Unpacking Acculturation: Hispanic Acculturation Strategies and Alcohol-Related Outcomes

Background and Purpose: Hispanics endure great adverse effects from alcohol, with cirrhosis being among the ten largest Hispanic health disparities. Acculturation may play a key role. Research suggests that younger and U.S.-born Hispanic immigrants have higher lifetime prevalence rates for alcohol use disorders than those who arrived in the U.S. later in life. Understanding the relationship between Hispanic acculturation and alcohol-related outcomes can inform the development of prevention and intervention services, meet the needs of an important U.S. population, and help reduce health disparities. However, studies have been inconclusive. Consensus is lacking on the existence and nature of the relationship between Hispanic acculturation and alcohol-related outcomes. Using the bicultural model of acculturation, which predicts acculturation strategies, we aimed to examine this relationship in a national probability sample. Specifically, the bidimensional model posits that individuals may pursue separation, integration, and assimilation strategies. We hypothesized that Hispanics pursuing assimilation would have the highest alcohol consumption and rates of DSM-IV alcohol diagnoses.

Methods: We utilized data from wave 2 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC; 2001–2002, n=43,093; 2004–2005, n=34,653). NESARC is a nationally representative survey of alcohol consumption, alcohol use disorders, and risk factors. Wave 2 included an 11-item acculturation scale adapted from the Brief Acculturation Rating Scale-II that assesses language proficiency and preference, and race-ethnic social preference. Item responses were rated 1-5 (from Only Spanish/All Hispanics to Only English/All Other Ethnic Groups) and summed to form a scale from 11 to 55. Higher scores indicate higher acculturation. Congruent with the bicultural model, we divided individuals into three groups or acculturation strategies: assimilation (most acculturated group), integration (bicultural group), and separation (least acculturated group). We then examined the relationship between acculturation strategy, rates of alcohol abuse and dependence, and average daily use of alcohol.

Results: As hypothesized, analyses found significantly lower risk of DSM-IV Alcohol Abuse and Dependence for the bicultural and separation groups than for the assimilated one. Controlling for sociodemographic differences, bicultural Hispanics had a lower probability of lifetime diagnosis of alcohol abuse (OR=0.48, p<0.0001) and dependence (OR=0.43, p<0.0001) than assimilated Hispanics. Those pursuing a separation strategy also had lower lifetime odds than assimilated Hispanics for abuse (OR=0.20, p<0.0001) and dependence (OR=0.20, p<0.001). For past-year diagnoses, bicultural Hispanics had lower odds of abuse than assimilated Hispanics (OR=0.62, p=0.45), but not of dependence. Separated Hispanics had lower odds than assimilated Hispanics for both abuse (OR=0.26, p=0.0001) and dependence (OR=0.37, p=0.0001). There were no differences between acculturation strategies on average daily consumption of alcohol.

Conclusions/Implications: Our findings support previous research that reports a relationship between acculturation proxies (e.g., U.S. born, age of arrival) and worsening alcohol outcomes. We extend this research by using a direct measure of acculturation. Further research should seek to explore and isolate elements of each acculturation strategy that represent risk or protective factors for increased alcohol consumption, abuse and dependence. By examining acculturation strategies, we can identify individuals and groups at-risk and develop tailored prevention programs to meet their unique needs.