Latino Adolescent Substance Use in the United ... - Wiley Online Library

RONALD B. COX JR. BRANDON BURR

Oklahoma State University

Stephen F. Austin State University*

ADRIAN J. BLOW AND JOSE´ RUBE´ N PARRA CARDONA Michigan State University**

Latino Adolescent Substance Use in the United States: Using the Bioecodevelopmental Model as an Organizing Framework for Research and Practice

Research has indentified numerous risk and protective factors related to adolescent alcohol and other drug (AOD) use. However, most theoretical models do not account for nuances attributable to variations in culture or how these may influence prevention and treatment models. In this article, we have 4 primary purposes: First, we present an extensive and critical review of the literature on adolescent AOD use among Latino youths; second, we point out the idiosyncrasies associated with AOD use among Latino youths; third, we organize the literature according to Bronfenbrenner’s bioecodevelopmental framework to bring together findings from a number of fields and disciplines in a thoughtful manner; and fourth, we point out different implications for researchers and practitioners.

233 HES, Dept. Human Development and Family Science, Oklahoma State University, Stillwater, OK 74078 ([email protected]). *Department of Child and Family Development, COE Annex 104, Stephen F. Austin State University, Nacogdoches, TX 75962 ([email protected]). **Department of Human Development and Family Studies, Michigan State University, East Lansing, MI 48824-1030 ([email protected]; [email protected]). Key Words: adolescent, bioecodevelopmental model, Latino, substance use.

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During the past several decades, the field of adolescent substance use has made strides toward understanding adolescent substance use as a separate phenomenon from adult usage (Liddle & Dakof, 1995). As science discovers more about the etiology of youth substance use, interventions have been developed that reduce the risk of onset, or at least the harmful effects of use. However, prevention and treatment efforts, to be successful, need a strong theoretical foundation that unites the plethora of research into a comprehensible model that explains existing knowledge, incorporates new developments, and posits new hypothesized relationships to test in subsequent research. Recent studies in the field of adolescent substance use have begun to focus on substance use risk regulation, particularly on how numerous contextual factors interact with the characteristics of the individual (e.g., Brody et al., 2009). Ethnicity or culture as a context has emerged as a regulator interacting with both risk and protective factors to produce different effects from those normally found among youths from the majority culture. For example, African American youths, in spite of being disproportionately represented in high-risk neighborhoods (a risk factor), have consistently reported lower prevalence rates of substance use than European American youths (Johnston, O’Malley, Bachman, & Schulenberg, 2009). Likewise,

Journal of Family Theory & Review 3 (June 2011): 96–123 DOI:10.1111/j.1756-2589.2011.00086.x

Latino Adolescent Substance Use in the United States international studies, such as that of Brook et al. (1998), have noted lower prevalence of substance use among Colombian youths regardless of increased substance availability (a risk factor). These examples illustrate the importance of considering cultural and unique contextual factors when explaining adolescent substance use. In the United States, Latino populations constitute approximately 15.1% of the general population and 20% of K–12 enrollment in schools (U.S. Bureau of the Census, 2008). Latino students currently represent the fastest-growing racial group in U.S. schools, and by 2050, it is estimated that they will account for half of all school-age youths (Fry & Gonzales, 2008; Laird, DeBell, & Chapman, 2006). Moreover, within this one ethnic group, multiple variations in cultural expression exist depending on country of origin and immigration experience. A lack of attention to the idiosyncrasies created by distinct cultural experiences and contexts may impair the quality of services of treatment providers and the assumptions of researchers. As a result, it is essential that the undergirding theory these individuals use allows for the complex interactions between individual characteristics and multiple levels of contextual influences. One theory that has been central in applying this approach to the understanding of human development is Bronfenbrenner’s (2005) bioecodevelopmental model. Although some published studies on Latino substance abuse have referenced one aspect or another of the bioecodevelopmental model as a theoretical underpinning for their work, a scarcity of programs of research have thoroughly informed their intervention according to Bronfenbrenner’s model. In this article, our purpose is not to create a new theory. Instead, we use the bioecodevelopmental model to organize the literature on Latino adolescent substance use in a way that is useful to both researchers and practitioners. We review research studies and integrate their findings into the bioecodevelopmental model. We then shine a light on gaps that need to be addressed in future studies and provide applications for researchers and providers working with this population. By using this developmental theory to organize the literature, we offer a framework to guide researchers and treatment providers as they assess how multiple factors in layered contexts interact to influence substance-using behavior while also accounting for unique cultural characteristics.

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A BRIEF SUMMARY OF FACTORS RELATED TO ADOLESCENT SUBSTANCE ABUSE What F´elix-Ortiz and Newcomb (1992) stated more than a decade ago continues to ring true today: ‘‘Among the hundreds of possible influences that have been studied across all domains, no one factor or group of factors has successfully accounted for all patterns of drug use and abuse’’ (p. 292). The literature on adolescent substance abuse is diverse and researchers have examined a number of risk factors connected to its development. For example, risk factors include individual characteristics (Clark & Winters, 2002; Colby, Lee, Lewis-Esquerre, Esposito-Smythers, & Monti, 2004; Swadi, 1999), parental and family relationships (Chassin, Ritter, Trim, & King, 2003; Stanton & Todd, 1982), peer relationships (Bauman & Ennett, 1994; Hussong, 2002), school bonding (Hill & Werner, 2006; Murguia, Zeng-yin, & Kaplan, 1998), religion (Chen, Dormitzer, Bejarano, & Anthony, 2004), and neighborhood environment (Duncan, Duncan, & Strycker, 2002). Some scholars have attempted to put these factors into a coherent framework. For example, Strait (1999) organized a group of risk and protective factors into common factors associated with drug use in both Caucasian and Hispanic youths, as well as unique factors associated with substance use specifically among Hispanic youths. The identified common factors were divided in to two categories: social contextual factors (e.g., economic factors, availability of substances) and individual and interpersonal factors (e.g., peer and family networks). The unique factors were identified as sociocultural factors, including cultural identification, acculturation, values and culture conflict, and acculturative stress (Strait, 1999). However, this review did not address the distinct trajectories produced through person-environment interactions. So although this contribution is extremely useful, we propose that the bioecodevelopmental model provides a framework that more accurately and easily translates into strategies for both researchers and clinicians. EXPANDING THE LENS: THE BIOECODEVELOPMENTAL MODEL Bronfenbrenner’s (2005) bioecodevelopmental model conceptualizes adolescent development as merging information from multiple

98 disciplines (e.g., genetics, biology, psychology, family studies, sociology, anthropology) to take into account the numerous factors that constitute the adolescent experience (Bronfenbrenner & Ceci, 1994). The model posits that an individual interacts with different contexts to form and guide development, and that those contexts are nested within four layers or systems of influence in which the individual lives (Bronfenbrenner, 1979): microsystem, mesosystem, exosystem, and macrosystem. The layers evolve in increasing levels of abstraction from direct influences to more indirect influences on the developing individual. The microsystem comprises elements in the individual’s immediate environment, such as family, peers, and school. The mesosystem refers to how the microsystems interact with one another to influence the individual’s development. The exosystem refers to systems that exert their influence on the individual indirectly through the microsystem (e.g., a parent’s work influences the parent who influences the child, a teacher’s relationship with school administrators affects the teacher’s interaction with child). The macrosystem is the most abstract of the systems and includes influences such as cultural values, national economic climate, and policies. Later, Bronfenbrenner (1989) proposed the chronosystem to encompass the evolving interconnected nature of the person-environment interaction over time. As Bronfenbrenner further developed the theory, process came to occupy an increasingly important role. He emphasized that discernible differences in individual development, not only across but also within societies, result from the interplay between individual and environment effects. In the bioecological theory of human development, Bronfenbrenner and Ceci (1994) embraced both sides of the nature-versusnurture argument and posited that individuals possess heritable genetic qualities whose potential is actualized through progressively more complex reciprocal interaction with the immediate environment through mechanisms known as proximal processes. According to Bronfenbrenner’s model, the focus is on how certain kinds of genetic potentials (genotype) are actualized to determine distinct developmental outcomes (phenotype) of effective psychological functioning. Not all of the genotypic possibilities that a child inherits necessarily progress into a phenotypic form. Which phenotypes ultimately emerge depends on the interaction between the

Journal of Family Theory & Review principal proximal settings of the developing child. From this perspective, the developing child begins with an inherited genetic potential that follows a path. However, from the very outset, the path through which genotypes are transformed (their potential actualized) into phenotypes (developmental outcomes) is the mechanism of proximal processes, or the shaping interplay between genetic qualities and the individual’s environment. Even developmental changes like puberty that would seem to be biologically based and thus acontextual have been shown to be mediated by family, peer, and school influences (Simmons & Blyth, 1987). In this manner, social contexts are always causally involved to some extent in every aspect of human development (Bateson, Jackson, Haley, & Weakland, 1968). INDIVIDUAL FACTORS EXIST IN A BIOECOLOGICAL CONTEXT Several variables have been identified in the literature as mechanisms through which individual characteristics may operate to form risk factors for the onset of alcohol and other drug use (AOD). In a review of the literature, Swadi (1999) pointed to numerous personality attributes that have been associated with higher or lower risk for AOD, such as poor self-control, high levels of novelty seeking, risk taking, ambition, negative affect, impulsiveness, willingness to work hard, self-reliance, and feeling capable and accepted, as well as unsociable, untrustworthy, rebellious, and impulsive behaviors. Along these same lines, other findings have noted the associations between adolescent neurological development and its influence on adolescent behavior. In a recent review of the literature, Lopez, Schwartz, Prado, Campo, and Pantin (2008) cited increasing evidence that the brain is not fully developed until late adolescence and early adulthood, thus limiting critical thinking and decision-making execution and emphasizing rewards over costs. This immaturity in cognitive development may result in more impulsive decisions and risky behaviors such as substance use (Lopez, Schwartz, Prado, Campo, et al., 2008). Gender Most research in the United States has shown that men and women differ in age of initiation,

