Suicidal behaviors among Latina adolescents: An ecodevelopmental approach and narrative review.

INTRODUCTION: For the past several decades, Latina adolescents have consistently shown high rates of suicidal behaviors (i.e., suicidal ideation, planning, and attempts), higher than Latino adolescents and adolescents of most other ethnic groups. Yet, progress toward establishing evidence-based intervention efforts to address this urgent public health issue has been slow. The purpose of this narrative review is to summarize empirical findings on etiological factors associated with Latina adolescent suicidal behaviors using an ecodevelopmental, gender-specific framework that contextualizes Latina adolescent development. METHODS: To be included, peer reviewed empirical manuscripts had to focus on suicidal behaviors (i.e., suicide attempts, suicide plan, and/or suicidal ideation) of adolescents (ages 11-19 or in grades 7-12) who self-identified as either Latina or Hispanic and a girl in the United States. RESULTS: A total of 19 studies met review criteria and focused on microsystemic and intrapersonal predictors. Microsystemic predictors included family (i.e., family-adolescent discrepancies in acculturation, family functioning, family-daughter interactions), peer (i.e., victimization, friendships), and school (i.e., functioning, achievement) factors, while intrapersonal predictors were emotional vulnerability, psychosocial functioning, and substance use. CONCLUSIONS: Family-related phenomena were the most widely studied. Research on school and peer microsystems was comparatively sparse, and several promising intrapersonal development factors have been underexplored. A notable limitation of existing studies is that samples consisted primarily of U.S.-born adolescents living in urban areas. Additional research is needed to characterize factors on other ecodevelopmental levels, identify resilience processes, and examine within-group diversity among Latina adolescents. Implications for intervention and future directions are discussed.

Motivational pathways to problematic drinking among Latinx college drinkers.

Though Latinx drinkers experience disparities in problematic drinking, emerging mechanisms that lead to these disparities remain understudied. The objective of this study was to examine drinking motives as the most proximal pathways to problematic drinking that mediate the effects of personality and sociocultural distal antecedents among Latinx college drinkers. A total of 264 Latinx undergraduate drinkers (67% cisgender women, 31% cisgender men, 2% gender fluid/nonconforming individuals) completed a battery of self-report measures assessing problematic drinking, drinking motives, alcohol expectancies, sensation seeking, stress, campus climate, injunctive peer drinking norms, and familismo. Consistent with hypotheses, structural equation modeling revealed that coping motives were the strongest predictors of problematic drinking. Stress, campus climate, and alcohol expectancies were indirectly associated with problematic drinking through coping motives. Unexpectedly, sensation seeking had a direct effect on problematic drinking while familismo was not a protective factor. Stress and campus climate emerged as two important sociocultural antecedents associated with problematic drinking through coping motives. Findings also generally support the tenets of motivational models of alcohol use and extend their applicability to Latinx college drinkers. Results highlight the need for culturally responsive interventions that address motivational pathways to problematic drinking within the sociocultural environment in which Latinx college drinkers are embedded. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Facilitating Change in Drinking Cognitions and Behaviors Among Three Immigrant Generations of Latinx Youth Through a School-Based Intervention: Findings From a Multi-Site Clinical Trial.

Latinx youth experience disparities in the availability of and participation in evidence-based interventions to reduce hazardous alcohol use. The aim of this secondary data analysis was to examine whether Project Options, a brief, evidence-based alcohol use intervention was beneficial for Latinx participants. A total of 331 first-, second-, and third-generation immigrant Latina and Latino youth who participated in a multi-site, hybrid effectiveness/efficacy clinical trial of the intervention were selected for analyses. Mixed-effects growth models tested changes in drinking cognitions (i.e., perception of peer drinking, intention to drink next month, alcohol use and cessation expectancies) and behaviors (i.e., number of past-month drinking days, average number of drinks per occasion, and maximum number of drinks per occasion) across three time points (i.e., baseline, 4-weeks, and 12-weeks). Consistent with prior Project Options studies, participants with more drinking experience reported greater decreases in perception of peer drinking, intentions to drink next month, and all drinking behaviors than those with less experience. While no changes were observed in expectancies, first-generation participants endorsed lower positive use expectancies than second- and third-generation youth as well as more favorable cessation expectancies than third-generation teens. In concert with prior studies demonstrating the intervention's success in recruitment and retention of Latinx participants, results suggest that Project Options might be a promising school-based intervention for Latinx youth. This intervention has the potential to reach adolescents who might otherwise not participate in traditional programming and help decrease disparities in availability of evidence-based practices for Latinx youth.

Impact of Ethnic Composition on Mechanisms of Change in School-Based Substance Use Intervention Groups.

