Bicultural Stress and Adolescent Risk Behaviors in a Community Sample of Latinos and Non-Latino European Americans

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Bicultural Stress and Adolescent Risk Behaviors in aCommunity Sample of Latinos and Non-LatinoEuropean AmericansAndrea J. Romero a; Daniel Martinez a; Scott C. Carvajal aba Mexican American Studies & Research Center, Department of Psychology,College of Social and Behavioral Sciences, University of Arizona, Tucson, AZ, USAb The Melvin and Enid Zuckerman College of Public Health, University of Arizona,Tucson, AZ, USA

Online Publication Date: 01 November 2007To cite this Article: Romero, Andrea J., Martinez, Daniel and Carvajal, Scott C.(2007) 'Bicultural Stress and Adolescent Risk Behaviors in a Community Sample ofLatinos and Non-Latino European Americans', Ethnicity & Health, 12:5, 443 - 463

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Bicultural Stress and Adolescent RiskBehaviors in a Community Sample ofLatinos and Non-Latino EuropeanAmericansAndrea J. Romeroa, Daniel Martinezb &Scott C. Carvajala,c

aMexican American Studies & Research Center, Department of Psychology, College of Social and

Behavioral Sciences, University of Arizona, Tucson, AZ, USA; bMexican American Studies &

Research Center, Department of Psychology, College of Social and Behavioral Sciences, University

of Arizona, Tucson, AZ, USA & cThe Melvin and Enid Zuckerman College of Public Health,

University of Arizona, Tucson, AZ, USA

Objectives. The study examined the relation between adolescent risk behaviors and

bicultural stress due to discrimination, immigration, and acculturation factors. We

hypothesized bicultural stress would be related to increased risk behavior and depressive

symptoms independent of socioeconomic status, ethnic self-identification, and accultura-

tion.

Design. Middle school student participants (n�519; median age 14) completed a

self-report questionnaire on their risk behaviors, psychosocial antecedents, and socio-

demographic factors. Latino (304) and non-Latino European American (215)

students were surveyed through a large, urban, West Coast US school district.

Results. More bicultural stress was significantly related to reports of all risk behaviors

(i.e. smoking, drinking, drug use, and violence) and depressive symptoms. Further,

bicultural stress was a robust explanatory variable across sub-groups, and appears largely

independent from depressive symptoms.

Correspondence to: Andrea J. Romero, PhD, Mexican American Studies and Research Center, University of

Arizona, Cesar Chavez Building No. 23, P.O. Box 210023, Tucson, AZ 85721-0023, USA. Tel: �1 520 626 8137.

Email: [email protected]

ISSN 1355-7858 (print)/ISSN 1465-3419 (online) # 2007 Taylor & Francis

DOI: 10.1080/13557850701616854

Ethnicity and Health

Vol. 12, No. 5, November 2007, pp. 443�463

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Conclusion. The hypotheses were supported. Bicultural stress appears to be an important

underlying factor for health disparities among US adolescents. Future research may

consider promoting well-being in majority, as well as minority adolescents, through

targeting sources of bicultural stressors or examining ways to moderate their effects on

adolescent risk behaviors.

Keywords: Bicultural; Adolescent; Risk Behavior; Health Disparities

Adolescents’ risk behaviors are central indicators of their health (Jessor 1998; CDC

2004). Latinos now represent the largest ethnic minority in the US, and they are

disproportionately represented in younger populations (US Census Bureau 2001).

Latino ethnicity is a pan-ethnic label that typically refers to a common language

(Spanish) or a common ancestry (Americas south of the US), encompassing the same

ethnics groups as the label ‘Hispanic’, which is more frequently used in US

government records (Marın & Marın 1991). While for some health outcomes,

Latinos are healthier than would be expected based on ethnic trends in education and

income (the ‘Hispanic epidemiological paradox’; see De La Torre & Estrada 2001;

Farley et al. 2005), this has not been the case regarding adolescent risk behaviors.

Rather, disparities research has identified that, relative to other US youth, Latino

youth report early age of onset of substances (Ellickson et al. 2004; Kandel et al. 2004;

De La Rosa et al. 2005; Johnston et al. 2005; Stueve & O’Donnell 2005) as well as high

rates of violence and depressive symptoms (Hovey & King 1996; CDC 2004).

Additionally, some subgroups of Latino youth based on nationality and/or

acculturation are at further disparate risk; however, much of this research has been

inconsistent due to the limited measures of cultural change (e.g. lack of orthogonal or

multidimensional assessments) utilized in national surveys (Carvajal et al. 2002;

Unger et al. 2004a; Borrell 2005).

One way to advance health disparities research is by examining plausible

psychosocial factors that may better explain disparities than broad ethnic labels

(e.g. Walsh et al. 2000; Nazroo 2001; Bradby 2003). Scholars have increasingly

articulated the negative impact of stress on health outcomes, particularly stress

related to discrimination and prejudice (Karlsen & Nazroo 2001; Williams et al. 2003;

Mays et al. 2007). The current work aims to elucidate factors underlying disparities in

Latino and non-Latino European American youths by examining the role of

bicultural stressors and considering multiple potentially relevant socio-demographic

variables, including current measures of cultural orientation within Latinos.