Latino Adolescent Substance Use in the United States extent of use, and the pattern of how drug use progresses. For example, men generally start using earlier than women (Kandel & Yamaguchi, 1993) and progress from alcohol to illicit drugs without necessarily using cigarettes. However, women more often begin drug use with cigarettes before transitioning to illicit drug use (Kandel, Warner, & Kessler, 1998). Women have also been found to have a reduced tendency to develop drinking problems and to use illicit substances across all ethnicities in comparison to males (Griffin Botvin, Scheier, Diaz, & Miller, 2000; Haas, 2004; Johnston, O’Malley, Bachman, et al., 2009). For instance, one research team found that 66% of Mexican men who drink alcohol consume five to six drinks during a drinking episode, compared to only 16% of Mexican women who drink (Medina-Mora & Rojas Guiot, 2003). Even though there seem to be gender differences in drug use rates and age of initiation, the prevalence of casual substance use is approximately equal for male and female adolescents (Sarigiani, Ryan, & Petersen, 1999), and some studies have suggested a growing convergence in substance use patterns among boys and girls in the United States (National Center on Addiction and Substance Abuse, 1996, 2003). Still, several researchers have stressed the role of gender and ethnicity in the development of adolescent substance use (e.g., Griffin et al., 2000; Haas, 2004; Johnston, O’Malley, Bachman, et al., 2009; Kulis, Marsiglia, & Hurdle, 2003). Distinct socialization patterns for boys and girls in Latino cultures have created stark gender differences in substance use among this population (Medina-Mora & Rojas Guiot, 2003). The socialization process for Latinos often leads to traditional gender roles characterized by notions of machismo and marianismo. From a psychosocial perspective, machismo is a male gender role that emphasizes attitudes and behaviors of bravado, aggressiveness, and patriarchal dominance, along with honor, respect, dignity, and responsibility for family (Neff, 2001). Marianismo is a cultural gender role for women, which reflects spiritual superiority due to a greater capacity for humility, abnegation, and forbearance, along with a greater concern for expressing nurturance, devotion to family, and submissiveness (Stephens & Greer, 1995; Valentine & Mosley, 2000). As a result, Latino boys are often rated as more impulsive and oppositional, and Latino girls are rated as

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more passive (Pineda et al., 1999). Traditional gender roles tend to affect substance use among men by allowing and even encouraging them to drink as a sign of their masculinity and by generally discouraging women from drinking, except among family and at events such as weddings (Loury & Kulbok, 2007; Unger et al., 2006; Wycoff, 2000). Some literature has suggested that the differences between gender expectations are lessening and that some Latinas are taking on more traditionally masculine traits, especially in more urban areas and as they acculturate into U.S. culture (Gutmann, 2003; Portes & Rumbaut, 2001). This coincides with other research that has suggested a growing convergence in substance use patterns among boys and girls in the United States (National Center on Addiction and Substance Abuse, 1996, 2003). Partly as a result of rigid gender roles, substance use patterns among recent Latino immigrants tend to follow those in their countries of origin (Vega, Gil, & Wagner, 1998), and they increase for both men and women as they become more acculturated to U.S. customs and values (Alaniz, Treno, & Saltz, 1999; Galvan & Caetano, 2003). By the third generation in the United States, drinking patterns for Latino immigrants mirror those of the majority group (Gilbert & Collins, 1997). However, the effect of the new culture on Latino immigrants varies by gender. Latina women, in part because of their initially high rates of abstention and low rates of heavy drinking, show much greater increases over time than do Latino men (Collins & McNair, 2002; National Institute on Alcohol Abuse and Alcoholism, 1997). Still, Latinos who become highly acculturated into U.S. culture are at a substantially increased risk for substance use and its accompanying problems, and this is particularly pronounced for women (Caetano & Clark, 2003). Acculturation, primarily through Englishlanguage acquisition, affects new immigrants by expanding their social networks. Influence from new social networks increases the opportunities for encountering prodrug peers and for using substances while also eroding family ties through increased individualism (Chilcoat, Breslau, & Anthony, 1996; Marsiglia, Kulis, Hussanini, Nieri, & Becerra, 2010). The effects of parental influences on youths’ substance use may also differ by gender. Voisine, Parsai, Marsiglia, Kulis, and Nieri (2008) found that boys and girls whose parents were more permissive about drinking were much

100 more likely to use substances. Likewise, strong parental injunctions against substance use had an equally protective effect against use for boys and girls. However, only girls whose parents allowed them to go out whenever they chose were more likely to use substances. Similar parental attitudes had no effect on boys’ substance use (Voisine et al., 2008). Voisine et al. (2008) also looked at male and female adolescent attitudes toward substance use and found that higher levels of linguistic acculturation and parental permissiveness that allowed youths to drink at parties and to go out whenever they wish were all associated with weaker attitudes toward substance use only for girls. Strong parental injunctive norms against substance use showed equally significant negative associations for girls’ and boys’ attitudes toward substance use (Voisine et al., 2008). A possible limitation of Voisine et al.’s (2008) study is that it looked only at Mexican American students, and, as such, it provides only a withingroup perspective. Other research has shown that parental injunctive norms against substance use, though an effective deterrent, had little variation by ethnicity (Elek, Miller-Day, & Hecht, 2006). Even though traditional gender roles are often criticized from the perspective of an individualistic culture, some research has found that adherence to traditional gender roles exerts a protective function against substance use for Mexican and Mexican American youths (Marsiglia & Holleran, 1999; Moon, Hecht, Jackson, & Spellers, 1999). These findings suggest that culturally grounded programs designed to reduce the risk of substance use among Latino youths use the traditional values of machismo for boys, marianismo for girls, and familismo for all youths and their families. Encouraging families to build on the strengths of cultural norms and to establish expectations and consequences for their children’s behaviors may prove effective for Latino families whose children face increasing pressures from acculturation. In conclusion, the gender gap in substance use seems to be narrowing for U.S. youths and for Latino youths who are highly acculturated. For Latino youths who are less acculturated, traditional gender roles may play a key protective factor. These findings emphasize the importance of conceptualizing the effects of individual characteristics such as gender on adolescent substance use in the context other ecosystem influences. Important research still remains to examine what

Journal of Family Theory & Review aspects of the notions of machismo, marianismo, and familismo most influence adolescent substance use and how these concepts interact with other ecosystem influences, such as peers and families, to promote either risk or resilience in Latino adolescents. Mental Health Other reports have found that, among childhood characteristics predicting adolescent alcohol use disorders, childhood mental health issues (including conduct, attention deficit hyperactivity, major depressive, and anxiety disorders) were prominent factors in the onset of alcohol difficulties (e.g., Clark & Winters, 2002). However, some have suggested that a common genetic and environmental influence is responsible for the association between childhood mental disorders and AOD disorders (Waldman & Slutske, 2000). Some have also linked gender differences in substance use to personality and mental health characteristics. For instance, negative and depressed affect, anxiety, sociability, self-control, and conscientiousness have all been associated with substance-using behaviors in adolescents (Flannery, Vazsonyi, & Rowe, 1996; Kashden, Vetter, & Collins, 2005; Wills, Sandy, & Yaeger, 2000). Yet personality attributes such as conscientiousness and selfcontrol appear to predict decreased substance use in girls but not boys (Adalbjamardottir & Rafnsson, 2001; Kashden et al., 2005). Certainly, individual factors are important to consider when investigating predictors of adolescent substance use. Yet more expansive conceptualizations are needed, particularly when exploring the topic with Latino adolescents. For example, little is known about how personality and gender are associated with substance-using behavior in Latino adolescents specifically. In addition, little is known on how mental health and psychopathology are related to Latino adolescents’ substance-using behaviors. Also, how might contextual and environmental factors influence individual propensities for Latino adolescent substance using behavior? It is to these interactions that this discussion now turns. GENETICS BY ENVIRONMENT INTERACTION The role of genetics in the development of alcohol abuse and alcoholism has gained momentum

