Racial and ethnic variations in caregiving-related physical, emotional, and financial strain during COVID-19 among those caring for adult cancer patients.

PURPOSE: Cancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers' emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain. METHODS: We conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race, ethnicity, gender and age. Caregivers had to be adults living in the USA and currently providing unpaid care to an adult cancer patient (i.e., during COVID-19) and prior to the pandemic. We assessed the caregivers' emotional, physical, and financial strain and asked them to compare to preCOVID-19 caregiving. Analyses included descriptive and linear regression adjusting for sociodemographic and caregiving-related variables. RESULTS: A total of 285 caregivers met eligibility, and most were nonHispanic white (72.3%) and female (59.6%). Based on a scale of "1: Much lower" to "5: Much higher", the financial, physical and emotional strain/stress experienced by caregivers compared to preCOVID-19 was, on average, 3.52 (SD: 0.82; range: 1-5) for financial strain, 3.61 (SD: 0.86; range: 1-5) for physical strain, and 3.88 (SD: 0.89; range: 1-5) for emotional stress. NonHispanic black caregivers were significantly more likely than nonHispanic white caregivers to indicate that caregiving-related financial strain was higher than preCOVID-19. Moreover, Hispanic caregivers compared to nonHispanic white caregivers reported caregiving-related emotional stress was higher than preCOVID-19. CONCLUSION: These findings suggest a need to be attentive to racial and ethnic variations in emotional and financial strain and provide targeted support in clinical care and via public policy during a public health crisis.

Validation of the brief scale for the evaluation of acculturation stress in migrant population (EBEA)

Abstract Background: Acculturation stress is associated with poorer physical and mental health and a lower level of psychological well-being. The causes of acculturation stress are diverse, but most are similar in the migrant population. Despite the importance of evaluating this variable, few studies have reported culturally adapted and validated instruments for specific populations. Based on this, the aim of this study was to evaluate the psychometric properties of a short scale for the evaluation of acculturation stress (EBEA). Methods: Two studies were conducted, involving 1725 first-generation Colombian and Peruvian migrants living in Chile, between the ages of 18 and 60 years. In addition to the EBEA and as evidence of validity, the Beck Anxiety Scale and the WHOQOL-BREF psychological health domain were applied. A confirmatory factor analysis was carried out, and the reliability and nomological validity were evaluated. Results: The results in both studies indicated that the scale presents a factorial structure of three dimensions: (a) the stress derived from the preparation and departure from the country of origin, (b) the stress produced by socioeconomic concerns in the host country, and (c) the tensions typical of adaptation to sociocultural changes or Chilean society. The reliability coefficients and the analysis of their nomological validity were very good. Conclusions: The EBEA is a measure that offers quick, useful screening for researchers who need a short measure for research among migrants. This tool contributes to the work of education, prevention, and intervention in the field of general health and migrants' mental health.

Racial Differences in the Biochemical Effects of Stress in Pregnancy.

Prenatal stress has been linked to preterm birth via inflammatory dysregulation. We conducted a cross-sectional study on female participants who delivered live, singleton infants at University of Pittsburgh Medical Center Magee Women's Hospital. Participants (n = 200) were stratified by cumulative risk scores using a combination of individual factors (maternal education, diabetes, hypertension, smoking, relationship status, obesity, depression) and neighborhood deprivation scores. We hypothesized that inflammatory cytokines levels differ by risk group and race. Multiplex analyses of IL-6, IL-8, IL-10, IL-13 and TNF-alpha were run. We found that Black birthing people had more risk factors for chronic stress and had lower levels of IL-6 compared to White birthing people. When stratified by risk group and race, low-risk Black birthing people had lower levels of IL-6 compared to low-risk White birthing people, and high-risk Black birthing people had lower levels of IL-8 compared to high-risk White birthing people. Higher area deprivation scores were associated with lower IL-6 levels. Our results suggest that the relationship between chronic stress and inflammatory cytokines is modified by race. We theorize that Black birthing people encounter repetitive stress due to racism and social disadvantage which may result in stress pathway desensitization and a blunted cytokine response to future stressors.

Do stress, life satisfaction, depression and alcohol use predict quitting among Aboriginal and Torres Strait Islander smokers?

