Alcohol Use among Latinx Early Adolescents: Exploring the Role of the Family.
Focusing such research within the context of early adolescence is critical, as this developmental stage is characterized by multiple psycho-social and biological changes (Harris & McDade, 2018); as well as, exploration and experimentation with new prosocial and antisocial behaviors (Boyas, Stauss, & Murphy-Erby, 2012; Endedijk et al., 2019). During this stage, some youth turn to alcohol as a coping mechanism (Salvy, Pedersen, Miles, Tucker, & D'Amico, 2014; Grigsby et al., 2018), which is alarming considering the negative correlation between the age of alcohol consumption and long-term alcohol use problems (Gopiram & Kishore, 2014; Kim et al., 2017). Thus, there is a continuing need to identify approaches that curtail the onset of experimenting behaviors that have adverse consequences. Although past intervention approaches have primarily focused on school and youth-only based programs, recent prevention efforts have been shifting towards developing programs that harness the role of the family (Hussong & Smith, 2018). This shift reflects the mounting research suggesting various links between myriad familial factors--such as family structure and parental monitoring and practices--and adolescent substance use (Abar, Clark, & Koban, 2017; Hoffmann, 2017; Lardier, Barrios, Garcia-Reid, & Reid, 2018). For example, previous research suggests that youth who are part of single-parent households are more prone to report higher levels of substance use than youth from dual-parent families (Ewing et al., 2015; Hoffman, 2017).
A malleable family factor relating to adolescent risky-health behaviors explored in the literature is parental monitoring (Dishion & McMahon, 1998; Lippold, Greenberg, Graham, & Feinberg, 2014; Sellers, O'Brien, Hernandez, & Spirito, 2018). Much of the earlier research on parental monitoring has examined this topic in aggregate form, whereby each parental practice is combined to examine as a scale form. Yet, in order to identify what specific parenting practice(s) is significantly associated with alcohol use and finetune preventative efforts, research should parcel out each parenting practice to determine its effect.
There seems to be a cultural dimension to alcohol drinking, In the Latinx case, culture can be elusive because they are a heterogeneous cultural group. Latinx youth's cultural processes appear to be important predictors of alcohol use behaviors (Guerrero et al, 2013, Szapocznik et al, 2007). Subgroup differences in their rates of alcohol use are often associated with national origin, place of residence, acculturation and acculturation stress, gender, and SES (Alvarez et al, 2004). For example, Mexican American men in the Southwest report heavier and more consistent alcohol consumption and are more likely to engage in binge-drinking behaviors than other Latinxs such as Cubans, Central Americans, and South Americans (Alvarez et al., 2007). Place of birth and age at migration to the United States are strong predictors of alcohol use for Latinxs as they serve as proxies for acculturation into mainstream American society (Vega & Sribney, 2005).
Another area that needs further exploration pertains to what happens to the adolescent's refusal self-efficacy when they are offered alcohol by a family member. This issue is vital given that empirical evidence suggests that there is a relationship between refusal self-efficacy and alcohol consumption (Jang, Rimal, & Cho, 2012; Smart, Osilla, Jonsson, & Paddock, 2018). Such research regarding the interplay of familial factors and alcohol use is particularly salient for Latinx adolescents because of the crucial cultural role that family factors--such as family structure, parental monitoring, parental practices and acculturation--play on their overall behavioral health outcomes (Epstein, Botvin, & Diaz, 2000; German, Gonzales, & Dumka, 2003; Lardier et al., 2018; Miranda, Bilot, Peluso, Berman, & Van Meek, 2006; Myers et al., 2009; Wahl, Eitle, 2008; Zhen-Duan, & Taylor, 2014). In summation, due to the growing consumption of underage alcohol use among Latinx adolescents, there is a need to propel preventive intervention research in this area that considers the family structure, parental monitoring, parental practices and acculturation.
