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Social influence predictors of alcohol use among New York Latino youth
Addictive Behaviors, Vol. 19, No. 4, pp. 363-372, 1994 Copyright 0 1994 Elsevier Science Ltd
Pergamon
Printed in the USA. All rights reserved 0306-4603/94$6.00 + .OO
SOCIAL INFLUENCE PREDICTORS OF ALCOHOL USE AMONG NEW YORK LATIN0 YOUTH LINDA DUSENBURY,
JENNIFER A. EPSTEIN, and TRACY DIAZ
Institute for Prevention Research,
GILBERT
J. BOTVIN,
Cornell University Medical College
Abstracl - We examined demographic and social influence predictors of adolescent drinking among New York City Latin0 adolescents, including specific Latin0 subgroups (i.e., Puerto Rican, Dominican, Colombian, and Ecuadorian). Sixth- and seventh-grade students (N = 3129) who identified themselves as Latin0 or Hispanic on the survey questionnaire comprised our Latin0 sample. The survey included self-reported frequency of alcohol use, demographic items, and measures of social influences for drinking. Logistic-regression analyses revealed that social influences (how many friends drink, attitudes of parents and friends toward respondent’s drinking) are strong predictors of current drinking (defined as drinking at least once a month) for the overall sample of Latin0 youth, as well as for Puerto Rican youth and Dominican youth. Findings are discussed in terms of their implications for prevention.
Among White populations, certain risk factors appear to be reliably associated with drinking during adolescence; important among these are social influences, including parental and family use or abuse, family attitudes toward drinking, drinking practices among friends and attitudes toward drinking by friends, and the individual’s normative expectations or perceptions about the prevalence of drinking among peers and adults generally (USOTA, 1991). Indeed, it is now generally acknowledged in the substance use field that multiple social risk factor models are important to the understanding of adolescent substance use (Austin & Gilbert, 1989; Botvin & Botvin, 1992; U.S.O.T.A., 1991; Vega, Zimmerman, Warheit, Apospori, & Gil, 1993). In terms of adolescent populations, the rate of substance use in general, and alcohol use and abuse in particular, varies across ethnic groups (Barnes & Welte, 1986a; Barnes & Welte, 1986b; Castro, Maddahian, Newcomb, & Bentler, 1987; Maddahian, Newcomb, & Bentler, 1988; Welte & Barnes, 1987), including Latin0 populations. For example, in their study of drinking among 7th-12th grade students (n = 27,335) across New York state, Barnes and Welte (1986a) found that drinking prevalence was lower among Latin0 youth than among White adolescents, though rates of heavy drinking and drinking-related problems were almost as high for Latinos as for White adolescents. While some school-based studies have found lower rates of alcohol use among Latinos, researchers caution that this may be the result of school-based sampling and higher drop-out rates experienced by Latinos (Austin & Gilbert, 1989; Zambrana & Aguirre-Molina, 1987).
This research was supported by Grant 1 R18 CA 39280 to Dr. Gilbert J. Botvin from the National Cancer Institute. For their support and cooperation in this project, we would like to thank the administrations and the schools of the Archdiocese of New York, the Diocese of Brooklyn and Queens, and the New York City Board of Education. Requests for reprints should be sent to Linda Dusenbury, PhD, Department of Public Health, Cornell University Medical College, 411 E. 69th St., New York, NY 10021. 363
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In their review of the literature, Austin and Gilbert (1989) conclude that Latino boys who drink tend to drink more heavily than Latin0 girls or than non-Latin0 boys, and that they appear more likely to have problems related to their alcohol use. They also observed that the pattern for initiation for Latinos and non-Latinos appear similar, with boys beginning to drink at a younger age, drinking more heavily, and having more alcohol-related problems than girls. Nationally, the three major Latin0 groups are Mexican-Americans (58%), Puerto Ricans (14%), and Cuban Americans (6%) (USDHHS, 1985). Most research of Latinos’ substance use has been conducted with Mexican-Americans from the southwestern region of the U.S. (Austin & Gilbert, 1989). Research on specific Latin0 subgroups is limited, particularly among northeastern Latinos. In New York City, the four major Latin0 groups are (a) Puerto Ricans, (b) Dominicans, (c) Colombians, and (d) Ecuadorians. Thus, in the present study of alcohol use among Latin0 youth, the only group in common with national samples are Puerto Rican New York City residents. Studies of the etiology of alcohol use provide a basis for assessing the potential appropriateness of prevention approaches, and for guiding the development of new approaches for Latin0 youth. The current study was designed to explore social influence predictors of adolescent drinking among New York City Latin0 populations, including specific Latin0 subgroups (i.e., Puerto Rican, Dominican, Colombian, and Ecuadorian youth). This study is important because there is limited information about alcohol use during adolescence for Latinos in general and among Puerto Rican youth in particular, and there is even less data available on Dominican, Colombian, and Ecuadorian youth. There are numerous cultural differences between the four major Latin0 populations in New York City. A major difference between Puerto Ricans and the other Latin0 groups is that since 1917, Puerto Ricans have been U.S. citizens. Puerto Ricans have a longer history and a more established community in New York City (Chavez, 1991). However, predicting how this difference might impact on substance use is not a simple matter. Puerto Ricans have the lowest socioeconomic status of the Latin0 groups, which might be expected to be associated with higher substance use. But studies of their native countries suggest that Ecuadorians (Aguilar, 1990) and Colombians (Tori-es de Galvis & Murrelle, 1990), particularly Colombian youth, have a high rate of alcohol use and abuse. Thus, because of their different cultural heritages and their different histories in the U.S., we expected that there might be differences in the predictors of alcohol use among the different groups of Latin0 youth. Although this is a school-based study, it focuses on early adolescence, when the drop-out rate is still low. Sixth- and seventh-graders were selected for this study because national studies indicate that the majority of adolescents have begun experimenting with alcohol by the time they reach the eighth grade (USOTA, 1991). In a previous study, we found that social influence variables predicted smoking status for Latin0 youth (Dusenbury et al., 1992). In another study using a seventhgrade sample, we reported that alcohol use appeared to be higher among Dominican youth than among Puerto Rican youth, and higher among boys compared with girls (Bettes, Dusenbury, Kerner, James-Ortiz, & Botvin, 1990). The current study extends this previous research by analyzing data for a more inclusive sample (sixthand seventh-graders) and by examining three types of social influence variables (peer and parental approval, drinking by friends, and perceived prevalence of drinking
Drinking in Latin0 youth
365
