ACCULTURATION AND LATINO HEALTH IN THE UNITED STATES

ACCULTURATION AND LATINO HEALTH IN THE UNITED STATES

Acculturation and Latino Health in the United States

ACCULTURATION AND LATINO HEALTH IN THE UNITED STATES: A Review of the Literature and its Sociopolitical Context
 
Key Words health outcomes, Hispanic, assimilation, health behaviors, health care use
■ Abstract This chapter provides an overview of the concept of acculturation and reviews existing evidence about the possible relationships between acculturation and selected health and behavioral outcomes among Latinos. The effect of acculturation on Latino health is complex and not well understood. In certain areas—substance abuse, dietary practices, and birth outcomes—there is evidence that acculturation has a negative effect and that it is associated with worse health outcomes, behaviors, or per- ceptions. In others—health care use and self-perceptions of health—the effect is mostly in the positive direction. Although the literature, to date, on acculturation lacks some breadth and methodological rigor, the public health significance of findings in areas in which there is enough evidence justifies public health action. We conclude with a set of general recommendations in two areas—public health practice and research—targeted to public health personnel in academia, community-based settings, and government agencies.
ORDER A CUSTOM-WRITTEN PAPER NOW
INTRODUCTION
Health outcomes for Latinos are generally favorable when compared with other racial and ethnic groups in the United States. Two commonly used measures of population health include rates of adult and infant mortality. Mortality statistics for adults show that Latinos in the United States have lower mortality rates than do non-Latino whites and blacks. For example, in 2001 the age-adjusted mortality rate for Latinos was 22% lower than was the age-adjusted mortality rate among
0163-7525/05/0421-0367$20.00 367

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
368 LARA ET AL.
non-Latino whites and 41% lower than was the age-adjusted mortality rate for non- Latino blacks (6). Similarly, birth outcomes statistics for 2001 show that infant mortality among Latinos was similar to that of non-Latino whites, and it was 58% lower than that of non-Latino blacks (6).
Yet the health outcomes of U.S. Latinos present a pattern of substantial het- erogeneity in several dimensions. First, important indicators of population health vary among Latinos of Mexican, Puerto Rican, Cuban, and other Latino origin or cultural heritage. For instance, mortality and prevalence rates of chronic ill- ness vary among both Latino children and adults of these different subgroups (33, 53, 55, 98, 102). Second, wide ranges of factors have been explored to ex- plain this heterogeneity. These factors include more traditionally studied attributes such as socioeconomic status, educational level, and age, as well as other, less studied, contextual factors such as language fluency and immigration status, in- cluding time and number of generations living in the United States. These factors often are described as part of the phenomenon of acculturation to U.S. mainstream culture.
The focus of this chapter is to provide public health practitioners with an un- derstanding of the concept of acculturation as one of many factors influencing the health of Latinos in the United States. We begin with a brief historical re- view of the concept, followed by a synopsis of how the term acculturation has been defined and used in the public health literature to date. We then present a critical review of existing evidence about the possible relationships between acculturation and selected health and behavioral outcomes among U.S. Latinos. On the basis of this review of existing evidence, we conclude with a summary of the relevance of acculturation to the design, planning, and implementation of public health programs for the Latino population; and we present recommen- dations for public health personnel in community, academic, and government settings.
ACCULTURATION AND ASSIMILATION: A HISTORY OF THE CONCEPTS
Milton Gordon (61) summarized thinking on the experience of European immi- grant ethnic groups in America during the late nineteenth and early twentieth centuries in his 1964 book Assimilation in American Life, in which assimilation and acculturation were presented as unidirectional and inevitable. To become as- similated into the host society, the immigrant ethnic group had to make the major accommodation and develop, in the words of Gordon’s mentor, Robert E. Park, “the memories, sentiments and attitudes of other persons and groups and, by shar- ing their experience and history. . .[become] incorporated with them in a common cultural life” (113). Those memories, sentiments, and attitudes the immigrants had to adopt were, of course, the “middle-class cultural patterns of largely white Protestant, Anglo-Saxon origins,” often referred to as the “core culture” (61). When