Research Purpose and Hypotheses
The purpose of this study was to examine whether changes in alcohol use over time varied across prevention intervention conditions. Specifically, we investigated whether early adolescents who were part of the Familias Preparando la Neuva Generation (Familias) intervention reported changes in alcohol use that differed significantly from those in the condition group that only received the keepin' it REAL (kiR) curriculum. Familias is a culturally-grounded prevention program that sought to enhance family functioning as a method of preventing and reducing drug use among Latinx youth. It is a parenting intervention that was developed by incorporating aspects of the universal kiR, a youth-centered prevention program (Gosin, Marsiglia, & Hecht, 2003; Marsiglia & Hecht, 2005) and the Familias Unidas parent-centered prevention program (Coatsworth, Pantin, & Szapocznik, 2002). Incorporating a family strengthening component can be an essential approach in developing drug use prevention interventions among Latinx adolescents (Castro, Garfinkle, Naranjo, Rollins, Brook, & Brook, 2007; Kaftarian & Kumpfer, 2000; Prado et al., 2009).
Based on the literature, we hypothesized that the effects of the Familias intervention would strengthen the effects of KiR because of the parent component. Thus, we hypothesized that youth who were part of the Familias intervention would report significantly lower levels of alcohol use at Wave 2 compared to youth who only participated in the kiR curriculum or were part of the control group. It was also hypothesized that youth who perceived increased levels of parental monitoring, who lived in a two-parent household, who were able to resist alcohol even if a family member offered them alcohol and were less linguistically acculturated would report significantly less use of alcohol compared to youth who reported lower levels of parental monitoring, who did not live in a two-parent household, who were not able to resist alcohol if it was offered to them by a family member and who were more linguistically acculturated.
This secondary data analysis utilized data from a 4-year longitudinal investigation. The original purpose of this study was to test the effectiveness of a culturally-based parent education program beyond the effects of a youth-only intervention.
Research Design and Procedures
The study design consisted of a randomized three-group repeated measures study. The study included three waves of data collection: (1) the first wave was carried out at the baseline (pretest) period, (2) the second wave immediately following the intervention and (3) the third wave at one-year post-baseline. This study uses Wave 1 and Wave 2 of the child data from both cohorts. In all, nineteen middle schools located in a large Southwest city with a high census of Latinx students (greater than 70% during the 2007-2008 school year) were invited to participate in this study. Ultimately, nine schools agreed to participate. All of the 7th-grade students and their parent(s) in those nine schools were eligible to participate. Data were collected in the fall (September-November) of the school year (2009 for Cohort 1; 2010 for Cohort 2). Baseline data were collected separately from both consented youth and parents. The follow-up data were collected from youth and parents after the interventions in the spring (March-May) of the same school year (2010 for Cohort 1; 2011 for Cohort 2).
Nine schools were stratified into three blocks in accord with the percentage of Latinx students in each school. The schools with the three highest percentages of Latinx students were entered into Block 1, while the schools having the three lowest percentages of Latinx students were entered into Block 3. This stratification formed three blocks, each with three schools. Within each block, random numbers were generated and designated to each school. The schools within each block were then arranged in numeric order. Within each block, the school producing the lowest numerical value was assigned to the parent-youth condition (PY), the middle value was assigned to the youth-only (YO) condition, and the highest value was assigned to the control (C) condition.
Informed parental consent was obtained by trained study personnel. Parents could select one of three choices: (1) to consent both parent and youth; (2) to consent only youth; (3) not to consent either parent or youth. The overall consent rate for the study was 77% for both youth and parents in both cohorts. For youth, the overall consent rate was 76%, but varied slightly by condition: (a) PY condition=77%; (b) YO condition=78%; (c) C condition=74%. For parents, the overall consent rate was 79% and also varied by condition: (a) PY condition=75%; (b) YO condition=81%; (c) C condition=79%.
The youth (n = 458) who participated in the study were evenly split across gender lines, with 228 males and 230 females. Most of the youth in the sample were of Mexican-ancestry (85%). A higher percentage lived with both biological parents (66%), and the majority received free lunch (87%). As for condition assignment, 128 were randomly assigned to the PY, 165 were in the YO, and 165 were assigned to the C.
