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© 2003 American Public Health Association
RESEARCH AND PRACTICE |
Joseph C. Gfroerer and Lucilla L. Tan are with the Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies, Rockville, Md.
Correspondence: Requests for reprints should be sent to Joseph C. Gfroerer, SAMHSA Office of Applied Studies, 5600 Fishers Lane, Room 16-105, Rockville, MD 20857 (e-mail: jgfroere{at}samhsa.gov).
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INTRODUCTION |
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 TOP INTRODUCTION METHODSRESULTSDISCUSSIONReferences |
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The prevention of substance use is a critical component of health promotion among youths. Of the 72.3 million youths under 18 years of age in the United States in 2000, 2.8 million were foreign-born.1 Research has suggested that foreign-born youths experience increasing risk of substance use as they become assimilated into US society (i.e., become acculturated).2,3 This study provides the first national estimates of the prevalence of substance use among foreign-born youths aged 12 to 17 years and explores the association between acculturation, defined as the length of residence in the United States, and substance use.
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METHODS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Data from the 1999 and 2000 National Household Survey on Drug Abuse (NHSDA) were used.4–6 The NHSDA is an ongoing nationally representative survey of the noninstitutional civilian population aged 12 years and older.4 Data were collected by a combination of computer-assisted personal interview and audio computer-assisted self-interview techniques to enhance privacy. Respondents could answer in English or Spanish. Weighted response rates were 91 percent for household screening and 80 percent for youth interviews.5,6 The interview response rate for youths was 86 percent among Hispanics and 82 percent among non-Hispanic blacks. Only 0.2 percent of selected youths did not respond because of language barrier.
Youths born outside the United States were classified as foreign-born and others were classified as US-born, based on the question, "Were you born in the United States?" Foreign-born respondents were also asked, "In what country or US territory were you born?" and "About how long have you lived in the United States?" The sample of 50 947 youths represented 23.2 million youths in the nation, of which 7.1 percent were foreign-born. Among the foreign-born youths, 28.4 percent were born in Mexico, 5.1 percent in Germany, 4.6 percent in the Philippines, and 3.0 percent in India, Vietnam, and Korea (North and South).
Prevalence estimates were computed for past-month use of cigarettes, alcohol (any, binge, and heavy), marijuana, and other illicit drugs (cocaine, heroin, hallucinogens, inhalants, and nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives). Past-month use is defined as use at least 1 time during the 30 days before the interview. Cigarette use includes smoking all or part of a cigarette. Binge alcohol use is having 5 or more drinks on the same occasion at least once in the past 30 days. Heavy alcohol use is having 5 or more binge days in the last 30 days. Comparisons of prevalence estimates between foreign-born and US-born youths were made using t-tests. Multiple logistic regressions were run with SUDAAN software (Research Triangle Institute, Research Triangle Park, NC) to assess the effect of length of residence with controls for gender, age, race/ethnicity, family income, region, and population density.
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RESULTS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Substance-use prevalence rates were lower (P < .05) among foreign-born youths than among US-born youths, especially for youths aged 16 to 17 years (Table 1
). Consistent with previous studies of acculturation, we found heterogeneity among Hispanic subgroups.7,8
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Logistic regression showed that differences in prevalence between foreign- and US-born youths diminished with increasing length of residence in the United States among foreign-born youths (Table 2
). Foreign-born youths who had resided in the United States for less than 5 years had lower (P < .05) prevalence than did US-born youths for all the substances. Prevalence estimates for foreign-born youths in the United States for 10 or more years were not significantly different from estimates for US-born youths, except for heavy alcohol use. Separate regressions for ages 12 to 14 years and 15 to 17 years yielded similar results.
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An additional analysis used the language selected by the respondent for the survey interview as an alternative measure of acculturation among Hispanics. For each of the substances, we found that the prevalence estimate among Hispanics was higher (P < .05) for those who responded in English than for those who responded in Spanish.
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DISCUSSION |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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This study reinforces the findings of previous studies reporting lower rates of substance use among foreign-born youths compared with US-born youths, but increased risk of use as they become acculturated.2,3,7,9,10 A better understanding of these results could be gained by studying how acculturation interacts with known risk and protective factors for substance use.11 Acculturation occurs through contacts with parents and peers, formal education, and exposure to media such as television, movies, and magazines. Each of these could influence a youth’s propensity to use substances. In addition, access to substances of abuse may be greater for youths who are more fluent in English or more in touch with local customs for obtaining substances. Research in this area should help prevention planners design programs that appropriately consider acculturation to reduce substance use among immigrant youth.
A limitation of this study is that it is based on self-reports; therefore, prevalence estimates may be subject to underreporting. This could vary by country of birth as well as by acculturation. Views of substance use may differ across cultures.
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Footnotes |
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Peer Reviewed
Accepted for publication January 7, 2003.
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References |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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1. Statistical Abstract of the United States: 2001. Washington, DC: U.S. Bureau of the Census; 2001. Table 44—Native and Foreign-Born Populations by Selected Characteristics: 2000, p. 45. Also available at: http://www.census.gov/prod/2002pubs/01statab/pop.pdf. Accessed February 26, 2002.
2. Vega WA, Gil AG, Zimmerman RS. Patterns of drug use among Cuban-American, African-American, and white non-Hispanic boys. Am J Public Health 1993;83:257–259.
3. Blake S, Ledsky R, Goodenow C, O’Donnell L. Recency of immigration, substance use, and sexual behavior among Massachusetts adolescents. Am J Public Health. May 2001;91:794–798.[Abstract]
4. Summary of Findings from the 2000 National Household Survey on Drug Abuse. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2001. Appendix A. Office of Applied Studies, NHSDA Series H-13, DHHS publication SMA 01-3549.
5. 2000 National Household Survey on Drug Abuse: Data Collection Final Report. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; March 2002. Table 7.1—Summary of NHSDA Results, Table 7.14–7.15—2000 Interview Results—By Age (Total US), and Table 7.19—2000 Interview Results—By Age & Race, Type of County, Region and Gender.
6. 1999 National Household Survey on Drug Abuse: Data Collection Final Report. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2000. Table 7.20—1999 CAI Interview Results—By Gender and Age (Total), and Table 7.25—1999 CAI Interview Results—By Age ad Race, Type of County, Region & Gender. Available at: http://www.samhsa.gov/oas/nhsda/1999/Collect/section7.htm#t7_20. Accessed on February 26, 2002.
7. Wagner-Echeagaray FA, Schutz CG, Chilcoat HD, Anthony, JC. Degree of acculturation and the risk of crack cocaine smoking among Hispanic Americans. Am J Public Health 1994;84:1825–1827.
8. Amaro H, Whitaker R, Coffman, Heeren, T. Acculturation and marijuana and cocaine use: findings from HHANES 1982–84. Am J Public Health 1990;80(supplement):54–60.
9. Epstein JA, Botvin GJ, Diaz T. Linguistic acculturation associated with higher marijuana and polydrug use among Hispanic adolescents. Substance Use Misuse March 2001;36(4):477–499
10. Chen X, Unger J, Cruz T, Johnson C. Smoking patterns of Asian-American youth in California and their relationship with acculturation. J Adolesc Health May 1999;24(5):321–328[Web of Science][Medline]
11. Wright D, Gerstein P, Lane J, Huang L. Risk and Protective Factors for Adolescent Drug Use: Findings from the 1997 National Household Survey on Drug Abuse. Rockville, Md: Office of Applied Studies, Substance Abuse and Mental Health Services Administration; February 2001. Publication SMA 01-3499.
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