among peers and adults) considered to be important in predicting adolescent substance use (Austin & Gilbert, 1989). We also included three basic demographic variables: age, gender, and academic performance. Moreover, this study goes beyond earlier studies to examine the social influence predictors of alcohol use within Latin0 subgroups. METHODS
Subjects A total of 47 schools with student bodies composed of 25% or more Latin0 youth participated in the project. The universe of schools considered eligible for this study included all public and Catholic schools in New York City whose student body was at least 25% Latino. Both public and Catholic schools in New York City serve urban minority youth from low-income families. Schools were targeted for recruitment based on the proportion of Latin0 students and with the assistance of district level administrators. The process of obtaining administrative clearance was slower in some schools than in others. Recruitment continued until the recruitment goal of at least 5000 students was reached. Of the 47 schools participating, 36 were Catholic schools and 11 were public schools; 39 of the 47 schools (83%) in the current study served youth from families with average income levels at or below 150% of the federal poverty level. All sixth- and seventh-graders in English-speaking, mainstream classes participated in the study. A passive consent procedure was used to obtain parental consent, and more than 90% of the available students completed the baseline survey. The sample was evenly distributed between the two school types, with 2,681 students (49%) from Catholic schools and 2,820 students (51%) from public schools. Since there were no differences found between the school types, the two groups were combined in all the analyses. A total of 3,129 (57%) sixth- and seventh-grade students who identified themselves as Latin0 or Hispanic on the survey questionnaire participated in the current study. The mean age of students was 12.61 years (range: lo-18 years) at the time of the baseline survey. Fifty-two percent of the sample were female. Forty-three percent of the sample were Puerto Rican (n = 1265), 20% were Dominican (n = 582), 7% were Colombian (n = 216), and 7% were Euadorian (n = 216). The remaining 23% (n = 663) of the students identified with another Latin0 subgroup (e.g., Mexican, Cuban), or with more than one Latin0 subgroup (e.g., Puerto Rican and Dominican combination). One hundred eighty-seven students did not indicate their Latin0 subgroup. Survey instrument The instrument was a self-report 143-item questionnaire which covered demographics, substance use, and psychosocial factors. It included items on self-reported alcohol use and the perceived social influences for drinking alcohol. Background variables. Items were collected to determine basic background information concerning gender, age, academic performance (grades), and ethnicity. If students indicated that they were Latin0 or Hispanic, they were asked to indicate their Latin0 subgroup status, which included Puerto Rican, Dominican, Colombian, Ecuadorian, and other Latin0 groups. Only those students identifying themselves as Latin0 or Hispanic were included in the present study.
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Alcohol measures. Students indicated how often (if ever) they drank alcoholic beverages on a 9-point scale: (1) never tried them, (2) tried them, but don’t use them now, (3) less than once a month, (4) about once a month, (5) about two or three times a month, (6) about once a week, (7) a few times a week, (8) about once a day, and (9) more than once a day (excluding drinking during religious ceremonies). Data from this 9-point scale were used to create a dichotomous measure of current drinking which was defined as drinking alcoholic beverages once a month or more. Thus, the current drinking measure compared students who drank at least once a month (4 to 9 on the 9-point scale) to students who drank less than once a month (1 to 3 on the 9point scale). Perceived social injluences on drinking. Several social influences on drinking were assessed including (1) drinking by friends, (2) perceived attitudes of parents and friends toward whether the respondent drinks, and (3) perceived prevalence of general drinking among peers and adults. Drinking by friends was measured on a 5-point scale ranging from “none” to “all/nearly all.” The perceived attitudes of parents and friends toward the respondent’s drinking were assessed, in separate items, on a 5-point scale ranging from “strongly against” to “strongly in favor of it.” The perceived prevalence of drinking among peers and adults was measured using separate items (“In your opinion, how many people your age [adults] drink alcoholic beverages?“) on a S-point scale ranging from “none” to “almost all.” Procedure
The survey staff members and February. students were
was administered in the classroom by teams of three to five project during a regular 40-minute period during a 4-week period in January Teachers were not involved in the data collection activities, and the assured that their answers would remain confidential.
Data analysis
The data were analyzed with SPSS/PC+ software (Norusis, 199Oa, 1990b). First, within the major ethnic groups, prevalence of drinking was determined for boys and girls. Next, a series of logistic regressions were used to analyze demographic and social influence predictors of drinking status for Latin0 youth, comparing adolescents who drink once a month or more with those who drink less than once a month. Individuals for whom any of the variables were missing were omitted from these analyses. The first logistic-regression analysis was carried out for the entire Latin0 sample. Subsequent analyses were conducted for specific Latin0 groups; separate logistic-regression analyses were carried out for Puerto Rican youth and Dominican youth. These represented the groups for which there was adequate sample size to support the analyses. Unfortunately, because of the small sample sizes, it was not possible to conduct separate logistic-regression analyses for the Colombian or Ecuadorian samples. RESULTS
Table 1 presents the prevalence of drinking (at least monthly) by ethnic and gender groups. Boys tended to have higher drinking prevalence rates than girls, and Dominican students (particularly Dominican boys) tended to have higher drinking rates than other Latin0 subgroups.
Drinking in Latin0 youth
Table 1. Current drinking prevalence subgroup and gender
by Latin0 Boys
Girls
Puerto Rican Dominican Colombian Ecuadorian Other Latin0
Predictors
%
n
%
n
4.2 5.6 6.8 1.7 5.5
624 319 103 116 347
8.0 14.4 14.2 7.0 7.6
641 263 113 100 316
of drinking in the overall sample
A logistic regression was conducted for the entire Latin0 sample. Demographic and perceived social-influence variables were entered into the equation simultaneously. Latin0 groups were compared using Puerto Ricans as the reference group. The other demographic variables were age, sex, and academic performance. Socialinfluence variables included prevalence of drinking among friends, perceived drinking prevalence among youth and adults generally, and parents and friends attitudes about whether the respondent drinks. Table 2 presents the predictors of current drinking for the overall sample. Sex emerged as a predictor, with the odds of current drinking 2.54 times more likely for boys than girls. Dominican and Colombian students were more likely to be drinkers.
