Mario De La Rosa, Ph.D. Mariana Sanchez, Ph.D. Candidate

1. Recent Latino Immigrant Study: Examining the Influence of Pre-Immigration Assets on the Substance Use and HIV Risk Behavior of Recent Latino Immigrants Mario De La Rosa, Ph.D. Mariana Sanchez, Ph.D. Candidate ACKNOWLEDGEMENTSThis study was supported by award number P20MD002288 from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities, or the National Institutes of Health .

2. Background:Latino Immigrants in the U.S.

3. Latino Immigrants in Miami-Dade County • Latinos make up 62.5% of the 2.5 million people living in Miami-Dade County • Miami-Dade County is also the only county in the Unites States with an immigrant majority (U.S. Census, 2009) • Over the past four decades, net migration into the County has accounted for more than 75% of its population growth (Miami-Dade County, 2009)

4. Latino Paradox

5. Study Objectives • Determine how the HIV risk behavior of recent Latino immigrants are influenced by pre-immigration assets (e.g., family functioning, social capital, religious coping), early in their immigration process. • Central hypothesis: The relationship between pre-immigration assets and post-immigration HIV risk behaviors will be mediated by post-immigration acculturation stress and substance use over a two-year time period in the U.S., while controlling for pre-immigration HIV and substance use risk behaviors.

6. Conceptual Framework Immigration to the U.S. Acculturation Stress Pre-Immigration Assets HIV Risk Behavior Substance Use Baseline Substance Use & HIV Risk Beh. T0 T1 T2 Time 12 mo. 24 mo.

7. Research Aims • Aim 1: Examine the influence of pre-immigration assets on post-immigration HIV risk behaviors among recent Latino immigrants over time. • Hypothesis 1: Recent Latino immigrants with higher levels of pre-immigration assets will exhibit lower levels of HIV risk behaviors over the two-year time period. • Aim 2: Examine the effects of pre-immigration assets on post-immigration acculturation stress and substance use among recent Latino immigrants over time. • Hypothesis 2: Recent Latino immigrants with higher levels of pre-immigration assets will have lower levels of post immigration acculturation stress and substance use over the two-year time period.

8. Research Aims • Aim 3: Examine the influence of pre-immigration assets on post-immigration HIV risk behaviors among recent Latino immigrants over time. • Hypothesis 1: The relationship between pre-immigration assets and post-immigration HIV risk behaviors will be mediated by post immigration acculturation stress and substance use over the two-year time period in the U.S. while controlling for pre-immigration HIV risk behaviors.

9. Methods • Study Design • Three waves of data collection (baseline and two follow ups) spaced twelve months apart over a period of two years. • Sample • N=527 Latino immigrants • Living in Miami-Dade County (only county in the U.S. with an immigrant majority- 51%) • 18-34 years of age • < 1 year since immigration into the U.S. • Primarily recruited through respondent driven sampling • Data Collection Procedure • Face-to-face administered interviews using psychometrically sound instruments

10. Significance of the RLIS • Conducting innovative research that, acknowledges the importance of pre-immigration factors in predicting post-immigration HIV risk behavior, an often neglected area in the literature. • Identify important predictors of HIV and substance use behavior trajectories for Latino immigrants in the U.S. • Enhance existing and develop new HIV and substance abuse prevention programs that identify, sustain, and incorporate assets of Latino populations into culturally grounded interventions.

11. Initial Findings from the RLIS:Baseline Sample Demographics N=527 Latino immigrants representing 18 Latin American Countries Mean age: 26.87 years Mean time in the US: 6.77 months Legal Status: Undocumented immigrants (30%), documented immigrants (70%) Education: 18% of RIS participants had college degrees, 34% had attended some college, 29% had a high school or equivalent degree, and 19% had not completed high school. Income: Mean total household income in the three months prior to immigration was $5265.11 (SD = $5148.32), which translates to an annual average household income of approximately $21,000. Alcohol users= (n=365); Drug users= (n=82)

12. Initial Findings from the RLIS: Challenges and Strategies in Recruiting, Interviewing, & Retaining Recent Latino Immigrants in Substance Abuse and HIV Epidemiologic Studies Data collection activities of this study have provided insights in identifying, recruiting, interviewing, and retaining Latinos in community based studies: • Utilizing a combination of translation techniques ensured the development and implementation of culturally appropriate questionnaires • Respondent driven sampling facilitated identifying participants • Establishing rapport and trust was critical for interviewing • Maintaining a tracking protocol was most important for retention

13. Initial Findings from the RLIS:Alcohol Use among Latinos: A Comparison of Pre-Immigration, Post Immigration, & U.S. Born Latinos Study Design Comparedalcohol use of pre-immigration Latinos utilizing baseline data from the RLIS (N=527) to- Alcohol use of post-immigration and U.S. born Latinos utilizing NSDUH report focusing on trends in alcohol use among persons 18 years of age and older between 2004 and 2009. NSDUH Sample • Approximately 6500 Latinos ages 18-34 of South or Central American, Dominican, and Cuban descent Hypothesis • Regular, heavy, and binge alcohol will be lower among both Latino male and females immigrant ages 18-25 and 26-34 prior to their immigration as compared to their U.S. born Latino and post immigration Latino counterparts.