The Familias intervention was developed using principles of Community-Based Participatory Research. It was guided by Ecodevelopmental theory (Coatsworth et al., 2002; Pantin, Schwartz, Sullivan, Prado, & Szapocznik, 2003; Szapocznik & Coatsworth, 1999), which sought to strengthen family functioning as a method of preventing adolescent substance use (Coatsworth et al., 2002; Perrino, Gonzalez-Soldevilla, Pantin, & Szapocznik, 2000; Szapocznik & Coatsworth, 1999). Familias focuses on familial and parent-child influences that characterize Latinx youth and family functioning (Locke, Newcomb, & Goodyear, 2005). The curriculum includes eight interactive and hands-on workshops that focus on themes such as knowing your child's world, communicating with your child, managing your child's behavior effectively and talking with teens about risky behaviors. A full description of the development of Familias has been reported elsewhere (Bermudez Parsai, Gonzalez Casto, Marsiglia, Harthun, & Valdez, 2011).
The program was delivered over an eight-week period. Parent groups met once a week at their child's school either in the early evening or on the weekend. About 5 to 10 parents participated in each group. Approximately 69% of the parents attended all 8 lessons, while on average, parents attended 6 to 8. The curriculum was delivered by trained bilingual facilitators. In every meeting, facilitators went over the norms of the group, responded to questions about earlier workshops, reviewed homework and delivered the lesson. The workshops were conducted in English only, or Spanish only, and parents were given the option of attending either one. Group activities were designed to provide parents the opportunity of applying what they learned and think about ways they could put this knowledge into practice. After the conclusion of each workshop, parents were asked to complete assignments at home with their family or youth.
The outcome variable, past month's amount of youth alcohol use at Wave 2 was examined to assess the immediate effects of Familias. Youth alcohol use is a self-reported measure that is considered a developmentally appropriate question for this age group (Kandel & Wu, 1995). This was a single item that asked youth, "How many drinks of alcohol (more than a sip of beer, wine, or liquor) have you had in the last 30 days? Responses ranged from none = 1 to more than 30 = 7.
Treatment Group: As indicated previously, this study design consisted of three groups: (1) Parent & Youth Condition -PY-Parents received Familias, and their youth received kiR; (2) Youth Only Condition-YO- Youth received kiR, but parents did not receive Familias; (3) Control Condition-C- Neither parents nor youth received any curriculum. Because of our hypothesis, the YO condition serves as the reference group. To control for the effect that alcohol use at Wave 1 may moderate the effects of the intervention, an interaction term was created by multiplying the measure of alcohol use at Wave 1 by the treatment condition. Thus, two interaction terms were entered into the model.
Perceived parental monitoring was measured using 5 questions. For example, "How often do your parents know what you do with your free time?" and "How often does your mom and dad allow you to do whatever you want?". Responses for the parental monitoring items ranged from 1 (Never) to 5 (Most of the time). Alcohol refusal self-efficacy was measured by a single item. Youth were asked if they were sure they would say NO if a family member offered them alcohol. Responses ranged from 1 (Very sure) to 4 (Not at all sure). This analysis controlled for the exact Wave 1 substance use counterpart of the Wave 2 substance use measure. In other words, the model controls for alcohol frequency at Wave to determine alcohol frequency at Wave 2.
Linguistic acculturation accounts for the greatest portion of the variance in acculturation scales (Marin et al., 1987; Marin & Marin, 1991), and it has been used as a proxy for acculturation by adolescent substance use researchers (Myers et al., 2009). In this study, students were asked two questions regarding the language they usually speak with their family and with their friends. The responses, ranging from 1 (English only) to 5 (Spanish only) for the two items, were averaged to generate a single score as a measure of students' acculturation level.
The principal aim of the current study is to examine how changes in alcohol use over time varied across intervention conditions, specifically whether students who were part of the PY intervention reported changes in alcohol use that differed significantly from the YO group. Since the alcohol use outcome variable was measured on a 7-point Likert scale, Ordinary Least Squares (OLS) regression was used. Regression diagnostics were performed to ensure that the underlying regression assumptions were not violated (Tabachnick & Fidell, 2001). Statistical significance was measured at the 95% confidence interval level (p=[less than or equal to] 0.05). All statistical analyses were conducted using Stata 10.0 (StataCorp, 2009).