Research on Acculturative Stress

There is substantial literature on immigrant populations’ perception of stress due to

such factors as prejudice, discrimination, minority status, and pressure to learn

English (Cervantes et al. 1991; Hovey 2000; Berry, 2003). Some researchers define

444 A. J. Romero et al.

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prejudice as the everyday negative interactions between ethnic groups that may result

from ethnocentrism, and suggest that it may be a major source of stress for many

minority groups (Allison 1998; Clark et al. 1999; Sellers & Shelton 2003; Meyer 2004).

In adolescence, peer discrimination may be particularly stressful because positive

acceptance by peers is highly salient (Williams-Morris 1996; Romero & Roberts 1998;

Arnett 2002; Spears-Brown & Bigler 2005). Stress may come not only from pressure

to adopt the US majority culture, in fact, some acculturative stress models suggest

adolescents may perceive pressure to maintain their culture of origin from peers

within their own ethnic group. For example, same-ethnic group youth may use

derogatory terms, such as ‘oreo/apple/banana/coconut’, to imply that youth act

‘White’ despite their exterior ethnic phenotype (Oetting & Beauvais 1990�1991;

LaFromboise et al. 1993).

Acculturation-related stressors experienced by adolescents occur not only within

peer contexts, but in other contexts such as school or family (Compas et al. 1987).

For example, intergenerational gaps and conflicts within the family may be a source

of stress in families, where adolescents are acculturating faster than their parents

(Szapocznick et al. 1978; Gil et al. 2000). Additionally, dichotomies between language

at home and school may create bilingual environments such that youth feel pressure

to speak English and Spanish fluently (Romero & Roberts 2003a).

While many acculturation models emphasize cultural exchange between cultures

(see Zagefka & Brown 2002; van de Vijver & Phalet 2004), most acculturation stress

research has been guided by linear models of acculturation with a focus on stress

experienced by immigrant groups acculturating to majority cultures (Carvajal et al.

2002). It was posited that minority ethnic groups experience unequal pressure to

assimilate due to less power and lower status; whereas majority ethnic groups have

minimal or no pressure to acculturate to the minority culture (Berry 2003). Thus, it is

implied that stress from navigating more than one culture would be predominantly

experienced by minority groups. However, orthogonal models of acculturation have

demonstrated that individuals can adhere to more than one culture independently

(Oetting & Beauvais 1990�1991; LaFromboise et al. 1993; van de Vijver & Phalet

2004), and related research has demonstrated that some majority youth also

experience cultural context stressors similar to those described in acculturative stress

models (e.g. Romero et al. in press).

Conceptualizing and Measuring Bicultural Stress

While the preponderance of the focus of acculturative stress research is on stresses

experienced by immigrant groups, there may be intra and inter-cultural pressures

that impact broader populations of youth. For example, ethnocentrism among

minority groups may lead to negative stereotypes and discriminatory behavior of

European Americans, the majority group (Romero & Roberts 1998). In a previous

study of discrimination among a multiethnic group of adolescents, perceived racial

prejudice reports were generally higher for African American and Latino youth,

Ethnicity & Health 445

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though all adolescent groups, including European Americans, reported some level of

perceived prejudice (Fisher et al. 2000).

Based on the conceptualizations of orthogonal acculturation models, we define

‘bicultural stress’ as the perception of stress due to everyday life stressors that result

from pressure to adopt the majority culture as well as pressure to adopt minority

cultures for youth in multiethnic environments (Romero & Roberts 2003a). To

address cultural stressors for minority and majority adolescents, Romero et al.

(2003a) developed, validated and examined a general measure of bi-cultural stress

using a subjective, context-specific (Lazarus 2000) model. Examples of stressors

include those due to perceived discrimination, negative stereotypes, intergenerational

acculturation gaps, and pressure to speak multiple languages (Romero et al. 2003a).

This measure addresses the cultural context of stressors that are not only increasingly

present for US youth, but will be increasingly prevalent throughout industrial nations

where there are substantial demographic changes in immigrant or minority youth

populations (Arnett 2002; Zagefka & Brown 2002).

Though bicultural stress is higher among minority groups, such stressors have been

reported among European American individuals (e.g. Romero et al. in press). We

believe this perspective holds important contributions to the understanding of youth

stressors globally, not only for immigrants, but also for minority and majority ethnic

groups (e.g. Bourhis et al. 1997), as adolescents increasingly navigate between

multiple cultures and languages in school and at home. Also, living in an

environment with more than one culture may create stresses from negotiating

more than one set of values, norms, and identities (Stonequist 1935; LaFromboise

et al. 1993). Furthermore, regions in the US that do not have one ethnic majority are

becoming increasingly prevalent, which may provide unique opportunities to study

more multidirectional exchanges of culture and perceptions of stress (US Census

Bureau 2001).