Latino Adolescent Substance Use in the United States since Jellinek’s (1946) early work. Research seems to indicate that problem drinking is, at least in part, a heritable family disorder with a genetic origin (e.g., Cloninger, 1987). For example, twin studies consistently find that genetic factors explain a portion of the variance in the development of alcoholism and other drugs (e.g., Hettema, Corey, & Kendler, 1999; Prescott & Kendler, 1999). However, how sizable a portion of the variance can be attributed to heritable characteristics is not entirely clear. Koopmans, Slutske, Heath, Neale, and Boomsma (1999) reported that the proportion of shared family environmental influences from four general population twin studies ranged from 37% to 88%. They concluded that ‘‘family environmental influences are at least as important as, if not more important than, genetic influences in determining the risk for initiating alcohol use among adolescents and young adults’’ (p. 445). As was previously stated, the bioecodevelopmental model posits a genotype-environment interaction to explain the variance in alcohol and other drug use. At least four examples of this interaction can be found in the behavioral genetics literature (i.e., Boomsma, de Geus, van Baal, & Koopmans, 1999; Heath, Jardine, & Martin, 1989; Koopmans et al., 1999; Rose, Kaprio, Winter, Koskenvuo, & Viken, 1999). Together, these studies lend evidence to the basic premise of Bronfenbrenner’s bioecodevelopmental model, namely, that the interaction of specific environmental contexts with a genotype influences the risk of alcohol use initiation among adolescents and young adults. The implication of these studies is that individual characteristics are an important consideration in understanding the etiology of adolescent substance abuse. However, as Bronfenbrenner (1995) pointed out, characteristics of the individual are often studied as developmental outcomes but seldom conceptualized as sources of variation in the person’s susceptibility or risk to the developmental effects of proximal processes (i.e., enduring patterns of interaction between the person and his or her environment). As such, no single factor or event can be said to cause addiction, genetically or otherwise. ENVIRONMENT AND THE INDIVIDUAL: THE RIPPLING EFFECT Environmental surroundings and social contexts are an important means through which

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meaning is created and interpreted, and they influence individual engagement in substance use (Bateson, 1972; Bubolz & Sontag, 1993; Watzlawick, Weakland, & Fisch, 1974). In the bioecodevelopmental model, culture represents a prominent overarching context, which interacts with other proximal contexts in which the adolescent is embedded along the developmental pathway to influence substance use (Szapocznik, Prado, Burlew, Williams, & Santisteban, 2007). In these terms, taking into account cultural processes relevant to overall Hispanic family daily living, above and beyond those related to race and ethnicity, becomes an important endeavor in exploring the etiology of Latino adolescent substance use (Prado, Szapocznik, Maldonado-Molina, Schwartz, & Pantin, 2008). Cultural values and beliefs refer to the implicitly or explicitly expressed ideas regarding what is good, right, and desirable in a society and on which the specific norms for appropriate behavior are founded in a given group of individuals (Schwartz, 1999). Bronfenbrenner (1979) asserted that cultural belief systems are transmitted to the more immediate contexts of family, school, peers groups, and workplaces, where they then directly and indirectly influence proximal processes. Over time, these belief systems in interaction with immediate contexts are internalized and become a part of the developing individual, influencing future development. Once ingrained in the society, these beliefs contribute to the macrosystemic influences on the developing person. Reported high drug-use prevalence in Latino adolescents points to the need to examine more closely potential risk and protective processes related to drug use. Some evidence suggests that certain risk and protective processes exist that are particularly relevant to Latino families in the United States (De La Rosa, 2002; Pantin, Schwartz, Sullivan, Coatsworth, & Szapocznik, 2003; Prado et al., 2008). For instance, certain cultural values and beliefs at the macrosystem level may be at odds between immigrant Latino families and the U.S. host county. Acculturation, though a two-way process, generally refers to the changes in values, beliefs, and behaviors a minority group undergoes as it adapts to the majority culture (Berry, 1997). The disequilibrium of cultural belief systems in turn may ripple across Latino parents as former connections with important social support networks in the form of family, friends, and other close

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Journal of Family Theory & Review

relationships become challenging to replicate in the United States. Once lost, important relationships that previously offered a sense of belonging and a source of identity may lead to increased levels of isolation and stress (i.e., exosystem influences) as parents find aspects of U.S. culture hazardous and uninviting (Hines, Garcia-Preto, McGoldrick, Almeida, & Weltman, 1992; Hovey & Maga˜na, 2002; Martinez, 2006). In these families, Latino adolescents may encounter less difficulty adapting to the new culture than their parents did, and they likely seek out opportunities to interact with their surroundings, whereas their parents may view this process as dangerous (Hines et al., 1992; Martinez, 2006). These differential acculturation levels between Latino adolescents and parents may incite family conflict (i.e., microsystem influences), and these family issues may ripple outward into peer and school interactions as the Latino adolescent seeks acceptance and support from deviant peer groups. In turn, this may lead to antisocial and delinquent behaviors such as school disruption and substance use as a means of expressing rebellion against traditional values in Latino families such as respeto (i.e., mesosystem influences; Coatsworth, Pantin, & Szapocznik, 2002; Prado et al., 2008; Szapocznik et al., 2007). Thus, cultural discrepancies present at the macrosystem level influence potential risk and protective factors in multiple other systems of influence in which the adolescent is embedded (Romero, Marinez, & Carvajal, 2007). Bioecodevelopmental insights add depth, thus allowing observations across the multiple systems pertinent to adolescent development as potentially influencing substance-using behavior. It is to these interactions that we now turn. MICROSYSTEMIC INFLUENCES Family as a Context Family relationships have been found to play a major role in the development of adolescent substance abuse (Chassin et al., 2003; Hawkins, Catalano, & Miller, 1992; Stanton & Todd, 1982). Inconsistent discipline, parental discipline style, reduced parental monitoring, parent-child communication, parental support, and level of family cohesion all have noted influences on adolescent substance abuse development (Anderson & Henry, 1994; Baumrind, 1991; Chilcoat et al., 1996; Fletcher, Darling, Steinberg, & Dornbusch, 1995; Gorman-Smith,

Tolan, Zelli, & Huesmann, 1996; Hussong & Chassin, 1997; King & Chassin, 2004; Wills, Resko, Ainette, & Mendoza, 2004). A large body of literature has supported the notion that the family is the most essential and fundamental system affecting human development and the socialization processes (e.g., Bronfenbrenner, 1979; Cardona, Nicholson, & Fox, 2000). In Latino families, this concept may be particularly true given the emphasis placed on close family networks and togetherness. Thus, of all the influencing microsystemic components in the Latino adolescent world, the family may hold the greatest degree of influence (Pantin et al., 2003). This is generally referred to as familismo, which is identified as a central part of Latino culture (Contreras, Hendrick, & Hendrick, 1996; Halgunseth, 2004; Keefe, 1984). The Latino value familismo has to do with the idea that all members of a certain family strongly identify with their particular family, and individual families maintain a great amount of family loyalty (Halgunseth, 2004). In the Latino adolescent world, the level of parental involvement in the adolescent’s peer and social networks has been shown to protect against drug abuse and risks for other delinquent behaviors. Families characterized by distant and disorganized interactions, high conflict, and poor communication are more likely to experience adolescent drug abuse and delinquent behavior problems (Clark, Neighbors, Lesnick, Lynch, & Donovan, 1998; Cooper, Pierce, & Tidwell, 1995). Connection and emotional closeness between adolescents and parents may be particularly important in protecting against adolescent substance use. Close relationships between parents and adolescents characterized by high emotional support have been associated with decreased alcohol use in adulthood and other protective outcomes (Newcomb, 1997; Vaccaro & Wills, 1998). In contrast, a lack of family support, low family pride, and chaotic family environments serve as risk conditions related to drug use for Latino adolescents (Cooper et al., 1995; Vega, Gil, & Zimmerman, 1993). Some reports have indicated that the protective aspects of the familistic cultural orientations of Latino families may erode with increased interaction with U.S. society. Strains on the parent-child relationship could be linked to intergenerational relationship conflict and acculturation issues represented by the struggle between

Latino Adolescent Substance Use in the United States parents and children who have drifted apart through differences in adapting to U.S. culture. For example, as children look to fit in with the host culture and parents emphasize the native culture, increased conflict and rigidity can result (Gil, Wagner, & Vega, 2000; Hines et al., 1992). Thus, familistic facets of Latino families and Latino family interactions involve potential risk factors, as well as protective factors that potentially contribute to the development of substance use. High levels of family connection in Latino families are a protective mechanisms against youth substance use, whereas elevated levels of parent-child conflict, in particular over discrepancies in family values due to different degrees of assimilation into the majority culture, may increase Latino adolescent substance use (Coatsworth et al., 2002; Szapocznik et al., 2007). Following Bronfenbrenner and Ceci (1994), parental and family socialization styles and practices interact with individual and cultural characteristics to influence subsequent behavioral outcomes (Szapocznik et al., 2007). However, although the body of literature identifying family facets and processes as influencing Latino adolescent substance use is growing and providing valuable insight, more investigation is needed on specifically which cultural values are conflicting and creating acculturative discrepancies, and how those discrepancies influence adolescent substance use. For instance, although parent-child conflict has been identified as a risk factor for adolescent substance use, limited information exists as to what types of conflict particularly predict substance use (e.g., intensity of conflict, nature of conflict), especially for Latino families. Also, how might parent-child conflict differentially associate with substance use behaviors in Latino adolescent females versus adolescent males? How might cultural values (e.g., familism) play a role in the socialization of Latino men versus women to influence substance use? How might intergenerational conflict over values and practices influence engaging in substance use differently for male and female adolescents? What specific aspects of the erosion of familistic values over time appear to be the most potent in predicting substance use? And, more generally, how might interactions among family processes, peer relationships, school relationships, and community ties play a role in influencing substance use? How might interactions between these different contexts be different in primarily Latino populated areas versus