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
ACCULTURATION AND LATINO HEALTH 369
immigrants had expunged their own ethnicity, the host society then would allow the “cleansed” ethnic group entry into “the social cliques, clubs and institutions of the core society,” that is, into their inner-circle institutions (61). The most intimate entry, and the endpoint of the assimilation process, was intermarriage, upon which the minority groups’ separate identity, having lost all value, would cease to be even a memory.
Acculturation, the acquisition of the cultural elements of the dominant society— language, food choice, dress, music, sports, etc.—was the process by which as- similation was to be achieved. Warner & Srole (151) described the acculturation process as one in which ethnic groups unlearned their inferior culturally based be- haviors. The primary investigator of a maternal and child health project in Riverside County, California, sighed about the difficulty of getting Mexican immigrants to expunge their health-harming culture when she wrote, “So steeped are these people in their traditional ways and so accustomed are they to ill health and the constant presence of death, and so stupid are they in their ignorance, illiteracy and wast- ing diseases that lifting them out of this abyss is a real job” (84). In these views, acculturation to white, Anglo-Saxon norms would be the best thing to happen to ethnic groups, and the quicker the better.
Then, only months after Gordon published his state-of-the-art monograph, the Watts area of Los Angeles exploded in the first of the “long hot summers” that racked urban America, and changes in immigration law allowed the entry of a significant number of immigrants for the first time in nearly 40 years, only this time largely from Mexico, other Latin American countries, and Asia. Initially, experts assumed that the acculturation and assimilation models of the past would guide the fortunes of these new immigrant groups. But the unilinear, unidirectional, and inevitable assimilation of the earlier groups seemed suddenly to become an elusive goal. Some theorists tried to rework the old models, adding new elements that had been overlooked. Perlman & Waldinger (116), for example, pointed out that earlier European immigrant mobility had not been the result of individual choice and gumption alone; entry to inner-circle institutions came only after organized ethnic communities exerted economic, political, and legal pressure to force those institutions to accept individuals from ethnic communities.
Other theorists began to see some structural differences between earlier and current waves of immigrants. Alba (2) noticed a bimodal pattern of immigration. “Human capital immigrants,” largely from Asia, who arrived with higher educa- tional and occupational levels than those achieved on average by U.S.-born non- Latino whites, seemed to be succeeding quickly, in spite of racial distinctiveness. “Labor immigrants,” largely from Mexico and Central America, with lower edu- cational and occupational levels, made much slower progress. Portes & Rumbaut (119) noted in their study of second-generation children of immigrants that assim- ilation outcomes varied across immigrant minorities, and that archetypical rapid acceptance and integration into the American mainstream represented just one pos- sible outcome. They offered a model of segmented assimilation, in which different groups could wind up in vastly different relationships to mainstream American

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
370 LARA ET AL.
society, depending on three different variables: the human capital possessed by the immigrant group (education, wealth, occupational skills, and English ability), the policies of governmental institutions and the attitudes of native populations, and the structure and resources of the immigrants’ families and communities. Groups with high human capital, whose presence is welcomed by policies generated by native populations, are likely to experience a smooth transition akin to that per- ceived of the older, European immigrant groups. Groups with low human capital, however, whose presence is resented or even rejected by the policies of the na- tive population, are likely to wind up in a subordinate, permanent multi-ethnic underclass. In between would be a group whose individual members might have low human capital but whose community resources and networks provide access to social and economic mobility; even if the group’s presence is resented by the native population, its very ethnicity provides a source of strength.
In Portes & Rumbaut’s model, the process of acculturation can vary, ranging from dissonant acculturation, in which the child acquires cultural capital before the parent does, thereby upsetting parental roles; to consonant acculturation, in which parent and child acquire cultural elements at the same speed, preserving parental authority; to selective acculturation, in which a functioning ethnic community mediates between parent and child.
DEFINITIONS OF ACCULTURATION USED IN THE PUBLIC HEALTH LITERATURE
Unidimensional and Bidimensional Acculturation Models
Influenced by this previous historical context, the use and application of the concept of acculturation in the public health literature to date has included both unidimen- sional and bidimensional models. Unidimensional definitions, sometimes referred to as a “zero-sum game” (17, 36, 37, 124), assume that the acculturation experi- ence occurs along a linear continuum from not acculturated (total immersion in the culture of origin) to completely acculturated (total immersion in the dominant or host culture); as the individual acculturates into the dominant culture, he or she loses his or her original cultural paradigms (17, 36, 37, 86). Unidimensional models probably best describe the experience of assimilation by which individuals “become part of the new group, and ‘fold in’ with members of the new culture” (11, 86).
Bidimensional models, questioning the validity of these assumptions, propose that acquiring or adhering to a new dominant culture is independent of maintaining the original culture (11, 17, 85, 87, 124, 125). Cultural maintenance is the degree to which an individual continues to value and adhere to the norms of the culture of origin. The level of participation and contact the individual has with the new dominant culture also can vary. Both domains theoretically range from full partic- ipation to full rejection of either culture’s values, behaviors, and attitudes (11, 17).

