Technical and relational process in MI sessions with a sample of Hispanic/Latinx adults who engage in heavy drinking: A latent growth mediation model.

The current study tests the Motivational Interviewing (MI) technical and relational hypotheses in a sample of Hispanic/Latinx adults (N = 276) who engage in heavy alcohol consumption. MI causal theory hypothesizes that therapist use of MI consistent skills (i.e., technical hypothesis) and embodiment of the MI Spirit (i.e., relational hypothesis) will elicit client change talk, which is a putative mechanism of positive client outcome after the session. We tested these associations in a rigorous parallel process latent growth curve mediation modeling framework. The data are from a completed randomized clinical trial of a culturally-adapted (CAMI) versus un-adapted MI targeting hazardous alcohol use and consequences. Results. The unconditional growth models for the mediator (i.e., proportion of change talk relative to sustain talk) and two study outcomes (i.e., percent of heavy drinking days; alcohol-related consequences) showed a linear effect over a 12-month period with a slower rate of growth at later timepoints. Contrary to expectations, the latent growth mediation models did not show relationships between MI-consistent skills (i.e., technical predictor) or latent MI Spirit (i.e., relational indicator) and the slope factor for proportion change talk. The slope factor for proportion change talk was also not associated with the slope factors for percent heavy drinking and consequences over follow-up. Conclusions. In this novel population for MI process analysis, the technical and relational hypotheses were not supported. Studies that are exploratory may be needed to further investigate the causal model in populations that are not often represented in MI process research.

Examining a Race-Sex Interaction Effect on Binge Drinking Among Afro-Latina/o Adults in the US.

Latinx/es are often racially homogenized in alcohol use disparities research, leaving the behavioral and mental health status of Afro-Latinx/es unknown. Though Latina/o and Black adults consume less alcohol than non-Latina/o Whites, they may binge drink to cope with discrimination. Gendered racism uniquely and negatively affects Black women's psychological well-being and may increase their chances of engaging in risky drinking. This may be the case for Afro-Latina women, but no study has disaggregated alcohol use disparity outcomes among a nationally representative sample of Latina/o adults by race and sex. This study (1) examines the relationship between racial self-classification (White-Latina/os vs. Afro-Latina/os) and binge drinking in the past year and (2) tests whether sex (male vs. female) moderates the relationship between race and binge drinking. Secondary data that included a respondent sample of 9415 Latina/o adults was obtained and analyzed from the 2013-2018 National Health Interview Survey. Multivariate analyses included logistic regression models to assess the main effects of race, sex, and interaction effect of the two on binge drinking while controlling for sociodemographic variables. The probability of Afro-Latina/o adults binge drinking trends lower than White-Latina/os. Respondents' sex moderated the association between racial self-classification and binge drinking. We discuss racial identity salience, mujerismo, and gendered racism as possible protective and risk factors for Afro-Latina/os and Afro-Latina women to contextualize these findings.

Intersectional forms of racism and sexual minority stress are associated with alcohol use among Latinx sexual minority men with greater Hispanic/Latinx cultural orientation.

Background: Latinx sexual minorities with increased levels of acculturation report higher rates of alcohol use, and discrimination may impact this association. Yet, there is little research examining the concomitant impact of racism and sexual minority stress (i.e. intersectional discrimination) and the additive effect of acculturation on Latinx sexual minority men's risk for hazardous alcohol consumption.Objectives: This study investigated the role of perceived stressfulness of intersectional discrimination in the relation between acculturation (US cultural orientation/Hispanic cultural orientation) and alcohol use among Latinx sexual minority men.Methods: A structural equation model was utilized to test the indirect effect of discrimination between acculturation and alcohol use with a sample of 357 Latinx sexual minority men (Mage = 28.39) recruited via Amazon MTurk.Results: The indirect effect between the Hispanic cultural orientation to alcohol use through intersectional forms of discrimination was significant and positive (b = .19, SE = .03, p < .01). The indirect effect for the US cultural orientation to alcohol use through intersectional forms of discrimination was significant and negative (b = -.10, SE = .03, p < .01).Conclusion: Contrary to previous literature, Latinx sexual minority men with a higher Hispanic cultural orientation reported higher levels of intersectional forms of discrimination, which in turn was associated with increased alcohol use. Those with a higher US cultural orientation reported lower levels of intersectional forms of discrimination, which in turn was associated with decreased alcohol use. These findings may help identify mechanisms that exacerbate health disparities for Latinx sexual minority men.