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ethnically diverse areas, impoverished versus more affluent areas, and rural versus urban areas? Extended Kin as a Context Another area of family as a context is extended kin. With respect to the concept of familismo, important Latino family relationships often extend beyond the nuclear family to include close ties with grandparents, uncles and aunts, cousins, and other kin relationships. Extended family members may play active roles is the socialization of children in Latino families (Bacallao & Smokowski, 2007; Halgunseth, 2004). Reports have indicated that Latino households in the United States comprise greater numbers of extended family members than those of non-Hispanic White family households (Landale & Oropesa, 2007). However, the debate as to whether the nature of coresidence among Latino extended-family households in the United States is primarily culturally or structurally based is unclear. For instance, some scholars have suggested that Latino extended-family households also serve as important sources of economic and social support, particularly for more recent immigrants, as household members pool economic resources, provide mutual child care, and offer emotional availability to buffer negative experiences associated with the transition to life in the United States (Kamo, 2000; Landale & Oropesa, 2007; Van Hook & Glick, 2007). Van Hook and Glick (2007) found that complex family households of newly arrived Mexican-origin immigrants are relatively unstable (high degree of turnover), often involving living arrangements with family members from a similar generation and nonkin relations (e.g., friends). Whether households include extended-family kin relationships also varies within Latino populations in the United States. For example, although Mexican Americans born in the United States are much less likely to live in extendedfamily households than those living in Mexico, reports indicate that foreign-born immigrant families may mourn the loss of familial ties and the support experienced in their native country (Bacallao & Smokowski, 2007; Van Hook & Glick, 2007). These results and patterns suggest a divergence from the more traditional extendedfamily household structure found in Latin America, and that perhaps Latino extendedfamily networks and household structures differ

104 by nativity and time spent living in the United States (Van Hook & Glick, 2007). Family composition and household structure have been identified as connected with substance use in youths (e.g., Barrett & Turner, 2006) and, to some degree, in Latino youths (e.g., Allen et al., 2008; Gil, Vega, & Biafora, 1998). Some therapeutic models operating from a family systems framework have, in theory, emphasized the inclusion of extended family members in Latino youth substance use treatment and prevention programs, but in practice they rarely have gone beyond including immediate family members such as parents and siblings (e.g., Gil, Vega, et al., 1998; Liddle, Dakof, et al., 2001; Pantin et al., 2003). Scholars have called for more attention to the influence of nonnuclear family arrangements and ties on the nature of family relationships in general, and on behavioral outcomes (e.g., Gil, Vega, et al., 1998; Milardo, 2005). For example, little is known on how extended family and kinship ties influence Latino adolescent substance using behavior. Does the effect of these ties on substance using behavior differ by U.S. versus foreign birth or length of time in the United States? Could acculturation mediate the influence of extended family ties on adolescent substance use? Many questions remain about whether extended family ties are related to adolescent substance using behavior and if so, how. Finally, and more generally, an important area of research refers to differential cultural identity development and identification with cultural values. This line of research inquiry is critical, as there is a high need to avoid generalizations about Latino subpopulations. For example, Parra-Cardona et al. (2008) found that country of origin is a critical factor for Latinos’ identification with specific cultural values and gender roles. Future investigation in these areas is warranted because treatment development should be consistent with the cultural values that most commonly inform target populations. Expanding the focus beyond the parent and child relationships to more accurately capture important aspects of the relationship and to include other potentially important systems of influence can help researchers and practitioners gain a clearer picture through which to enhance future substance use prevention efforts. Attention to both individual and family characteristics, extended family relationships, family processes, and the interaction of those factors

Journal of Family Theory & Review with surrounding contexts can be most beneficial for those working with substance use prevention and intervention efforts with Latino youths. A discussion of additional contexts follows. Peers as a Context Independent of ethnicity, adolescence is generally a time when unique and powerful relationships with peers are formed (Carlo, Fabes, Laible, & Kupanoff, 1999). Among Caucasian youths in the United States, peer affiliations are a robust predictor of initiation and continuation of substance use in adolescents (Oetting & Lynch, 2002). Deviant peers consistently increase the chances of substance initiation and subsequent abuse (Bauman & Ennett, 1994; Hawkins, Catalano, et al., 1992), whereas prosocial peers reduce the use of substances (Apospori, Vega, Zimmerman, Warheit, & Gil, 1995). However, in at least one Latin American country, the association between peers and substance use has been less prominent. Among the few studies examining adolescent substance use in Venezuela, three found mixed effects regarding the relationship between peers and substance use. In a sample of youths attending schools in the northcentral part of Venezuela, Osorio, Ever, Ortega de Medina, and Pillon (2004) found that peers were only mildly associated with drug use. In a study conducted in the same general location, Navarro and Pontillo (2002) found that peer relationships covary moderately with substance use. Cox, Blow, Maier, and Parra (2010), in an investigation of age of first use among schoolattending youths in Caracas, found a negative relationship when limiting the association of peer drug use to age of first illicit drug use (r = −.36, p < .001) but only a meager, nonsignificant correlation when grouping together any drug, licit or otherwise, which suggests that the effects of peers on age of first use may differ by drug type among Venezuelan youths. Peer influence has been a topic of interest among researchers studying the general population of adolescents but has not been a focus of research on Latino youths (Buchanan & Smokowski, 2009). Latino youths living in the United States may experience different cultural influences that lead to increases in the role peers play in substance use. Some studies have suggested that Latino adolescents who have increased interactions with non-Latino peers adopt, to some degree, the attitudes and

Latino Adolescent Substance Use in the United States perceptions of non-Latino peers related to substance use (Carvajal, Photiades, Evans, & Nash, 1997; Pantin et al., 2003). Other studies show that Latino adolescents who have friends who smoke, use marijuana, and use alcohol are at an increased risk of using the same substances (Frauenglass, Routh, Pantin, & Mason, 1997; Segura, Page, Neighbors, Nichols-Anderson, & Gillaspy, 2003). For Latino adolescents this may be because of a perception of the relationship between substance use and social status. Frauenglass et al. (1997) noted that, for Latino adolescents, the normative identity formation process of adolescence may lead them to engage in substance use to increase social status in efforts to become ‘‘more American’’ (p. 20). Segura et al. (2003) also found that Latino adolescents were more likely to use alcohol if they perceived that their social status would advance through engaging in alcohol use. Although peer substance use is generally associated with increased risk of use in adolescents (e.g., Wills & Cleary, 1999), further research is needed to assess how peer groups influence substance-using behaviors in Latino adolescents. For instance, does the ethnicity or nativity status of those in the peer group make a difference? How might acculturation status make a difference? Do less acculturated Latino adolescents who interact with more acculturated Latino adolescents engage in more substanceusing behaviors? Also, how might gender and acculturation interact to influence the role of peer associations in substance use for Latino youths? Further investigation on the topic is warranted. Schools as a Context Schools are an important socialization factor for youths. In general, youths who form a positive bond to their school have a decreased likelihood of developing problem behaviors, such as delinquency, violence, and substance use (Hawkins, Guo, Hill, Battin-Pearson, & Abbott, 2001; Lonczak, Abbott, Hawkins, Kosterman, & Catalano, 2002; McBride et al., 1995). Unfortunately, as students transition from early to mid-adolescence (approximately sixth to the eighth grade), their attitudes toward school become increasingly negative (Simons-Morton, Crump, Haynie, & Saylor, 1999), with males showing sharper declines than females (Oelsner, Lippold, & Greenberg, 2010). Additionally, a sizable increase in problem behaviors occurs

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during the transition into adolescence. For example, one study reports that before middle school, fewer than 10% of sixth graders have used tobacco and 5% have used alcohol. However, by the eighth grade, the figures jump to 30% and 70%, respectively (Johnston, O’Malley, & Bachman, 1994). The few studies that have examined Latino students’ school bonding have found that Latino students perceive more institutional barriers than do whites, have a greater probability of dropping out, and on average have lower levels of academic success (Diaz, 2005; Driscoll, 1999; Lagerwey & Phillips, 2003; Martinez, DeGarmo, & Eddy, 2004). However, when a concentrated effort was made to help Latino students overcome the barriers to attaching to their school and teachers, student attitudes regarding their academic potential and their actual rate of success increased (Conchas, 2001). Schools may not only effect the developing youth directly through the creation of a personal bond; there may also be a contagion effect related to how contextual influences can explain geographic concentrations of drug use in a certain school in comparison with others (Petronis & Anthony, 2003). According to the contagion model, students in schools develop similar substance use habits through social interactions with other peers (Murray & Hannan, 1990). A school climate of norms and attitudes toward drug use may be transmitted from peer to peer and either encourage or dissuade substance use; this process makes varying substance abuse rates noticeable across schools (Kumar, O’Malley, Johnston, Schulenberg, & Bachman, 2002). For example, Henry and Slater (2007) found that, regardless of a student’s personal level of school attachment, students who attend schools where the pupils overall tend to be well attached are less likely to use alcohol. Other researchers found that schoollevel socioeconomic status (SES) was more predictive of age of substance use onset than was family attention, antisocial behavior, or gender among Venezuelan youths (Cox et al., 2010). Still, little is known about the mechanisms through which Latino youths form a positive bond with schools, and how language, minority status, cultural background, levels of acculturation, and other unique factors might moderate the process. Further research in this area needs to focus on Latino students in general, and in particular on the challenges of the recently arrived, for