Table 2. Predictors of current drinking
Predictor Age Sex (female=) Academic performance (As and Bs”) Bs and Cs Cs and Ds Latin0 group (Puerto Rican”) Dominican Colombian Ecuadorian Other Latin0 Friends drink (none=) Few Some to all Parents’ attitudes (negative”) Neutral/favorable Friends’ attitudes (negativea) Neutral/favorable General prevalence among peers (most/alla) None/few Half General prevalence among adults (most/alla) None/few Half aReference category.
Odds ratio
95% Confidence interval
1.12 2.54
.95 1.80-
1.33 3.60
1.13 1.12
.77 .72 -
1.67 1.75
1.99 1.92 .50 1.37
1.31 1.08.20 .88-
3.00 3.43 1.25 2.15
8.44 23.30
5.14 - 13.84 13.93 - 38.96
2.21
1.50-
3.26
2.01
1.37-
2.95
.69 .91
.43 .59 -
1.08 1.40
.58 .93
.30.61 -
1.11 1.42
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et al.
Dominican students had 1.98 the odds of being drinkers compared to Puerto Rican students; Colombian students had 1.92 times the odds of being drinkers. The proportion of friends who drink emerged as a powerful predictor of current drinking. In terms of social influence predictors, the odds of current drinking among students who reported that some to all of their friends drank were 23.30 times higher than among students who reported that none of their friends drank. Even among students who reported that a few of their friends drank, the odds that they were current drinkers were 8.44 times greater than for students who reported that none of their friends drank. Parents’ and friends’ attitudes were correlated with current drinking. Compared with students whose parents had negative attitudes about the respondent’s drinking, the odds of being a current drinker were 2.21 times higher for students whose parents held neutral or favorable attitudes toward the respondent’s drinking. Friends’ attitudes also predicted current drinking: the odds of being a current drinker were twice as high for students whose friends held neutral or favorable as opposed to negative attitudes about the respondent’s drinking. Perceptions about general prevalence of drinking among peers and adults did not emerge as predictors of current drinking. Predictors
of drinking among specific Latin0 groups
The logistic-regression analyses were carried out separately for Puerto Rican and Dominican youth. The same variables were entered into the equation as in the analysis for the overall sample, with the exception of the Latin0 subgroup. Puerto Rican youth. Table 3 presents the results of the logistic-regression equation for Puerto Rican students. Sex emerged as a significant predictor. The odds of being a current drinker were 3.14 times higher for boys than girls. As in the analysis for the overall sample, two types of social influence variables were powerful predictors:
Table 3. Predictors
of current drinking for Puerto Ricans
Predictor Age Sex (femalea) Academic performance (As and Bsa) Bs and Cs Cs and Ds Friends drink (nonea) Few Some to all Parents’ attitudes (negative”) Neutral/favorable Friends’ attitudes (negative=) Neutral/favorable General prevalence among peers (most/all”) None/few Half General prevalence among adults (most/all”) None/few Half “Reference category.
Odds ratio
95% Confidence interval
1.31 3.14
l.OO1.71 -
1.71 5.77
.99 .99
._50.46-
1.95 2.12
11.20 55.05
3.75 - 33.44 18.67 - 162.35
2.19
1.13 -
4.24
3.30
1.59 -
6.83
.78 1.08
.36.53 -
1.71 2.20
.44 1.25
.14.62 -
1.41 2.51
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Table 4. Predictors
of current drinking for Dominicans
Odds ratio
Predictor
Age Sex (femalea) Academic performance (As and Bs”) Bs and Cs Cs and Ds Friends drink (none=) Few Some to all Parents’ attitudes (negativea) Neutral/favorable Friends’ attitudes (negativea) Neutral/favorable General prevalence among peers (most/alla) None/few Half General prevalence among adults (most/alla) None/few Half
95% Confidence interval
1.20 3.22
.86 1.64 -
1.68 6.35
2.10 1.07
1.01 .43 -
4.35 2.70
7.84 11.16
3.45 - 17.84 4.26 - 29.22
2.38
1.13 -
5.05
1.88
.90-
3.92
.88 1.62
.33 .67 -
2.32 3.95
.38 .50
.08.20-
1.81 1.24
“Reference category.
compared to having no friends who drink, having a few friends who drink increased the odds 11.20 times that respondents were current drinkers, and having some to all friends who drink, the odds were increased 55.05 times. Parental and friends attitudes also emerged as predictors. When parents’ attitudes toward the respondent’s drinking were neutral or favorable, as compared to negative about drinking, the odds of current drinking increased 2.19 times. When friends’ attitudes toward the respondent’s drinking were perceived to be neutral or favorable, the odds increased 3.30 times. Perceptions about the general prevalence of drinking among peers and adults did not emerge as significant predictors. Dominican youth. Table 4 presents the results of the logistic regression for Dominican youth. As with Puerto Rican youth, sex was a predictor: the odds of being a current drinker were 3.22 times as great for boys than ,girls. Social influences were again the strongest predictors. Friends’ drinking was the strongest predictor. Having a few friends who drink increased the odds of current drinking 7.84 times; having some to all friends who drink increased the odds 11.16 times. Parental attitudes were also significant; neutral or favorable attitudes toward the respondent’s drinking increased the odds of respondents’ drinking 2.38 times. Friends attitudes did not emerge as a significant predictor for Dominican youth. DISCUSSION
This study was intended to examine the social influence predictors of drinking among multi-ethnic Latin0 youth, focusing on young adolescents in sixth and seventh grade in New York City schools. The findings of the current study indicate that even among young adolescents, the pattern of social influence predictors of alcohol use is similar to those identified as important by Austin and Gilbert (1989), but which had not been previously shown specifically for Puerto Rican, Dominican, Colom-