Bicultural Stress and Health Disparities

While the relation between bicultural stressors and risky health behaviors has not

been examined using the Bicultural Stress scale (Romero et al. 2003a), some related

stress indicators have been associated with risk behaviors (e.g. Booker et al. 2004;

Bennett et al. 2005; Krieger et al. 2005). Also, Latino adolescents who experience

acculturative stress and/or discrimination report more negative mental health

outcomes (e.g. Cervantes et al. 1991; Vega 1998; Samaniego & Gonzales 1999; Hovey

2000; Szalacha et al. 2003; Krieger et al. 2005). Measures of subjective bicultural stress

and/or bicultural conflict have been examined in Latinos, and positively associated

with depressive symptoms (Benet-Martinez et al. 2002; Romero & Roberts 2003a;

Romero et al. in press). Lazarus (1997) argues that the subjective component of stress

is important to represent psychological reactions to acculturation, and to more

clearly link acculturative stress to mental health outcomes. Further, utilizing


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subjective measures clarifies that not all individuals may experience equivalent levels

of stress due to bicultural experiences (LaFromboise et al. 1993).

The Current Study

The aims of the present research are to examine the relations between a new

measure of bicultural stress (Romero & Roberts 2003a; Romero et al. in press) and

markers of adolescent health in a diverse urban West Coast US community sample.

This sample is further unique in that there is no ethnic majority in the target

population, with the largest ethnic groups and those included in the current study

being Latino and non-Latino European American adolescents. Guided by general

subjective stress and coping models (e.g. Folkman & Lazarus 1980; Lazarus 2000)

we expect that the subjective perception of bicultural stress will be associated with

more frequent risk behaviors and more depressive symptoms. Further, we will

contextualize bicultural stress with ethnicity as well as other socio-demographic

factors (Phinney et al. 1998; Goodman et al. 2003; Weden & Zabin 2005). Research

indicates the perception of stress associated with acculturation is subjective, and

may vary based on demographics and language preferences (Padilla et al. 1986;

Rogler et al. 1991; LaFromboise et al. 1993; Lazarus 1997), though we expect

bicultural stress to be a stronger underlying explanatory variable for disparities than

demographic variables (Walsh et al. 2000). Based on theory and previous empirical

findings we posit the following hypotheses:

Hypothesis 1: Bicultural stress will be related to higher levels of reporting all risk

behaviors and depressive symptoms.

Hypothesis 2: The relations of bicultural stress to risk behaviors and depressive

symptoms will account for much of the disparities attributable to other socio-

demographics.

Additionally, the generality and robustness of the findings will be further tested in

exploratory analyses. Specifically, the relations among bicultural stress, risk

behaviors, and depressive symptoms will be examined for consistency consistent

across subgroups (e.g. gender or ethnic differences in the role of stress; Zambrana &

Silva-Palacios 1989; Booker et al. 2004). Also, as depressive symptoms are a well-

known factor related to adolescents’ health, we will examine whether bicultural

stress is distinct from depressive symptoms in relation to risk behaviors. This

approach may further extend the potential contribution of bicultural stress to

understanding health disparities research. Finally, the potential influence of school

ethnic and other demographic characteristics (Sampson et al. 2005) on the

estimation of the relations between stress and the health outcomes will be

examined.


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Methods

Participants and Procedures

Participants (n�519) included self-identified Latinos (n�304) and non-Latino

European Americans (n�215) from a larger cross-sectional sample. The larger

sample was of 8th grade students who were surveyed from a large urban school

district in the West Coast of the US. Trained staff collected the data at the schools in

the fall of 2000. Active parent and student consent procedures were employed, and

participants were recruited for this sample through randomly selected classrooms

from all seven middle schools of that district. The median age of participants was 14

years, and 54% were female.

There was evidence that our study sample well represents the local population.

The ethnic variation of the larger cross-sectional survey matched the records of

the participating, no ethnic-majority, K12 school district (Carvajal et al. 2004).

Also, the educational background reported for the participants’ parents was

consistent with the educational background as reported on the US Census (2000)

for the county in which the participating district resides (e.g. respondents indicated

38% of their mothers and 41% of their fathers attained a bachelors degree; the

county Census data, collected about one year prior to our survey, showed a rate of

40.4% for all adults). While not specific to the Latino and non-Latino European

American sub-samples employed for this study, the response rate for our larger

study was 61%. Additional aspects of the random sampling and data collection

procedures for our cross-sectional data are detailed elsewhere (Carvajal et al. 2002,

2004; Romero et al. in press).

Coding of ethnicity followed the guidelines of the National Longitudinal Study of

Adolescent Health (2001, 2001a) study principally funded by the US National

Institute of Child Health and Human Development, and one of the most

comprehensive surveys of youth’s health status. Youth were categorized as Latinos

based on affirmative responses as follows (a) pan-ethnic label Latino/a or Hispanic,

(b) one of the specific Latino sub-groups (e.g. ‘Mexican American’, ‘Cuban American’,

or ‘Puerto Rican), (c) youth who reported more than one ethnic group including

Latino and either European American or American Indian. Mexican American (78%)

was the most frequent specific Latino sub-group, followed by those of Central

American descent (9%), and Puerto Rican descent (7%). Youth were categorized as

non-Latino European American when they identified as ‘White (Caucasian/non-

Hispanic) and no other specific group. It should be noted that ethnic representation

varied substantially between schools, the lowest and highest proportion of Latinos

and European Americans ranged from 16 to 81%, 6 to 52%, and 10 to 39%,

respectively. Also, 35% of all respondents of the larger survey were excluded from the

current investigation as they were from another ethnic group or multiple ethnic

groups. They were not included because we did not have sufficient sample size to

generate stable ethnic specific risk behavior estimates*the primary aims of the

current study.