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whom institutional structures are woefully inadequate to accommodate their needs. Further, studies that incorporate multiple contexts are needed to capture the interactions of individual, family, school, and peer group characteristics and their combined influence on substance use in Latino adolescents. A discussion of the interrelation between contexts and its influence on Latinos’ substance use follows. MESOSYSTEMIC INFLUENCES Family, Peer, and School Interactions Families, peers, and schools are all microsystemic influences on child development in Bronfenbrenner’s model. However, increasing evidence supports the notion that the interactional patterns distinguishing the family-peer-school mesosystem have a strong influence on healthy behavioral outcomes and on the power to shape the developmental trajectory. Currently, mesosystemic interactions are understudied, yet some important findings have emerged relating to how the different interactions and patterns shape development and influence Latino adolescents’ substance use (Epstein & Lee, 1995; Szapocznik & Coatsworth, 1999). Family and peer networks are gaining attention as mutually interdependent and influential realms of the ecological system. These interactions present important areas of consideration in the etiology of drug use in Latino adolescents. As noted earlier, the support shown for active parental monitoring of adolescent activities and peer relationships as a potential protective factor against delinquent behavior and drug use is prominent (Chilcoat et al., 1996; Patterson & Stouthamer-Loeber, 1984; Steinberg, Fletcher, & Darling, 1994). In addition, parents’ direct contact and involvement with their adolescent’s peers may help parents organize social interactions for their youths and take a more active role in the peer selection process, thus potentially leading to reduced negative peer influences and increased social opportunity (Szapocznik & Coatsworth, 1999). Peer selection, likewise, is associated with school attainment, as members of deviant peer groups are more likely to have lower levels of school performance and to drop out (Carlo et al., 1999). Conflicts over parental value systems and values held by peers may contribute to substanceusing behaviors in Latino adolescents, whereas

family support may counteract the influence of deviant peer behaviors for Latino adolescents (Coombs, Paulson, & Richardson, 1991; Frauenglass et al., 1997). For instance, familistic values have been cited as reducing the influence of deviant peers in Mexican adolescents (Germ´an, Gonzales, & Dumka, 2009). Other findings have noted the interrelated nature of low parental monitoring, poor school functioning, increased conduct and aggressiveness issues, substanceusing peer groups, and increased substanceusing behavior (Lopez, Schwartz, Prado, Huang, et al., 2008; Lopez, Wang, et al., 2009). The quality of parenting and the use of specific parenting behaviors have also been shown to be related to the quality of children’s peer relations and school attainment (Eccles et al., 1993; Kahen, Fainsilber-Katz, & Gottman, 1994). Lagerway and Phillips (2003), in a study on Latinos, commented that student success was related to parent’s encouragement to do well in an effort to combat racial stereotyping. Other researchers found that school attainment differed among racial groups (M. K. Johnson, Crosnoe, & Elder, 2001) and that student’s perception of discrimination on the part of teachers and administrators created institutional barriers that affected levels of school attainment (Conchas, 2001; Martinez et al., 2004). Strong connections with family and school may serve as potentially important protective mechanisms for Latino youths. The connection between the Latino adolescent’s family system and other important and relevant systems to the adolescent, such as the school environment, has been noted as an important factor in lowering the overall magnitude of risk factors present (Pantin et al., 2003). Marsiglia, Miles, Dustman, and Sills (2002) explored the roles of families and schools affecting onset of substance use among Latino adolescents. Their findings suggest that strong family connections and school dedication were sources of resiliency for Latino youths against substance use, despite high druguse rates and impoverished neighborhood influences. The converse, low commitment to family and school, may influence substance-using behavior in Latino youths (Strait, 1999). Schools and especially family relationships offer sources of support, direction, structure, and important environments for learning prosocial behavior (Marsiglia, Miles, et al., 2002; Strait, 1999). Thus, Latino youths with strong bonds to family

Latino Adolescent Substance Use in the United States and school may experience protective mechanisms against delinquent behavior through the process of positive influential environments (i.e., family, home, school), thereby counteracting potentially negative environments (i.e., neighborhood poverty, high drug use, and availability). Parents’ involvement in their children’s schools in various forms (e.g., classroom volunteer work, participation in school–community efforts) has been associated with increased social development and academic accomplishment (Griffith, 1996; Keith & Lichtman, 1994; Paulson, 1994). Efforts aimed to alter the mesosystemic effects on youths’ academic and social development should consider organizing programming around parent-school interactions and increase opportunities to collaborate (Szapocznik & Coatsworth, 1999). Because a lack of legal immigration status tends to create reticence to engage the larger system among immigrants, efforts at the mesosystemic level may be particularly efficacious for improving parent-school interactions with Latino families in which one or more members are not legal residents. Evidence suggests that parents are the most salient influence on their children’s long-term educational goals but that peers are a more persuasive influence on the day-to-day activities that directly affect adolescents’ school performance (Steinberg, Darling, & Fletcher, 1995). Interestingly, Steinberg, Darling, et al. (1995) also found that ethnicity moderated this relationship, with minority students relatively more influenced by their peers than EuropeanAmerican youths. Because of the segregated nature of schools, minority youths find their choices of peer groups to be restricted. For example, Asian American youngsters reported the highest level of peer support for academic achievement but the lowest levels of parental involvement in school-related activities. In contrast, African American parents score among the highest with respect to parental involvement in their child’s school, but African American youths find it difficult to gain membership into the ‘‘brains’’ peer group. Therefore, the homogenizing influence of their peer group offset negative effects of lack of parental involvement for Asian American students, and for African American students a lack of support from their peer network offset the positive benefits of supportive parents. Thus, at the mesosystem level (intersection of the family, peer, and school

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microsystems), the macrosystemic influence of U.S. culture that promotes segregation can produce moderating effects (Steinberg, Darling, et al., 1995). Still, most of the studies cited here take the traditional approach of accounting for the variance in one outcome while controlling for the other variables in the model. Future research needs to focus on more complex models that assess the interaction effects of multiple variables and their paths nested in groups on substance using behavior. EXOSYSTEMIC INFLUENCES Neighborhood as a Context for Family and Peer Interaction Social networks such as families are rooted in the larger community, and attention is increasingly being paid to how these contextual factors affect several areas of public health, including substance use (Warner et al., 2006). Systemic theory suggests that when members of a community form local social ties, their ability for community social control is augmented and perceptions of collective efficacy are enhanced, both of which influence public health outcomes (Kawachi, Kennedy, & Glass, 1999; Sampson & Groves, 1989). Several empirical studies have tested this theory and found associations between collective efficacy and cohesion and on multiple measures of violence and youth alcohol and drug use in disadvantaged neighborhoods (Duncan et al., 2002; Nash & Bowen, 1999; Sampson, Raudenbush, & Earls, 1997). In a different approach, Fletcher et al. (1995) examined the extent to which adolescents are influenced by the parenting style of their peer’s parents who live in the same community, independent of the adolescent’s own parents parenting style. They found that a preponderance of parental authoritativeness (Baumrind, 1991) among the adolescent’s peers is related to a variety of healthy adjustment indicators beyond the contributions of the adolescent’s own parents. The link, however, was not direct but indirectly transferred through the peer’s choice for nondeviant peers. Surprisingly, though, if the friend is already engaged in delinquent activities, the prevalence of authoritativeness among the friends’ parents directly reduces delinquent behavior. Thus, it seems that the influence of multiple authoritative parents in a

108 neighborhood creates a community-wide impact on delinquent behavior. Evidence also suggests that adolescents’ perception of neighborhood activity may be particularly important. Nash and Bowen (1999) did not measure actual neighborhood crime rates or social control, only the adolescent’s perception of each. They found that adolescent’s perception of neighborhood crime served as a risk factor, and their perception of neighborhood informal social control acted as a protective function for their own prosocial behavior. Such findings are important to consider because demographic profiles suggest substantial socioeconomic disadvantages for Latino populations in the United States. Reports have pointed out overrepresentations in terms of low-income and limited education levels among the Hispanic population in the United States, with more than 20% living below the federal poverty line, approximately 50% of Latinos older than 25 not completing high school, and more than 25% completing less than the ninth grade (Ramirez & de la Cruz, 2002). These limited economic opportunities and associated effects of poverty on community and neighborhood concerns may increase vulnerabilities to substance abuse in Latino adolescents (Warner et al., 2006). Latino families residing in particularly socially and economically disadvantaged neighborhoods may experience heavy exposure to crime, violence, and drug use. Experiences related to daily living in disadvantaged neighborhoods may lead some Latino adolescents to perceive ‘‘routine’’ drug-using behaviors as normative, which presents associated community-based risk factors (see Pantin et al., 2003). Others have disputed previous studies inferring that high poverty is correlated with drug use, finding that, despite increased poverty and substance-using rates, Latino youths were able to resist frequent drug offers (Marsiglia, Miles, et al., 2002). Resiliency against the deleterious effects of poverty has been attributed to the bond, attachment, and involvement of youths with their family and high levels of residential stability and increased home ownership in disadvantaged Latino communities (Hilarski, 2005; Marsiglia, Miles, et al., 2002; Ross, Reynolds, & Gries, 2000; Strait, 1999). Some additional evidence has suggested that levels of social capital may be relatively high in Latino communities, thus presenting an important future