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bian, and Ecuadorian youth. For example, in the present study, sex and Latin0 subgroup were significant demographic predictors of current drinking. Consistent with previous studies with non-Latin0 youth, and with Latin0 youth in general (Austin & Gilbert, 1989), boys in all the Latin0 groups represented in this study appeared more likely to be current drinkers than girls. Social influence variables, including friends’ drinking, friends’ attitudes and parental attitudes toward the respondent’s drinking were powerful predictors of current alcohol use. While the literature on studies with specific Latin0 groups has been limited, there is extensive literature concerning social influence predictors for alcohol use in White, non-Latin0 youth (USOTA, 1991). In addition, numerous studies with White, non-Latin0 youth have found an inverse relationship between academic performance and substance use (Bachman, Johnston, & O’Malley, 1981). Based on the larger literature, there were a number of unexpected findings in the current study. Specifically, perceived social norms concerning drinking by adults or by peers did not emerge as significant predictors of current drinking, nor did academic performance in the current study. However, it is important to interpret the findings of this study with caution, due to the limited number of studies with Latin0 youth. Differences in the findings of studies with non-Latin0 youth and Latin0 youth may be the result of demographic factors such as socioeconomic factors, family structure, or urban living, rather than ethnicity or Latin0 culture. Nevertheless, several predictors replicated findings of non-Latin0 youth for Latin0 youth: boys were more likely to be drinkers than girls, students whose friends drink were more likely to be current drinkers than students whose friends do not drink, and favorable or neutral attitudes of parents and friends toward whether the respondent drinks (approval) increased the odds for current drinking. Previous research with the same sample found that Puerto Rican students were more likely to be current smokers than Dominican students (Dusenbury et al. 1992). In this study, we found that Dominicans and Colombians were more likely to be current drinkers compared to Puerto Ricans. However, the differences between Dominicans, Colombians, and Puerto Ricans may not be true of these subgroups when they are in their native land. There are significant differences between these groups in terms of length of time they have been in the U.S. It may be the better established Puerto Rican community has cultural factors which help to protect Puerto Rican youth in terms of alcohol use. Moreover, while less information is available about Dominican youth in their own country, Colombian youth appear at high risk for alcohol-related problems in their own country (Torres de Galvis & Murrelle, 1990), and this risk may follow them when they immigrate to the U.S. Future research will be necessary to investigate these possibilities directly. The drinking status of friends was a predictor for all Latin0 subgroups. Sex (being a boy) and parental approval of whether the respondent drinks increased the odds of current drinking for the overall Latin0 sample as well as for Puerto Ricans and Dominicans considered in separate analyses. These results suggest that there are similarities between the Latin0 subgroups in terms of the social influence and basic demographic predictors of current drinking. Further research with larger samples of Colombian and Ecuadorian youth will be necessary in order to identify which variables predict consistently across these other Latin0 subgroups and which variables only predict for particular subgroups. The generalizability of the current study is limited to a school-based sample. However, while students and drop-outs may differ, the student population in the
Drinking in Latin0 youth
371
sixth and seventh grade is still relatively stable (91%), and the drop-out rate low, even for Latin0 youth (New York City Board of Education, 1993). A greater limitation of the current study is that since it only included Latin0 students in Englishspeaking classes, these findings may not generalize to less acculturated Latin0 populations in bilingual classes. Future studies will be needed to explore drinking rates in bilingual Latin0 youth. The current study demonstrates the powerful relationship between social-i’nfluence variables and drinking across a number of Latin0 groups during early adolescence, and there are three major implications for prevention. First, the findings of this study suggest that the types of interventions which will prevent alcohol use would be those which address the social influences to drink particularly among friends. Prevention programs that teach skills such as assertiveness, decision-making, and other social skills would best prepare Latin0 youth for pressure from their friends to use alcohol. The social-influence predictors of this study of alcohol use are consistent with the social-influence predictors of our previous study of smoking prevalence (Dusenbury et al., 1992), and a second implication of this study is that the most efficient approach to prevention may be general life skills interventions meant to prevent more than one form of substance use, rather than interventions targeted at the use of specific substances. This is consistent with the conclusion of Barnes and Welte (1986b) who found that alcohol consumption was correlated with other drug use and problem behaviors, suggesting the importance of more comprehensive prevention strategies. Finally, our findings concerning the importance of social influences are consistent with previous studies for non-Latin0 Whites (Miller & Slap, 1989) and non-Latin0 Blacks (Botvin et al., 1989). Thus, the third implication for prevention is that the types of interventions which will prevent substance use in one population (i.e., interventions that teach students to cope with influences to use cigarettes, alcohol, and drugs) are likely to be effective in other populations. Interventions which are sensitive to a range of cultures are likely to have the greatest impact, particularly in school settings, since most schools are integrated and include students from a variety of cultural backgrounds.