The role of the relational context and therapists' technical behaviors in brief motivational interviewing sessions for heavy alcohol consumption: Findings from a sample of Latinx adults.

INTRODUCTION: Motivational interviewing (MI) theory and process research highlights the role of therapist technical and relational behaviors in predicting client in-session statements for or against behavior change (i.e., change and sustain talk, respectively). These client statements, in turn, have been shown to predict intervention outcomes. The current study examines sequential associations between therapist behaviors and client change and sustain talk in a sample of Latinx individuals who engage in heavy alcohol consumption. DATA: Data are from a completed randomized clinical trial of a culturally adapted (CAMI) versus unadapted MI targeting alcohol use and consequences among Latinx individuals. METHOD: The study collected observational coding data with the Motivational Interviewing Skill Code (MISC 2.5, i.e., therapist behaviors and global ratings) and the Client Language Assessment - Proximal/Distal (CLA-PD, i.e., client language). Frequentist and Bayesian sequential analyses examined the relationship among nine different categories of therapist behaviors and three different categories of client language (i.e., change talk, sustain talk, neutral). We examined odds ratios and conditional probabilities for the direction, magnitude, and significance of the association between the use of MI technical behaviors and subsequent client statements about change. The study compared these same transitional associations between low/average (i.e., <4) and high (i.e., ≥4) MI Spirit sessions. RESULTS: The pattern of results was replicated across both analytic frameworks. Questions and reflections about change talk versus sustain talk versus neutral statements showed greater odds of predicting the intended client response (i.e., change talk, sustain talk, neutral, respectively) compared to other possible client responses. Conditional probabilities for these transitions were high, ranging from 0.55 to.88. The magnitude of certain technical transitions significantly differed between low/average and high MI Spirit sessions. CONCLUSIONS: Analyses supported the hypothesized associations between therapist use of technical MI behaviors and client change language within this Latinx sample. Analyses of MI Spirit as a moderator of these transitions showed partial support.

Latinx Sexual Minority Adolescent Substance Use: State of the Science and Call for Intersectional Minority Stressors and Protective Factors.

Purpose of review: Latinx sexual minority adolescents (LSMA) are at an intersection of ethnic and sexual minority (SM) status and may experience heighten risk of substance use and related problems. These youth may also hold unique protective factors that help mitigate the effects of minority stress and curb substance use. Little is known, however, about the intersectional minority stressors (i.e., due to ethnicity and SM status) and protective factors related to substance use among this population. Recent Findings: According to the minority stress model, there are unique minority stressors and resiliency factors that can help explain differences in behavioral health rates between white SM and SM of color. Research supports the notion that minority stressors (e.g., stigma/risk, homophobic bullying, and family rejection of SM status) confer risk for substance use among LSMA. In terms of resilience, less is known, but there may be some protective factors that have not been measured that could explain lower rates in some substances (i.e., club drugs and methamphetamine). Summary: Little is known about how the intersections of ethnicity and SM status are associated with substance use in adolescence. Future research should assess the temporal relationship of multilevel (i.e., intrapersonal, relational, and system), intersectional (i.e., ethnicity and SM status) minority stressors and protective factors unique to LSMA on substance use. We propose that the findings from these future studies will help to create socioculturally appropriate behavioral health treatments that consider the intersectional risks and strengths within the LSMA population.

Racialization and Psychological Distress among U.S. Latinxs.

This study investigated the relationship between race and psychological distress among Latinxs in the United States. Using data from the National Health Interview Survey (NHIS) 2010-2018, we estimated the relative risk ratios (RRR) of experiencing psychological distress among White, Black and Other Latinxs from Mexico, Cuba, Dominican Republic, and Puerto Rico. Results revealed that Black Latinxs experienced higher levels of psychological distress than their White counterparts. Additional analysis among and within groups showed that Puerto Ricans and Dominicans reported higher psychological distress than Mexicans, and that race was associated with the distress of Cubans and Mexicans, but not with the distress of Puerto Ricans and Dominicans. Future work on the effect of racial self-identification on Latinxs' mental health-related outcomes, such as psychological distress, should include multidimensional measures of racial identity, such as self-reported and ascribed race, racial ideology, as well as measures of skin color and discrimination. Integrating racialization experiences during clinical assessments would help practitioners to gain a more comprehensive picture of how these identities and experiences may shape the stress, distress, and mental health outcomes (e.g., depression, anxiety) of different racial and ethnic Latinx groups in the U.S.

