Drug and Alcohol Dependence 84S (2006) S8–S16
Hispanic drug abuse in an evolving cultural context:
An agenda for research
Lynn A. Warnera,∗, Avelardo Valdezb, William A. Vegac,
Mario de la Rosad, R. Jay Turnere, Glorisa Caninof
aSchool of Social Welfare, University at Albany, State University of New York, 135 Western Avenue, Albany, NY 12222, USA
bUniversity of Houston, 237 Social Work Building, Houston, TX 77204-4013, USA
cUniversity of Medicine and Dentistry, New Jersey, Room 3717, 151 Centennial Ave., Piscataway, NJ 08854, USA
dSchool of Social Work, Florida International University, University Park Campus, DM-463 11200 S.W. Eighth Street, Miami, FL 33199, USA
eCenter for Demography and Population Health, Florida State University, 617 Bellamy Building, Tallahassee, FL 32306, USA
fUniversity of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan 00936-5067, Puerto Rico
Drug abuse in the U.S. Hispanic population appears to be in a dynamic state of acceleration, although there are differences in drug use patterns
An understanding of the consequences of cultural adjustments for drug use is needed to effectively anticipate the scope and dimensions of illicit
drug use in the largest, rapidly growing, minority group in the U.S.
This paper provides an epidemiologic overview of current Hispanic drug use, summarizes research on the relationship between culture change
and drug use, organized according to individual, social (i.e., family and peer group), and community level influences on drug use, and offers a
systematic agenda for future research.
© 2006 Elsevier Ireland Ltd. All rights reserved.
Keywords: Hispanics; Substance use disorder; Epidemiology; Acculturation
Hispanics are the largest minority group in the U.S. with a
population of 40 million people (U.S. Census Bureau, 2005),
constituting 13.4% of the population. Due to high fertility and
immigration rates, this group is rapidly growing and projected
Bureau, 2004). The Hispanic population is youthful (e.g., 40%
of the population is under the age of 21), and disproportion-
ately low-income (e.g., 23% below the federal poverty line),
with limited educational attainment (e.g., more than half of His-
panics over the age of 25 have not graduated from high school)
(Ramirez and de la Cruz, 2002). Overall, the demographic pro-
file suggests that Hispanics are substantially socioeconomically
disadvantaged in ways that may increase individual vulnerabil-
ity to substance abuse. The purpose of this article is to identify
social science research initiatives that will yield data relevant
∗Corresponding author. Tel.: +1 518 591 8734; fax: +1 518 442 5380.
E-mail address: email@example.com (L.A. Warner).
for policies and programs to effectively anticipate the scope and
dimensions of drug use in this rapidly growing minority group,
and identify culturally relevant interventions.
The agenda was developed by reviewing epidemiologic data
on the scope of substance use and disorder among Hispanics
in the U.S. and research on risk and protective factors. To pro-
vide a context for the reader, this article summarizes studies
that highlight issues unique to Hispanics and were most influ-
ential in our decisions about needed research. At the outset it
is important to note that the review was more extensive than
can be captured here. For example, “drug use” includes alco-
hol, tobacco, and other licit and illicit substances, each with its
own set of epidemiologic surveillance systems and literatures.
Although most Hispanics with substance use disorders have
comorbid alcohol use disorders (Vega et al., 2003), the reverse
is not true. Thus, studies focused on alcohol dependence cannot
accurately capture drug use patterns. Further, stigma is associ-
substances are likely to experience stigma in different ways,
many of which stem from involvement in criminal activity, and
stereotypes about “addicts”. Consequently, results from studies
0376-8716/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved.
L.A. Warner et al. / Drug and Alcohol Dependence 84S (2006) S8–S16
on alcohol use among Hispanics may not be uniformly gener-
alizeable to substance abuse, and whenever possible we include
here studies that focused on illicit substances, or reported find-
ings separately for alcohol and other substances. (For a review
of illicit substances, see Galvan and Caetano, 2003).
A second criterion for including studies in this paper derives
from our assumption that it is unlikely that Hispanic drug-use
patterns are defined by factors that have not previously been
identified in the extensive body of research on risk and protec-
influences between cultural adaptation and known personal,
for research on the etiology of drug abuse among Hispanics is
alcohol use was instructive (e.g., Caetano, 1987). Additionally,
the current agenda was influenced by reviews of culture change
among Hispanics that have been conducted by mental health
researchers (Escobar et al., 2000; Escobar and Vega, 2000).
The review is organized into two main sections. The first
section is a brief overview of the current epidemiology of illicit
drug use and disorder among Hispanics in the U.S. It empha-
sizes the demographic correlates of nativity (e.g., immigrant
or U.S.-born), ethnicity (person’s or parents’ country of birth),
gender, and age-related patterns of drug-use. The second sec-
tion presents studies that speak to the interplay between culture
change and drug abuse etiology, organized around individual,
social (peer and family), and community levels of influence.
Because of epidemiologic shifts in Hispanic drug use identi-
fied in section one, studies that speak to gender and age-related
risks are emphasized. Important considerations for conducting
research with Hispanics and interpreting findings are identified
in both sections. Specific suggestions for future research are
presented separately in the final section.
Annual data from respondents (persons age 12 years and
lifetime illicit substance use than non-Hispanic blacks and non-
Hispanic whites, and higher rates than Asian Americans. For
example, in 1997, the lifetime rate for Hispanics was 25.9%,
whereas the rates for blacks and whites were 31.1% and 38.2%,
respectively (SAMHSA, 1998). As of 2003, rates had increased
for all groups, although the relative ranking of lifetime use by
race-ethnicity did not change: 37% for Hispanics, 44.6% for
blacks, and 49.2% for whites (SAMHSA, 2004). With other
measures of drug use, such as current use or substance use dis-
order, there tends to be little difference between the groups,
or higher rates among Hispanics than the other two groups.
