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Article Excerpt
Acculturation refers to the cultural and psychological processes and outcomes that result from prolonged intercultural contact between two culturally distinct groups (Berry 1997). As a framework to identify and understand patterns in drug and alcohol use, its main thesis suggests that the longer an immigrant group has been in the country, the more its behavior resembles that of the mainstream (Room 2005). Acculturation has been helpful in alcohol research to identify profiles of at-risk drinkers among Latinos who immigrate to the US. For example, increased acculturation has been associated with increased substance abuse (Cherpitel & Borges 2002; Gil, Wagner & Vega 2000), alcohol use (Gil, Wagner & Vega 2000; Polednak 1997), and problems associated with use (Cherpitel & Borges 2002; Grant, Stinson, Hasin, Dawson, Chou & Anderson 2004). In a comprehensive review, Gil and associates (2004) concluded that adults of Latino origin at "medium" to "high" acculturation levels are more at risk for problematic alcohol use than those who are less acculturated. This acculturation finding appears to be robust in that it has been observed over time (Caetano & Clark 2003), across independent epidemiological studies (e.g. Burnam, Hough, Karno, Escobar, Timbers & Telles 1987), and in a clinical sample of patients from a hospital emergency room (Cherpitel & Borges 2002).
Though helpful, the limitations of acculturation as a model need to be addressed to better understand what about acculturation might be related to increased drinking problems (Gutmann 1999; Hunt, Schneider & Comer 2004; Room 2005). First, acculturation is typically perceived as assimilation, a uni-directional process of change whereby immigrants are assumed to shed their cultural practices and adopt the cultural norms of the host society. However, acculturation needs to be understood more broadly as a process that does not follow a single sequence. Assimilation is only one strategy to acculturation (Berry 1997; Cortes 2003). In the case of drug and alcohol use, identified as markers of ethnic identity and acculturation, it has been documented that many trajectories of drug and alcohol use are possible within a single immigrant group (Gutmann 1999; Hunt et al. 2004; Room 2005) following migration to a new country. For example, some immigrant groups practice abstention from alcohol as part of their cultural practice even after generations of living in the US (Room 2005).
A second critique of acculturation is that it needs to be more broadly studied, extending investigative analyses to peoples' social and physical worlds (Hunt et al. 2004; Gutmann 1999). Acculturative change is usually located exclusively within the individual (Gutmann 1999; see Hunt et al. 2004, for a review). In fact, external factors such as limited access to resources can also influence acculturation (Kleinman 1995; Lopez 2003; Hunt et al. 2004). For example, after immigrating to the US, Latinos may experience fewer social networks compared to being in a Latin-American country. This external structural change, not just internal cultural values (e.g. familismo) can contribute to Latino families becoming more dependent on each other. Therefore, we need to understand shifts in drinking behavior more broadly as the result of changes in peoples' social, physical, and cultural worlds. Thirdly, models of acculturation need to provide some idea of the behavior of interest in the country of origin, to explore whether changes in behavior here in the US, are attributable to living in the United States (Hunt et al. 2004; Gutmann 1999). Without discussion of the "baseline level" of the targeted behavior prior to immigration it is difficult to make statements about behavior change.
Qualitative methodologies have the potential to shed some light on what about acculturation might be related to increased drinking problems. Such an approach can provide a broader assessment of acculturation processes (not simply language) to capture the multiple social and cultural processes associated with drinking and related problems. Qualitative studies are particularly good at identifying how the social world contributes to health and health related behaviors (Garro 2003; Kleinman 1995; Hunt et al. 2004). Of particular interest would be to examine the "baseline level" of Latinos' drinking in their home country and how it compares with their drinking in the United States. Doing so could provide a window in the presumed culture change thought to take place after immigrating to the US (Gutmann 1999; Hunt et al. 2004).
We carried out a qualitative study to provide a broader perspective of acculturative processes that addressed the concerns mentioned above. It was hoped that by taking a more open-ended approach relative to survey format we would be able to capture richer information from the participants, including descriptions of their social worlds. A qualitative approach was appropriate for the exploratory nature of the study. Study goals were to better understand participants' experiences of being in a new country and how/whether that influenced their drinking behavior.
We queried participants about their social worlds (e.g., social networks and work) to examine its role as it related to their drinking behaviors. We also compared Latinos' health behavior of interest (alcohol consumption) in their home countries and in the United States. Our intent was to obtain our participants' "baseline" alcohol consumption behaviors prior to immigration to the US so that we could identify possible changes. Lastly, we considered whether to use a homogenous (one Latino group only) or heterogeneous (individuals of different nationalities) sample.
We recognize that the category "Latino" is a term that reflects a grouping together of individuals from very diverse cultures of origin (Room 2005). Findings from multinational epidemiological studies (Obot & Room 2005), and ethnographies of individual ethnic groups in the Northeast (Gordon 1978; Gordon 1986), illustrate the diversity of alcohol-related norms across Latino sub-groups. However, we were not interested in examining the cultural differences between sub-ethnic groups. Our main interest was to examine the social experiences and drinking behaviors of Latino immigrants in the Northeastern part of the United States. Using this approach made it possible to identify thematic elements that could be common to a diverse group of Latinos. Second, as the study constituted the first phase of a program of research designed to tailor standard alcohol interventions to the particular needs of Latino heavy drinkers, it was important that the present study was comprised of that target sample.
Given the disproportionately higher number of Latinos who suffer from health problems related to late-stage alcoholism (Singh & Hoyert 2000; Stinson, Grant & Dufour 2001), it was of public health interest to investigate this question with respect to Latinos who drink frequently and at high levels of alcohol consumption. We decided to include Latinos who were comfortable speaking English as well as Spanish because research suggests that more highly acculturated (typically measured as more frequent use of English) Latinos experience more drinking-related problems (e.g., Caetano & Clark 2003). The resulting sample of participants was all foreign-born, spoke Spanish and some English, and met criteria for frequent heavy drinking. An innovation of the study is its focus on Latinos groups in the Northeast. With some exceptions, (Gordon 1978; Gordon 1985; Polednak 1997), the majority of alcohol research has sampled Mexican-Americans in the Southwest or California (Zayas, Rojas & Malgady 1998). This study will contribute to increasing knowledge about South American and Caribbean Latinos, groups that are well represented in Rhode Island and throughout the Northeast region. Research questions guiding the study included: 1) A comparison of the quality and conditions of lives in the country of origin and in the...
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