OBJECTIVE: To examine whether baseline measures of stress, life satisfaction, depression and alcohol use predict making or sustaining quit attempts in a national cohort of Aboriginal and Torres Strait Islander smokers. METHODS: We analysed data from the nationally representative quota sample of 1,549 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in the Talking About The Smokes baseline survey (April 2012-October 2013) and the 759 who completed a follow-up survey a year later (August 2013-August 2014). RESULTS: More smokers who reported negative life satisfaction, feeling depressed, higher stress or drinking heavily less often than once a week at baseline made a quit attempt between the baseline and follow-up surveys. In contrast, of these smokers who had made quit attempts between surveys, more who reported higher stress were able to sustain abstinence for at least one month; other associations were inconclusive. Conclusions and implications for public health: Health staff and Aboriginal and Torres Strait Islander smokers need not see being more stressed as an obstacle to quitting among Aboriginal and Torres Strait Islander people. Health staff should emphasise the benefits to mental health that come with successfully quitting smoking.

Symptom-Related Distress among Indigenous Australians in Specialist End-of-Life Care: Findings from the Multi-Jurisdictional Palliative Care Outcomes Collaboration Data.

Symptom relief is fundamental to palliative care. Aboriginal and Torres Strait Islander (Indigenous) Australians are known to experience inequities in health care delivery and outcomes, but large-scale studies of end-of-life symptoms in this population are lacking. We compared symptom-related distress among Indigenous and non-Indigenous Australian patients in specialist palliative care using the multi-jurisdictional Palliative Care Outcomes Collaboration dataset. Based on patient-reported rating scale responses, adjusted relative risks (aRRs) stratified by care setting were calculated for occurrence of (i) symptom-related moderate-to-severe distress and worsening distress during a first episode of care and (ii) symptom-related moderate-to-severe distress at the final pre-death assessment. The p-value significance threshold was corrected for multiple comparisons. First-episode frequencies of symptom-related distress were similar among Indigenous (n = 1180) and non-Indigenous (n = 107,952) patients in both inpatient and community settings. In final pre-death assessments (681 Indigenous and 67,339 non-Indigenous patients), both groups had similar occurrence of moderate-to-severe distress when care was provided in hospital. In community settings, Indigenous compared with non-Indigenous patients had lower pre-death risks of moderate-to-severe distress from overall symptom occurrence (aRR 0.78; p = 0.001; confidence interval [CI] 0.67-0.91). These findings provide reassurance of reasonable equivalence of end-of-life outcomes for Indigenous patients who have been accepted for specialist palliative care.

Illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh: A cross-sectional study.

BACKGROUND: Despite recognition that palliative care is an essential component of any humanitarian response, serious illness-related suffering continues to be pervasive in these settings. There is very limited evidence about the need for palliative care and symptom relief to guide the implementation of programs to alleviate the burden of serious illness-related suffering in these settings. A basic package of essential medications and supplies can provide pain relief and palliative care; however, the practical availability of these items has not been assessed. This study aimed to describe the illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh. METHODS AND FINDINGS: Between November 20 and 24, 2017, we conducted a cross-sectional study of individuals with serious health problems (n = 156, 53% male) and caregivers (n = 155, 69% female) living in Rohingya refugee camps in Bangladesh, using convenience sampling to recruit participants at the community level (i.e., going house to house to identify eligible individuals). The serious health problems, recent healthcare experiences, need for medications and medical supplies, and basic needs of participants were explored through interviews with trained Rohingya community members, using an interview guide that had been piloted with Rohingya individuals to ensure it reflected the specificities of their refugee experience and culture. The most common diagnoses were significant physical disabilities (n = 100, 64.1%), treatment-resistant tuberculosis (TB) (n = 32, 20.5%), cancer (n = 15, 9.6%), and HIV infection (n = 3, 1.9%). Many individuals with serious health problems were experiencing significant pain (62%, n = 96), and pain treatments were largely ineffective (70%, n = 58). The average age was 44.8 years (range 2-100 years) for those with serious health problems and 34.9 years (range 8-75 years) for caregivers. Caregivers reported providing an average of 13.8 hours of care per day. Sleep difficulties (87.1%, n = 108), lack of appetite (58.1%, n = 72), and lack of pleasure in life (53.2%, n = 66) were the most commonly reported problems related to the caregiving role. The main limitations of this study were the use of convenience sampling and closed-ended interview questioning. CONCLUSIONS: In this study we found that many individuals with serious health problems experienced significant physical, emotional, and social suffering due to a lack of access to pain and symptom relief and other essential components of palliative care. Humanitarian responses should develop and incorporate palliative care and symptom relief strategies that address the needs of all people with serious illness-related suffering and their caregivers.