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
ACCULTURATION AND LATINO HEALTH 371
Bidimensional models emphasize integration or biculturalism, in that they aim to characterize the experience by which individuals “feel equally comfortable in both cultures, hold the values and respect for norms of both cultures, and retain a dual cultural identity” (86).
In bidimensional acculturation models, different subcategories or states are possible: (a) assimilation—complete acquisition of the new culture, from the lack of desire to maintain the culture of origin or for other reasons; (b) separation— maintenance of the culture of origin through rejection or avoidance of the new culture; (c) integration—embracing and valuing both cultures; and (d) margina- lization—exclusion (voluntarily or not) by both cultures (17). A similar, some- what parallel categorization for the possible states within the bidimensional model has been articulated by Mendoza: (a) cultural shift—substituting new alternate cultural norms for original customs; (b) cultural resistance—resisting acquiring new alternate cultural norms while maintaining original customs; (c) cultural incorporation—adapting customs from both original and new alternate customs; and (d) cultural transmutation—alternating between original and new alternate cultural practices, thus creating a unique subcultural entity (100).
Transition into one of these categories or states assumes that an individual has control over these domains (11). This is not necessarily the case. Separation or marginalization, as described previously, can result from societal circumstances— such as prejudice, institutional racism, and segregational rules or laws—or his- torical circumstances, such as when a territory is invaded or annexed by another country (86).
In conceptualizing the process of acculturation, Marin postulates that the “cul- ture learning” that is part of the acculturation process can be described on three levels. (a) First is a mostly superficial level including “the learning (and forget- ting) of the facts that are part of one’s cultural history or tradition” and “changes in the consumption of food and in the uses of the media” (86). Perhaps the reason these are considered superficial is that the adoption of things like food and media depends on the relative availability of these versus the ones from the culture of origin. (b) Next is an intermediate level including behaviors that are central to a person’s social life, such as language preference and use, and preference for the ethnicity of friends, neighbors, spouse, and media in a multicultural environment. (c) Last is a more significant level and perhaps more permanent cultural learning, or adoption, of values and norms, including both maintenance of original cultural norms (e.g., familism in Latinos) and nonlinear adoption of new values. For exam- ple, Sabogal et al. (126) have shown that although certain aspects of familism—a sense of obligation and the power of the family as a behavioral referent—change as an individual becomes more acculturated, others (e.g., support received and expected from relatives) remain important to highly acculturated Latinos as well as to the less acculturated (126).
Magaña, who found that biculturalism does not equate to the equal embrace of both cultures, has further highlighted the nonlinear nature of the acculturation process. For example, bicultural individuals may speak Spanish predominantly