Table 1 shows that at Wave 1, approximately one-quarter (23.2%) of youth reported using at least some amount of alcohol, (M = 1.41, SD = .96). At baseline, the treatment group and comparison group did not significantly differ in terms of alcohol use (t = -0.5549, p=> .05). The PY group report having 1.38 (SD = .07) drinks, while the YO group reported drinking on average 1.33 (SD = .06) drinks of alcohol. At Wave 2, the number of youths reporting at least some amount of alcohol use increased to 30.0% (M= 1.63, SD= 1.24).
OLS regression results for the effects of the intervention on alcohol use are presented in Table 2. The overall model was significant (F= 17.59, p=<.001) and the predictor variables explained 30% of the variance in alcohol use at Wave 2. The amount of alcohol used at Wave 1 was positively associated with the amount of alcohol used at Wave 2 (b = .64, p=<.00\). In other words, youth reported an increase in alcohol use between Waves 1 and 2. Alcohol use also shared a significant and negative association with a youth's perception that their parents did not allow them to do what they wanted. Controlling for alcohol use at baseline, the findings suggest that at Wave 2, youth reported significantly less alcohol use when parents did not allow them to do what they wanted (b = -.19, p=<.01). Last, alcohol use was also significantly related to their sense of self efficacy. All else held constant in Wave 2, when a family member offers a youth alcohol, it increased their likelihood of alcohol use (b = . 15, p=<.01).
In light of recent reports that observe the continued prevalence of alcohol use among Latinx adolescents, there is a clear need for alcohol use preventive interventions. The findings indicate that youth who received the combined family and youth curricula reported significantly lowered rates of alcohol use between baseline and follow-up suggesting that the addition of a family component to substance abuse prevention programs for youth is a promising strategy. These results support growing research that family-based prevention programs can play a pivotal role in preventing and reducing substance use behaviors among Latinx adolescents (Bo, Hai, Jaccard, 2018; Coatsworth, Pantin, & Szapocznik, 2002; Hussong & Smith, 2018; Kuntsche & Kuntsche, 2016).
The findings also suggest that family factors produced mixed results. We found partial support for our hypotheses that parental monitoring practices would be significantly associated with adolescent alcohol use. The findings suggest that youth who perceived that their parents do not allow them to do what they wanted was significantly associated with lowered alcohol use in Wave 2. However, we did not find support for the other items. Among the sample, parents who know what friends their children spend free time with, usually know what they do after school, tell them what time to be home, ask where they are going, when they leave the house and know what the youth do with their free time did not significantly predict alcohol use.
Our finding contradicts earlier research that suggests that parental monitoring was significantly associated with lowered alcohol use among adolescents (Bermudez Parsai et al., 2011; Mahedy et al., 2018; Strunin et al., 2013; Yap, Cheong, Zaravinos-Tsakos, Lubman, & Jorm, 2017). One possible explanation for the non-significant finding could relate to the difference in how parental monitoring items were analyzed. Yet, for prevention purposes, it was prudent on our part to try and tease out the effects of each parenting practice. Otherwise, when analyzed collectively, the effects of each parenting practice could be eclipsed. An alternative explanation may relate to the measures themselves raising a question as to whether parental monitoring is accurately measured among Latinx families who are less acculturated. For example, in the measures used in this study, and others, the parenting practices are individualistic. It is plausible that parental monitoring in Latinx families happens in conjunction with other family members as, on average, they subscribe to a more collectivist perspective. However, most of the existing research and current parental monitoring measures have focused on Western cultures (Venkatraman, Dishion, Kiesner, & Poulin, 2010), which overlooks the prospect that meanings, norms and acceptability of parenting practices vary across cultures (Yu, Cheah, Hart, & Yang, 2018). Thus, more research is needed that delves into how parental monitoring occurs among collectivist cultures (Venkatraman et al., 2010), such as the case of the Latinx community. Future research should explore qualitatively how parental monitoring occurs within less acculturated Latinx families and consider how parental monitoring practices themselves have evolved. Paulson and Sputa (1996) maintain that it is reasonable to suppose that parenting approaches and their influence on adolescent outcomes change during this vastly fluctuating developmental period. For example, there are some studies suggesting that parents are now turning to digital resources for parenting support (Calam, Sanders, Miller, Sadhnani, & Carmont, 2008; Nieuwboer, Fukkink, & Hermanns, 2013). Researchers should determine if monitoring and tracking now involve technological devices and/or software applications and how this may unfold for Latinx parents, particularly those with lower levels of acculturation. Answers to these questions may inform the development of future alcohol use prevention efforts with this population.
