Cannabis Frequency of Use Among Latinas and Non-Latinas at Risk of a Substance-Exposed Pregnancy: The Role of Acculturation and Psychological Distress

Background and Purpose: Cannabis use during pregnancy can cause serious health complications for women and their offspring. However, little is known about individual and sociocultural factors that may contribute to a substance-exposed pregnancy (SEP) among Latina adults who use cannabis.  An intersectional framework that considers the impact of substance use among racial and ethnic minority women is critical as it can lead to improved efforts at addressing disparities in care. This study examined the relationship of acculturation, psychological distress, alcohol use and alcohol problems with the frequency of cannabis use among adult Latinas and non-Latinas at risk of an SEP.  

Methods: The study used baseline data from a randomized controlled trial testing the efficacy of CHOICES Plus, an intervention targeting risky alcohol and tobacco use among women at risk of an SEP in primary care clinics, in Houston, Texas.  Although cannabis use was not a target behavior of the intervention, the protocol included questions on cannabis use and frequency of use.  Acculturation was measured by the Short Acculturation Scale for Hispanics (Marin et al., 1987).  Psychological distress was measured by the Brief Symptom Inventory-18 (Deragotis, 2001).  The hypothesized model included 191 participants and was analyzed using structural equation modeling.  Model fit statistics included the CFI ≥ .95 and RMSEA ≤ .05.  Multigroup analysis was conducted to test structural invariance between Latinas and non-Latinas. 

Results: Latinas comprised 40% of the sample (n = 76). The majority of non-Latinas were African American (n = 88, 76.5%).  Latinas were younger, more likely to be married or living with a partner, and consumed less daily alcohol compared to non-Latinas. Latinas’ acculturation score (M = 39.97, SD = 8.54) fell in the bicultural range.  Results suggested an acceptable fit of the data χ² = 639.34, df = 384, p < .001, CFI = .92, RMSEA = .06, for the overall final model and explained a modest amount of variance (R² = .12) in cannabis use frequency.  Greater acculturation was associated with more frequent cannabis use (b =.20, p =.01) and more psychological distress (b =.27, p =.03).  Psychological distress was in turn associated with greater frequency of cannabis use (b =.28, p <.001).  Average number of drinks per week was directly related to alcohol problems (b = .57, p <.001).  Alcohol problems were found to be indirectly related to cannabis use frequency through psychological distress.  Multigroup analysis indicated no group differences, demonstrating that the model was structurally equivalent across groups.    

Conclusions and Implications:  Findings underscore the critical role of acculturation and psychological distress on cannabis frequency of use and have relevant implications for preventive efforts addressing problematic cannabis use among Latinas and other minority groups at risk of an SEP in community health settings. Interventions targeting problematic cannabis use should consider the role of psychological distress in assessment and treatment. Moreover, for Latinas, examining possible acculturation-related stressors and enhancing cultural protective factors may better address their needs and lead to improved SEP treatment outcomes.