Stress, stressors, and substance use: Differential risk for hookah use among African American college students.

Using differential, multivariable risk models, we assessed the contribution of substance use and stress/traumatic events to hookah use among African American college students (n = 1,402) using data from the Fall 2012 American College Health Association-National College Health Assessment (ACHA-NCHA) II. Lifetime hookah use was 24.8%, with 34.2% of lifetime users having done so in the past 30 days. Compared to nonusers, hookah users had significantly higher use rates of alcohol, marijuana, other tobacco, and other drugs. Furthermore, hookah use was more likely among those with cumulative stress, yet less likely among older students. An implication is that prevention messages may need to be tailored for African American college students and particularly target younger students, substance users, and those with cumulative stress. These findings also inform policy discussions regarding hookah use on college campuses.

Intragroup xenophobic attitudes, ethnic identity, and substance use among Latinx adolescents.

This study examined intragroup xenophobic attitudes, ethnic identity, and substance use (N = 905). Drawing on cognitive dissonance theory, we hypothesized that intragroup xenophobic attitudes among Latinx individuals would be associated with higher levels of substance use (SU) in early adulthood and that ethnic identity would increase the strength of that association. We found that in 10th grade, xenophobic attitudes were higher among respondents with lower ethnic identity, a longer family history in the United States, and less stress. In a longitudinal analysis, SU in emerging adulthood was highest among males, those reporting higher stress in 10th grade, and those with a longer family history in the United States. There was a significant interaction of ethnic identity and xenophobia on substance use (ß = -.12, p < .001), indicating that substance use was higher among Latinxs with low ethnic identity who harbor xenophobic attitudes. Findings are explained using system justification theory because intragroup xenophobia appears to operate as a coping strategy that is maladaptive for Latinx individuals reporting low ethnic identity but somehow useful to those with high ethnic identity.

Idioms of resilience among cancer patients in urban South Africa: An anthropological heuristic for the study of culture and resilience.

Despite the large body of research on idioms of distress in anthropology and transcultural psychiatry, few scholars have examined the concepts that people use to describe social and psychological resilience. The experience of social and psychological resilience is embedded in and shaped by social, political, and economic contexts-much like the factors that shape idioms of distress. As resilience literature more broadly has adopted a socio-ecological rather than trait-based approach, anthropology has much to contribute. This article investigates what idioms of resilience and cultural scripts emerge among low-income patients with cancer residing in Soweto, a peri-urban neighborhood in Johannesburg, South Africa. We conducted 80 life history interviews to better understand what social and psychological factors led some people to thrive more than others despite extraordinary adversity. We describe one idiom of resilience, acceptance (ukwamukela in isiZulu), and three broader themes of resilience that emerged from life history narrative interviews (social support, religious support, and receiving medical care). We also present two examples from study participants that weave these concepts together. Our findings suggest that rarely is one form of resilience experienced in isolation. A focus on idioms of resilience can help chart the complex dimensions of acceptance and the dynamic social, religious, political, and temporal factors that mediate both suffering and resilience within individuals and communities.

Psychosocial Stressors, Depression, and Physical Activity among African Americans.

Objectives: In this study, we examined how racial discrimination and neighborhood perceptions relate to physical activity and sedentary behavior mediated through depression symptoms. Methods: Data were from the first year of a longitudinal cohort study, Project Creating a Higher Understanding of cancer Research and Community Health (CHURCH), based on a convenience community sample of church-attending African Americans collected between April 2012 and March 2013 (N = 370) in Houston, Texas. Measures included racial discrimination, perceived neighborhood problems and vigilance, depression (CES-D), physical activity (IPAQ-short), and sedentary behavior. Results: Main effects from the structural equation model showed that racial discrimination (b = .20, p < .01) was related to greater depression symptoms. The same pattern emerged for neighborhood problems, but the effect was not significant (b = .20, p = .07). Further, depression symptoms were related to less physical activity (b = -.62, p = .03) and greater sedentary behavior (b = .64, p < .01). Indirect effects showed that depression mediated the relationship between racial discrimination and neighborhood problems on physical activity and sedentary behavior. Conclusions: Depression symptoms are an important mechanism by which racial discrimination and perceived neighborhood problems impact physical activity and sedentary behavior.

