Introduction
Hispanics comprise the largest minority group in the United States, with a population of 42.7 million, 40 percent of whom are under age 21. Surveys of the Nations youth suggest that younger Hispanics have a higher rate of illicit substance use than African American or white adolescents. Since young people are at higher risk of substance abuse and addiction than older individuals, Hispanic youth are particularly vulnerable to substance abuse.
It also is important to recognize the tremendous diversity of the Hispanic community that shares a common language, but is constituted of ethnically and culturally diverse groups. This issue of NewsScan highlights NIDA-supported studies included in a special supplement to the journal Drug and Alcohol Dependence that address the multifaceted issues of substance abuse and addiction within Hispanic populations.
Identifying Research Opportunities To Improve Drug Treatment Services among Hispanics
Despite the rapid expansion of research on service use and delivery over the past decade, the challenge of improving drug treatment services for Hispanics is an important one. Models that have succeeded with Caucasian populations do not necessarily meet the needs of Hispanics. Limited use of drug treatment services (i.e., low program enrollment, retention, and completion), as well as barriers to service delivery and use among Hispanic drug abusers, suggest an ongoing challenge in understanding and delivering services that address the unique Hispanic culture and its healthcare needs.
In a recent review article, Dr. Margarita Alegria of Harvard Medical School and her colleagues make research recommendations in four priority areas to improve the delivery of drug treatment services for Hispanics. These include:
- Understanding the community context where Hispanics live by characterizing the local Hispanic community in terms of structure, cultural composition, and relations with the non-Hispanic community and involving local community members and community-based organizations in community-based research.
- Testing the effectiveness of community-based therapeutic approaches that take advantage of natural supports and facilitate reintegration.
- Assessing barriers to service utilization such as Latinos understanding of health matters, communication between caregivers and clientele, and the impact of insurance coverage on engagement and retention.
- Developing and testing a community-based service delivery model in Hispanic communities that focuses and integrates social, health and drug abuse services.
- WHAT IT MEANS: These findings suggest that a well-defined concept of the Hispanic community setting will assist investigators in tailoring strategies to improve service delivery and address barriers to use among Hispanic drug abusers.
These research recommendations were published in the September 2006 supplement issue of Drug and Alcohol Dependence.
Adapting Research To Prevent Substance Abuse among Hispanic Youth
Many studies identify drug abuse prevention interventions among youth, but few relate specifically to Hispanic/Latino populations. Thus, there is a need for research that examines culturally relevant risk and protective factors, and for research that is sensitive to cultural issues that affect Hispanic adolescents and young adults.
Dr. Felipe Gonzalez Castro of Arizona State University and his colleagues reviewed 18 previously published studies to develop recommendations for future research aimed at developing culturally relevant interventions for Hispanic populations.
The scientists recommend that future studies:
- Be guided by theory relevant to Hispanics;
- Propose specific cultural hypotheses and ways to test them;
- Incorporate cultural variables into research design and model tests based on theory-driven research approaches relevant to Hispanics;
- Examine mechanisms of effect (i.e., not just what works but how it works), including the role of youth ethnic identity and the parentchild relationship as sources of risk or protection;
- Improve cultural relevance and appeal of programs to increase participant motivation and sustain participation; and
- Address issues of fidelity and adaptation in program design, implementation, and testing in response to unique community needs.
- WHAT IT MEANS: Although effective drug abuse intervention programs for youth exist, they may not be culturally relevant to successfully enable Hispanic youth to modify unsafe and risky behaviors. Designing future research to prevent substance abuse among Hispanic youth and adapting tested and effective programs to be relevant to Hispanic youth could produce changes in behavior that reduce the risks and occurrence of substance abuse among this population.
The scientists published this research review in a special supplement to Drug and Alcohol Dependence in September 2006.
Scientists Identify Areas of Research To Prevent HIV in Hispanic Adolescents
According to information released by the U.S. Census Bureau in May 2006, Hispanics continue to be the largest minority in the United States, with a population of 42.7 million. As adults, Hispanics are disproportionately affected by HIV/AIDS, with an HIV infection rate nearly four times that for non-Hispanic whites.
It is important to study prevention efforts among Hispanic teens to lower the disparities in HIV/AIDS rates when they become young adults. Drug and alcohol abuse can increase the likelihood for risky sexual activity, and Hispanic youth consistently report higher rates of unprotected sexual behavior than non-Hispanic whites, thus increasing their risk for sexually transmitted diseases, including HIV.