The rates of illicit substance use in the past month were sim-
ilar across the main ethnic groups: 8.0% of Hispanics, 8.3% of
whites, and 8.7% of blacks reported current illicit substance use
in 2003. With the most serious measure of drug use, substance
(9.8%), followed by whites (9.2%) and blacks (8.1%).
mated to be lower for Hispanics (22.9%) than whites (29.5%)
in the National Comorbidity Survey (which focuses on a more
limited age range (persons ages 15–54 years) than the NSDUH
and also excluded Spanish speakers), the groups did not dif-
fer from each other in the persistence of disorder (Breslau et
al., 2005). Substance use disorder in the past year among those
with a lifetime disorder was 23.3% for Hispanics and 23.6% for
National surveys restricted to adolescent populations sug-
gest that the younger the respondents, the more likely Hispanics
have higher rates of illicit substance use compared to whites
and blacks. Among eighth grade respondents in the Monitoring
the Future study, Hispanics reported the highest rates of illicit
drug use in the past year since 1992 (Johnston et al., 2004). In
2002, one fifth of eighth grade Hispanics had used an illicit sub-
stance. Roughly one-third of Hispanic and white tenth graders
reported illicit substance use, which is greater than the propor-
tion of black peers in the same grade, and the substance use
rate of Hispanic high school seniors falls between the rate of
whites and blacks. Similar patterns were found in data from the
2003 Youth Risk Behavior Surveillance Survey: among males,
(46.7%) fell between the rate reported by whites (40.5%) and
and current cocaine use was highest among Hispanics (Centers
for Disease Control and Prevention, 2004).
Data on the U.S. Hispanic population as a whole obscures
within-group variation. Hispanics are heterogeneous: About
two-thirds of the population is Mexican, followed by Cen-
tral and South American (14.3%), Cuban (3.7%), Puerto Rican
(8.6), and other (6.5%) (Ramirez and de la Cruz, 2002). Within
these groups there are further variations by nativity status,
length of stay in the U.S. and languages spoken (Borrell, 2005).
sample sizes sufficient to estimate rates by national origin. Data
changes when analyses are restricted to adolescents. For exam-
ple, data from the Monitoring the Future surveys indicate that
Cuban adolescents have the highest reported 12 month illicit
drug use rates of any ethnic group in the U.S. (Wallace et al.,
A consistent finding in Hispanic drug use research has been
that the U.S.-born report higher rates of experimental drug use,
abuse, and dependence than immigrants do (Amaro et al., 1990;
tant to note that although persons born in Puerto Rico are U.S.
L.A. Warner et al. / Drug and Alcohol Dependence 84S (2006) S8–S16
citizens, and thus are not technically foreign-born, island-born
ditions underscore the importance of studying place of birth as
a correlate of substance abuse within groups defined by national
persons had any lifetime drug use disorder, which reflects a
rate of 1.7% among foreign-born Mexican Americans and
12.0% among U.S.-born Mexican Americans. However,
there is suggestive evidence that differences by nativity are
not significant when samples are comprised of adolescents.
Turner and Gil (2002) reported no difference in substance
use disorder rates between U.S.-born and foreign-born Cuban
2.2. Age at onset
Adolescence is the period in the life course when substance
ical findings confirm that the younger a person is when sub-
stances are first used, the greater the likelihood of drug use
problems in later adolescence and early adulthood (Ellickson et
about interactions between nativity and age with regard to pro-
gression to substance dependence. A longitudinal community
study of males provides a noteworthy contribution along these
dimensions; substance use during early adolescence was asso-
ciated with substance use disorder during young adulthood, but
the risk was greatest for African Americans and foreign-born
Hispanics, the groups who reported the lowest rates of early use
(Gil et al., 2004).
An extensive set of studies also suggests that the order in
et al., 1992; Kandel, 1985; Newcomb and Bentler, 1986). Most
of this research shows that individuals who ever used an illicit
use (“gateway” substances) preceded marijuana use and depen-
dence (e.g., Kandel, 2002), and marijuana use preceded illicit
drug use and dependence (Vega and Gil, 2005). The use of an
illicit substance before a licit substance is considered to be a
breach of the normative sequence, although etiological studies
have not focused on the consequences of breaches for the devel-
opment of substance use disorder.
Studies that have examined initiation patterns among differ-
ent ethnic groups have not generated consistent findings. Vega
imentation before gateway drug use among Hispanics, while
others found no difference in the patterns across ethnic groups
(Brook et al., 1998b). Yamaguchi and Kandel (2002) found that
dom patterns than whites. Further complexity in sequencing has
been reported based on analyses of Youth Risk Behavior Survey
trolling for other factors, the use of illicit substances before licit
female youth, compared to white youth.
Most population-based studies among adults have found
that the prevalence of substance use, abuse and dependence is
significantly higher among males than females (Anthony et al.,
1994; Hughes et al., 1997; Warner et al., 1995), and the male
to female ratio is often substantially greater among Hispanics
than non-Hispanic whites (Bachman et al., 1991; Canino et al.,
1993; Vega et al., 1998). The higher sex ratio difference among
Hispanics compared to whites has been attributed to negative
sanctions against female substance use in the traditional Latino
family (Oetting and Beauvais, 1990), and relatively more
stigma against Hispanic female compared to white female
drug users (Valdez et al., 2000). The extent to which family
processes correspond with traditional customs is likely to vary
by national origin, which may help explain why Puerto Rican
women tend to report higher rates of illicit drug use than other
Hispanic women (Amaro et al., 1990). Gender also appears
to interact with nativity and age at immigration. For example,
Mexican American women compared to Mexican immigrant
in adulthood, and exceptionally lower among Hispanic women
who were older when they moved to the U.S. (Vega et al.,
terns have yet to be elaborated, secular changes in gender role
expectations overall may explain why recent studies of adoles-
cents in most race/ethnicity groups either do not find a gender
According to data from combined 2002 and 2003 NSDUH sur-
veys, rates of past month illicit drug use were similar for male
(11.5%) and female (10.1%) Hispanic youths aged 12–17 years
no significant gender differences in rates of substance use dis-
orders between older adolescents either in the U.S. mainland or
2.4. Summary of substance use epidemiology
Caution in comparing substance use prevalence estimates
across studies, regardless of the population, is warranted.