Journal of Family Theory & Review area of focus for studies on community influences on Latino drug use (Warner et al., 2006). Similarly, Sampson and Groves (1989) cited the presence of informal social control in the neighborhood as a protective factor against delinquent behavior. For example, the presence of supervised after-school activities would aid in decreasing the presence of delinquent behavior. These protective factors may also be augmented when families reside in communities that have a high consensus of intergenerational closure (i.e., overlapping social networks between parents and children) with respect to child rearing (Furstenberg, 2005). Although little attention has been given to sociocultural change in the community and neighborhood contexts, and how those changes influence drug use, such sociocultural change has been evident along the U.S.Mexico border. Studies focusing on the TexasMexico border show that reports of Latino adolescent depressive symptomatology and drug use are high as these areas experience continued increases in trafficking and drug availability (Brown & Benedict, 2007; Swanson, Linskey, Quintero-Salinas, Pumariega, & Holzer, 1992). Much more research is needed in this area, but findings to date support the assumption that cultural transition processes at the community level influence adolescents’ drug use. The field is primed for more expansive research into influences on Latino adolescents’ substance-using behaviors that involve exosystemic influences. Particularly interesting are the discrepant findings noting that, on the one hand, impoverished and dangerous neighborhoods are risk factors for substance use for Latino adolescents, but on the other hand, there is increased resistance to drug offers by Latino adolescents in primarily poor areas. Some of these protective factors may be due to family bonds, community cohesiveness, and informal community networks of social control. Further research is needed to more accurately capture and tease out these influences. For instance, how might Latino parenting practices, socialization practices, transmission of cultural values such as familism, and community levels of social control be associated with neighborhood- and community-level adolescent substance use? Is the influence of these processes different in primarily Latino communities versus more ethnically diverse areas? How might these processes

Latino Adolescent Substance Use in the United States be different in communities with more collective parenting efforts versus more individualized efforts? How might the protective nature of the processes be different in communities that border Mexico versus those that do not? How might the protective nature of these processes differ in rural versus urban areas? Work that examines the different influences on Latino adolescents’ substance use at the exosystem level can lead to more effective directions for community and neighborhood substance use initiatives.

MACROSYSTEM INFLUENCES ON THE DEVELOPMENT OF SUBSTANCE USE As stated earlier, cultural values and beliefs are connected with what is good, right, and desirable in a society and, in turn, delegate norms for appropriate behavior in a given group of individuals (Schwartz, 1999). Bronfenbrenner asserted that cultural belief systems are transmitted to the more immediate contexts of family, school, peers groups, and workplaces, where they directly and indirectly influence proximal processes. Over time, these belief systems interact with immediate contexts and are internalized, becoming part of the developing individual and influencing future development. As the beliefs become embedded in the societal system, they come to represent macrosystem influences on development (Bronfenbrenner, 1979). On the macrosystemic level, Latino culture has consistently been referred to as collectivist in nature. In this regard, the interests of the group and the relationships among group members hold greater priority over individual concerns and needs. Individualistic cultures place great value on individual identity and more emphasis on one’s own needs and goals over the needs and goals of the group. The United States has been cited as having values connected with the individualistic orientation (Hammer & Rogan, 2002; Trubisky, Ting-Toomey, & Lin, 1991). Researchers have noted the interconnection between familismo and collectivism; some have even cited familismo as a component of collectivism (Realo, Allik, & Vadi, 1997; Schwartz, Montgomery, & Briones, 2006). Some evidence suggests that substance use rates are higher in nations with more individualistic cultural orientations, and lower substance use rates in collectivist cultures may be directly related to the high intensity of connection and bonds

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among individuals (T. P. Johnson, 2007; Triandis, 1995). Some reports indicate that the supportive and protective aspects of collectivist and familistic cultural orientations of Latino families may erode and lose foundation across generations as families interact increasingly with U.S. society. As newly adopted attitudes and values trickle down into peer group, school, and family interactions, once-present protective factors (i.e., traditional family values related to familistic and collectivist cultures) regress and are replaced with others more in line with the individualistic orientation of the new environment in the United States. These newly adopted goals, beliefs, attitudes, and practices may be connected with individual Latino adolescents’ developmental pathways at greater risk for producing substance using behavioral outcomes. Yet inherent in Bronfenbrenner’s macrosystemic influence is the recognition of the heterogeneity that resides in any culture, as well as the influence of culture being anchored in the context of specific historical period. Certainly, not all ‘‘Latino’’ cultural components are the same. Despite being united by a common language, the U.S. Latino community is far from a homogeneous group. Latinos have immigrated to the United States from diverse countries, each with its unique historical and cultural traditions. The effects of these contextual characteristics have been shown to influence patterns of Latino adolescents’ substance use. For example, in a study of seven Spanish-speaking countries of the Americas, Dormitzer et al. (2004) found significant between-country variability in prevalence rates across seven different substances. Different national histories, governmental policies, economics, geographical locations, and the like are macrosystemic effects that influence the exosystems, mesosystems, and microsystems that comprise proximal processes, which in turn interact with a genotype to determine the developmental trajectory of the individual. A Discussion of Cultural Process Moderators Recent study findings have highlighted the disparity in substance use prevalence rates between Anglo and Latino cultures. In general, study findings have indicated that substance use, in particular illicit drug use, is on the rise in Latin America, yet the prevalence rates are still markedly lower than in Anglo cultures, namely, the United States (Aguilar-Gaxiola

110 et al., 2006). In the United States, Hispanic 8th and 10th graders report the highest lifetime, annual, and 30-day prevalence rates of alcohol, cigarette, and licit or illicit drug use (excluding amphetamines) in comparison with African Americans and non-Hispanic Whites (Johnston, O’Malley, Bachman, et al., 2009). Interestingly, the high prevalence rates for Hispanic 8th and 10th graders reverse for most major drugs as students move to the 12th grade. Thus, in the 12th grade, the drug prevalence rates for Hispanics fall between those for African American and non-Hispanic Whites (Johnston, O’Malley, Bachman, et al., 2009; Szapocznik et al., 2007). Several researchers have noted the importance of taking into account factors related to acculturation and assimilation when investigating Latino adolescents’ substance use (e.g., De La Rosa, 2002; De La Rosa, Vega, & Radisch, 2000; Gil, Wagner, et al., 2000; Szapocznik et al., 2007). Acculturation has been described as ‘‘the process of change that occurs when culturally distinct groups and individuals come into contact with another culture’’ (Samaniego & Gonzales, 1999, p. 190). The varying levels of acculturation, such as gradual integration of cultural beliefs, language, values, and behaviors characteristic of the prevailing society, may predict adolescent substance use. Reports centered on substance use prevalence rates among Latino adolescents have noted differences in comparisons of U.S.-born and foreign-born Hispanics. Vega, Aguilar-Gaxiola et al. (2002) found that U.S.-born Hispanic adolescents reported significantly higher rates of drug use than foreign-born Hispanics. Turner, Lloyd, and Taylor (2006) also found elevated levels of drug use in U.S.-born Hispanics in a sample of young adults identified as Cuban or ‘‘other Hispanic.’’ Length of time since immigration to the United States has also gained attention as a potential contributing factor to Latino adolescents’ substance use. Latino adolescents born in the United States, who have lived for a longer time in the United States and who also maintain higher levels of acculturation, report higher rates of delinquent behaviors including substance use (Gil, Wagner, et al., 2000; Turner et al., 2006; Warner et al., 2006). A relatively consistent finding in Latino substance use literature is that those with higher levels of acculturation experience higher levels of overall substance use. Gil, Wagner, et al. (2000) found higher levels of alcohol use among

Journal of Family Theory & Review U.S.-born, highly acculturated Latino adolescents, as well as among highly acculturated Latino adolescents living greater amounts of time living in the United States—both reported higher levels of alcohol use than more recent immigrants and less acculturated Latino adolescents. In a sample of Latino adolescents mostly of Cuban descent, Vega, Gil, and Wagner (1998) also found that those with lower levels of acculturation to U.S. society had lower levels of substance use initiation and continued experimentation than either bicultural or highly acculturated adolescents in the study. The exact mechanism by which acculturation and U.S. nativity affect substance-using behaviors in Latino youths is a topic of current investigation. De La Rosa (2002) reviewed current findings documenting the relationship between the acculturation process and substance use among Latino adolescents. In his review, he cited Vega, Gil, et al.’s (1998) argument for a double-jeopardy effect as an explanation for this phenomenon. De La Rosa (2002) reasoned that U.S.-born Latinos with low levels of acculturation endure a twofold risk. The adolescents experience the language problems and restricted life changes that are particular to foreign-born Latino youths, and they battle discrimination and acculturation conflicts pertinent to Latino youths born in the United States. Researchers have also noted the multidimensional influence of acculturation as a process that occurs at peer, family, community, and even broader societal levels. In this sense, the context in which the acculturation process takes place has a great influence on developmental outcomes (De La Rosa, 2002). Findings support the notion that education level, SES, neighborhood environment, skin color, nativity, and overall level of acculturation all potentially mediate the influence of acculturation on Latino adolescents’ substance use (De La Rosa, 2002; GuilamoRamos, Jaccard, Johannson, & Turrisi, 2004; Portes & Rumbaut, 1997; Vega, Gil, et al., 1998; Vega, Aguilar-Gaxiola, et al., 2002). The effects of the macrosystemic interactions then can be experienced at the microsystem level. The Americanization of Latino youths through associations with non-Latino peers and U.S. societal influences places increased importance on peer-sponsored beliefs and behaviors. These practices tend to separate Latino adolescents from traditional familistic values such as