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Measures

Participants completed a self-report questionnaire (English and Spanish versions

offered). The variables of focus in the current study included assessments of socio-

demographics, bicultural stress, risk behaviors and depressive symptoms.

Bicultural stress

Bicultural stress was measured from a 20-item scale (Romero & Roberts 2003a). This

scale (see Appendix A) addresses everyday stressors within schools, peers, and family

contexts, and include factors related to discrimination, intragroup pressures

(Rodriguez et al. 2002; Romero & Roberts 2003a), intergroup conflict, and

acculturation. The range of responses to each stressor are ‘Does not apply’ (coded

as 0), ‘Not stressful at all’ (coded as 1), ‘A little bit stressful’ (coded as 2), ‘Quite a bit

stressful’ (coded as 3), and ‘Very stressful’ (coded as 4). These items provide

information on whether youth experienced the stressors when dichotomized (does

not apply or is present) or the intensity of stressfulness if kept continuous (‘Not

stressful at all’ to ‘Very stressful’ if it was experienced). An average score was taken

across all items and used in the analyses of the current study. Internal consistency of

the full scale was high within each ethnic group (European Americans a�0.94 and

Latinos a�0.94).

Socioeconomic status (SES)

Socioeconomic status (SES) has a pervasive impact on health and its adequate

measurement is critical in ethnic health disparities research (Karlsen & Nazroo 2002).

To best represent SES from the available youth self-reports, we used three indicators:

parental education, perceived SES, and home characteristics. Data from adolescents

on their parent’s education level is generally considered to be a marker of social class

with relatively high validity (Wills et al. 1995). Parental education was measured by

the average of the mother’s and father’s education. Responses ranged from 1 to 4,

where 1 represented less than high school, and 4 represented graduating from college.

Perceived socioeconomic status and household structure have proven to be

particularly useful proxy measures for SES among adolescent samples, as many

may not reliably know their parents’ education or income (Gore et al. 1992).

Perceived SES (1�4) was the average of three questions (‘Compared to others in your

‘‘city’’/‘‘school’’/‘‘community’’ do you think your family’s income is ‘‘somewhat less’’/

‘‘a little less’’/‘‘a little more’’, ‘‘somewhat more’’ than most others’) where higher

scores indicate higher SES. Home characteristics (0�2) reflected the sum of two

dichotomous items reflecting whether they lived in a house (yes�1) and whether

their rooms to resident ratio in their home (calculated from separate questions) was

greater than or equal to one (yes�1). These indicators of SES were significantly

(pB0.05) positively associated with each other overall and within all ethnic groups;


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thus we created an overall SES variable by equally weighting parental education,

perceived SES and household SES into a composite variable (Romero et al. in press).

Generational status

Generational status categories for Latinos were based on the generation definitions

from Cuellar et al. (1995). Generational status is proxy for acculturation that has been

found associated with language acculturation and cultural values among adult

samples (Cuellar et al. 1995), as well as with adolescent populations (Carvajal et al.

2002; Romero & Roberts 2003b). Latinos were identified as first generation if they

indicated they were born outside the US. Latinos were identified as second generation

if they were not first generation, but reported at least a parent was born outside the

US. Latinos were identified as third generation or higher if participants marked they

and their parents were born in the US.

Acculturation

Language acculturation among Latinos was measured by an 8-item version of the Bi-

dimensional Acculturation scale (Marın & Gamba 1996), modified for use in multi-

ethnic adolescent populations (Carvajal et al. 2002). Responses to each item ranged

from ‘Never’ (coded as 1) to ‘Always’ (coded as 4). Four items from this scale measure

English orientation (a�0.76) and four items from the scale measure language other

than English orientation (a�0.90). The English and Other language orientation

summed scales were dichotomized into ‘high’ or ‘low’ based on the median score

(Cuellar et al. 1995), necessary given the high ceiling of the English orientation scale

for the Latino participants. Parallel to related work (Romero & Roberts 2003a;

Romero et al. 2004; Romero et al. in press), three language preference groups best

represented these Latino youth: (1) Other language preference (low English); (2)

Bilingual preference (high English and high other language); (3) English preference

(high English and low other language).

Risk behaviors

Risk behaviors assessments paralleled those in US national surveys, including the

Youth Risk Behavior Survey (CDC 2004), the Monitoring the Future study (Johnston

et al. 2005), and the National Longitudinal Study of Adolescent Health (2001). These

included self-reports of (1) ‘any drinking in lifetime’; (2) ‘heavy drinking in the past

month’ (having five or more drinks in a row in the past 30 days); (3) ‘any smoking in

lifetime’; (4) ‘smoking in last 30 days’; (5) ‘illegal drug use in lifetime’ (marijuana or

other illicit substances); (6) ‘weapon carrying in the past 30 days’; and (7) ‘having

been in a physical fight in the past 12 months’. These variables were dichotomized

prior to conducting inferential analysis, where no engagement of such behavior was

coded as ‘0’, and any engagement of such behavior was coded as ‘1’.