Disadvantaged neighborhoods and racial disparity in breast cancer outcomes: the biological link.

Neighborhoods encompass complex environments comprised of unique economic, physical, and social characteristics that have a profound impact on the residing individual's health and, collectively, on the community's wellbeing. Neighborhood disadvantage (ND) is one of several factors that prominently contributes to racial breast cancer (BC) health disparities in American women. African American (AA) women develop more aggressive breast cancer features, such as triple-negative receptor status and more advanced histologic grade and tumor stage, and suffer worse clinical outcomes than European American (EA) women. While the adverse effects of neighborhood disadvantage on health, including increased risk of cancer and decreased longevity, have recently come into focus, the specific molecular mechanisms by which neighborhood disadvantage increases BC risk and worsens BC outcomes (survivorship, recurrence, mortality) are not fully elucidated. This review illuminates the probable biological links between neighborhood disadvantage and predominantly BC risk, with an emphasis on stress reactivity and inflammation, epigenetics and telomere length in response to adverse neighborhood conditions.

Associations Between Stress and Cardiovascular Disease Risk Factors Among Million Hearts Priority Populations.

PURPOSE: To estimate the effects of stress on hypertension and high cholesterol with a focus on Million Hearts priority populations. DESIGN: A population-based cross-sectional survey on cardiovascular health and its risk factors. SETTING: Million Hearts cardiovascular community screenings. SAMPLE: Deidentified data were collected on a convenience sample of 59 798 participants. MEASURES: Self-reported stress score using the Perceived Stress Scale-4 (PSS-4), blood pressure, and total cholesterol. ANALYSIS: Descriptive statistics were used to estimate the prevalence of high stress (PSS-4 score ≥ 9), prehypertension or hypertension, and elevated total cholesterol. Multiple logistic regression modeling was used to estimate the effect of stress on the risk of elevated blood pressure and total cholesterol. RESULTS: Twenty-four percent of the participants had high stress. Younger participants had an increased prevalence of high stress than older participants (28% vs 20%, P < .001). African Americans had a high prevalence of stress (26.4%), prehypertension or hypertension (65.4%), and elevated total cholesterol (48.6%). Compared to those with low stress, high stress was associated with significant higher risks of having prehypertension/hypertension (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.28-1.53) and elevated cholesterol (OR = 1.53, 95% CI = 1.41-1.66). CONCLUSIONS: Stress needs to be routinely identified and treated, especially in Million Hearts priority populations. More research is needed in designing culturally sensitive and effectively tailored interventions relative to both stress and disease management.

The Giscombe Superwoman Schema Questionnaire: Psychometric Properties and Associations with Mental Health and Health Behaviors in African American Women.

The purpose of this research was to examine the psychometric properties of the Giscombe Superwoman Schema Questionnaire. Three separate studies conducted with 739 African American women provided preliminary evidence that the Questionnaire's factor structure aligns with the Superwoman Schema Conceptual Framework and has good reliability. In addition, it is positively associated with perceived stress, depressive symptoms, using food to cope with stress, poor sleep quality, and physical inactivity. This study provides preliminary evidence to suggest that the Giscombe Superwoman Schema Questionnaire is psychometrically sound; Superwoman Schema is associated with health behaviors and psychological states that may increase risk for illness.

Cumulative Psychosocial Stress and Ideal Cardiovascular Health in Older Women.