Research can be based on a range of definitions of use or
disorder, a range of drugs (e.g., marijuana, cocaine or both),
and non-comparable age groups (e.g., 12–15 years or 11–17
consequences for participation and reliability of reporting. For
comparisons within Hispanic groups, the preceding overview
reinforces the need to interpret prevalence estimates in light of
sample characteristics such as national origin, nativity, gender
and age. Research by Lillie-Blanton et al. (1993) illustrated the
importance of adjusting rates according to community context;
blacks and whites had similar cocaine use rates when they were
matched by neighborhood, but black had higher rates according
to unmatched analyses.
L.A. Warner et al. / Drug and Alcohol Dependence 84S (2006) S8–S16
With these caveats in mind, the epidemiologic data suggest
that drug abuse in the U.S. Hispanic population appears to be
in a dynamic state of acceleration. Older Hispanics report lower
but rates among Hispanic adolescents are similar to or greater
than rates among non-Hispanic white adolescents. Gender dif-
ferences in drug use rates are notable among older Hispanics,
but not younger; and, at least for some Hispanic subgroups,
substance abuse prevalence among U.S.-born adolescents is no
different from foreign-born adolescents.
3. Drug abuse risk and protective factors in evolving
same as those for drug abuse or dependence. In general, situa-
in initial substance use (U.S. Congress, Office of Technology
Assessment, 1994), whereas affective, cognitive and behavioral
dysregulation are implicated in the progression from drug use
to abuse or dependence (Dawes et al., 2000). As stated in the
Introduction, it is unlikely that Hispanic drug-use patterns are
defined by factors that have not previously been identified in
the extensive body of research on risk and protective factors,
some of which evaluates the role of culture. (See the article on
prevention research in this volume for additional coverage of
culture and drug use). Notable shifts in Hispanic demographics
and substance use patterns point to culture change as a key area
Various definitions of culture change (i.e., acculturation,
assimilation and adaptation) have been included in Hispanic
turation may operate differently for Hispanic subgroups; based
on analyses of three national surveys, acculturation was associ-
group (Wagner-Echeagaray et al., 1994). Also, the salient fea-
tures of culture change may differ for the approximately 40% of
the U.S. Hispanic population that is foreign-born (Ramirez and
de la Cruz, 2002), and Hispanics born in the U.S. but who live
in families and communities with strong cultural connections.
an individual assimilates the practices and values of the domi-
nant culture, rather than the attainment of a status (i.e., one has
adopted the host culture or not) (Coatsworth et al., 2005; De la
Rosa, 2002; LaFromboise et al., 1993). Culture change is chal-
been used in Hispanic health research, see Hunt et al., 2004),
with place of birth and number of years living in the United
States often used as proxy measures. Moreover, acculturation is
not only an individual-level process but occurs at peer, family
and community levels as well (Weigers and Sherraden, 2001),
yet how culture change operates at these other levels, and the
conditions under which it is adaptive or not, are not well under-
stood. In each of the following subsections, we describe facets
of social and cultural adjustment that are theoretically linked
to individual, family and peer, and environmental correlates of
substance use, and identify research that speaks to the influence
of culture change on drug use patterns.
3.1. Individuals, culture change, and drug use
For individuals, culture change can influence values, prefer-
ences, and attitudes about normative behavior (Betancourt and
predominate use of English rather than Spanish (Epstein et al.,
2001; Marsiglia and Waller, 2002) have been identified as cor-
positive attitudes toward drug use have been found to increase
with number of years in the U.S. (Velez and Ungemack, 1995).
Individuals’ stress exposure and coping responses are also
theoretically linked with culture change (De la Rosa, 2002). In
this area, research on mental illness is particularly instructive
and relevant, given strong evidence that psychiatric disorders
are implicated in the etiology of drug use disorders (Biederman
et al., 1997; Kessler et al., 1996; McGee et al., 2000). For exam-
ple, lower rates of mental illness among foreign-born compared
to U.S. born Hispanics have been interpreted as an “immigrant
uations that may be particularly stressful (e.g., high crime, high
U.S.-born Hispanics (e.g., Escobar et al., 2000; Ortega et al.,
2000; Vega et al., 1998). One explanation for the finding is a
selection effect: healthy people migrate, yielding a group of
immigrants who are much less vulnerable to psychosocial stres-
sors. Research on rates of drug use prior to exiting one’s home
country is not widely available, but data on age at onset of drug
use suggest foreign-born Hispanics are not likely to have used
drugs prior to leaving their countries (Vega et al., 2002).
Others have argued that foreign-born Hispanics have lower
risk for negative outcomes because they have relatively modest
expectations about what success means, whereas the U.S.-born
experience more distress given barriers to their substantially
al., 1987). According to a study of Hispanic middle school stu-
dents, immigrants viewed their current lives in comparison with
life in their home countries, where economic and social con-
ditions were often worse, but U.S.-born Hispanics were more
likely to compare themselves with their peers in the United
and Suarez-Orozco, 1995). The investigators suggested that as
a result of the different frames of reference, U.S.-born Hispanic
youth experience more distress. Substance use could be a way
of coping with this distress, or a way to gain entrance to a social
network that is perceived to be better off.
Culture change processes, if associated with exposure to
negative life events, may also factor into the development of
substance abuse. Turner and Lloyd (2003) demonstrated that
lifetime cumulative exposure to major negative life events sig-
nificantly increases risk for the subsequent onset of drug depen-
dence among Hispanics, as among other groups. Because the
study was conducted in South Florida where Hispanics are a
L.A. Warner et al. / Drug and Alcohol Dependence 84S (2006) S8–S16
majority rather than a minority group, and half of those stud-
ied were from the relatively privileged Cuban background, the
results may not be generalizable to other Hispanics. It has been
Central American refugees and immigrants might increase the
need for mental health care in this group (U.S. Department of
Health and Human Services, 2001). It is reasonable to question
if traumas or losses surrounding immigration have distinct con-
regard to substance use as self-medication.
3.2. Families and peer groups, culture change, and drug use
Families and peers, as conduits of social control and social
learning, have important influences on drug use. In Hispanic
cultures “familism” has been identified as a uniquely defining
itive parent–child relationships are protective against drug use
are potentially more salient for Hispanics than other groups. For
inhibiting effect against drug use among Hispanic adolescents
than African-American and non-Hispanic white adolescents
that substance use increases when acculturation erodes tradi-
tional family values, including “respeto” (respect for parents),
family support and family pride (Vega and Gil, 1998).
may contribute to the erosion of familism (Szapocznik, 1979).