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
372 LARA ET AL.
within the family, while maintaining social affiliations with individuals from both Latino and non-Latino cultural groups. In contrast, individuals who shift away from Latino to non-Latino culture speak English primarily within the home, yet at the same time they socialize predominantly with others of Latino descent (85).
Acculturation Measures and Scales
Public health researchers have used different proxy measures, including summary acculturation scales, to describe and understand the complex phenomenon of ac- culturation. Several unidimensional and bidimensional acculturation scales have been developed and published to date (9, 31, 32, 36, 37, 41, 54, 72, 87, 90, 100, 121, 134, 150, 159). Other than the key distinction of uni- versus bi-dimensionality, scales differ in the subconstructs of acculturation they intend to measure, includ- ing (a) engaging in culturally specific behaviors, such as music, diet, and media; (b) proficiency in, use of, and preference for the Spanish or English language; (c) knowledge of culture-specific history and current events; (d) a sense of cultural identity; and (e) adoption of and belief in culture-specific values. These scales have been used and validated to different degrees. All scales include language as a subconstruct. Some scales exclude the behavioral component because engaging in these behaviors reflects, to a certain extent, the availability and accessibility of culture-specific items such as music and food, not an individual’s preference per se (86, 159). Also, values and norms are more difficult to measure than are language preferences and patterns in food consumption, and therefore they are not included in many of the scales (86).
The heavy dependence of acculturation measures and scales on language has pros and cons. Supporters argue that psychometric analyses show that language items, compared with other constructs, explain most of the variance of acculturation scales (86). Also, although language is a complex construct—involving differential capacities to read, speak, and think, as well as levels of use based on preferences or opportunity for use (87, 159)—it is among the easiest acculturation constructs to measure. In his Behavioral Acculturation Scale (BAS) scale, for instance, Marin (87) makes distinctions between language use, proficiency, and media exposure.
Critics, in contrast, argue that the language measures do not capture the com- plexity of language use among bicultural individuals. Marin (86) states that “among Latinos/as it is to easy to find people who are primarily English or Spanish speak- ing, regardless of either their place of birth or their length of residence in the U.S., as well as individuals who are fully bilingual.” Furthermore, acquisition of the English language does not necessarily mean sustenance of the Spanish language, or vice versa. An initially monolingual person can become either bilingual in the native and host languages or monolingual in the host language (86).
Critics of acculturation scales outline other weaknesses aside from this potential overemphasis on language. These can include the lack of appropriate psychometric testing, such as in the informal adaptation of previously validated scales, and the inclusion of sociodemographic characteristics (e.g., generation of respondents) as measures instead of as correlates of acculturation (criterion variables). For instance,

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
ACCULTURATION AND LATINO HEALTH 373
the large-scale Hispanic Health and Nutrition Examination Survey (HHANES) uses a mixture of criterion and measurement variables in identifying the level of acculturation. Critics argue that the inconsistent relationships observed between the effects of acculturation in different Latino health outcomes are, in fact, due in large part to these differences in measurement (86).
In addition to summary scales, researchers also have used some of the same individual constructs to measure by proxy the acculturation phenomenon. Other than language, some of these proxy measures—including generational status (first, second, or third U.S. generation), age at immigration, place of birth (United States versus foreign), and place of education—assume that acculturation can be approx- imated by the amount of exposure individuals have to the dominant culture (17, 105, 125).
Significant variability may exist in the effects and manifestations of accultura- tion at the individual level, and acculturation scales aim at capturing that variability. Groups may behave differently than do individuals, e.g., Mexican Americans may, as a group, show certain effects of acculturation, but an individual Mexican Amer- ican might have different shades of use/effect of language, income, etc. (11, 17).
Understanding and measuring acculturation are complex and difficult under- takings. Ideally, they would involve describing not only proxy measures for the construct, but also important contextual factors likely to be important mediators of the process. Contextual factors influencing the process of acculturation have been summarized by Cabassa (17). These include context prior to immigration (soci- ety of origin factors and individual factors), immigration context, and settlement context (society of settlement factors and individual factors). Another important modifier is the variability among individuals in the degree of stress experienced, the coping capacity of individuals, and the actual outcome of the acculturation process (11, 17).
In summary, although Redfield’s original definition of acculturation implies bidirectional influence (17, 86), most theories and measures to date have captured “the changes that occur in the group and individuals that are being acculturated to a dominant culture” and the “psychological and social changes that groups and individuals experience when they enter a new and different cultural context” (11, 17). Acculturation is a “rather fluid process that implies movement at different speeds across different dimensions (e.g., behaviors, attitudes, norms, and values) and planes. . .[and] that does not typically follow a deficit mode, but rather implies growth across a variety of continua” (86).
CURRENT EVIDENCE REGARDING THE EFFECTS OF ACCULTURATION ON LATINO HEALTH OUTCOMES
Literature Review Methods
Prior to conducting our review, we identified a list of areas on which to focus our literature search. Our process of selection and review of the scientific literature was

