Stress burden, drug dependence and the nativity paradox among U.S. Hispanics

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Abstract

It seems well established that exposure to social stress, including acculturation stress, increases risk for psychiatric and substance problems, and that the disadvantaged experience higher levels of such exposure. Such evidence points to the expectation that immigrant minority groups must be at elevated risk relative to their native-born counterparts. That the opposite appears to be true for various immigrant groups within the U.S. constitutes what has been referred to as the nativity health paradox. This paper examines the association between nativity and drug dependence among the distinctive and understudied Hispanic population of South Florida and attempts to evaluate competing explanations for the apparent advantage of immigrant populations. Based on data on a representative sample young adults of Cuban and other Hispanic backgrounds (n = 888), we found the paradox to be limited to women and confirmed the finding of prior research that acculturation plays a major role in explaining this difference in risk. We also found cumulative exposure to major and potentially traumatic events to be lower rather than higher among immigrants, to be a strong predictor of drug dependence and to contribute importantly toward accounting for observed nativity differences among women. Taken together, cumulative stress exposure and degree of acculturation explained 40% of the nativity difference. Finally, our results suggest that social support matters for risk primarily because such support more effectively acts to reduce exposure to social stress among foreign-born young Hispanic women.

Introduction

The “stress process model” (Billings and Moos, 1982, Pearlin, 1989, Pearlin et al., 1981) has become a highly prominent theoretical framework for conceptualizing both status differences in health and variations in the risk, and protective factors implicated in these differences. This model developed out of a recognition that the health significance of life stress depends upon more than differences in the extent of stress exposure, involving also the influence of social and personal resources that exert both mediating and moderating effects in the linkage between stress exposure and health outcomes.

Research accumulated over the past 20 years has provided strong support for the utility of this model (Aneshensel and Phelan, 1999, Avison and Gotlib, 1994, Kaplan, 1983). For example, the stress process has been reported to account for a substantial minority of observed differences in depressive symptomatology across individuals and for a large portion of reliably observed variation across social statuses (Turner and Lloyd, 1999). In addition, there is now convincing evidence that a high level of cumulative exposure to major stressors increases risk for the occurrence of drug dependence as well as the occurrence of depressive and/or anxiety disorders (Turner and Lloyd, 2003, Turner and Lloyd, 2004).

A fundamental proposition associated with this framework is that social positions substantially define the conditions of life to which individuals are subjected (Kohn, 1969, Kohn, 1972). To the extent that important differences in personal histories and in current social conditions tend to be conditioned by social statuses, including those of gender, ethnicity and nativity, the hypothesis follows that relationships between these statuses and substance use problems at least partially arise from status variations in exposure to stress.

Research has also established three additional points of relevance to this paper. The first is that the significance of social stress for mental health and substance use risk has been demonstrated to apply within as well as across groups described by gender, race, ethnicity, and socioeconomic status (Aneshensel and Phelan, 1999). Second, exposure is differentially distributed such that disadvantaged groups tend to experience significantly higher levels of social stress (Turner and Avison, 2003, Turner et al., 1995). Third, the acculturation process is a source of stress that has been linked with health and substance-use risk in studies within the United States (e.g. Cobas et al., 1996, Vega et al., 1998a, Vega et al., 1998b), and throughout much of the rest of the world (Al-Issa and Tousignant, 1997).

However, in most countries for which data are available, immigrant status has been found to be associated with elevated risk for mental health and drug-use problems relative to being native-born. For example, this pattern of findings has been observed among Southeast Asian immigrants in Canada (Amaral-Dias et al., 1984, Morgan et al., 1984), Turkish immigrants in Belgium (Gailly, 1997), former Soviet Union residents in Israel (Schiff et al., 2005), South Sea Island immigrants to Australia (Kahn and Fua, 1995), and four immigrant minority groups in Sweden (Anders, 2001).

Taken together, this array of evidence points strongly to the expectation that immigrant minority groups must be at elevated risk for mental health and substance problems relative to their native-born counterparts. After all, they tend to be of comparatively low socioeconomic status and it is clear that they experience higher levels of acculturation stress. That the evidence, at least with respect to Hispanic immigrants in the U.S., is contrary to this expectation constitutes a highly provocative paradox, the answer to which may be of substantial significance to prevention science. This paper examines the association between nativity and drug dependence among the distinctive and understudied Hispanics resident in South Florida and attempts to evaluate competing explanations for the apparent advantage of immigrant populations.

Section snippets

Background

Although there is evidence that the health paradox among Hispanics extends to groups of differing national origins, this apparent advantage has been best documented with respect to Mexican Americans (Scribner, 1996). It appears that this paradox with respect to psychiatric and substance use problems was first convincingly demonstrated by the Los Angeles site of the Epidemiologic Catchment Area studies (Hough et al., 1983, Robbins and Regier, 1991). U.S.-born Mexican Americans were found to have

Data and methods

This paper is based on a study of the prevalence and social distributions of psychiatric and substance use disorders, and of factors that increase and decrease risk for such disorders among a representative cohort of 1803 young adults. Most (93%) were between 19 and 21 years of age when interviewed between 1997 and 2000. The study possesses unique potential for contribution in at least two respects. First, this is one of the first large-scale community studies to estimate the occurrence of

Results

Preliminary analyses revealed no difference between Cubans and other Hispanics in the lifetime incidence of drug dependence disorders among either males or females. Given our focus on the role and significance of nativity, this similarity and the need to maintain reasonable statistical power advised combining the Cuban and other Hispanic sub-groups for the purpose of descriptive analyses.

Table 1 assessed nativity differences by gender for the combined Cuban/other Hispanic sample on drug

Discussion

The question of the significance of the stress process model for understanding the origins of psychiatric and substance disorders, and for explaining nativity differences in such disorders, is an important one about which there is very little credible information. Although some research has reported linkages between drug use disorders and recent life events, as well as certain other stress process variables, significant interpretive problems necessarily attach to most of these findings. The

Acknowledgement

This work was supported by Grant 5 RO1 DA 10772 from the National Institute on Drug Abuse to R. Jay Turner.

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