Because attachment to cultural prerogatives is likely to vary
2000), youths’ drug use and other negative behavior may reflect
the strains engendered when children have greater levels of
acculturation than parents. A recent study in which a mother’s
cents’ antisocial behavior (Eamon and Mulder, 2005), supports
the notion that minimization of acculturation gaps across the
generations may be beneficial. On the other hand, caution is
warranted if parents themselves increase their substance use as
part of their acculturation.
To the extent that acculturation weakens any prohibitions
against divorce, or against unmarried women having children,
that Hispanic youth living in two parent households are signif-
icantly less likely to use substances than those living in single
parent households or with neither parent (Gil et al., 1998, 2000;
Krohn et al., 1996). Additionally, Hispanic youth from single
parent households were more likely to use alcohol or drugs than
African-American and white non-Hispanic counterparts from
single parent households (Krohn et al., 1996). There is some
by Hispanic subgroup: Mexican and Puerto Rican adolescents
in single versus two parent families had higher drug use, but
no such association was found for Cuban American adolescents
holds are disproportionately poor, estimates of the influence of
require studies that control for socioeconomic status.
The culture-related strains in parent–child relationships may
also shape opportunities for Hispanic youths to associate with
deviant peers. For example, a series of studies of Puerto Rican,
Colombian and African American adolescents shows poor
relationships with parents are related to youths’ development
of unconventional attitudes and rebelliousness, which in turn
increased youths’ vulnerability to deviant peers and drug use
(Brook et al., 1998a; Chappin and Brook, 2001). Other research
on linguistic acculturation (e.g., youths’ use of English to com-
municate with parents) identified that peers’ drinking norms
mediated the relationship between acculturation and polydrug
use (Epstein et al., 2003).
vious section that substance use may be a way to gain entrance
to a more desirable social network. Krohn et al. (1996) showed
that Hispanic alcohol users were less likely to have friends from
their own ethnic groups than non-alcohol users, lending sup-
port to the argument that greater acculturation, vis-` a-vis greater
numbers of friendships with non-Hispanic youth than Hispanic
youth, may be related to increased substance use in Hispanic
The impact of acculturation on Hispanic women’s traditional
roles within the family, and related consequences for women’s
drug use patterns are more difficult to predict. On one hand,
women who use drugs are severely stigmatized because of cul-
turally embedded gender norms (Mora, 2002) that may not
readily change. On the other hand, the stressors associated with
acculturation might establish countervailing pressures toward
ners, given research that points to the influential role that males
play in women’s initiation and persistent use of drugs (Amaro
in this issue for other concerns related to gender, culture, and
3.3. Communities, culture change, and drug use
Family and social networks are embedded in larger com-
munity contexts, and there has been increasing attention to the
mate the association between individuals’ perceptions of social
capital in the community, such as collective efficacy, and public
health outcomes (e.g., Kawachi et al., 1999). Evidence suggests
that social capital may be relatively higher in predominately
Hispanic communities, and thus may be a particularly impor-
tant focus for future studies of Latino drug use. For example,
the pernicious effects of poverty in some neighborhoods may
be neutralized by high levels of residential stability and home-
ownership in low-income Hispanic communities (Ross et al.,
2000). Other studies have focused on the neighborhood as the
unit of analysis, and examined the way characteristics, such as
level of poverty, may predict outcomes that are correlated with
drug abuse, such as depression (Wight et al., 2005), but not drug
sures found that marital status of parents, immigrant generation
L.A. Warner et al. / Drug and Alcohol Dependence 84S (2006) S8–S16
and dimensions of neighborhood social context accounted for
the differences in rates of violence between black, white, and
Hispanic youth (Sampson et al., 2005).
Given the relatively recent gains that have been made in our
understanding of contextual influences on health, it is not sur-
prising that changes in social context have yet to be examined
in any consistent way. Similarly, change in the cultural con-
text of communities or neighborhoods, and its association with
drug use patterns, is unexplored. Studies conducted along the
U.S.-Mexico border support the assumption that culture change
processes at the community level relate to drug use. For exam-
ple, according to a survey of primarily Mexican adolescents
in schools on both sides of the Texas-Mexico border, rates of
depressive symptoms, drug use, and suicide were high in both
drug use than youth residing in Mexico (Swanson et al., 1992).
Case studies of drug abuse and community capital, like those
conducted by Valdez et al. (1997) in Laredo, Texas, promise to
be an important methodology for developing hypotheses about
communities in transition, and their vulnerability to drug abuse.
4. Research agenda
The last several years have witnessed substantial advances
in research on drug abuse among Hispanics in the U.S., includ-
ing federal support for studies that oversample minority groups,
and thus allow for sufficient sample size to investigate within
group profiles, and design strategies that improve data reliabil-
ity, such as Spanish-language interview protocols and measures
(e.g., Alegr´ ıa et al., 2004a,b). Understanding the complex inter-
in this review requires commitment to a research agenda that
crosses geographic borders, includes researchers from multiple
ponent of the research agenda is described in more detail below,
and specific questions are offered.
4.1. Crossing borders
Research must have the capacity to manage variations in
and different geographic areas (e.g., rural and small towns,
border areas, and densely populated metropolitan areas) and
cation studies conducted in Hispanic communities with diverse
characteristics are needed.
two reasons. First, a substantial proportion of Hispanics were
not born in the U.S. Consequently the epidemiology of drug use
in this country is structured to some extent by prevailing drug
use patterns in the countries of origin, as well as social norms
and attitudes about gender- and age-appropriate behavior. Tests
of hypotheses about the stresses and consequences of culture
change could be more rigorous with epidemiological data from
the sending countries. Second, Hispanics who come to the U.S.
to work, but do not intend to stay, constitute a unique and pos-
sibly highly vulnerable sub-group. It is possible that drug use
back to their nations of origin, with unknown consequences for
indigenous populations (Vega et al., 1998).