BACKGROUND: Research implicates acute and chronic stressors in racial/ethnic health disparities, but the joint impact of multiple stressors on racial/ethnic disparities in cardiovascular health is unknown. METHODS: In 25 062 women (24 053 white; 256 Hispanic; 440 black; 313 Asian) articipating in the Women's Health Study follow-up cohort, we examined the relationship between cumulative psychosocial stress (CPS) and ideal cardiovascular health (ICH), as defined by the American Heart Association's 2020 strategic Impact Goals. This health metric includes smoking, body mass index, physical activity, diet, blood pressure, total cholesterol, and glucose, with higher levels indicating more ICH and less cardiovascular risk (score range, 0-7). We created a CPS score that summarized acute stressors (eg, negative life events) and chronic stressors (eg, work, work-family spillover, financial, discrimination, relationship, and neighborhood) and traumatic life event stress reported on a stress questionnaire administered in 2012 to 2013 (score range, 16-385, with higher scores indicating higher levels of stress). RESULTS: White women had the lowest mean CPS scores (white: 161.7±50.4; Hispanic: 171.2±51.7; black: 172.5±54.9; Asian: 170.8±50.6; Poverall<0.01). Mean CPS scores remained higher in Hispanic, black, and Asian women than in white women after adjustment for age, socioeconomic status (income and education), and psychological status (depression and anxiety) ( P<0.01 for each). Mean ICH scores varied by race/ethnicity ( P<0.01) and were significantly lower in black women and higher in Asian women compared with white women (ß-coefficient [95% CI]: Hispanics, -0.02 [-0.13 to -0.09]; blacks, -0.34 [-0.43 to -0.25]; Asians, 0.34 [0.24 to 0.45]); control for socioeconomic status and CPS did not change these results. Interactions between CPS and race/ethnicity in ICH models were not significant. CONCLUSIONS: Both CPS and ICH varied by race/ethnicity. ICH remained worse in blacks and better in Asians compared with whites, despite taking into account socioeconomic factors and CPS.

Stress and Resilience: Key Correlates of Mental Health and Substance Use in the Hispanic Community Health Study of Latino Youth.

This study examined associations of immigrant generation, acculturation, and sources of stress and resilience with four outcomes-depression symptoms, anxiety symptoms, alcohol susceptibility, and smoking susceptibility. We used data from 1466 youth (ages 8-16) enrolled in the Hispanic Community Health Study of Latino Youth (SOL Youth), a probability sample of Hispanic/Latino youth living in Chicago (IL), Miami (FL), Bronx (NY), and San Diego (CA). We found no evidence of an immigrant paradox. Greater children's acculturative stress was associated with depression/anxiety symptoms; greater parent's acculturative stress was associated with smoking susceptibility. Family functioning and children's ethnic identity were associated with fewer depression/anxiety symptoms and lower alcohol/smoking susceptibility. Although acculturation-related stressors increase youths' risks for poor mental health and substance use, the development of positive ethnic identities and close, well-functioning family support systems can help protect Latino/Hispanic children from the negative behavioral and health-related consequences of stress.

A Mixed-Methods Study to Examine the Role of Psychosocial Stress and Air Pollution on Hypertension in Mexican-Origin Hispanics.

PURPOSE: Independent and combined effects of air pollution and psychosocial stressors on hypertension, a risk factor for cardiovascular disease, among Hispanics are not well studied. METHODS: We administered a pilot-tested questionnaire on individual- and neighborhood-level psychosocial stressors, developed with community input, to nearly 2500 individuals from the MD Anderson Cancer Center cohort of Mexican-Americans. We used data from local air quality monitors to estimate individual exposures to ozone (O3) and fine particulate matter (PM2.5) for the 12-month period preceding enrollment using inverse distance interpolation. We applied logistic regression models to examine relationships between exposures to psychosocial stressors and air pollution with prevalent hypertension and used stratified analyses to examine the interacting effects of these two exposures on hypertension. RESULTS: There was a positive association between prevalent hypertension and a high frequency of feeling anxious or depressed (prevalence odds ratio (POR) = 1.36, 95% CI [1.06-1.75]) and experiencing aches and pains (POR = 1.29, 95% CI [1.01-1.64]). The odds of having hypertension were also elevated among those worrying about their own health (POR = 1.65, 95% CI [1.30-2.06]) or about not having enough money (POR = 1.27, 95% CI [1.01-1.6]). We observed an inverse association between O3 and hypertension. There was no interaction between psychosocial stressors and O3 on hypertension. CONCLUSION: Our findings add to the evidence of a positive association between individual and family stressors on hypertension among Hispanics and other racial/ethnic groups. Contrary to previous studies reporting positive associations, our results suggest that long-term exposure to O3 may be inversely related to prevalent hypertension.

Interrelatedness of Distress Among Chinese-Speaking Patients and Family Caregivers.