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Depressive symptoms

An aim of the current study was to relate stress to somatic and affective

symptomatology rather than to categorize individuals with clinical levels of

depression (Crockett et al. 2005). Thus, depressive symptoms were measured with

an 8-item shortened version of the CES-D (Radloff 1977). The measure includes

assessments of the frequency of experiencing four major symptom domains of

depression within the past week: negative affect, absence of positive affect (reversed

scored), somatic complaints, and interpersonal problems (Rushton et al. 2002). There

is evidence supporting the measures applicability for ethnic minority adolescents

(Carvajal et al. 2002; Crockett et al. 2005). Items referred to the past seven days;

respondents exhibiting four or more symptoms in the previous week were considered

high for depressive symptoms (Carvajal et al. 2002). The scale also showed high

internal consistency for all respondents and across each ethnic group in our data

(a�0.81 overall; a�0.78 within Latinos; a�0.84 within European Americans).

Results

Socio-demographic Characteristics and Their Associations to Bicultural Stress

Within the full sample (n�519), 57% reported that a parent had a college degree,

79% lived in a house, and 33% lived in a home with greater or equal number of

rooms as residents (see Table 1). Analysis revealed significant associations between

ethnicity and our composite SES measure (pB0.01), though the magnitude of their

relations also shows there is substantial non-overlap (h2�0.244). Overall, Latinos

reported lower SES than European Americans. Latinos were closely evenly divided

between those who did or did not have parents born outside the US (49% were third

generation or higher, 15% were first generation), and 74% were bilingual-oriented or

other language-oriented (Table 1). Latinos reported significantly (h�0.18; pB0.05)

higher bicultural stress (M�12.5) than non-Latino European Americans (M�7.9).

Also, Latinos of lower SES (r��0.27, pB0.01), and those Spanish-oriented (versus

bilingual or English-oriented Latinos) (h�0.24, pB0.05) reported more stress.

There were no differences in stress due to gender, age or generational status within

Latinos.

Risk Behaviours and Depressive Symptoms in the Full Sample

The first set of analyses employed univariate logistic regression to estimate

associations between ethnicity, SES (standardized in all logistic models to facilitate

the interpretation of odds ratios), and bicultural stress (standardized in all logistic

models to facilitate the interpretation of odds ratios) in Latinos and non-Latino

European Americans (n�519). Table 2 presents the unadjusted and adjusted

proportions of each risk behavior associated with the study variables. The univariate

models (yield unadjusted odds ratios) show Latinos at increased risk for smoking,


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illegal drugs use and fighting, and those of lower SES are at increased risk for

smoking, illegal drugs use and depressive symptoms. Bicultural stress (standardized

in logistic models) is significantly (pB0.05) associated with higher levels of all risk

behaviors and depressive symptoms. In the multivariate models (yield adjusted odds

ratios), stress accounted for nearly all ethnic and SES differences, except (1) SES and

stress were both independently associated with ever smoking and self-identification as

Latino, and (2) stress was related to fighting. Not presented in the tables, from the

multivariate models older age was associated with the smoking variables (Ever: OR�1.8; 95% CI�1.0�3.0; last 30 days: OR�2.4; 95% CI�1.1�5.1), boys reported

higher levels of the violence indicators (Weapon: OR�3.2; 95% CI�1.3�8.0; Fight:

OR�5.0; 95% CI�3.0�8.3), and females reported more depressive symptoms

(Female as referent, OR�0.6; 95% CI�0.4�0.9).

Risk Behaviours and Depressive Symptoms in Latinos

Univariate logistic regression was employed to estimate associations between

acculturation variables, SES and bicultural stress in the sample of Latinos (n�304). Table 3 shows the unadjusted and adjusted proportions of each risk behavior

associated with other study variables. Few acculturation or SES differences emerged:

those Spanish-oriented reported more lifetime drinking than the English-oriented in

Table 1 Sample characteristics (n�519)

Latino (% ormean (SD))

European American(% or mean (SD))

Total (% ormean (SD))

Age (range 12�14) 14.1 (0.4) 14.2 (0.4) 14.1 (0.4)Female 57 56 56First generation 15 n/a n/aSecond generation 36 n/a n/aThird generation 49 n/a n/aSpanish-oriented (language

acculturation)31 n/a n/a

English-oriented (languageacculturation)

26 n/a n/a

Bilingual (languageacculturation)

43 n/a n/a

Parent graduate college 39 81 57Perceived SES score (range: 1�4) 2.61 (0.67) 2.86 (0.58) 2.71 (0.65)Live in a house 69 90 79Rooms/resident ratio 19 49 33SES composite score (raw; range:

1�3.7)2.28 (0.51) 2.84 (0.43) 2.51 (0.55)

Bicultural stress score (raw;range: 0�6.5)

12.4 (14.0) 7.9 (11.3) 10.4 (13.0)

Base 304 215 519

Perceived SES was the average of three questions (e.g. ‘Compared to others in your city you think your family’s

income is . . .). SES composite was derived from by equally weighting parental educational level, perceived SES

and home structure.