4.2. Input from multiple disciplines
Immigration and culture change processes are likely to be
extremely sensitive to chronological age insofar as it is a proxy
for developmental level and exposure to life stress. Expertise
from multiple disciplines is needed to evaluate the components
of that statement. Cultural anthropologists, psychologists and
sociologists have unique perspectives on development within
context, and discipline-specific models of stress and coping. In
a collaboration across disciplines, the relative contribution to
drug abuse of such things as values, norms, role functioning,
deviance, abnormal development, and stigma can be systemati-
A related line of inquiry focuses on the interplay between
exposure to stressors, psychiatric illness and drug dependence.
There is a pressing need for research to evaluate variations in
stress exposure and stress vulnerability among Hispanics of
differing national origins. The incorporation of biogenetic fac-
requires insight from basic and applied sciences, including neu-
robiology and psychiatry. (See a review of biological research
on drug abuse and addiction in this issue).
Finally, each discipline has its own experts on alcohol,
tobacco, and psychotropic drugs, as well as illicit substances.
In addition to engaging all substance-specific researchers in the
design and implementation of studies that advance this research
agenda, it would be extremely helpful to have formal arrange-
ments for ongoing cross-substance dissemination of research
that speaks to culture change processes.
4.3. Application of multiple research methods
Methodological considerations are paramount for three top-
ics in the research agenda: culture change and developmental
processes at the individual level, the experiences and meaning
of culture shifts among women and families, the measurement
of culture change at community levels.
Longitudinal studies of Hispanics are necessary to isolate
ages at which acculturation processes have an impact, and when
the risk for progression from use to abuse may be greatest.
Although initiation of substance use in adulthood is rare, other
changes in drug use patterns are more likely, and longitudi-
nal designs should capture broad age ranges across multiple
cohorts. These design features would help identify conditions
and ages when substance use escalates to dependence, or when
persons mature out of illegal drug use. For adolescents in par-
ticular, who experience tremendous transitions in identity and
value formation, narrowly spaced observation points are critical
to our understanding of dynamic processes such as adolescent
socialization and acculturation.
Ethnographic and qualitative studies are needed to under-
L.A. Warner et al. / Drug and Alcohol Dependence 84S (2006) S8–S16
vary with national origin. For example, given evidence that
U.S.-born Latino parents have much higher drug use rates than
foreign-born Latinos (Vega and Sribney, 2003), it is important
to reexamine family dynamics, and reevaluate the accultura-
tion gap hypothesis. Qualitative study might also help identify
aspects of culture change and social and economic assimilation
that influence drug use because of their main effects on family
functioning. For example, some responses to limited economic
be probed through interviews and observation.
Qualitative studies are also well suited to give voice to
Hispanic women and girls about the complicated negotiations
around gender roles, expectations, and substance use. In par-
ticular, research on the negative consequences of acculturation
on familism suggests that maintaining more traditional family
roles may be protective, at least with regard to youths’ drug use.
It would be important to know the extent to which support for
traditional family roles may have unintended consequences for
women, possibly by encouraging them to stay in unhealthy rela-
tionships with partners who are themselves using substances.
Community factors are arguably the least understood influ-
ences on individual drug use behavior, and there are many more
questions than there are data about interrelationships between
shifting neighborhood demographics, cultural norms, and drug
use. A set of measures that captures drug activity at the commu-
nity level, as well as changes in culture, needs to be developed.
Surveys of community residents can be used to collect data on
such factors as tolerance in the community for drug use, per-
ceived availability of drugs and drug treatment services, and
drug use in social networks. Records on arrests, drug mentions
in emergency room visits, and actual availability of drugs and
drug treatment services can also be used to gauge community
level drug use indicators. Changes in culture could be gauged,
is foreign-born, and primarily Spanish speaking.
With collaboration across sites, as described above, it would
be possible to maximize cost-effectiveness, explanatory value
and statistical power. This in turn would facilitate testing differ-
ences between unique subgroups and establish opportunities to
aggregate data to test hypotheses about culture change and risk
and resilience at the individual and community levels.
Alegr´ ıa, M., Takeuchi, D., Canino, G., Duan, N., Shrout, P., Meng, X.-L.,
et al., 2004a. Considering context, place and culture: the National Latino
and Asian American study. Int. J. Meth. Psychiatr. Res. 13, 208–220.
Alegr´ ıa, M., Vila, D., Woo, M., Canino, G., Takeuchi, D., Vera, M., Febo, V.,
Guarnaccia, P., Aguilar-Gaxiola, S., Shrout, P., 2004b. Cultural relevance
and equivalence in the NLAAS instrument: integrating etic and emic in
the development of cross-cultural measures for a psychiatric epidemiology
and services study of Latinos. Int. J. Meth. Psychiatr. Res. 4, 270–288.
Amaro, H., Hardy-Fanta, C., 1995. Gender relations in women’s addiction
and recovery. J. Psychoactive Drugs 27, 325–337.
Amaro, H., Whitaker, R., Coffman, G., Heeren, T., 1982-84. Acculturation
and marijuana and cocaine use: Findings from the HHANES. Am. J.
Public Health 80, 54–60.
Anthony, J.C., Warner, L.A., Kessler, R.C., 1994. Comparative epidemiology
of dependence on tobacco alcohol, controlled substances, and inhalants:
basic findings from the National Comorbidity Survey. Exp. Clin. Psy-
chopharmacol. 2, 244–268.
Bachman, J.G., Wallace, J.M., O’Malley, P.M., Johnston, L.D., Kurth, C.L.,
Neighbors, H.W., 1976-89. Racial/ethnic differences in smoking, drinking,
and illicit drug use among American high school seniors. Am. J. Public
Health 81, 372–377.
Betancourt, H., Lopez, S.R., 1993. The study of culture, ethnicity and race
in American psychology. Am. Psychol. 48, 629–637.
Biederman, J., Wilens, T., Mick, E., Faraone, S.V., Weber, W., Curtis, S.,
Thornell, A., Pfister, K., Jetton, J.G., Soriano, J., 1997. Is ADHD a risk
factor for psychoactive substance use disorders? Findings from a four-year
prospective follow-up study. J. Am. Acad. Child Adolescent Psychiatr. 36,
Boles, S., Casas, M., Furlong, M., Gonzalez, G., Morrison, G., 1994. Alcohol
and other drug use patterns among Mexican American, Mexican and
Caucasian adolescents: New directions for assessment and research. J.