Latino Adolescent Substance Use in the United States respect, and they weaken bonds between adolescents and their parents (Gil, Wagner, et al., 2000). In comparison with the acculturation of their parents, youths’ acculturation to ‘‘Americanism’’ has been shown to increase parental accounts of family and cultural stress, and less effective parenting has been associated with a higher likelihood of youth substance use (Martinez, 2006). In addition, differential acculturation levels of Latino adolescents and parents may incite family conflict and lead adolescents to seek acceptance and support from delinquent peer groups and engage in substance use as a means to rebel against their parents. Thus, macrosystemic cultural values and beliefs may be at odds (i.e., collectivist vs. individualist). As the developing adolescent internalizes these contrary values and beliefs, family conflicts may arise, which potentially turn the adolescent away from more traditional belief systems and align him or her more with ‘‘normative’’ peer-sponsored beliefs and practices of U.S. society (Coatsworth et al., 2002). Thus, several of the most salient cultural moderation process factors appear to be linked to conflict in intergenerational values and other culturally linked developmental factors, which points to the interconnection between larger macro influences and more immediate microsystem influences. For instance, building on the acculturation gap information highlighted earlier, those adolescents born in the United States may experience and interpret the world around them differently than those born in Latin America. The manner in which adolescents are socialized in Mexico (e.g., characterizations, expectations of adolescents) may vary from socialization processes of adolescents in the United States (Uma˜na-Taylor & B´amacaG´omez, 2003; Suarez-Orozco & Suarez-Orozco, 1995). Additionally, the behaviors and practices of adolescents and adolescent peer groups may differ in Latin America from those in the United States. For example, engaging in substanceusing behaviors among adolescent peer groups in the United States has been cited as an activity to ‘‘fit in’’ with one’s peer group and promote group closeness, yet different activities and behaviors potentially increase closeness among adolescent peer groups in Latin America (Lightfoot, 1997; Springer, Kelder, Orpinas, & Baumler, 2007). Latino adolescents who have recently immigrated to the United States have

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been described as more resistant to peer pressure to engage in antisocial behaviors. As time and generational status increase in the United States, this resistance to pressure appears to weaken because Latino youths may strive to act and appear more ‘‘American’’ (Uma˜na-Taylor & B´amaca-G´omez, 2003). Thus, with continued exposure to the U.S. host culture, Latino adolescents adopt not only expressions and attitudes (e.g., fashion, food tastes) different from those of their native country but also common youth health-related behaviors. Media influences in the United States that glorify substance use largely not present in Latin America also may influence adolescents’ substance-using behaviors (Springer et al., 2007). Parents of Latino adolescents who have spent a considerable amount of time in the United States, and particularly parents of second-generation Latino adolescents, may have difficulty managing the newly adopted behaviors and attitudes of their children because they adapt and acculturate to the new environment at a different, often slower rate than children and adolescents in the family. Parents may experience increased trouble implementing discipline practices, setting limits, and supervising and monitoring activities of their children with peer groups, thus leading to increased risks of problem behavior. Parents may implement stricter parenting practices in an effort to protect their children from potentially harmful influences of the host country, which may interact with the majority culture’s influence on autonomy and increase parent-child conflict, thus pushing the adolescent further away from the family. This process may incite feelings of distance from the family in the adolescent, which limits family communication and cohesion and leads to increased peer influences and increased risk of problem behaviors (Chappin & Brook, 2001, Portes & Rumbaut, 2001; Wagner et al., 2008). In addition, adolescence has been identified as a period devoted to developing an integrated sense of identity. Youths of color face not only overarching tasks of identity development but also the merging of self-identification and selfpride with cultural and group identity (Erikson, 1968; James, Kim, & Armijo, 2000). Ethnic identity has been defined as the developmental processes distinct from that of acculturation. Ethnic identity involves exploration and resolution, as well as psychological processes that involve exploring one’s ethnicity and deriving

112 a conclusion as to what the ethnic identity means to the individual. Thus, ethnic identity development is a process of commitment and affirmation (Schwartz, Mason, et al., 2009; Uma˜na-Taylor, Alfaro, B´amaca, & Guimond, 2009). Ethnic identity development has been cited as related to family factors such as family ethnic socialization processes, which pertain to how children acquire beliefs, values, perceptions, and attitudes of a group and how they see themselves as part of the group. Such processes also buffer a youth’s awareness and management of racial discrimination (Rumbaut, 1994; Uma˜na-Taylor et al., 2009). Ethnic identity and family socialization practices have been identified as important processes in the lives of families of color (Uma˜na-Taylor & B´amacaG´omez, 2003). Research has noted a relationship between ethnic identity and family ethnic socialization. For instance, Uma˜na-Taylor et al. (2009) found that family ethnic socialization predicted ethnic identity exploration and resolution, and that family ethnic socialization fully mediated the relationship between generational status and ethnic identity. However, they also found that generational status influenced family ethnic socialization processes. Adolescents with greater generational status (i.e., more U.S.-born family members) reported lower levels of family ethnic socialization, which predicted lower familistic values. Thus, these findings support the bioecosystemic notion that family ethnic socialization practices in the microsystem are influenced by larger-level factors, such as generation status and acculturative processes, which influence the adolescent’s ethnic identity development. The authors noted that Latino families who have resided less time in the United States tend to use more socialization practices revolving around their ethnicity; thus, adolescents from these families may tend to explore their ethnic identity to a greater degree in terms of what it means to them (Uma˜na-Taylor et al., 2009). It may be that stronger ethnic identity indicates closer connection to family and familistic values, which have been deemed a protective factor against substance use for Latino youths. Other investigations have sought to explore the influence of personal norms, personal identity, and ethnic pride on substance-using behavior, and how these factors associate with substance use differently from ethnic identity. Elek et al. (2006) found that adolescents who

Journal of Family Theory & Review held personal norms against substance use had lower recent and lifetime reports of marijuana use. This finding was particularly strong for Mexican and Mexican American adolescents in the sample. In a sample of Hispanic adolescents, Schwartz, Mason, et al. (2009) found personal identity confusion and school functioning to be more strongly associated with conduct problems and substance use than either personal identity affirmation or ethnic identity. Finally, Castro, Stein, and Bentler (2009) noted the interconnection between ethnic pride and ethnic identity, in that ethnic pride involves recognizing one’s ethnic identity while heartedly endorsing that identity. Their findings indicated that ethnic pride was strongly correlated with lower levels of cigarette and alcohol use for girls but not boys. For boys in the sample, traditional family values were correlated with lower substance use. Other findings have noted an interaction between ethnic pride and family values influencing substance-using behaviors (e.g., Castro & Hern´andez-Alarc´on, 2002). One divergent finding of note merits discussion in this section. James, Kim, and Armijo (2000) found that in ethnic minority youth, stronger ethnic identity was associated with heavy drug use. Their findings were based on a mixed sample of Hispanic, Asian American, African American, and Native American youths, not Hispanic youths alone. A potential explanation is that ethnic and cultural identity and cultural traditions diminish with increased acculturation (Castro & Coe, 2007; Cuellar, Nyberg, & Maldonado, 1997; Gil, Wagner, et al., 2000). Additional findings point toward how different levels of ethnic identity and nativity in the United States interact with the acculturation process to influence youths’ substance use. Ethnic identity and ethnic pride have also been noted to influence substance use through personal characteristics, such as personal norms regarding the use of substances and avoidance attitudes, which have been shown to be connected with the family environment and family practices in the microsystem (Castro & Hern´andez-Alarc´on, 2002; Castro et al., 2009; Elek et al., 2006). Thus, the relationships among ethnicity, ethnic pride, family socialization, and substance use are not entirely straightforward. Although some findings have reported direct relationships between strong ethnic identity and lower youth substance use (e.g., Marsiglia, Kulis, Hecht, & Sills, 2004), others have noted

Latino Adolescent Substance Use in the United States that ethnic identity may influence differential patterns of substance use for youths, and those patterns may vary by ethnic background (F´elix-Ortiz & Newcomb, 1992; Gil, Wagner, et al., 2000). Dissimilar operational definitions of ethnic identity and ethnic pride across various research settings and blanket grouping of Latinos from multiple ethnic and geographical backgrounds further convolute the picture of how the development of ethnic pride and ethnic identity influence substance use across situations and settings for Latino adolescents from diverse backgrounds. James et al. (2000) also pointed out the influential role of social influences (e.g., peers, family, school, community) in addition to, and in relation to, ethnic identity in the development of substance use behavior. In this regard, broader conceptualizations of the array of different factors to consider when investigating relationships between cultural factors and substance use are needed. For instance, how might differences in ethnic identity development and family socialization practices for Latinos differ in low-SES areas versus more affluent areas? Some evidence also has suggested that rural Latino families face unique challenges, such as small and isolated ethnic communities, lack of cohesive ethnic communities, and limited support systems (Torres-Stone & Meyler, 2006). How might ethnic identity development and family socialization influence substance use differently in rural versus urban Latino communities (and in homogenous Latino vs. heterogeneous communities)? In addition, how might the acculturation of both parents and children influence ethnic identity formation, family socialization processes, and substanceusing behavior? How might these factors differ by gender? This body of work presents encouraging areas for future exploration. Further research is needed to address the wide array of contextual influences that potentially influence substance use in Latino adolescents, and greater attention to the acculturation process and family functioning factors in conjunction with ethnic identity and family socialization processes are warranted. These findings also point toward continued development in prevention efforts. The evidence cited here posits that family socialization processes, ethnic identity formation, and the development of ethnic pride may act as buffers between adolescents and risk-taking