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Table 2 Crude and adjusted odds of risk behaviors and depressive symptoms associated with ethnicity, SES and bicultural stress in Latino

and non-Latino European American adolescents (n�519)

Latino SES bicultural stress % COR (CI) AOR (CI) COR (CI) AOR (CI) COR (CI) AOR (CI)

Ever drank 58 1.3 (0.9�1.9) 1.1 (0.7�1.8) 0.8 (0.7�1.0) 0.9 (0.8�1.2) 1.7 (1.4�2.2) 1.7 (1.3�2.1)Drank heavily in the last month 4 1.1 (0.4�3.0) 0.8 (0.2�2.6) 0.8 (0.5�1.2) 0.9 (0.5�1.6) 1.8 (1.3�2.6) 1.8 (1.2�2.7)Ever smoked cigarettes 27 2.0 (1.3�3.0) 1.4 (0.8�2.3) 0.6 (0.5�0.7) 0.7 (0.6�0.9) 1.6 (1.3�1.9) 1.4 (1.1�1.8)Smoked a cigarette in the last

month9 1.4 (0.8�2.7) 1.3 (0.6�2.8) 0.7 (0.6�1.0) 1.0 (0.7�1.5) 1.8 (1.4�2.3) 1.8 (1.4�2.4)

Ever used illegal drugs 13 1.7 (1.0�2.9) 1.3 (0.7�2.6) 0.6 (0.5�0.8) 0.8 (0.6�1.1) 1.6 (1.2�2.0) 1.4 (1.1�1.9)Carried a weapon in the last month 6 1.6 (0.7�3.5) 1.4 (0.5�3.8) 0.8 (0.6�1.2) 1.4 (0.8�2.3) 2.3 (1.6�3.2) 2.1 (1.5�2.9)Been in a fight in the last year 23 2.0 (1.3�3.2) 1.9 (1.1�3.3) 0.8 (0.7�1.0) 1.1 (0.9�1.5) 1.7 (1.4�2.2) 1.9 (1.5�2.3)Depressive symptoms 21 1.2 (0.8�1.8) 0.8 (0.5�1.5) 0.7 (0.6�0.9) 0.8 (0.6�1.0) 1.5 (1.2�1.9) 1.5 (1.2�1.8)

Crude odds ratios (COR) reflect associations of ethnicity (referent is European American), SES (lower to higher, standardized prior to this analysis), and stress (lower to higher,

standardized prior to this analysis) to risk behaviors and depressive symptoms. Adjusted odds ratios (AOR) were derived from models that including those variables as well as

age and sex as covariates. Significant covariates not presented above were as follows: older age was associated with the smoking outcomes, boys reported higher levels of

weapon carrying and fighting, and females reported more symptoms (estimates reported in the text). Eth

nicity

&H

ealth

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Table 3 Crude and adjusted odds of study outcomes associated with acculturation, SES and total bicultural stress in Latino adolescents (n�304)

Acculturation SES bicultural stress % COR (CI) AOR (CI) COR (CI) AOR (CI) COR (CI) AOR (CI)

Ever drank 54 ns 2.4 (1.1�5.0)a 0.8 (0.7�1.1) 0.9 (0.7�1.2) 1.7 (1.4�2.2) 1.7 (1.3�2.1)Drank heavily in the last month 5 ns ns 0.6 (0.3�1.2) 0.6 (0.2�1.3) 1.8 (1.3�2.6) 1.8 (1.2�2.7)Ever smoked cigarettes 27 2.1 (1.1�4.0)b 2.9 (1.3�6.4)b 0.6 (0.5�0.8) 0.6 (0.5�0.9) 1.6 (1.3�1.9) 1.4 (1.1�1.8)Smoked a cigarette in the last month 10 ns ns 0.8 (0.5�1.2) 0.9 (0.5�1.4) 1.8 (1.4�2.3) 1.8 (1.4�2.4)Ever used illegal drugs 13 ns ns 0.7 (0.5�1.0) 0.7 (0.5�1.1) 1.6 (1.2�2.0) 1.4 (1.1�1.9)Carried a weapon in the last month 7 ns ns 0.9 (0.5�1.4) 1.3 (0.7�2.4) 2.3 (1.6�3.2) 2.1 (1.5�2.9)Been in a fight in the last year 23 ns ns 1.0 (0.7�1.3) 1.1 (0.8�1.5) 1.7 (1.4�2.2) 1.9 (1.5�2.3)Depressive symptoms 23 ns ns 0.8 (0.6�1.1) 1.0 (0.7�1.4) 1.5 (1.2�1.9) 1.5 (1.2�1.8)

Crude odds ratios (COR) reflect associations of acculturation (those identified as Spanish-oriented, English-oriented or bilingual), SES (lower to higher, standardized prior to

this analysis), and bicultural stress (lower to higher, standardized prior to this analysis) to risk behaviors and depressive symptoms. Adjusted odds ratios (AOR) were derived

from models that included those variables as well as generational status, age and sex as covariates. For the acculturation variable, each of the three classifications were compared

to one another, and significant (pB0.05) odds ratios are presented. Significant covariates not presented above were as follows: higher generation status was related to more

symptoms and boys were more likely to have been in a fight (estimates reported in the text).aSpanish-oriented with English-oriented as referent.bEnglish-oriented with bilingual as referent.