Clin. Child Psychol. 23, 39–46.
Borrell, L.N., 2005. Racial identity among Hispanics: implications for health
and well-being. Am. J. Public Health 95, 379–381.
Breslau, J., Kendler, K., Su, M., Gaxiola-Aguilar, S., Kessler, R.C., 2005.
Lifetime risk and persistence of psychiatric disorders across ethnic groups
in the United States. Psychol. Med. 35, 317–327.
Brook, J.S., Brook, D.W., De la Rosa, M., Duque, L.F., Rodriguez, E.,
Montoya, I.D., Whiteman, M., 1998a. Pathways to marijuana use among
adolescents: cultural/ ecological, family, peer, and personality influences.
J. Am. Acad. Child Adolescent Psychiatr. 37, 759–766.
Brook, J.S., Whiteman, M., Balka, E.B., Win, P.T., Gursen, M.D., 1998b. Sim-
ilar and different precursors to drug use and delinquency among African
Americans and Puerto Ricans. J. Genet. Psychol. 159, 13–29.
Burnam, A., Huogh, R.L., Karno, M., Escobar, J., Telles, C., 1987. Accul-
turation and lifetime prevalence of psychiatric disorders among Mexican
Americans in Los Angeles. J. Health Social Behav. 28, 89–102.
Caetano, R., 1987. Acculturation and attitudes toward appropriate drinking
among U.S. Hispanics. Alcohol Alcohol.: Int. J. Med. Council Alcohol.
Canino, G., Anthony, J.C., Freeman, D., Shrout, P., Rubio-Stipec, M., 1993.
Drug abuse and illicit drug use in Puerto Rico. Am. J. Public Health 83,
Centers for Disease Control and Prevention, 2004. Surveillance Summaries,
May 21, 2004. MMWR 53 (No. SS-2).
Chandler, C.R., Tsai, T.M., Wharton, R., 1999. Twenty years after: replicating
a study of Anglo- and Mexican-American cultural values. Soc. Sci. J. 36,
Chappin, S.R., Brook, J.S., 2001. The influence of generational status and
psychosocial variables on marijuana use among black and Puerto Rican
adolescents. Hispanic J. Behav. Sci. 23, 22–36.
Coatsworth, J.D., Maldonado-Molina, M., Pantin, H., Szapocznik, J., 2005.
A person-centered and ecological investigation of acculturation strategies
in Hispanic immigrant youth. J. Commun. Psychol. 33, 157–174.
Dawes, M.A., Antelman, S.M., Vanyukov, M.M., Giancola, P., Tarter, R.E.,
Susman, E.J., Mezzich, A., Clark, D.B., 2000. Developmental sources of
variation in liability to adolescent substance use disorders. Drug Alcohol
Depend. 61, 3–14.
De la Rosa, M.R., 1988. Natural support systems of Hispanics: a key dimen-
sion for their well-being. Health Social Work 15, 181–190.
De la Rosa, M., 2002. Acculturation and Latino adolescents’ substance use:
a research agenda for the future. Subst. Use Misuse 37, 429–456.
Eamon, M.K., Mulder, C., 2005. Predicting antisocial behavior among Latino
young adolescents: an ecological systems analysis. Am. J. Orthopsychiatr.
Ellickson, P.L., Hays, R.D., Bell, R.M., 1992. Stepping through the drug use
sequence: longitudinal scalogram analysis of initiation and regular use. J.
Abnorm. Psychiatr. 101, 441–451.
Epstein, J.A., Botvin, G.I., Diaz, T., 2001. Alcohol use among Hispanic
adolescents: role of linguistic acculturation and gender. J. Alcohol Drug
Educ. 45, 18–32.
L.A. Warner et al. / Drug and Alcohol Dependence 84S (2006) S8–S16
Epstein, J.A., Doyle, M., Botvin, G.J., 2003. A mediational model of the
relationship between linguistic acculturation and polydrug use among His-
panic adolescents. Psychol. Reports 93, 859–866.
Escobar, J.I., Hoyos Nervi, C., Gara, M.A., 2000. Immigration and mental
health: Mexican Americans in the United States. Harvard Rev. Psychiatr.
Escobar, J.I., Vega, W.A., 2000. Mental health and immigration’ s AAAs:
where are we and where do we go from here? J. Nervous Mental Dis.
Felix-Ortiz, M., Fernandez, A., Newcomb, M.D., 1998. The role of intergen-
erational discrepancy of cultural orientation in drug use among Latina
adolescents. Subst. Use Misuse 33, 967–994.
Galvan, F.H., Caetano, R., 2003. Alcohol use and related problems among
ethnic minorities in the United States. National Institute on Alcohol Abuse
and Alcoholism http://www.niaaa.nih.gov/publiations/arh27-1/87-94.htm.
(Accessed September 24, 2005).
Gil, A.G., Vega, W.A., Biafora, F., 1998. Temporal influences of family
structure, and family risk factors on drug use initiation in a multi ethnic
sample of adolescent boys. J. Youth Adolesc. 23, 373–393.
Gil, A.G., Wagner, E.F., Vega, W.A., 2000. Acculturation, familism, and
alcohol use among Latino adolescent males: longitudinal relations. J.
Community Psychol. 28, 443–458.
Gil, A.G., Wagner, E.F., Tubman, J.G., 2004. Associations between early-
adolescent substance use and subsequent young-adult substance use dis-
orders and psychiatric disorders among a multiethnic male sample in
South Florida. Am. J. Public Health 94, 1603–1608.
Grant, B.F., Stinson, F.S., Hasin, D.S., Dawson, D.A., Chou, S.P.,
Anderson, K., 2004. Immigration and lifetime prevalence of DSM-
IV psychiatric disorders among Mexican Americans and Non-Hispanic
Whites in the United States. Arch. Gen. Psychiatr. 61, 1226–
Guerra, L.M., Romano, P.S., Samuels, S.J., Kass, P.H., 2000. Ethnic differ-
ences in adolescent substance initiation sequences. Arch. Pediatr. Adolesc.