REFERENCES Aguilar, E. (1990). Prevalence of the improper use of alcohol, tobacco and drugs in the Ecuadorian population. Bulletin of PAHO, 24, 35-38. Austin, G. A., & Gilbert, M. J. (1989). Substance abuse among Latin0 youth. Prevention Research Update, 3, l-28. Bachman, J. G., Johnston, L. K., & O’Malley, P. M. (1981). Smoking, drinking and drug use among American high school students: Correlates and trends, 197.5-1979. American Journal of Public Health, 71, 59-69. Barnes, G. M., & Welte, J. W. (1986a). Patterns and predictors of alcohol use among 7-12th grade students in New York State. Journal of Studies on Alcohol. 47. 53-62. Barnes, G. M., & Welte, J. W. (1986b). Adolescent alcohol usd: Subgroup differences and relations to other problem behaviors. Journal of Adolescent Research, 1,79-94. Bettes, B. A., Dusenbury, L., Kemer, J., James-Ortiz, S., & Botvin, G. J. (1990). Ethnicity and psychosocial factors in alcohol and tobacco use in adolescence. Child Development, 61, 557-565. Botvin, G. J., Batson, H., Witts-Vitale, S., Bess, V., Baker, E., & Dusenbury, L. (1989). A psychosocial approach to smoking prevention for urban black youth. Public Health Reports, 104,573-582. Botvin, G., & Botvin, E. (1992). School-based and community-based prevention approaches. In J. H. Lowinson, P. Ruiz, and R. B. Millman (Eds.), Substance abuse: A comprehensive textbook (2nd ed.), Baltimore: Williams and Wilkins. Castro, F. G., Maddahian, E., Newcomb, M. D., & Bender, P. M. (1987). A multivariate model of the
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determinants of cigarette smoking among adolescents. Journal of Health and Social Behavior, 28, 273-289. Chavez, L. (1991). Out of the barrio: Toward a new politics of hispanic assimilation. New York: Basic Books. Dusenbury, L., Kemer, J., Baker, E., Botvin, G., James-Ortiz, S., & Zauber, A. (1992). Predictors of smoking prevalence among New York Latin0 youth. American Journal of Public Health, 82,55-58. Maddahian, E., Newcomb, M. D., & Bentler, P. M. (1988). Adolescent drug use of intention to use drugs: Concurrent and longitudinal analyses of four ethnic groups. Addictive Behaviors, 13, 191-195. Miller, S. K., & Slap, G. B. (1989). Adolescent smoking: A review of prevalence and prevention, Journal of Adolescent Health Care, 10,129-135. New York City Board of Education. (1993). Citywide projle: Middle schools 1991-1992. New York: Author. Norusis, M. J./SPSS Inc. (199Oa). Advanced statistics. Chicago: SPSS Inc. Norusis, M. J./SPSS Inc. (199Ob). Base manual. Chicago: SPSS Inc. Torres de Galvis, Y., & Murrelle, L. (1990). Consumption of dependence producing substances in Colombia. Bulletin of PAHO, 24, 12-21. U.S. Department of Health and Human Services [USDHHS]. (1985). Report of the Secretary’s Tusk Force on Black and Minority Health. U.S. Government Printing Office. Author. U.S. Office of Technology Assessment [USOTA]. (1991). Adolescent health-Volume II: Background and the effectiveness of selected prevention and treatment services (OTA-H-466). Washington, DC: U.S. Government Printing Office. Vega, W. A., Zimmerman, R. S., Warheit, G. J., Apospori, E., & Gil, A. G. (1993). Risk factors for early adolescent drug use in four ethnic and racial groups. American Journal of Public Health, 83, 185-189. Welte, J. W., & Barnes, G. M. (1987). Youthful smoking. Patterns and relationships to alcohol and other drug use. Journal of Youth and Adolescence, 10,327-340. Zambrana, R., & Aguirre-Molina, M. (1987). Alcohol abuse prevention among Latin0 adolescents: A strategy for intervention. Journal of Youth and Adolescence, 16, 97-113.
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SOCIAL INFLUENCE PREDICTORS OF ALCOHOL USE AMONG NEW YORK LATIN0 YOUTH LINDA DUSENBURY,
JENNIFER A. EPSTEIN, and TRACY DIAZ
Institute for Prevention Research,
GILBERT
J. BOTVIN,
Cornell University Medical College
Abstracl - We examined demographic and social influence predictors of adolescent drinking among New York City Latin0 adolescents, including specific Latin0 subgroups (i.e., Puerto Rican, Dominican, Colombian, and Ecuadorian). Sixth- and seventh-grade students (N = 3129) who identified themselves as Latin0 or Hispanic on the survey questionnaire comprised our Latin0 sample. The survey included self-reported frequency of alcohol use, demographic items, and measures of social influences for drinking. Logistic-regression analyses revealed that social influences (how many friends drink, attitudes of parents and friends toward respondent’s drinking) are strong predictors of current drinking (defined as drinking at least once a month) for the overall sample of Latin0 youth, as well as for Puerto Rican youth and Dominican youth. Findings are discussed in terms of their implications for prevention.
Among White populations, certain risk factors appear to be reliably associated with drinking during adolescence; important among these are social influences, including parental and family use or abuse, family attitudes toward drinking, drinking practices among friends and attitudes toward drinking by friends, and the individual’s normative expectations or perceptions about the prevalence of drinking among peers and adults generally (USOTA, 1991). Indeed, it is now generally acknowledged in the substance use field that multiple social risk factor models are important to the understanding of adolescent substance use (Austin & Gilbert, 1989; Botvin & Botvin, 1992; U.S.O.T.A., 1991; Vega, Zimmerman, Warheit, Apospori, & Gil, 1993). In terms of adolescent populations, the rate of substance use in general, and alcohol use and abuse in particular, varies across ethnic groups (Barnes & Welte, 1986a; Barnes & Welte, 1986b; Castro, Maddahian, Newcomb, & Bentler, 1987; Maddahian, Newcomb, & Bentler, 1988; Welte & Barnes, 1987), including Latin0 populations. For example, in their study of drinking among 7th-12th grade students (n = 27,335) across New York state, Barnes and Welte (1986a) found that drinking prevalence was lower among Latin0 youth than among White adolescents, though rates of heavy drinking and drinking-related problems were almost as high for Latinos as for White adolescents. While some school-based studies have found lower rates of alcohol use among Latinos, researchers caution that this may be the result of school-based sampling and higher drop-out rates experienced by Latinos (Austin & Gilbert, 1989; Zambrana & Aguirre-Molina, 1987).