Support was also found for the hypothesis that being offered a drink by a family member significantly impacts a youth's refusal skills. Specifically, being offered alcohol by a family member significantly reduces a youth's ability to refuse, which increases their likelihood of alcohol use. A national study revealed that most adolescents aged 12-14 years did not pay for the alcohol they consumed and, in several instances, they received it from a family member (SAMHSA, 2016). This finding could suggest that family plays a significant role in assisting youth in their development of refusal skills. In some ways, when a family member offers a youth a drink, the message being sent is that it is acceptable for the youth to consume alcohol at such a young age. Such actions could minimize the personal consequences, such as being punished or losing a privilege, which is one of the factors that deter adolescent alcohol use (Pettigrew, Miller-Day, Krieger, & Hecht, 2011). Preventive programs containing an empowerment component may assist parents in ensuring that their children are not offered alcohol by other family members because poor family management practices can double the likelihood of adolescent alcohol use (Shortt, Hutschinson, Chapman, & Toumbourou, 2007).
The present study contributes to the preventive intervention of adolescent alcohol use; however, several limitations should be acknowledged. First, the majority of the sample in this study was comprised of individuals who were monolingual (Spanish only) or preferred communicating in the Spanish language. These indicators suggest that this study's sample was not highly acculturated. Additionally, most of the sample participants were of Mexican and Mexican American ancestry; however, the Latinx community is not a monolithic group and represent a wide range of within-group diversity, such as language use and cultural beliefs and patterns. Thus, the findings cannot be generalized to a broader, multilingual, more acculturated Latinx group. Second, this study relied on self-report measures of alcohol use. The use of biomarkers could have enhanced the reliability of our findings. Related, the youth-only data could have created a single-rater bias that could be enhanced with a multi-informant approach. In this case, parental-level data could have enhanced the results of this study. Third, due to the data collection procedures used, long-term causal inferences of the effectiveness of the intervention cannot be made. Last, the items used to measure parenting practices, such as parental monitoring, while standardized and commonly used, may not completely capture the way(s) in which parental monitoring occurs among less acculturated Latinx families. Parental monitoring measures that capture a more collectivist perspective could have altered the results of this study.
Counselors and educators can incorporate the study's findings into their professional work in several ways. First, results provide more empirical support for recognizing how family-based interventions can be used to decrease alcohol use among adolescents. Our findings are consistent with a recent metanalysis focused on parent-based interventions and adolescent alcohol use, which suggests that parent-based interventions are efficacious in preventing or reducing adolescent alcohol use (Bo et al., 2018). These results show that parents can be persuasive positive influences during adolescence (Botzct et al., 2019). Additionally, Botzet and colleagues (2019) maintain that including parents in prevention interventions may better prepare parents on how to influence appropriate behavioral skills and anti-alcohol attitudes among their adolescent children. Second, counselors and educators can remind parents that allowing adolescents to do whatever they want can have adverse consequences. Parents should be encouraged to establish and reinforce boundaries so that they do not come off as exhibiting tolerant or permissive attitudes and practices, which over time has been shown to be associated with increased alcohol use (Mahedy, 2018; Mallett et al., 2019). Last, counselors and educators should be encouraged to use culture as a strength-based approach. As evidenced by our findings, using an intervention with cultural components can help reduce adolescent alcohol use. Interventions should consider the culture of their target population given that culture helps individuals make sense of the world in which they live and of their relationships in which they engage (Baumeister, 2010).
