-being associated with all substances analyzed. The odds of lifetime substance use by Latino and non-Latino White immigrants were lower than for US-born non-Latino Whites. Immigrant Latinos’ odds of lifetime substance use were lower than for US-born Latinos. Moderate or great perceived risk was associated with lower likelihood of lifetime use of all substances except cigarettes. Conclusions. Foreign birth appeared to protect against substance use among both Latino and non-Latino White immigrants. Future studies should examine potential protective factors, including cultural beliefs and practices, acculturation, familial ties, and social network influences. The significant health, social, and economic burdens of substance use and abuse 1 demand greater understanding of the interplay between risk and protective factors, including race/ethnicity and nativity. Latinos appear to engage in health-promoting substance use behaviors over their lifecourse. 2 ^– 5 Data from the National Survey on Drug Use and Health (NSDUH) indicate that past-month and past-year rates of illicit substance use are similar for Latinos and non-Latino White adults, yet estimates of lifetime illicit substance use differ (37.2% vs 48.1%, respectively). 4 The mechanisms underlying differences in substance use have not been fully elucidated. Psychosocial factors such as social norms, peer and family attitudes toward and behaviors regarding substance use, family bonding, individual academic accomplishments, and substance use at a young age (i.e., preadolescence or adolescence) may influence lifetime attitudes and behaviors regarding substance use. 6 ^– 8 Using nationally representative data, we examined the roles of perceived risk to health (of substance use) and immigration characteristics as correlates of substance use among immigrant and US-born Latinos and non-Latino Whites. Demographic shifts and variations in substance use may create a need for detailed investigations of Latinos’ and immigrants’ substance use behaviors. Latinos are the largest racial/ethnic subgroup in the United States. By 2005, more than 41.9 million Latinos resided throughout the country, and of these, 40% were foreign-born. 9 If current trends continue, by 2045, 23% of all US residents (approximately 90.3 million people) will be of Latino ancestry. 10 Attending to the health and health care needs of Latinos and immigrants is a vital investment in the nation’s future health. Heterogeneity among Latinos and non-Latino Whites underscores the need for disaggregating data by birthplace. 3 ^, 11 ^, 12 The National Epidemiological Survey on Alcohol and Related Conditions showed that US-born Whites were more likely to meet criteria for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ), 13 substance use disorder than were native and immigrant Mexican American adults; yet, even US-born Mexicans were more likely than were Mexican immigrants to be diagnosed with any substance use disorder. 3 Cross-cultural studies found that substance use varies among immigrants between and within birth countries. 12 ^, 14 ^, 15 In Mexico, which historically has sent large numbers of immigrants to the United States, 11 the prevalence of lifetime substance use is less than that of industrialized countries (the United States, Canada, the Netherlands, Brazil, and Germany) 12 ; yet, substance use varies geographically within the country. Rates of illicit substance use are highest in Tijuana (14.7%) and Ciudad Juarez (9.2%), cities on the US–Mexico border where injection of heroin, methamphetamine, and cocaine is particularly prevalent. 16 Substance use prevalence also varies by birthplace (i.e., mainland vs island) and immigration experiences among Puerto Ricans. 17 Non-Latino White immigrants are heterogeneous, including both Western (e.g., United Kingdom) and Eastern Europeans (e.g., Poland, Russia). 11 One US study reported higher lifetime odds of any substance use disorder among US-born non-Latino Whites compared with White immigrants 3 ; data were not disaggregated by country of origin. Yearly and lifetime rates of use of certain substances (cocaine, marijuana) may be lower in some European countries 14 ^, 15 compared with rates in the United States. Frameworks explaining differences in illicit substance use by country of nativity have considered psychosocial factors such as acculturation 18 and social environment (e.g., family health behaviors and family cohesion, age at initiation). 6 Gil and Vega’s framework of immigrant adolescent substance use 18 proposes the migration context as one of several factors shaping substance use behaviors, reflecting a family’s premigration socioeconomic and cultural circumstances as well as age at immigration. This framework also includes immigration and postmigration experiences (e.g., authorized vs unauthorized migration, family vs individual migration or family reunification, labor migration, arrival conditions, acculturation and assimilation stresses.) Potentially protective psychosocial factors include a risk-reducing familial context, including negative attitudes toward substance use, abstention from substance use by siblings and parents, and family involvement and cohesion. Delayed initiation into substance use (i.e., after adolescence) is itself associated with reduced risk of engaging in substance use over the lifecourse. 6 Thus, the mere presence or absence of 1 or more risk factors does not imply future substance use. For this reason, interactions between risk and protective factors must be examined systematically. We examined the substance use attitudes and behaviors of immigrant and native-born populations to assess the relation between race/ethnicity and nativity and substance use. We analyzed various psychosocial factors relevant to immigrant communities’ experiences with illicit substance use to answer the following research questions: (1) Do perceptions regarding the health and social impacts of illicit substance use vary according to race/ethnicity and nativity? (2) Are race/ethnicity, nativity, and level of perceived risk to health posed by substance use independently associated with illicit substance use? (3) Are other immigration-related measures (e.g., age at immigration, language preferences) independently associated with immigrants’ level of illicit substance use? We hypothesized that persons who migrated to the US as adolescents would be more likely to engage in substance use than would postadolescent immigrants and that individuals indicating a Spanish-language preference (vs English) for survey participation would be less likely to engage in substance use.