This research was supported by Grant 1 R18 CA 39280 to Dr. Gilbert J. Botvin from the National Cancer Institute. For their support and cooperation in this project, we would like to thank the administrations and the schools of the Archdiocese of New York, the Diocese of Brooklyn and Queens, and the New York City Board of Education. Requests for reprints should be sent to Linda Dusenbury, PhD, Department of Public Health, Cornell University Medical College, 411 E. 69th St., New York, NY 10021. 363
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In their review of the literature, Austin and Gilbert (1989) conclude that Latino boys who drink tend to drink more heavily than Latin0 girls or than non-Latin0 boys, and that they appear more likely to have problems related to their alcohol use. They also observed that the pattern for initiation for Latinos and non-Latinos appear similar, with boys beginning to drink at a younger age, drinking more heavily, and having more alcohol-related problems than girls. Nationally, the three major Latin0 groups are Mexican-Americans (58%), Puerto Ricans (14%), and Cuban Americans (6%) (USDHHS, 1985). Most research of Latinos’ substance use has been conducted with Mexican-Americans from the southwestern region of the U.S. (Austin & Gilbert, 1989). Research on specific Latin0 subgroups is limited, particularly among northeastern Latinos. In New York City, the four major Latin0 groups are (a) Puerto Ricans, (b) Dominicans, (c) Colombians, and (d) Ecuadorians. Thus, in the present study of alcohol use among Latin0 youth, the only group in common with national samples are Puerto Rican New York City residents. Studies of the etiology of alcohol use provide a basis for assessing the potential appropriateness of prevention approaches, and for guiding the development of new approaches for Latin0 youth. The current study was designed to explore social influence predictors of adolescent drinking among New York City Latin0 populations, including specific Latin0 subgroups (i.e., Puerto Rican, Dominican, Colombian, and Ecuadorian youth). This study is important because there is limited information about alcohol use during adolescence for Latinos in general and among Puerto Rican youth in particular, and there is even less data available on Dominican, Colombian, and Ecuadorian youth. There are numerous cultural differences between the four major Latin0 populations in New York City. A major difference between Puerto Ricans and the other Latin0 groups is that since 1917, Puerto Ricans have been U.S. citizens. Puerto Ricans have a longer history and a more established community in New York City (Chavez, 1991). However, predicting how this difference might impact on substance use is not a simple matter. Puerto Ricans have the lowest socioeconomic status of the Latin0 groups, which might be expected to be associated with higher substance use. But studies of their native countries suggest that Ecuadorians (Aguilar, 1990) and Colombians (Tori-es de Galvis & Murrelle, 1990), particularly Colombian youth, have a high rate of alcohol use and abuse. Thus, because of their different cultural heritages and their different histories in the U.S., we expected that there might be differences in the predictors of alcohol use among the different groups of Latin0 youth. Although this is a school-based study, it focuses on early adolescence, when the drop-out rate is still low. Sixth- and seventh-graders were selected for this study because national studies indicate that the majority of adolescents have begun experimenting with alcohol by the time they reach the eighth grade (USOTA, 1991). In a previous study, we found that social influence variables predicted smoking status for Latin0 youth (Dusenbury et al., 1992). In another study using a seventhgrade sample, we reported that alcohol use appeared to be higher among Dominican youth than among Puerto Rican youth, and higher among boys compared with girls (Bettes, Dusenbury, Kerner, James-Ortiz, & Botvin, 1990). The current study extends this previous research by analyzing data for a more inclusive sample (sixthand seventh-graders) and by examining three types of social influence variables (peer and parental approval, drinking by friends, and perceived prevalence of drinking
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among peers and adults) considered to be important in predicting adolescent substance use (Austin & Gilbert, 1989). We also included three basic demographic variables: age, gender, and academic performance. Moreover, this study goes beyond earlier studies to examine the social influence predictors of alcohol use within Latin0 subgroups. METHODS
Subjects A total of 47 schools with student bodies composed of 25% or more Latin0 youth participated in the project. The universe of schools considered eligible for this study included all public and Catholic schools in New York City whose student body was at least 25% Latino. Both public and Catholic schools in New York City serve urban minority youth from low-income families. Schools were targeted for recruitment based on the proportion of Latin0 students and with the assistance of district level administrators. The process of obtaining administrative clearance was slower in some schools than in others. Recruitment continued until the recruitment goal of at least 5000 students was reached. Of the 47 schools participating, 36 were Catholic schools and 11 were public schools; 39 of the 47 schools (83%) in the current study served youth from families with average income levels at or below 150% of the federal poverty level. All sixth- and seventh-graders in English-speaking, mainstream classes participated in the study. A passive consent procedure was used to obtain parental consent, and more than 90% of the available students completed the baseline survey. The sample was evenly distributed between the two school types, with 2,681 students (49%) from Catholic schools and 2,820 students (51%) from public schools. Since there were no differences found between the school types, the two groups were combined in all the analyses. A total of 3,129 (57%) sixth- and seventh-grade students who identified themselves as Latin0 or Hispanic on the survey questionnaire participated in the current study. The mean age of students was 12.61 years (range: lo-18 years) at the time of the baseline survey. Fifty-two percent of the sample were female. Forty-three percent of the sample were Puerto Rican (n = 1265), 20% were Dominican (n = 582), 7% were Colombian (n = 216), and 7% were Euadorian (n = 216). The remaining 23% (n = 663) of the students identified with another Latin0 subgroup (e.g., Mexican, Cuban), or with more than one Latin0 subgroup (e.g., Puerto Rican and Dominican combination). One hundred eighty-seven students did not indicate their Latin0 subgroup. Survey instrument The instrument was a self-report 143-item questionnaire which covered demographics, substance use, and psychosocial factors. It included items on self-reported alcohol use and the perceived social influences for drinking alcohol. Background variables. Items were collected to determine basic background information concerning gender, age, academic performance (grades), and ethnicity. If students indicated that they were Latin0 or Hispanic, they were asked to indicate their Latin0 subgroup status, which included Puerto Rican, Dominican, Colombian, Ecuadorian, and other Latin0 groups. Only those students identifying themselves as Latin0 or Hispanic were included in the present study.
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Alcohol measures. Students indicated how often (if ever) they drank alcoholic beverages on a 9-point scale: (1) never tried them, (2) tried them, but don’t use them now, (3) less than once a month, (4) about once a month, (5) about two or three times a month, (6) about once a week, (7) a few times a week, (8) about once a day, and (9) more than once a day (excluding drinking during religious ceremonies). Data from this 9-point scale were used to create a dichotomous measure of current drinking which was defined as drinking alcoholic beverages once a month or more. Thus, the current drinking measure compared students who drank at least once a month (4 to 9 on the 9-point scale) to students who drank less than once a month (1 to 3 on the 9point scale). Perceived social injluences on drinking. Several social influences on drinking were assessed including (1) drinking by friends, (2) perceived attitudes of parents and friends toward whether the respondent drinks, and (3) perceived prevalence of general drinking among peers and adults. Drinking by friends was measured on a 5-point scale ranging from “none” to “all/nearly all.” The perceived attitudes of parents and friends toward the respondent’s drinking were assessed, in separate items, on a 5-point scale ranging from “strongly against” to “strongly in favor of it.” The perceived prevalence of drinking among peers and adults was measured using separate items (“In your opinion, how many people your age [adults] drink alcoholic beverages?“) on a S-point scale ranging from “none” to “almost all.” Procedure
The survey staff members and February. students were
was administered in the classroom by teams of three to five project during a regular 40-minute period during a 4-week period in January Teachers were not involved in the data collection activities, and the assured that their answers would remain confidential.