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the multivariable model, and more lifetime smoking was reported by those of lower

SES and those English-oriented relative to bilingual-oriented in univariate and

multivariate models. However, bicultural stress was again associated with all

outcomes, more stress was significantly related to all risk behaviors and depressive

symptoms. Also, in the multivariable models, higher generation status was related to

more depressive symptoms (OR�1.9; 95% CI�1.2�3.2), and boys were more likely

to have been in a fight (OR�4.9; 95% CI�2.6�9.8).

Exploratory Logistic Regression Models to Evaluate the Robustness of the Relations

Between Bicultural Stress and Risk Behaviours

We tested two series of logistic regression models based on the previous models to

further verify the generality of the findings. The first set examined if stress was more

relevant for specific sub-groups. To do this, we evaluated gender and ethnicity by

bicultural stress interactions in the full sample. None of these 16 models approached

significant improvement (p�0.15) as expressed in the change in the log likelihood of

the multivariate models. Next, we added depressive symptoms as continuous

covariate in the multivariable models predicting risk behaviors. Bicultural stress

remained the single most predictive variable of the majority of risk behaviors, and

was only non-significant for a single outcome in these models, predicting ever

smoking (i.e. in this model OR�1.3; 95% CI�1.0�1.5; p�0.058).

Did Region Specific Demographics of Schools Influence Bicultural Stress?

As some schools had majority European Americans and other schools majority

Latinos, we were concerned that the variability in the proportion of each ethnic group

between schools may have impacted the respondents’ personal experience of

bicultural stress (Romero et al. in press). To address this concern, we used variance

components analyses using maximum likelihood to evaluate the potential presence of

school level variance in our bicultural stress measure, and if so, estimate the

magnitude via the intra-class correlation (ICC). As covariates may frequently impact

the magnitude of ICC estimates (Murray 1998), the sociodemographic variables

employed in our multivariable logistic models were also employed in this analysis.

The results suggest the intra-school correlation in bicultural stress was B0.001 in this

model. (Previous research suggest minimal ICCs for risk behaviors within these

schools; Carvajal & Granillo 2006.) These magnitudes of school-level variation would

have a negligible influence (B0.01%) on all parameter estimates and test statistics for

the individual variation-focused analyses conducted, and support the analytic models

used to test study hypotheses (Murray 1998). These multivariable variance

components analyses provide evidence that school-level characteristics were not

substantively influential on the experience of bicultural stress, and suggest the

findings generalizability to other non-majority and majority regions.


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Discussion

Researchers have increasingly emphasized the need to go beyond descriptive analyses

of health disparities, and attempt to identify underlying psychosocial and policy

relevant variables to guide public health promotion efforts (Walsh et al. 2000; Nazroo

2001; Myers & Rodriguez 2003; Unger et al. 2004a). The purpose of this study was to

investigate the subjective perception of bicultural stress and its relation to risk

behaviors among Latino and non-Latinos European American youth from a

community sample. Bicultural stress was defined as the perception of stress due to

everyday life stressors that result from navigating between more than one culture, and

the assessments include items relating to discrimination, negative stereotypes,

intergenerational acculturation gaps, and pressure to speak more than one language

(Romero et al. 2003a; Romero et al. in press). As hypothesized, higher bicultural

stress was consistently associated with more risk behavior engagement and higher

depressive symptoms. Also, as hypothesized, higher bicultural stress accounted for

the preponderance of the differences in risk behaviors due to ethnic self-identifica-

tion, socio-economic status and acculturation factors within Latinos, all of which are

factors more frequently presented in ethnic health disparities research.

The findings also show bicultural stress was generally independent of depressive

symptoms in relating to risk behaviors. Also, interactions between ethnicity and stress

in relating to risk behaviors or depressive symptoms were not observed in the current

study, nor was there evidence for school influences on the experience of bicultural

stress despite substantial school variability in ethnic composition. These findings

suggests that the experience of cultural and acculturative stressors by majority as well

as minority groups may impact health, and suggest substantial generality to bicultural

stress as a potential antecedent of multiple adolescent risk behaviors.

These findings have several implications for health disparities research that may

advance the work beyond descriptive analyses toward a better understanding of risk

behavior etiology, and improved intervention potential. Moreover, certain culturally

grounded adolescent prevention interventions are already beginning to address some

related issues in order to decrease health disparities, such as adolescent substance use

(Schinke et al. 1988; Unger et al. 2004b; Kulis et al. 2005; Hecht & Krieger 2006).

Additionally, in terms of issues of discrimination in multicultural environments,

recent modifications to the Contact Hypothesis, such that increased contact will

decrease prejudice, demonstrated with empirical evidence that improved intergroup

relations may be achieved through interventions (VanOudenhoven et al. 1996;

Voci & Hewstone 2003; Paolini et al. 2006). Findings of the current work suggest that

these interventions may be of relevance to both minority and majority adolescents.

The study has a number of limitations; one being that it was region specific.

However, due to demographic changes and increasing rates of immigration from

Latin America, the current study’s sample characteristics may foreshadow the

increasingly ethnic pluralistic nature of many communities within the US and other

industrial nations (Nazroo 2001; Arnett 2002; Zagefka & Brown 2002). Also, though


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ethnic variation varied substantially by school, our analyses revealed the experience of

stress was primarily tied to individual or family factors, and suggests these daily

youth stressors are likely to be experienced by adolescents across many regions and

settings. Another limitation was that the modest community-sized sample precluded

other ethnic comparisons (e.g. African Americans, Native Americans, Asian

Americans, multi-ethnic youth) or more specific within Latino categories based on

common nativity, history, immigration, acculturation, socioeconomic status, and

language characteristics (Marın & Marın 1991; de la Torre & Estrada 2001).