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
374 LARA ET AL.
as follows. In each area two of the investigators reviewed article and book titles for inclusion. The abstracts of those titles agreed on by two individuals were reviewed using a structured form for easy screening for relevance and summary of the key findings. A summary of findings in each area and resulting recommendations were discussed and approved by the coauthors. We supplemented our literature search with other key review articles familiar to the coauthors or referred to them by other experts in the field.
Overview of Findings
Table 1 presents a summary of the studies in the literature areas we reviewed: health behaviors, health care use and access, self-assessed health perceptions, birth outcomes, chronic diseases, and mental health outcomes. In evaluating the effect of acculturation we determined if the evidence from each study supported (a) a negative effect (acculturation is associated with worse health outcomes, behaviors, or perceptions), (b) a positive effect (acculturation is associated with better health outcomes, behaviors, or perceptions), or (c) a mixed or no effect. A mixed effect might be, for example, a study showing that acculturation had opposite effects by gender, or alternately a positive effect according to one measure of acculturation, e.g., foreign place of birth, but a negative or no effect according to another, e.g., language. In this section we provide an overview of the major findings of our review, followed by a more specific description by area of the findings of key studies.
Our most important overall finding is that the effect of acculturation, or more accurately, assimilation to mainstream U.S. culture, on Latino behaviors and health outcomes is very complex and not well understood. Although we can identify certain major positive or negative trends in the subject areas reviewed, the effects are not always in the same direction, and many times the effects are mixed. Thus, depending on the subject area, the measure of acculturation used, and factors such as age, gender, or other measured or unmeasured constructs, acculturation may have a negative, positive, or no effect on the health of Latinos.
Although not absolute, the strongest evidence points toward a negative effect of acculturation on health behaviors overall—substance abuse, diet, and birth out- comes (low birthweight and prematurity)—among Latinos living in the United States. More acculturated Latinos (those who are highly acculturated) are more likely to engage in substance abuse and undesirable dietary behaviors and expe- rience worse birth outcomes compared with their less acculturated counterparts. Furthermore, the negative effect of acculturation on substance abuse, although not completely uniform across areas, appears to have a stronger relative effect on women than on men (144, 148).
However, evidence suggests that the acculturation process has a positive effect on health care use and self-perceptions of health. Some studies have found that more acculturated Latinos are more likely to use preventive services (75, 96) (e.g., cancer screening) and have a better self-perception of health than do the less

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
ACCULTURATION AND LATINO HEALTH 375

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
376 LARA ET AL.
acculturated (51). There are important exceptions, however, in which the evidence is not as clear: for example, the effect of acculturation on immunization rates, where studies have shown both a negative and no effect (4, 52, 101, 120).
When reviewing the literature, we found that, across the board, past research studies have not been consistent in their measurement of acculturation or in their adjustments for possible confounding factors. This inconsistency is very important to consider in the overall interpretation of the findings. In some cases, the accul- turation effect on health outcomes can be related to whether language, country of origin, or an acculturation scale was used to measure acculturation. For example, English (46) found that Mexican maternal nativity, and not necessarily speaking Spanish, was associated with better birth outcomes. In other cases, when studies have controlled for factors such as age, educational attainment, income, insurance, and other predisposing, enabling, or need factors, the effects of acculturation di- minish or disappear (67, 157, 158). For example, in some studies, the “protective” or positive effect of acculturation on some health care use behaviors (e.g., cancer screening) has been accounted for by higher educational and income levels among the more acculturated (157). Solis and colleagues (134) found that socioeconomic status (SES) characteristics, and an access “score,” predicted health care use more strongly than did acculturation. Of the acculturation variables, language but not