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behaviors such as substance use behavior, and they may boost prosocial outcomes such as academic achievement. Researchers have called for more attention to these factors in the design and implementation of youth substance use prevention programming (Castro et al., 2009; Holley, Kulis, Marsiglia, & Keith 2006). FUTURE DIRECTIONS Certainly, there are numerous potential influences (micro, meso, exo, macro, and chrono) on the development of substance-abusing behavior among Latino adolescents. More complex investigations and analyses are needed to gain a more complete understanding of how different factors work together to explain what leads youths down the different paths toward substance use. Instead of teasing apart factors through a process of controlling and isolating variables, the bioecodevelopmental model attempts to look at how risk is regulated through the interaction of multiple factors. We note a few points of consideration here as examples of how the bioecodevelopmental model may prove useful for conceptualizing future investigative work. Further exploration of chronosystemic interactions on the development of substance-using behavior is warranted. Current important societal trends and political issues, such as the economic recession, shifts in political philosophy, and discrimination because of immigration status, may directly or indirectly influence the contexts of adolescents’ substance use. For example, increasingly rigid immigration policies may lead to more discrimination against Latinos in the workplace and at school, which in turn may lead to less institutional bonding with schools and more stress at home as parents worry about deportation, thus creating a breakdown in protective factors for Latino youths. The number of economic, social, and community resources and supports available to Latino families in the midst of an economic downturn may mediate the development of substance-using behaviors among Latino adolescents (Padilla, 1980; Smart & Smart, 1995; Vega, Gil, et al., 1998). Deeper exploration of the interactions between the different influential contextual systems involved (e.g., mesosystem influences) is needed. For example, many immigrant Latino parents may spend many hours at work in efforts to provide for family and establish a life in their new environment. Yet as parents spend more

114 time at the workplace, they may have less time available to be involved with children and adolescents with respect to school achievement, peer group associations, and whereabouts and activities. Thus, investigations of family-systemic interactions are important to consider when assessing influences on Latino adolescents’ substance use. Work in general and time spent at work may take on new meaning as Latino parents interact with the presiding norms of U.S. culture. Workrelated efforts may transform from providing for family to more materialistic goals (e.g., buying new cars, providing children with the best clothes or shoes). The conceptualization of work as an effort to net material gain is a value more in line with individualistic societies such as that of the United States. Thus, the interaction between different norms at the macrosystem level (i.e., individualistic vs. collectivist) would influence interactions found between other systems (e.g., work-family). Hence, the broader influences of the macrosystem in interaction with neighborhoods, workplaces, and families also merit further consideration in investigations of factors associated with Latino adolescents’ substance use. Researchers have called for greater emphasis on comprehensive interventions involving the broader ecological context for treating adolescent substance abuse (e.g., Coatsworth et al., 2002; Lopez, Schwartz, Prado, Campo, et al., 2008; Strait, 1999). Attention to important cultural facets of the different systems in which Latino adolescents interact also can enrich understanding of the emergence of symptoms and help professionals tailor competent treatment and intervention programs (Szapocznik et al., 2007). Particularly, interventions aimed to increase protective factors should combine support efforts to include family, peer, and school supports, as well as supportive factors from the broader ecological context to bolster protective factors against substance-using behavior along the adolescent developmental pathway. IMPLICATIONS FOR TREATMENT PROVIDERS If treatment providers and prevention specialists working with Latino youths are to effectively apply the research described in this overview, one basic and central strategy likely to increase positive outcomes is to focus on increasing and providing access to protective factors in the

Journal of Family Theory & Review environment while also reducing risk factors. Individual issues in the life of the adolescent appear to contribute to the onset of substance abuse difficulties. These include things such as personality variables, low degree of self-control, high levels of novelty seeking and risk taking, negative affect, and impulsiveness. These issues are common in adolescence and can be effectively treated using interventions such as individual, family, or group therapy. However, treating these issues in isolation of the context is likely a recipe for relapse in many cases. Risk factors exist in the interaction between the individual and the environment, especially in the interactions among families, schools, and neighborhoods. Interventions are required at each of these levels in some cases to reduce substance use risk-factor influences and to bring about sustained change. One example of this is the parent-child relationship. Several studies discussed here have noted the importance of this relationship, especially the protective factor of closeness and connection between parents and adolescents. The mismatch in cultural trajectories between the adolescent and parents in terms of acculturation often exacerbate substance use risk factors. Latino youths in these circumstances may align with peer groups in which the use of substances is the norm as a means of rebelling against the traditional belief systems of parents or extended family, or they may seek a sense of belonging by engaging in substance-using behavior with peer groups in attempts to appear ‘‘more American.’’ In another example, Latino adolescents often live in neighborhoods and communities that are dangerous, poor, or both, where substances are widely available, and where substance-using behaviors are considered routine or ‘‘everyday’’ practices. Therapists who take into account these factors from multiple environments could more aptly design and implement therapy interventions and treatment programs to significantly reduce risks factors while also upholding and increasing protective factors relevant to the context in which the adolescent lives. Interventions such as those used in multisystemic, structural ecosystems therapy (an adaptation of brief strategic family therapy originally designed for HIV-positive clients) and multidimensional therapy are based on the theoretical ideas emphasized in social-ecological theory and family systems theory. These are comprehensive models designed to treat issues in the

Latino Adolescent Substance Use in the United States environments in which they occur and to address the naturally occurring nuances of the context that maintains and perpetuates the issue (Liddle & Hogue, 2000; Randall & Cunningham, 2003; Randall, Henggeler, Cunningham, Rowland, & Swenson, 2001; Robbins, Schwartz, & Szapocznik, 2003; Szapocznik & Williams, 2000). For instance, multidimensional family therapy is both a family-based and a community-based intervention. Therapists act to increase support systems for the adolescent and family through making visits and coordinating services with schools, medical personnel, churches, and other community institutions. Intervention efforts are tailored to the specific needs of each family, both taking into account the unique perspectives of the adolescent, parents, and even extended family members and addressing the role of cultural history, values, rituals, and practices of the family. Thus, techniques are designed to facilitate and maintain connections among family members, to strengthen contacts with helpful community sources of support, and to reduce the influence and perceived importance of harmful factors (Liddle & Hogue, 2000). Also, structural ecosystems therapy uses interventions at the family relationship level while also focusing on multiple systems of influence. The model views interactional patterns that occur through and between Bronfenbrenner’s systems of influence, in the microsystem (e.g., adolescent–family relations, adolescentpeer relations), mesosystem (e.g., family-school relations, family-legal system relations, familypeer relations), and exosystem (e.g., community supports, parents’ sources of support) while taking into account the macrosystemic influences of cultural context as part of the treatment model to identify mechanisms to bolster support to parent and adolescents to reduce substance use risk factors. In this manner, structural ecosystems therapy uses both a homebased and community-based service-delivery approach (Robbins, Schwartz, et al., 2003; Robbins, Szapocznik, et al., 2008; Szapocznik & Williams, 2000). All of the therapy models described here have proved effective in treating adolescent behavioral problems and substanceusing behaviors (Hogue, Dauber, Samuolis, & Liddle, 2006; Henggeler, Pickrel, Brondino, & Crouch, 1996; Liddle, Rowe, Dakof, Henderson, & Greenbaum, 2009; Robbins, Szapocznik, et al., 2008; Sheidow & Woodford, 2003; Szapocznik & Williams, 2000).

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Finally, a critical area of consideration is awareness of individual and familial cultural variables and alternatives for treatment. For example, the clinical approach to be followed with a first-generation immigrant family may differ clearly from that used with a second- or third-generation Latino family (Parra-Cardona et al., 2008). CONCLUSION Though not exhaustive in its scope, the current review has brought together some of the more salient research findings from multiple disciplines. Instead of competing for prominence in their ability to explain the variance in adolescent substance use, under Bronfenbrenner’s systems-based bioecodevelopmental theory, the often unique causal factors and associations employed by different fields begin to come together to form a more coherent explanation of an enormously complex phenomenon. An increasingly clear picture of the connections between individual characteristics and the multiple systems and context that influence the development of adolescent substance use will aid developers of prevention programs to intervene more effectively on behalf of adolescents and their families. Certainly, there are commonalities that cut across cultures in the etiology of youthful substance use. However, there are also cultural idiosyncrasies that if sufficiently understood would advance attempts to address the problem of adolescent substance use wherever it is found. REFERENCES Adalbjamardottir, S., & Rafnsson, F. D. (2001). Perceived control in adolescent substance use: Concurrent and longitudinal analysis. Psychology of Addictive Behaviors, 15, 25 – 32. Aguilar-Gaxiola, S., Medina-Mora, M. E., Maga˜na, C. G., Vega, W. A., Alejo-Garcia, C., Quintanar, T. R., et al. (2006). Illicit drug use research in Latin America: Epidemiology, service use, and HIV. Drug and Alcohol Dependence, 84, 85 – 93. Alaniz, M. L., Treno, A. J., & Saltz, R. F. (1999). Gender, acculturation, and alcohol consumption among Mexican Americans. Substance Use and Misuse, 34, 1407 – 1426. Allen, M. L., Elliot, M. N., Fuligni, A. J., Morales, L. S., Hambarsoomian, K., & Schuster, M. A. (2008). The relationship between Spanish language use and substance use behaviors among Latino

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