14. Measures • Past month regular alcohol use was measured as having at least one drink in the past 30 days. • Past month heavy alcohol use was defined as drinking 5 or more drinks on the same occasion on each of five or more days in the past 30 days (SAMHSA, 2010a). • Past month binge drinking was measured as drinking 5 or more drinks on the same occasion on at least 1 day in the past 30 days

15. Alcohol Use Among Pre-Immigration, Post Immigration, & U.S. Born Latinos

16. Past Month Regular Alcohol Use By Gender

17. Past Month Heavy Alcohol UseBy Gender

18. Alcohol Use Discussion U.S. Born Immigrants Time 1 month prior Immigration point

19. Why these results?Future Research Directions Pre-immigration stresses • Stressors associated with the loss of close ties with friends and family from the country of origin as well as formal support systems (health care providers, schools) prior to immigration • Stressors associated with level of tangible and intangible social capital immigrants have or plan to bring with them prior to immigration (immigration status, financial resources, reasons why they immigrate, plan to bring or join family in the U.S., level of financial resources)

20. Why these results?Future Research Directions Psychological factors related to the post immigration experience soon after immigration • Optimistic expectations of beginning a new life with a host of opportunities for themselves and their families. • Leaving behind stressful life conditions such as long term unemployment, which is common among many young professionals in Latin America • Fear of political persecution because of their political affiliations or ideology. • Social factors related to the post immigration experience soon after immigration • Association with new non-drinking networks. • New social norms in the U.S., such as criminal penalties for driving while intoxicated, that are enforced (Social Control theory). • Fear of deportation, particularly for undocumented immigrants. • Wanting to fit into new host culture (often impacted by the cultural milieu of communities immigrants initially settle in after immigration)

21. Limitations • All intended analyses could not be completed due to NSDUH data on past month alcohol use for U.S. born Latino males ages 26-34 not being unavailable. • Participant-level demographic differences in income and education levels between the RLIS and NSDUH samples could also explain differences in alcohol patterns between groups. For instance: • RLIS sample reported higher higher education • NSDUH sample reported higher income • Issues with recall of alcohol use both for the RLIS and NSDUH sample. • Nonrandom nature of RLIS sample

22. Initial Findings: The Influence of Religious Coping on the Acculturative Stress of Recent Latino Immigrants Aim: Examine the association between pre-immigration religious coping styles (internal and external religious coping) and post-immigration acculturation stress among recent adult Latino immigrants. Hypothesis: After controlling for socioeconomic status and legal status (legal or illegal immigrant), participants with higher levels of religious coping will experience lower rates of acculturative stress.

23. Background: Acculturative Stress Acculturation: Acculturation is the exchange of cultural features that results when groups of individuals having different cultures come into continuous first hand contact; the original cultural patterns of either or both groups may be altered, but the groups remain distinct. Acculturation stress: a form of psychological or social stressors encountered by an individual due to an incongruence of beliefs, values, and other cultural norms between their country of origin and the country to which they have immigrated. Examples of social stressors: • legal status stress • language barriers • difficulties assimilating to beliefs, values, norms of the dominant culture • perceived feelings of inferiority and discrimination

24. Background:Religious Coping • Tix & Frazier (1998) define religious coping as “The use of cognitive and behavioral techniques, in the face of stressful life events, that arise out of one’s religion/spirituality.” • Religious coping can be beneficial by providing belief framework which: • facilitates cognitive restructuring of the meaning of an event • social support of a religious community • sense of control over stressful situations • Various forms of religious coping mechanisms: • internal (cognitive) religious coping • external (behavioral) religious coping

25. Religious Coping among Latinos • When controlling for education and other SES disparities, Latino’s use religious coping more frequently than do Non-Latino Whites. • Less acculturated Latinos use religious coping strategies more frequently than those with higher levels of acculturation. • Finch and Vega (2003) investigated the effect of social support on acculturation stress with a sample of 3012 participants of Mexican-origin. • Lowest rates of acculturative stress were displayed by participants with the highest religious support seeking behaviors. • Ellison and colleagues (2009) reported that religious involvement appeared to exacerbate the effects of acculturative stress on depressive symptoms of Mexican-origin adults.

26. Measures Religious Coping: Ways of Religious Coping Scale (Boudreaux et al., 1995). This instrument is a 40-item questionnaire measuring internal and external religious coping cognitions and behaviors. Total scale (Cronbach’s α = .95), internal scale (α =.97), and external scale (α =.93). Acculturative Stress: The immigration stress subscale of the Hispanic Stress Inventory Scale –Immigrant Version (Cervantes, Padilla, & Salgado de Snyder, 1990). The instrument is in a 5 point Likert scale format and the subscale used contains 18 questions. (Cronbach’s α = .85).

27. Measures Socio-economic status (SES): Measured by creating a total SES index score by multiplying participant’s total household income during the 3 months after immigration and level of education (1 = less than high school, 2 = high school, 3 = some training / college after high school, 4 = bachelor’s degree, 5 = graduate / professional studies). Legal status: Participants were asked to report their current legal status in the U.S. A total of fourteen possible categories were provided. These categories were then recoded into a dichotomous variable of legal (1) or illegal (0) immigration status.

28. Results:A Path Model of Acculturative Stress

29. Discussion • Dramatic loss of valuable religious resources, soon after immigration could make recent immigrants more vulnerable to experiencing acculturative stress. • Negative religious coping • passively leaving the responsibility for resolving crisis entirely up to divine intervention • feelings of divine abandonment and anger • found to have negative impacts on mental health by fostering feelings of guilt and shame; eroding feelings of competence and worth, and hopefulness; and distracting persons from more productive coping responses.

30. Limitations • No random sampling • Self report measures • Cross-sectional research design

31. Significance • Improve prevention/intervention skills and strategies necessary to assist recent Latino immigrants in mediating the negative aspects of the acculturation process (i.e., acculturative stress). • Gaining better insight into these coping mechanisms would provide valuable knowledge in targeting cognitions and behaviors that may need to be addressed when providing prevention and other intervention services to Latino immigrants • Development of culturally appropriate interventions that incorporate issues of religiosity when applicable into the clinical process