Data analysis
The data were analyzed with SPSS/PC+ software (Norusis, 199Oa, 1990b). First, within the major ethnic groups, prevalence of drinking was determined for boys and girls. Next, a series of logistic regressions were used to analyze demographic and social influence predictors of drinking status for Latin0 youth, comparing adolescents who drink once a month or more with those who drink less than once a month. Individuals for whom any of the variables were missing were omitted from these analyses. The first logistic-regression analysis was carried out for the entire Latin0 sample. Subsequent analyses were conducted for specific Latin0 groups; separate logistic-regression analyses were carried out for Puerto Rican youth and Dominican youth. These represented the groups for which there was adequate sample size to support the analyses. Unfortunately, because of the small sample sizes, it was not possible to conduct separate logistic-regression analyses for the Colombian or Ecuadorian samples. RESULTS
Table 1 presents the prevalence of drinking (at least monthly) by ethnic and gender groups. Boys tended to have higher drinking prevalence rates than girls, and Dominican students (particularly Dominican boys) tended to have higher drinking rates than other Latin0 subgroups.
Drinking in Latin0 youth
Table 1. Current drinking prevalence subgroup and gender
by Latin0 Boys
Girls
Puerto Rican Dominican Colombian Ecuadorian Other Latin0
Predictors
%
n
%
n
4.2 5.6 6.8 1.7 5.5
624 319 103 116 347
8.0 14.4 14.2 7.0 7.6
641 263 113 100 316
of drinking in the overall sample
A logistic regression was conducted for the entire Latin0 sample. Demographic and perceived social-influence variables were entered into the equation simultaneously. Latin0 groups were compared using Puerto Ricans as the reference group. The other demographic variables were age, sex, and academic performance. Socialinfluence variables included prevalence of drinking among friends, perceived drinking prevalence among youth and adults generally, and parents and friends attitudes about whether the respondent drinks. Table 2 presents the predictors of current drinking for the overall sample. Sex emerged as a predictor, with the odds of current drinking 2.54 times more likely for boys than girls. Dominican and Colombian students were more likely to be drinkers.
Table 2. Predictors of current drinking
Predictor Age Sex (female=) Academic performance (As and Bs”) Bs and Cs Cs and Ds Latin0 group (Puerto Rican”) Dominican Colombian Ecuadorian Other Latin0 Friends drink (none=) Few Some to all Parents’ attitudes (negative”) Neutral/favorable Friends’ attitudes (negativea) Neutral/favorable General prevalence among peers (most/alla) None/few Half General prevalence among adults (most/alla) None/few Half aReference category.
Odds ratio
95% Confidence interval
1.12 2.54
.95 1.80-
1.33 3.60
1.13 1.12
.77 .72 -
1.67 1.75
1.99 1.92 .50 1.37
1.31 1.08.20 .88-
3.00 3.43 1.25 2.15
8.44 23.30
5.14 - 13.84 13.93 - 38.96
2.21
1.50-
3.26
2.01
1.37-
2.95
.69 .91
.43 .59 -
1.08 1.40
.58 .93
.30.61 -
1.11 1.42
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Dominican students had 1.98 the odds of being drinkers compared to Puerto Rican students; Colombian students had 1.92 times the odds of being drinkers. The proportion of friends who drink emerged as a powerful predictor of current drinking. In terms of social influence predictors, the odds of current drinking among students who reported that some to all of their friends drank were 23.30 times higher than among students who reported that none of their friends drank. Even among students who reported that a few of their friends drank, the odds that they were current drinkers were 8.44 times greater than for students who reported that none of their friends drank. Parents’ and friends’ attitudes were correlated with current drinking. Compared with students whose parents had negative attitudes about the respondent’s drinking, the odds of being a current drinker were 2.21 times higher for students whose parents held neutral or favorable attitudes toward the respondent’s drinking. Friends’ attitudes also predicted current drinking: the odds of being a current drinker were twice as high for students whose friends held neutral or favorable as opposed to negative attitudes about the respondent’s drinking. Perceptions about general prevalence of drinking among peers and adults did not emerge as predictors of current drinking. Predictors
of drinking among specific Latin0 groups
The logistic-regression analyses were carried out separately for Puerto Rican and Dominican youth. The same variables were entered into the equation as in the analysis for the overall sample, with the exception of the Latin0 subgroup. Puerto Rican youth. Table 3 presents the results of the logistic-regression equation for Puerto Rican students. Sex emerged as a significant predictor. The odds of being a current drinker were 3.14 times higher for boys than girls. As in the analysis for the overall sample, two types of social influence variables were powerful predictors:
Table 3. Predictors
of current drinking for Puerto Ricans
Predictor Age Sex (femalea) Academic performance (As and Bsa) Bs and Cs Cs and Ds Friends drink (nonea) Few Some to all Parents’ attitudes (negative”) Neutral/favorable Friends’ attitudes (negative=) Neutral/favorable General prevalence among peers (most/all”) None/few Half General prevalence among adults (most/all”) None/few Half “Reference category.
Odds ratio
95% Confidence interval
1.31 3.14
l.OO1.71 -
1.71 5.77
.99 .99
._50.46-
1.95 2.12
11.20 55.05
3.75 - 33.44 18.67 - 162.35
2.19
1.13 -
4.24
3.30
1.59 -
6.83
.78 1.08
.36.53 -
1.71 2.20
.44 1.25
.14.62 -
1.41 2.51
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Table 4. Predictors
of current drinking for Dominicans
Odds ratio
Predictor
Age Sex (femalea) Academic performance (As and Bs”) Bs and Cs Cs and Ds Friends drink (none=) Few Some to all Parents’ attitudes (negativea) Neutral/favorable Friends’ attitudes (negativea) Neutral/favorable General prevalence among peers (most/alla) None/few Half General prevalence among adults (most/alla) None/few Half
95% Confidence interval
1.20 3.22
.86 1.64 -
1.68 6.35
2.10 1.07
1.01 .43 -
4.35 2.70
7.84 11.16
3.45 - 17.84 4.26 - 29.22
2.38
1.13 -
5.05
1.88
.90-
3.92
.88 1.62
.33 .67 -
2.32 3.95
.38 .50
.08.20-
1.81 1.24
“Reference category.