Experiences of Ethnic Discrimination Among US Hispanics: Intersections of Language, Heritage, and Discrimination Setting.

BACKGROUND: Informed by Latino Critical Race Theory, the present study examined how intersections between English use/proficiency, Spanish use/proficiency, and heritage group shape the varying experiences of ethnic discrimination reported by US Hispanic adults. METHODS: The study utilized data from 7,037 Hispanic adults from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. Multivariable binomial logistic regression modeled language use/proficiency, heritage, and demographic characteristics as predictors of past-year self-reported perceived ethnic discrimination, overall and in six different settings. RESULTS: Both English and Spanish use/proficiency were positively associated with increased adjusted odds of reporting ethnic discrimination overall, in public, or with respect to employment/education/ housing/courts/police; however, with respect to being called a racist name or receiving verbal/physical threats/assaults, a positive association was observed for English, yet not Spanish. Results also indicated a significant interaction between English use/proficiency and Spanish use/proficiency when predicting past-year ethnic discrimination overall or for any of the six types/settings examined, although the relationship between language use/proficiency and ethnic discrimination varied by Hispanic heritage group. CONCLUSION: Study findings emphasize that experiencing some form of ethnic discrimination is relatively common among US Hispanic adults, yet the prevalence and types or settings of ethnic discrimination vary widely on the basis of demographics, immigrant generation, heritage, and the interplay between English and Spanish use/proficiency.

Examining client self-exploration in motivational interviewing: Preliminary psychometrics of an observational rating measure.

PURPOSE: We examine in-session self-exploration among Latinx heavy drinkers who received a motivational interview (MI) to reduce heavy drinking. The goals of this study are to report the validity and reliability of an adaptation of the Global Client Rating for Self-Exploration from the Motivational Interviewing Skill Code (MISC SE). METHOD: The study measured the MISC SE as three subscales (Emotional, Cognitive, New Learning/Developing Discrepancy SE) to assess underlying processes that might allow for higher predictive validity in relation to behavioral change (drinking) outcomes. The study created a dichotomous variable, Personally Relevant Vulnerable Making (PR-VM), to distinguish the disclosure of particularly sensitive material related to drinking behavior. The study used the measure of Everyday Discrimination as a criterion variable for the PR-VM measure. The study collected observationally rated data for n = 158 participants. RESULTS: Subscales showed moderate correlations with the MISC SE (r = 0.421 to 0.574, p < .001). The MISC SE was not associated with number of drinking days or percent heavy drinking days at 3-month follow-up. Cognitive and New Learning/Developing Discrepancy SE were associated with fewer drinking days (r = -0.247 to -0.266, p < .005), and Cognitive SE was associated with percent heavy drinking days (r = -0.169, p < .05), Subscale interrater reliability was comparable to the MISC SE (ICC = 0.72 to 0.86). The study observed higher mean scores on the Everyday Discrimination scale when session PR-VM was present than when not present (t (df = 118) = -3.02, p < .005). CONCLUSIONS: The subscale adaptation of the SE measure may provide a sensitive approach to understanding how self-exploration relates to behavior change in the context of MI.

Latinx Use of Traditional Health Care: The Social Network Effect.

Studies on access to health care among Latinx communities have overlooked (a) the use of traditional healers and (b) the role of social networks in seeking traditional healers. Framed within the network-episode model, this study aimed to examine the role of individual, institutional, and personal network systems in the use of curanderxs among Latinxs in the United States. Using a nationally representative sample of Latinx adults (N = 3,997) from the 2007 Hispanic Healthcare Survey, authors conducted multivariate logistic regression analyses to investigate the impact of individual, institutional, and personal network systems on the use of curanderxs. Respondents who believed in spiritual healing (adjusted odds ratio [AOR] = 3.06) and came from a household that used curanderxs (AOR = 13.4) were more likely to seek the help of curanderxs when in need of health care. The personal network system had most explanatory power in the use of curanderxs. The findings add insight to the integration of traditional medicine in the provision of health care services to Latinxs in the United States. (Authors use the terms "Latinx" and "curanderx" to be inclusive of all gender identities.).