Delivering alcohol use intervention services in the school setting represents a key approach to engaging youth of all backgrounds, particularly underserved populations, in such programming. Relative progress has been made toward implementing culturally responsive services for youth; however, little is known about the role of ethnic composition on group processes purported to underlie mechanisms of change. We examined associations between ethnic group composition and therapeutic processes within a voluntary, school-based alcohol use intervention at seven schools across three cities (N groups = 353). Ethnic composition was characterized as: group ethnic diversity on a continuum, group ethnic homogeneity (i.e., where at least 66% of participants shared the same ethnicity), and comparing groups where one of the three largest ethnicities in the sample reached the majority (i.e., African-American vs. Hispanic vs. non-Hispanic white). Ratings on group processes were obtained from participants (satisfaction; belonging), facilitators (empathy; rapport), and coders (engagement; responsiveness). Mixed-effects models revealed that students in groups with African-American and Hispanic majorities reported a higher sense of satisfaction compared to groups with non-Hispanic white majorities. Facilitators endorsed expressing empathy more frequently with majority African-American and Hispanic groups than with non-Hispanic white groups. Study findings highlight the importance of considering different dimensions of ethnic composition when examining mechanisms of change in group intervention research.

Effects of sex composition on group processes in alcohol prevention groups for teens.

Although most alcohol and other drug prevention programs for adolescents are offered in group settings, little is known about the possible effects of sex composition on group processes and mechanisms of change. Using the Group Actor-Partner Interdependence Model framework, we examined how the sex constellation of adolescent prevention group members influenced youth satisfaction, engagement, and endorsement of healthy behavior during group. Participants in Project Options (N = 379; 61.8% girls; Mage = 16.1; SD = 1.4), a voluntary school-based alcohol prevention program, completed measures of satisfaction at each prevention session and observers rated engagement and change talk for each group. When analyses were oriented toward girls, their personal satisfaction, group-rated satisfaction, and group-level engagement were positively related to having more girls in the group. Similarly, in boys, personal satisfaction, satisfaction of the group as a whole, and engagement in groups improved when groups were composed of more girls. Statements supportive of healthy alcohol/drug-related decision making were unrelated to group composition. The findings suggest that the composition of girls and boys in groups has differential effects on some group processes. This avenue of research has merit for understanding the mechanisms associated with satisfaction and engagement in adolescent substance use prevention programs.

Ecodevelopmental predictors of early initiation of alcohol, tobacco, and drug use among Hispanic adolescents.

The purpose of this cross-sectional study was to test the transactional relationships of risk and protective factors that influence initiation of alcohol, tobacco, and drug use among Hispanic youth. Ecodevelopmental theory was used to identify factors at multiple ecological levels with a focus on four school-level characteristics (i.e. school socioeconomic status, school climate, school acculturation, and school ethnic composition). A sample of 741 Hispanic adolescents (M age=13.9, SD=.67) and their caregivers were recruited from 18 participating middle schools in Miami-Dade County, FL. Structural equation modeling was used to test the hypothesized ecodevelopmental model of early substance use, accounting for school clustering effects. Results provided strong support for the model (CFI=.95; RMSEA=.03). School SES was indirectly related to the likelihood of starting substance use through perceived peer use norms (ß=.03, p<.02). Similarly, school climate had an indirect effect on substance use initiation through family functioning and perceptions of peer use norms (ß=-.03, p<.01). Neither school ethnic composition nor school acculturation had indirect effects on initiation of substance use. Results highlight the importance of the interplay of risk and protective factors at multiple ecological levels that impact early substance use initiation. Further, findings underscore the key role of school level characteristics on the initiation of substance use and present opportunities for intervention.

Differences in quit attempts between non-Hispanic Black and White daily smokers: the role of smoking motives.

INTRODUCTION: The prevalence of smoking across racial/ethnic groups has declined over the years, yet racial health disparities for smoking persist. Studies indicate that non-Hispanic Black smokers attempt to quit smoking more often compared to non-Hispanic White smokers but are less successful at doing so. Research suggests that motives to quit smoking differ by race, however, less is known about the role of motives to smoke in explaining racial differences in attempts to quit smoking. METHODS: This study examined whether smoking motives accounted for the differential rates in quit attempts between non-Hispanic Black (n=155) and non-Hispanic White (n=159) smokers. Data were culled from a larger study of heavy-drinking smokers. The Wisconsin Index of Smoking Dependence Motives (WISDM) assessed motives to smoke. RESULTS: As expected, Black and White smokers reported similar smoking patterns, yet Black smokers reported higher rates of failed attempts to quit smoking than White smokers. Findings indicated that Black, compared to White, smokers endorsed lower scores in the negative reinforcement, positive reinforcement, and taste WISDM subscales and scores in these subscales mediated the relationship between race and quit attempts. CONCLUSIONS: In this study, Blacks, compared to Whites, endorsed lower motives to smoke, which are generally associated with successful quit attempts, yet they experienced more failed attempts to quit smoking. This study demonstrates racial health disparities at the level of smoking motives and suggests that Black smokers remain vulnerable to failed quit attempts despite reporting lower motives to smoke.

