Drug Use/abuse Prevalence, Etiology, Prevention, and Treatment in Hispanic Adolescents: A Cultural Perspective

Article excerpt

The purpose of this article is to provide an overview of the state of drug abuse research among Hispanic adolescents in the areas of prevalence, etiology, prevention, and treatment from a cultural perspective. Cultural and acculturation-related processes are central to the understanding of the epidemiology, etiology, prevention, and treatment of drug use among Hispanic adolescents. Culture is also embedded within each of the efficacious interventions for Hispanic adolescents, suggesting that integrating Hispanic cultural symbols and values is an important element in preventing and treating drug use and related problem behaviors in this population. The recommendations presented in this article, along with existing work in the fields of epidemiology, risk protection, prevention, and treatment, will help to reduce the health disparities in drug use and related problem behaviors in this vulnerable and rapidly growing segment of the U.S. population.

INTRODUCTION

Hispanics1 are the largest and fastest growing minority group in the United States (Ramirez & de la Cruz, 2003), representing 14% of the population. Moreover, Hispanics accounted for approximately half of all U.S. population growth between 2000 and 2005 (Bernstein, 2006; Huntington, 2004) and are projected to comprise one quarter of the U.S. population by 2050 (U.S. Census Bureau, 2005). Hispanics are also a youthful population, with more than one third under the age of 18 (Marotta & Garcia, 2003). Hispanic children and adolescents therefore represent a rapidly increasing share of American youth, and their welfare represents an important public health concern.

We focus on Hispanic adolescents in this article because, in addition to their large and growing numbers, Hispanic adolescents are disproportionately affected by substance use (Johnston, O'Malley, Bachman, & Schulenberg, 2007) and associated problem behaviors such as unsafe sexual behavior (Prado, Schwartz et al., 2006) and school dropout (Greene & Forster, 2003). There is some evidence that substance use (including alcohol, tobacco, and/or illicit drug use) may represent a major contributor to the health disparities between Hispanics and nonHispanic Whites. For one, Hispanic adolescents are likely to initiate substance use earlier than non-Hispanic White adolescents (Johnston et al., 2007). In turn, these disporportionate rates of early substance use initiation contribute considerably to the disparities observed between Hispanics and non-Hispanic Whites in the prevalence rates of HIV, assaults/homicides, intentional harm/suicides, and chronic lower respiratory disease (Arias, Anderson, Kung, Murphy, & Kochanek, 2003). The purpose of this article is to provide an overview of the state of drug abuse research among Hispanic adolescents in the areas of prevalence, etiology, and prevention and treatment from a cultural perspective.

Adolescent development is embedded in a complex set of contexts that influence, and are influenced by, the adolescent's developmental course (Szapocznik & Coatsworth, 1999). Culture is an important context that influences adolescent development toward or away from problematic behaviors, including drug use (Castro & Alarcon, 2002). Interest in the cultural patterns that may be found in Hispanic youth and their families stems from the belief that, beyond race and ethnicity, an understanding of cultural processes that are proximal to daily life is needed. Culture can be described as knowledge, skills, attitudes, and behaviors that are shared among a group of people and may be transmitted from one generation to the next (Carter, 1995). Elements of culture may be expressed through "familial roles, communication patterns, affective styles, and values regarding personal control, individualism, collectivism, spirituality, and religiosity" (Betancourt & Lopez, 1993, p. 630). For ethnic minority or immigrant groups, one important task of the family is to socialize children into the family's heritage culture (UmanaTaylor, Bhanot, & Shin, 2006). …