Med. 154, 1089–1095.
Hughes, T.L., Day, L.E., Marcantonio, R.J., Torpy, E., 1997. Gender differ-
ences in alcohol and other drug use among young adults. Subst. Use
Misuse 32, 317–342.
Hunt, L.M., Schneider, S., Comer, B., 2004. Should acculturation be a vari-
able in health research? A critical review of research on U. S. Hispanics.
Social Sci. Med. 59, 973–986.
Johnston, L.D., O’Malley, P.M., Backman, J.G., Schulenberg, J.E., 2004.
Demographic subgroup trends for various licit and illicit drugs,
1975–2003. (Monitoring the Future Occasional Paper No. 60). Ann Arbor,
MI: Institute for Social Research.
Kandel, D.B., 1985. Stages in adolescent involvement in drug use. Science
Kandel, D.B., 2002. Stages and Pathways of Drug Involvement: Examining
the Gateway Hypothesis. Cambridge University Press, London.
Kandel, D., Chen, K., Warner, L.A., Kessler, R.C., Grant, B., 1997. Preva-
lence and demographic correlates of symptoms of last year dependence
on alcohol, nicotine, marijuana and cocaine in the U. S. population. Drug
Alcohol Depend. 44, 11–29.
Kawachi, I., Kennedy, B., Glass, R., 1999. Social capital and self-rated health:
a contextual analysis. Am. J. Public Health 89, 1187–1193.
Kessler, R.C., Nelson, C.B., McGonagle, K.A., Edlund, M.J., Frank, R.G.,
Leaf, P.J., 1996. The epidemiology of co-occurring addictive and men-
tal disorders: implications for prevention and service utilization. Am. J.
Orthopsychiatr. 66, 17–31.
Khoury, E.L., Warheit, G.J., Zimmerman, R.S., Vega, W.A., Gil, A.G., 1996.
Gender and ethnic differences in the prevalence of alcohol, cigarette, and
illicit drug use over time in a cohort of young Hispanic adolescents in
south Florida. Women’s Health 24, 21–40.
Krohn, M., Lizotte, A., Thornberry, T., Smith, C., McDowall, D., 1996.
Reciprocal causal relationships among drug use, peers, and beliefs: a
five-wave panel model. J. Drug Issues 26, 405–428.
LaFromboise, T., Coleman, H.L.K., Gerton, J., 1993. Psychological impact
of biculturalism: evidence and theory. Psychol. Bull. 114, 395–
Lillie-Blanton, M., Anthony, J.C., Schuster, C.R., 1993. Probing the meaning
of racial/ethnic group comparisons on crack cocaine smoking. J. Am.
Med. Assoc. 269, 993–997.
Marsiglia, F.F., Waller, M., 2002. Language preference and drug use among
Southwestern Mexican-American middle school students. Soc. Work
Educ. 24, 145–148.
McGee, R., Williams, S., Poulton, R., Moffitt, T., 2000. A longitudinal study
of cannabis use and mental health from adolescence to early adulthood.
Addiction 95, 491–503.
Mora, J., 2002. Latinas in cultural transition: addiction, treatment and recov-
ery. In: Straussner, S.L.A., Brown, S. (Eds.), The Handbook of Addiction
Treatment for Women: Theory and Practice. Jossey Bass, San Francisco,
Newcomb, M.D., Bentler, P.M., 1986. Frequency and sequence of drug use:
a longitudinal study from early adolescence to young adulthood. J. Drug
Educ. 16, 101–120.
Office of Applied Studies, 2004. Substance use among Hispanic youths. The
NSDUH Report. Available at http://oas.samhsa.gov/2k5/HispanicYouth/
HispanicYouth.htm. Last accessed September 23, 2005.
Oetting, E.R., Beauvais, F., 1990. Adolescent drug use: findings of
national and local surveys. J. Consult. Clin. Psychol. 58, 385–
Ortega, A.N., Rosenheck, R., Alegr´ ıa, M., Desai, R.A., 2000. Acculturation
and the lifetime risk of psychiatric and substance use disorders among
Hispanics. J. Nerv. Mental Dis. 188, 728–735.
Perez, W., Padilla, A.M., 2000. Cultural orientation across three generations
of Hispanic adolescents. Hispanic J. Behav. Sci. 22, 30–39.
Ramirez, R., de la Cruz, G.P., 2002. The Hispanic population in the United
States: March 2002, Current Population Reports. U.S. Census Bureau,
Washington, DC, pp. P20–P545.
Ross, C.E., Reynolds, J.R., Geis, K.J., 2000. The contingent meaning
of neighborhood stability for residents’ psychological well-being. Am.
Sociol. Rev. 65, 581–597.
Sampson, R.J., Morenoff, J.D., Raudenbush, S., 2005. Social anatomy of
racial and ethnic disparities in violence. Am. J. Public Health 95,
Sloboda, Z., 2002. Changing patterns of “drug abuse” in the United States:
connecting findings from macro-and microepidemiologic studies. Subst.
Use Misuse 37, 1229–1251.
Smith, C., Krohn, M.D., 1995. Delinquency and family life among
male adolescents: the role of ethnicity. J. Youth Adolesc. 24, 69–
Suarez-Orozco, C., Suarez-Orozco, M.M., 1995. Transformations: Immigra-
tion, Family Life and Achievement Motivation among Latino Adolescents.
Stanford University Press, Stanford, CA.
Substance Abuse and Mental Health Services Administration, 1998. National
Household Survey on Drug Abuse: Population Estimates 1997. Available
at http://www.oas.samhsa.gov/nhsda/Pe1997/httoc.htm. Accessed June 3,
Substance Abuse and Mental Health Services Administration, 2002. Results
from the 2001 National Household Survey on Drug Abuse, vol. I. Sum-
mary of National Findings (Office of Applied Studies, NHSDA Series
H-17, DHHS Publication No. SMA 02-3758). Rockville.
Substance Abuse and Mental Health Services Administration, 2004. Overview
of Findings from the 2003 National Survey on Drug Use and Health
(Office of Applied Studies, NSDUH Series H-24, DHHS Publication No.
SMA 04-3963). Rockville, MD.