BACKGROUND: Cancer is a family disease, affecting the individual patient and the family. For Chinese patients and their families in Canada, adjusting to cancer may be particularly distressing when culture and language are not congruent with the mainstream model of care delivery. OBJECTIVE: In view of the limited research on the cancer experience of Chinese families, this study aims to examine the interrelatedness of patients and family caregivers' distress among a Chinese-speaking cancer population in Canada. METHODS: Semi-structured interviews were conducted with a purposive sample of 10 Chinese-speaking cancer patients and 6 family caregivers. Qualitative analysis of the interview data was conducted to construct cross-cutting themes regarding the experiences of distress after a cancer diagnosis. RESULTS: Four overarching themes emerged from the analysis: (1) misconception about cancer, (2) tensions in disclosure, (3) patient and family caregiver distress, and (4) concealing emotion in patient and family caregiver. Notably, the interrelatedness of patients and family caregivers' distress was highlighted, as patients and family caregivers both sought to regulate their own emotions to protect one another's mental well-being. CONCLUSION: The study provides insights into the distress of living with cancer and the impact on family relationships. Understanding the patients and family members' cultural and social contexts also provides the foundation for patient- and family-centered care. IMPLICATIONS FOR PRACTICE: Healthcare professionals can provide culturally appropriate care by recognizing the needs, values, and beliefs of cancer patients and their families. Furthermore, the patient-family-caregiver dyad needs to be considered as the unit of care.

Goal-Striving Stress Is Associated with Chronic Kidney Disease Among Participants in the Jackson Heart Study.

OBJECTIVE: Research that assesses the relationship between psychosocial factors and chronic kidney disease (CKD) among African Americans (AAs) is limited. Using the Jackson Heart Study (JHS) cohort data, we investigated the association of goal-striving stress (GSS)-the stress experienced from not reaching goals-with prevalent CKD among AAs. DESIGN: This was a cross-sectional analysis of JHS exam 1 data that assessed the relationship between GSS and CKD. SETTING AND PARTICIPANTS: We utilized a sample from the JHS (n = 4967), an AA sample of women and men, 35-84 years old from the Jackson, MS metro area. MAIN OUTCOME MEASURES: The baseline relationship between GSS levels (low, moderate, and high) and CKD (eGFR < 60 mL/min/1.73m2) was evaluated using a logistic regression model to estimate odds ratios (OR) on a 95% confidence interval (CI). The final model was adjusted for sex, age, socioeconomic status, health behaviors, risk factors, and total stress. RESULTS: After full adjustment, the odds of prevalent CKD increased by 52% (OR 1.52; 95% CI 1.04, 2.24) for those reporting high (versus low) GSS. CONCLUSIONS: Deficiencies between goal aspiration and achievement were associated with prevalent CKD. Potential interventions might consider the impact GSS contributes to prevalent CKD.

Education Moderates the Relationship Between Spirituality with Quality of Life and Stress Among Malay Muslim Women with Breast Cancer.

The purpose of this study was to investigate the relationship between spirituality with quality of life and stress of Malay Muslim breast cancer patients in Malaysia. In addition, the moderating role of education on this relationship was examined. Participants consisted of 145 conveniently selected Malay breast cancer patients. The results indicated that the more spiritual respondents reported a higher level of quality of life and lower level of stress. Moreover, education weakened the relationship between spirituality with quality of life and stress.

Family stress processes and drug and alcohol use by Mexican American adolescents.

The present study examines the influence of economic and family stress processes on change in drug and alcohol use in a cohort of 478 Mexican American youth (50.8% female) followed longitudinally beginning in Grade 5 when the youth averaged 10.4 years of age. Adolescents, their mothers (median age 36 at Grade 5), and their fathers (median age 39 at Grade 5) were assessed on economic hardship (Grades 5 through 7), family stress processes (Grades 5 through 9), and adolescent substance use (Grades 7 through 9). Hypotheses were derived from a culturally informed family stress model (FSM), which proposes that economic hardship initiates a sequential cascade of problems involving parents' emotional distress, interparental conflict, disruptions in parenting and increased risk for adolescent substance use. Structural equation modeling was used to test these hypothesized linkages and the findings were consistent with predictions derived from the FSM. The results also demonstrated that parents' familism moderated the association between parent distress and interparental conflict, acting as a source of resilience in this family stress process. Findings suggest that prevention and intervention efforts focused on reducing caregiver distress and interparental conflict and enhancing parenting practices, as well as policies that reduce the level of economic hardship experienced by families, may aid in the reduction of adolescent substance use. Additionally, interventions focused on facilitating the cultural value of familism may promote more positive interactions between Mexican American parents which, in turn, may promote more effective parenting practices that help to reduce the risk for adolescent substance use. (PsycINFO Database Record (c) 2018 APA, all rights reserved).