Taken together, the results of this investigation underscore a number of key findings. The findings go beyond merely providing evidence for family-focused programs to highlighting the possibility that such programs may be more effective for alcohol use prevention than youth-centered ones. Our findings provide short-term evidence that suggests that family-focused, culturally-grounded prevention programs can be a viable strategy to help decrease alcohol use among Latinx adolescents. We also found that, when isolated, each parental monitoring practice will not significantly deter youth from using alcohol. Of the five parental monitoring practices examined in this study, the findings suggest that not allowing youth to do what they want is a promising parenting practice that could significantly alter adolescent alcohol use compared to other methods of parental monitoring. The results also indicate that families can have adverse effects on adolescent alcohol use. Being offered alcohol by a family member was found to decrease a youth's ability to resist alcohol consumption. This is not surprising given the strong influence the immediate and extended family can have on Latinx adolescent behavior. The findings suggest that prevention efforts that include a culturally grounded parent component could be a more effective strategy to help Latinx adolescents refrain from alcohol use than youth-only programs. As evidenced by our results, the family unit can play a considerable role in the development of early adolescent prosocial and antisocial behaviors.
Correspondence concerning this article shoud be addressed to: Javier F. Boyas, Ph.D., Associate Professor, University of Georgia, 279 Williams St., Athens, GA, 30602, USA, Email: email@example.com.
Drs. Boyas and Marsiglia both developed the concept of this research project; analytic plan, data interpretation, developed the manuscript and approved the final version of the manuscript. Dr. Marsiglia had a role in the data collection. Tatiana Villarreal-Otalora contributed to the literature review and writing the manuscript. Drs. Boyas and Marsiglia agree to be accountable for all aspects of the work and ensure the accuracy and integrity of every stage of the research process carried out in this investigation.
CONFLICT OF INTEREST
The authors declare no conflicts of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
This research was supported by funding from the National Institutes of Health/National Institute on Minority Health and Health Disparities (NIMHD/NIH), award P20 MD002316 (F. Marsiglia, PL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMHD or the NIH.
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Javier F. Boyas, Ph.D., Tatiana Villarreal-Otdlora
University of Georgia
Flavio F. Marsiglia
Arizona State University
TABLE 1 Sample Frequency and Means Condition Parent-Youth 131 Youth only 164 Control 167 Gender Boys 228 Girls 230 Origin Mexican 388 Non-Mexican origin 70 Free Lunch Yes 389 No 73 Live with both parents Yes 299 No 154 Parent(s) ask where you are going when you leave the house Mean (SD) 1.47(0.85) Parent(s) know what you do with your free time Mean (SD) 1.97(0.98) Parent(s) know what friends you spend your free time with Mean (SD) 1.93(1.02) Parent(s) usually know what you do after school Mean (SD) 1.83(1.05) Parent(s) tell you what time to be home Mean (SD) 1.76 (0.96) Parent(s) allow you to do whatever you want Mean (SD) 3.20(0.74) Acculturation Mean (SD) .01 (0.78) Alcohol use (Wave 1) Mean (SD) 1.41 (0.96) Alcohol use (Wave 2) Mean (SD) 1.63(1.24) TABLE 2 OLS Regression Results for Substance Use (Wave 2) on Treatment Group and Substance Use (Wave 1) Alcohol Use Amount b SE Alcohol Use Wave 1 .69 (***) .09 Parent & Youth Condition x Substance use -.28 (*) .12 (Wave 1) Youth Only Condition x Substance use -.04 .09 (Wave 1) Treatment group (Parent-Youth vs. Youth .08 (ns) .17 Only) Treatment group (Control vs. Youth Only) -.22 (ns) .17 Parent(s) ask where you are going when you .05 (ns) .08 leave the house Parent(s) know what you do with your free .08 (ns) .07 time Parent(s) know what friends you spend your -.01 (ns) .07 free time with Parent(s) usually know what you do after .01 (ns) .07 school Parent(s) tell you what time to be home .02 (ns) .06 Parenl(s) allow you to do whatever you want -.20 (**) .07 Acculturation -.03 .07 Can refuse alcohol even if offered by family 14 (**) .05 Lives with biological parents -.13 .12 Constant 1.14 (**) .31 F 17.59 (***) [R.sup.2] .32 Adjusted [R.sup.2] .30 (***) p<.001, (**) p<.01, (*) p<.05
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|Author:||Boyas, Javier F.; Marsiglia, Flavio F.|
|Publication:||Journal of Alcohol & Drug Education|
|Article Type:||Clinical report|
|Date:||Aug 1, 2019|
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