Sokol-Katz, J.S., Ulbrich, P.M., 1992. Family structure and adolescent risk-
taking behavior: a comparison of Mexican, Cuban, and Puerto Rican
Americans. Int. J. Addict. 27, 1197–1209.
Swanson, J.W., Linskey, A.O., Quintero-Salinas, R., Pumariega, A.J., Holzer
III, C.E., 1992. A binational school survey of depressive symptoms, drug
use, and suicidal ideation. J. Am. Acad. Child Adolescent Psychiatr. 31,
Szapocznik, J. (Ed.), 1979. Mental Health, Drug and Alcohol Abuse: an His-
panic Assessment of Present and Future Challenges. National Coalition of
Hispanic Mental Health and Human Services Organizations, Washington,
S16 Download full-text
L.A. Warner et al. / Drug and Alcohol Dependence 84S (2006) S8–S16
Turner, R.J., Gil, A.G., 2002. Psychiatric and substance use disorders in south
Florida: racial/ethnic and gender contrasts in a young adult cohort. Arch.
Gen. Psychiatr. 59, 43–50.
Turner, R.J., Lloyd, D.A., 2003. Cumulative adversity and drug dependence
in young adults: racial/ethnic contrasts. Addiction 98, 305–315.
U.S. Census Bureau, 2004. Projected population of the United States, by race
and Hispanic origin: 2000-2050. Available at: http://www.census.gov/ipc/
www/usinterimproj/natprojtab01a.pdf. (Last accessed June 3, 2005).
U.S. Census Bureau, 2005. Annual resident population estimates of the United
States by age, race, and Hispanic or Latino origin: April 1, 2000 to July
1, 2002. Table NA-EST2002-ASRO-03. Available at http://www.census.
(last accessed June 3, 2005).
U.S. Congress, Office of Technology Assessment, 1994. Technologies for
understanding and preventing substance abuse and addiction. OTA-HER-
597. Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services, 2001. Mental Health: Cul-
ture, Race, and Ethnicity—A Supplement to Mental Health: A Report
of the Surgeon General. Rockville, MD: U.S. Department of Health and
Human Services, Substance Abuse and Mental Health Services Adminis-
tration, Center for Mental Health Services.
Valdez, A., Kaplan, C.D., Cepeda, A., 2000. The process of paradoxical
autonomy and survival in the heroin careers of Mexican American women.
Contemp. Drug Probl. 27, 189–212.
Valdez, A., Mata, A.G., Codina, G.E., Kaplan, C.D., 1997. Public health and
drug abuse problems in United States-Mexico border gateway cities: A
case study of Laredo, Texas. J. Border Health 2, 4–10.
Vega, W.A., Aguilar-Gaxiola, S., Andrade, L., et al., 2002. Prevalence and age
of onset for drug use in seven international sites: results from the inter-
national consortium of psychiatric epidemiology. Drug Alcohol Depend.
Vega, W.A., Alderete, E., Kolody, B., Aguilar-Gaxiola, S., 1998. Illicit drug
use among Mexicans and Mexican Americans in California: the effects
of gender and acculturation. Addiction 93, 1839–1850.
Vega, W.A., Gil, A., 1998. Drug Use and Ethnicity in Early Adolescents.
Plenum Press, New York.
Vega, W.A., Gil, A.G., 2005. Revisiting drug progression: long-range effects
of early tobacco use. Addiction. 100, 1358–1369.
Vega, W.A., Sribney, W., 2003. Parental risk factors and social assimilation in
alcohol dependence of Mexican Americans. J. Stud. Alcohol 64, 167–175.
Vega, W.A., Sribney, W., Achara-Abrams, I., 2003. Co-occurring alcohol,
drug, and other psychiatric disorders among Mexican origin people in
the United States. Am. J. Public Health 93, 1057–1064.
Vega, W.A., Sribney, W.M., Aguilar-Gaxiola, S., Kolody, B., 2004. 12-Month
prevalence of DSM-III-R psychiatric disorders among Mexican Ameri-
cans: Nativity, social assimilation, and age determinants. J. Nerv. Mental
Dis. 192, 532–541.
Velez, C.N., Ungemack, J.A., 1995. Psychosocial correlates of drug use
among Puerto Rican youth: generational status differences. Soc. Sci. Med.
Wagner-Echeagaray, F.A., Schutz, C.G., Chilcoat, H.D., Anthony, J.C.,
1994. Degree of acculturation and the risk of crack cocaine smok-
ing among Hispanic Americans. Am. J. Public Health 84, 1825–
Wallace Jr., J.M., Bachman, J.G., O’Malley, P.M., Johnston, L.D., Schulen-
berg, J.E., Cooper, S.M., 1976-2000. Tobacco, alcohol, and illicit drug
use: racial and ethnic differences among U.S. high school seniors. Public
Health Rep. 117, S67–S75.
Warner, L.A., Canino, G., Col´ on, H.M., 2001. Prevalence and correlates of
substance use disorders among older adolescents in Puerto Rico and the
Unites States: a cross-cultural comparison. Drug Alcohol Depend. 63,
Warner, L.A., Kessler, R.C., Nelson, C.B., Anthony, J.C., 1995. Preva-
lence and correlates of drug use and dependence in the United States.
Results from the National Comorbidity Survey. Arch. Gen. Psychiatr. 52,
Weigers, M., Sherraden, M., 2001. A critical examination of acculturation:
the impact of health behaviors, social support and economic resources
on birth weight among women of Mexican descent. Int. Migrat. Rev. 35,
Wight, R.G., Aneshensel, C.S., Botticello, A.L., Sep´ ulveda, J.E., 2005. A
multilevel analysis of ethnic variation in depressive symptoms among
adolescents in the United States. Soc. Sci. Med. 60, 2073–2084.
Yamaguchi, K., Kandel, D.B., 2002. Gender and racial/ethnic differences
in drug use progression. In: Kandel, D.B. (Ed.), Stages and Pathways
of Drug Involvement: Examining the Gateway Hypothesis. Cambridge
University Press, London, pp. 187–222.
Zapata, J., Katims, D., Yin, Z., 1998. A 2-year study of patterns and predic-
tors of substance use among Mexican American youth. Adolescence 33,