Additionally, in our data, we did not have visible markers of ethnicity (including

skin color and phenotype) that could impact the experience and perception of

bicultural stress (Montalvo 2004). Finally, like most surveys monitoring US levels

of adolescent risk behavior (CDC 2004; Johnston et al. 2005), there were no biological

markers of disease or behaviors, and the data were cross-sectional, limiting

interpretations of causal influence.

Despite these limitations, there are important strengths. The study employed many

relevant socio-demographic variables and a current acculturation scale (Marın &

Gamba 1996). As our study was before high-school and comprehensive within a

district, the sample was not susceptible to the exclusion of high-risk dropouts. This

issue may be particularly problematic for studies conducted through US public high

schools and confound health disparities research, since Latino males have among the

highest drop out rates (CDC 2004). Also, our stress measure included everyday

stressors related to discrimination, health relevant aspects to experiencing stress that

are under-identified in the literature (Meyer 2004). Further, the measure of bicultural

stress included subjective components of stress (Lazarus 2000), and was youth

focused (Romero et al. 2003a); discrimination events in employment and financing

typically assessed in adult populations (Meyer 2004) would probably not be relevant

to middle school aged youth.

In conclusion, to our knowledge, no national survey of adolescent health

implements a current measure of subjective bicultural change nor a theory-based

model of adolescent bicultural stressors (Romero et al. 2003a, in press). Given the

consistent and robust findings, the current study highlights the importance of

considering the measurement of bicultural stressors to address adolescent risk

behavior disparities, and their antecedents in diverse populations. Also, a growing

area of research has identified positive cultural buffers, such as a positive and

bicultural ethnic identity, that may help individuals cope with some of those stressors

(Benet-Martinez et al. 2002; Walters & Simoni 2002; Romero & Roberts 2003b).

Given many common etiological process for health behaviors and inequities across

nations (Nazroo 2001; Vega et al. 2002), it is likely that similar stressors are

experienced by many other youth in increasingly multi-ethnic youth contexts.

Interventions that address bicultural stress and potential coping processes may have

wide applicability to youth health promotion efforts in diverse communities.


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Acknowledgements

This research was supported by grants from the National Institute on Drug Abuse

(R03 DA14371), National Institute on Alcohol Abuse and Alcoholism (R21AA12803),

National Center on Minorities and Health Disparities (P60MD000155), and the

California Tobacco-Related Disease Research Program (7KT-0151) through ETR

Associates of Scotts Valley, CA. We also thank the participating school administrators,

staff and teachers, and acknowledge Karin Coyle, PhD, and Carrie Hanson, MA, at

ETR Associates. K. Coyle and C. Hansen were instrumental to the data collection and

project management of the initial survey funded by the California Tobacco-Related

Disease Research Program, but were not involved in the current study’s conceptua-

lization, analysis or writing.

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Appendix A

English Version of the Bicultural Stress Scale

20. Please indicate how stressful the following experiences have been for you. If you

have never had the experience please circle ‘1’: Never happened to me.

Please fill in only one answer for each item.

Neverhappened

to me

Not atall

stressful

A littlebit

stressful

Quite abit

stressful

Verystressful

a. I have been treated badly becauseof my accent

1 2 3 4 5

b. I have worried about family members orfriends having problems with immigration

1 2 3 4 5

c. I do not feel comfortable with people whoseculture is different than my own

1 2 3 4 5

d. I feel uncomfortable when others makejokes about people of my ethnic background

1 2 3 4 5

e. I have had problems at school because of mypoor English

1 2 3 4 5

f. I do not like it when others put downpeople of my ethnic background

1 2 3 4 5

g. I have felt that others do not accept mebecause of my ethnic group

1 2 3 4 5

h. I feel that I can’t do what most Americankids do because of my parent’s culture

1 2 3 4 5

i. I feel that belonging to a gangis part of representing my ethnic group

1 2 3 4 5

j. I do not understand why people from adifferent ethnic background act acertain way

1 2 3 4 5

k. I feel that it will be harder to succeedbecause of my ethnic background

1 2 3 4 5

l. Because of family obligations, Ican’t always do what I want

1 2 3 4 5

m. I have felt pressure to learn Spanish 1 2 3 4 5n. I have felt that I need to speak Spanish

better1 2 3 4 5

o. My friends think I’m acting ‘White’ 1 2 3 4 5p. My parents feel I do not respect

older people the way I should1 2 3 4 5

q. I have had to translate/interpret for myparents

1 2 3 4 5

r. I have felt lonely and isolated because myfamily does not stick together

1 2 3 4 5

s. I have had to help my parents by explaininghow to do things in the US

1 2 3 4 5

t. I have argued with my boyfriend/girlfriendover being too traditional

1 2 3 4 5


Bicultural Stress and Adolescent Risk Behaviors in a Community Sample of Latinos and Non-Latino European Americans

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