Determinants of problem drinking and depression among Latino Day laborers.

Little is known about alcohol misuse and depression among Latino day laborers despite the fact that they encounter multiple stressors (e.g., job instability, unsafe work environments). A structural equation model tested the relationships among laborer stress, social support, health status, current alcohol misuse, and depression. A sample of 89 male, urban Latino day laborers completed measures assessing these constructs in 2011. Stress was negatively related to physical health status, which was associated with depression. Findings suggest that stressors specific to being a day laborer resulting from their work and living conditions generate and maintain health disparities in this vulnerable population.

Alcohol use following an alcohol challenge and a brief intervention among alcohol-dependent individuals.

BACKGROUND AND OBJECTIVES: The study examined the effects of an alcohol challenge on naturalistic drinking among alcohol-dependent individuals and explored brief motivational interviewing (MI) as a potential intervention for these participants. METHOD: Alcohol-dependent individuals (n = 32, eight females) completed the intake assessment, alcohol challenge, one MI session, and 1-month follow-up (87.5% retention) where they completed measures of drinking and motivation for change. RESULTS: As expected, multilevel mixed models revealed that drinking did not increase post-alcohol challenge. Participants reported a reduction in ambivalence, drinking days, and a trend towards fewer total drinks between the MI and 1-month follow-up. CONCLUSIONS: Consistent with other studies, the alcohol challenge did not worsen alcohol use. Results support further investigation of brief MI for alcohol-dependent participants in alcohol challenges. SCIENTIFIC SIGNIFICANCE: Alcohol administration to alcohol-dependent participants appears to not exacerbate naturalistic drinking. MI may be a feasible intervention for non-treatment seeking alcohol-dependent participants in alcohol challenge studies.

Modeling alcohol use disorder severity: an integrative structural equation modeling approach.

BACKGROUND: Alcohol dependence is a complex psychological disorder whose phenomenology changes as the disorder progresses. Neuroscience has provided a variety of theories and evidence for the development, maintenance, and severity of addiction; however, clinically, it has been difficult to evaluate alcohol use disorder (AUD) severity. OBJECTIVE: This study seeks to evaluate and validate a data-driven approach to capturing alcohol severity in a community sample. METHOD: Participants were non-treatment seeking problem drinkers (n = 283). A structural equation modeling approach was used to (a) verify the latent factor structure of the indices of AUD severity; and (b) test the relationship between the AUD severity factor and measures of alcohol use, affective symptoms, and motivation to change drinking. RESULTS: The model was found to fit well, with all chosen indices of AUD severity loading significantly and positively onto the severity factor. In addition, the paths from the alcohol use, motivation, and affective factors accounted for 68% of the variance in AUD severity. Greater AUD severity was associated with greater alcohol use, increased affective symptoms, and higher motivation to change. CONCLUSION: Unlike the categorical diagnostic criteria, the AUD severity factor is comprised of multiple quantitative dimensions of impairment observed across the progression of the disorder. The AUD severity factor was validated by testing it in relation to other outcomes such as alcohol use, affective symptoms, and motivation for change. Clinically, this approach to AUD severity can be used to inform treatment planning and ultimately to improve outcomes.

Craving and subjective responses to alcohol administration: validation of the desires for alcohol questionnaire in the human laboratory.

OBJECTIVE: The abbreviated Desires for Alcohol Questionnaire (DAQ) is a self-report assessment of craving comprising the following subscales: (a) strong desires/intentions to drink, (b) negative reinforcement, and (c) positive reinforcement and ability to control drinking. Although the DAQ is sensitive to changes in alcohol craving precipitated by alcohol administration and/or cue exposure, no studies to date have examined the relationship between DAQ scores and subjective responses to alcohol. This study addresses this gap in the literature by testing the relationship between subjective responses to alcohol during alcohol administration and DAQ scores assessed 1 month later. METHOD: Individuals with alcohol dependence (n = 32) completed a randomized, single-blinded, intravenous alcohol administration in the laboratory in which subjective responses to the alcohol were measured, followed by a visit to the laboratory 1 month later to complete the DAQ. RESULTS: Analyses revealed robust associations between DAQ scores and alcohol craving during alcohol administration (partial correlations: r = .43-.50, ps < .01), with the exception of the positive reinforcement subscale (r = .20, p = .30). Subjective intoxication and sedation were only associated with the negative reinforcement subscale of the DAQ (r = .38, p < .05 and r = .33, p < .05, respectively). CONCLUSIONS: Craving, captured by the DAQ, is reliably and positively associated with alcohol-induced craving. The DAQ is also associated with specific dimensions of subjective responses to alcohol. These results support the clinical utility of the DAQ, particularly in large samples where experimental manipulations may not be feasible.