In a review of the literature, Dr. Guillermo Prado of Florida International University and his colleagues report that there are a number of areas in which further research is needed. Such areas include:
- Analyses of nationwide epidemiologic data examining risk and protective factors for substance abuse and unsafe sexual behavior among heterosexual and homosexual youth;
- Explaining variations in drug/alcohol abuse, unsafe sexual behavior, and HIV infection among Hispanic subgroups;
- The need for adaptive preventive interventions for Hispanic subgroups with varying risk and protection profiles;
- Incorporation of ethnic, cultural, and sexual identity into prevention programs for Hispanic adolescents;
- Examination of the role of gender in preventive interventions for Hispanic adolescents;
- Research on the effects of psychiatric comorbidity on drug/alcohol abuse, unsafe sex, and HIV riskand on the efficacy of prevention programs; and
- Increased focus on intravenous drug abuse as a mode of HIV infection among Hispanic adolescents.
- WHAT IT MEANS: There are a number of high priority research areas needed to reduce rates of HIV infection among Hispanic adolescents. There also remains a corresponding need to develop and evaluate interventions tailored to these different groups, and to assess how aspects of the various Hispanic cultures affect HIV risk and protection.
The scientists published their recommendations in a supplement to Drug and Alcohol Dependence in September 2006.
Researchers Suggest Directions for Biological Research on Drug Abuse and Addiction in Hispanics
Scientists have made progress in understanding the biological contributions to the processes of drug abuse and addiction and they are now starting to look at how racial/ethnic biological differences contribute to or protect against these public health problems.
Previously published data suggest that there are biological similarities and differences between Hispanics and other ethnic groups related to drug abuse and addiction. However, relatively few such studies have been conducted, and those that have been done have had low numbers of Hispanic participants and have failed to recognize the complexity and heterogeneity of Hispanic populations in the United States.
For example, Hispanic males in the United States have nearly twice the mortality rates for alcohol-related cirrhosis than their white counterparts - a difference that cannot be accounted for by alcohol consumption alone - and recent evidence points to differences in biological response to alcohol. One study showed that two biochemical markers of liver cell damage were increased in Mexican Americans relative to white non-Hispanic Americans, at the same levels of alcohol consumption.
In examining biological variables related to drug abuse and addiction among Hispanics, the researchers who reviewed the literature state that future research should include sufficient numbers of Hispanic subjects to obtain statistically valid data. In addition, such biological studies must consider biological identity to gather a population sample that is genetically similar, and should be designed to assess potential gene-environment and gene-gene interactions for the specific biological targets. Finally, scientists should pay attention to the ethical, legal, and social implications of their research.
- WHAT IT MEANS: Research on biological factors related to risk for and protection against drug abuse and addiction among Hispanic populations will lead to a better understanding and ultimately, better prevention and treatment of drug abuse. An emphasis on research in Hispanics also can provide an opportunity for cultivating the interest of young Hispanic scientists who can pursue biomedical problems of interest to specific populations, as well as the wider community.
Dr. Keith Trujillo of California State University and his colleagues published their review in a special supplement to Drug and Alcohol Dependence in September 2006.
A Review of Drug Treatment Outcomes, Needs, and Scientific Opportunities among Hispanic Adults
Increasing growth rates, healthcare disparities, and disproportionate rates of drug-related HIV/AIDS among Hispanic adults are among many reasons cited by researchers for identifying effective drug abuse treatments for this population.
Dr. Hortensia Amaro of Northeastern University and her colleagues conducted an extensive literature review on behavioral drug abuse treatment studies and pharmacotherapy for substance abuse disorders in Hispanics. Several research opportunities emerged as well as recommendations to improve drug abuse treatment for Hispanics.
The scientists reported a great need for pharmacotherapy studies among Hispanics with substance abuse disorders, in addition to a need for behavioral interventions tailored to the specific socioeconomic, language, and cultural requirements of Hispanics. Additional recommendations include the following:
- Increasing sample numbers to include Hispanic men and women in nonculturally-specific studies;
- Re-analyses of existing data to identify specific effect sizes for Hispanic populations;
- Testing of efficacious pharmacological and behavioral approaches in the Hispanic population; and
- Followup studies/analyses of treatments to determine differential efficacy across gender, Hispanic subgroups, acculturation levels, and socioeconomic background.
- WHAT IT MEANS: This literature review suggests that additional research is needed to determine which treatments are efficacious within Hispanic populations. For those approaches that are not efficacious, cultural modifications may improve the compatibility of drug abuse treatment among Hispanics.
The researchers published this review article in the September 2006 supplement issue of Drug and Alcohol Dependence.