compared to having no friends who drink, having a few friends who drink increased the odds 11.20 times that respondents were current drinkers, and having some to all friends who drink, the odds were increased 55.05 times. Parental and friends attitudes also emerged as predictors. When parents’ attitudes toward the respondent’s drinking were neutral or favorable, as compared to negative about drinking, the odds of current drinking increased 2.19 times. When friends’ attitudes toward the respondent’s drinking were perceived to be neutral or favorable, the odds increased 3.30 times. Perceptions about the general prevalence of drinking among peers and adults did not emerge as significant predictors. Dominican youth. Table 4 presents the results of the logistic regression for Dominican youth. As with Puerto Rican youth, sex was a predictor: the odds of being a current drinker were 3.22 times as great for boys than ,girls. Social influences were again the strongest predictors. Friends’ drinking was the strongest predictor. Having a few friends who drink increased the odds of current drinking 7.84 times; having some to all friends who drink increased the odds 11.16 times. Parental attitudes were also significant; neutral or favorable attitudes toward the respondent’s drinking increased the odds of respondents’ drinking 2.38 times. Friends attitudes did not emerge as a significant predictor for Dominican youth. DISCUSSION
This study was intended to examine the social influence predictors of drinking among multi-ethnic Latin0 youth, focusing on young adolescents in sixth and seventh grade in New York City schools. The findings of the current study indicate that even among young adolescents, the pattern of social influence predictors of alcohol use is similar to those identified as important by Austin and Gilbert (1989), but which had not been previously shown specifically for Puerto Rican, Dominican, Colom-
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bian, and Ecuadorian youth. For example, in the present study, sex and Latin0 subgroup were significant demographic predictors of current drinking. Consistent with previous studies with non-Latin0 youth, and with Latin0 youth in general (Austin & Gilbert, 1989), boys in all the Latin0 groups represented in this study appeared more likely to be current drinkers than girls. Social influence variables, including friends’ drinking, friends’ attitudes and parental attitudes toward the respondent’s drinking were powerful predictors of current alcohol use. While the literature on studies with specific Latin0 groups has been limited, there is extensive literature concerning social influence predictors for alcohol use in White, non-Latin0 youth (USOTA, 1991). In addition, numerous studies with White, non-Latin0 youth have found an inverse relationship between academic performance and substance use (Bachman, Johnston, & O’Malley, 1981). Based on the larger literature, there were a number of unexpected findings in the current study. Specifically, perceived social norms concerning drinking by adults or by peers did not emerge as significant predictors of current drinking, nor did academic performance in the current study. However, it is important to interpret the findings of this study with caution, due to the limited number of studies with Latin0 youth. Differences in the findings of studies with non-Latin0 youth and Latin0 youth may be the result of demographic factors such as socioeconomic factors, family structure, or urban living, rather than ethnicity or Latin0 culture. Nevertheless, several predictors replicated findings of non-Latin0 youth for Latin0 youth: boys were more likely to be drinkers than girls, students whose friends drink were more likely to be current drinkers than students whose friends do not drink, and favorable or neutral attitudes of parents and friends toward whether the respondent drinks (approval) increased the odds for current drinking. Previous research with the same sample found that Puerto Rican students were more likely to be current smokers than Dominican students (Dusenbury et al. 1992). In this study, we found that Dominicans and Colombians were more likely to be current drinkers compared to Puerto Ricans. However, the differences between Dominicans, Colombians, and Puerto Ricans may not be true of these subgroups when they are in their native land. There are significant differences between these groups in terms of length of time they have been in the U.S. It may be the better established Puerto Rican community has cultural factors which help to protect Puerto Rican youth in terms of alcohol use. Moreover, while less information is available about Dominican youth in their own country, Colombian youth appear at high risk for alcohol-related problems in their own country (Torres de Galvis & Murrelle, 1990), and this risk may follow them when they immigrate to the U.S. Future research will be necessary to investigate these possibilities directly. The drinking status of friends was a predictor for all Latin0 subgroups. Sex (being a boy) and parental approval of whether the respondent drinks increased the odds of current drinking for the overall Latin0 sample as well as for Puerto Ricans and Dominicans considered in separate analyses. These results suggest that there are similarities between the Latin0 subgroups in terms of the social influence and basic demographic predictors of current drinking. Further research with larger samples of Colombian and Ecuadorian youth will be necessary in order to identify which variables predict consistently across these other Latin0 subgroups and which variables only predict for particular subgroups. The generalizability of the current study is limited to a school-based sample. However, while students and drop-outs may differ, the student population in the
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371
sixth and seventh grade is still relatively stable (91%), and the drop-out rate low, even for Latin0 youth (New York City Board of Education, 1993). A greater limitation of the current study is that since it only included Latin0 students in Englishspeaking classes, these findings may not generalize to less acculturated Latin0 populations in bilingual classes. Future studies will be needed to explore drinking rates in bilingual Latin0 youth. The current study demonstrates the powerful relationship between social-i’nfluence variables and drinking across a number of Latin0 groups during early adolescence, and there are three major implications for prevention. First, the findings of this study suggest that the types of interventions which will prevent alcohol use would be those which address the social influences to drink particularly among friends. Prevention programs that teach skills such as assertiveness, decision-making, and other social skills would best prepare Latin0 youth for pressure from their friends to use alcohol. The social-influence predictors of this study of alcohol use are consistent with the social-influence predictors of our previous study of smoking prevalence (Dusenbury et al., 1992), and a second implication of this study is that the most efficient approach to prevention may be general life skills interventions meant to prevent more than one form of substance use, rather than interventions targeted at the use of specific substances. This is consistent with the conclusion of Barnes and Welte (1986b) who found that alcohol consumption was correlated with other drug use and problem behaviors, suggesting the importance of more comprehensive prevention strategies. Finally, our findings concerning the importance of social influences are consistent with previous studies for non-Latin0 Whites (Miller & Slap, 1989) and non-Latin0 Blacks (Botvin et al., 1989). Thus, the third implication for prevention is that the types of interventions which will prevent substance use in one population (i.e., interventions that teach students to cope with influences to use cigarettes, alcohol, and drugs) are likely to be effective in other populations. Interventions which are sensitive to a range of cultures are likely to have the greatest impact, particularly in school settings, since most schools are integrated and include students from a variety of cultural backgrounds.
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