Ecodevelopmental and intrapersonal moderators of a family based preventive intervention for Hispanic youth: a latent profile analysis.

Hispanic adolescents are disproportionately affected by externalizing disorders, substance use and HIV infection. Despite these health inequities, few interventions have been found to be efficacious for this population, and even fewer studies have examined whether the effects of such interventions vary as a function of ecodevelopmental and intrapersonal risk subgroups. The aim of this study was to determine whether and to what extent the effects of Familias Unidas, an evidence-based preventive intervention, vary by ecodevelopmental and intrapersonal risk subgroups. Data from 213 Hispanic adolescents (mean age = 13.8, SD = 0.76) who were enrolled in a randomized clinical trial evaluating the relative efficacy of Familias Unidas on externalizing disorders, substance use, and unprotected sexual behavior were analyzed. The results showed that Familias Unidas was efficacious over time, in terms of both externalizing disorders and substance use, for Hispanic youth with high family ecodevelopmental risk (e.g., poor parent-adolescent communication), but not with youth with moderate ecodevelopmental or low ecodevelopmental risk. The results suggest that classifying adolescents based on their family ecodevelopmental risk may be an especially effective strategy for examining moderators of family-based preventive interventions such as Familias Unidas. Moreover, these results suggest that Familias Unidas should potentially be targeted toward youth with high family ecodevelopmental risk. The utility of the methods presented in this article to other prevention scientists, including genetic, neurobiological and environmental scientists, is discussed.

Drinking initiation and problematic drinking among Latino adolescents: explanations of the immigrant paradox.

Studies indicate that U.S.-born Latino teens exhibit higher rates of alcohol use compared with their foreign-born counterparts. Different hypotheses have been advanced to explain the mechanisms underlying this immigrant paradox, including the erosion of protective cultural factors across generations and increased exposure to risky peer environments in the United States. The present study examined whether the immigrant paradox applies to drinking initiation and problematic drinking among Latino adolescents, and tested whether generational differences in family protective factors and peer risk factors might explain the immigrant paradox. A nationally representative sample of Latino teens (N = 2,482) of Cuban, Mexican, and Puerto Rican origin from 3 immigrant generations (21% first generation, 33% second generation, and 46% third and later generations) was obtained from the National Longitudinal Study of Adolescent Health. Logistic and negative binomial regression models indicated that early drinking initiation and problematic alcohol use were more prevalent among later-generation youth, supporting the immigrant paradox. Erosion of family closeness and increased association with substance-using peers mediated the relationship between generation and alcohol use patterns in this sample. Results provide support for culturally sensitive interventions that target peer perceptions of substance use and bolster protective family values among Latino adolescents.

The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: main effects and interaction effects by parental stress and social support.

INTRODUCTION: Drug and alcohol use disproportionately affect Hispanic youth. Despite these disparities, few empirically supported preventive interventions are available to ameliorate this public health concern among Hispanic youth. This study examined the effects of Familias Unidas, relative to Community Practice, in reducing past 90-day substance use, alcohol and marijuana dependence, and having sex while under the influence of alcohol or drugs. Additionally, this study explored whether Familias Unidas' effects varied by environmental context, namely parental stress and social support for parents. METHODS: A total of 242 delinquent Hispanic youth aged 12-17 years and their primary caregivers were randomized to either Familias Unidas or Community Practice and assessed at three time points. RESULTS: Familias Unidas was efficacious in reducing past 90-day substance use, illicit drug use, and in reducing the proportion of youth with an alcohol dependence diagnosis, relative to Community Practice. Results also showed a reduction in the proportion of youth who reported having sex while under the influence of alcohol or drugs. No differences between conditions were observed in past 90-day alcohol use or marijuana dependence. Intervention effects on illicit drug use and alcohol dependence varied by environmental context. For example, Familias Unidas was most efficacious for adolescents with parents exhibiting high stress and lower levels of social support. CONCLUSIONS: Familias Unidas was efficacious in reducing some drug and alcohol related outcomes. The findings also support the concept of targeting family-based interventions, such as Familias Unidas, for adolescents with parents exhibiting high stress and low levels of social support.