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
ACCULTURATION AND LATINO HEALTH 377
ethnic identification predicted use. From these findings Solis and colleagues (134) concluded that “the effect of language on screening practices should not be inter- preted as a cultural factor, but as an access factor.”
Finally, almost all research on the effects of acculturation on Latinos in the United States has been done on persons of Mexican origin. The very few studies that have compared the effect of acculturation across Latino subgroups suggest that the experience of acculturation and its effects on health outcomes may be different for Mexicans and Puerto Ricans. The prevalence of childhood asthma and related risk factors is associated with different effects in Mexicans and Puerto Ricans according to place of birth. Island-born Puerto Ricans—presumed to be less acculturated—have a higher prevalence of asthma than do those born in the 50 U.S. states and the District of Columbia. On the contrary, less acculturated (foreign- born) Mexican American children have a lower prevalence of asthma and related risk factors than do their more acculturated (U.S.-born) counterparts (81, 83). Likewise, diabetes in pregnancy is more prevalent among Island-born Puerto Ri- cans but not in foreign-born Mexicans (80). Investigators have shown some small differences in illness-related beliefs for asthma and diabetes among individuals of different Latino subgroups (110–112, 152). It is unlikely, however, that these small differences account for the large differences in prevalence. Another possibil- ity is varying patterns in disease recognition, diagnosis, and actual predisposition to disease. The degree to which possible differences in the acculturation experi- ences between Mexicans and Puerto Ricans account for this effect is a question for future research. The relevance of the concept of acculturation to Puerto Ricans— given that they are U.S. citizens and, thus, exposed to U.S. mainstream culture from birth—also should be examined.
ACCULTURATION IS ASSOCIATED WITH SEVERAL NEGATIVE HEALTH-RELATED BEHA-
VIORS AND HEALTH OUTCOMES IN LATINOS Most studies evaluating the relation- ship between acculturation and substance abuse have found a negative effect of acculturation on substance abuse behaviors, both in general and specifically in pregnancy, including use of illicit drugs, alcohol, and smoking. Negative effects of acculturation also have been demonstrated regarding dietary practices and birth outcomes.
1. Illicit drug use The negative effect of acculturation on drug use, including marijuana, cocaine, and other illicit drugs, has been demonstrated in adults, pregnant women, and adolescents (3, 57, 58, 144, 146). Some of these studies have shown a stronger negative effect in females than in males (144, 148). Although most studies have been conducted in Mexican American popu- lations, some have included other Latino subgroups. Turner (141) found a negative effect of acculturation among U.S.-born Cubans and other U.S.- born Caribbean-origin Latinos in southern Florida, and Velez (148) showed that, among Puerto Rican female adolescents, the effect of acculturation on drug use was more pronounced and was related to length of time lived in New York City. Some of these studies evaluated possible confounders and

10 Feb 2005 14:6 AR AR238-PU26-16.tex XMLPublishSM(2004/02/24) P1: JRX
378 LARA ET AL.
interactions. For example, Amaro (3) found that among Mexican Ameri- cans and Puerto Ricans of lower educational attainment, illicit drug use was linked more strongly with predominant use of English than it was among those of higher educational attainment. The relation between acculturation, as measured by language, and drug use also varied by sex, marital status, and place of birth. From these findings, Amaro concluded that the experience of acculturation is associated with socioeconomic context. Velez (148) found that lower socioeconomic status was associated with drug involvement by adolescents in New York City, but not among Puerto Ricans on the Island.
2. Drinking The detrimental effect of acculturation on patterns of alcohol use is clearest in women; the effect is more ambiguous among men (12, 92, 95, 96, 109, 117). Men have a higher prevalence of alcohol consumption to begin with, so the acculturation effect reflects a closing of the gap between men and women (89, 96, 154). Gender differences observed in the data from the HHANES analyzed by Marks et al. (96) illustrate that, on average, Mexican American, Cuban American, and Puerto Rican men are more than two times as likely to be alcohol users, compared with women (e.g., 77.4% for Mexican American men compared with 34.7% for Mexican American women). The correlation of acculturation and drinking was close to three times greater for Mexican American and Cuban American women than for men (0.30 versus 0.11, 0.36 versus 0.13, respectively) and six times greater for Puerto Rican women than for men (0.26 versus 0.04). The strong influence of non-Latino norms results in the adoption of practices similar to those of non-Latina women as Latinas acculturate. This effect is not observed in men because Latino and non-Latino men exhibit similar drinking behaviors to begin with.
The effect of acculturation on drinking is complicated and related to both frequency and volume of drinking. The relationship of consumption fre- quency, i.e., the number of days a person consumed any alcoholic beverage, and acculturation observed by Marı́n & Posner (89) showed that increased drinking is related to an increase in acculturation. Less acculturated Mexican Americans and Central Americans drank less often than did the more accul- turated (6.3 days versus 8.3 and 3.9 days versus 5.9, respectively). A reverse effect, however, was noticed with respect to volume, or the mean number of drinks per day. Less acculturated Latinos drank in greater volume, com- pared wit

Is this the question you were looking for? If so, place your order here to get started!