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Sociocultural stress, coping and substance use among Hispanic/Latino adolescents

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Sociocultural stress, coping and substance use among Hispanic/Latino adolescents

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SOCIOCULTURAL STRESS, COPING AND SUBSTANCE USE AMONG
HISPANIC/LATINO ADOLESCENTS

by

Rachel Grana

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PREVENTIVE MEDICINE)

August 2010

Copyright 2010 Rachel Grana

ii

ACKNOWLEDGEMENTS

Although the dissertation represents an original piece of work, countless people have
helped to make it possible. First and foremost, my committee deserves my unending
gratitude for their willingness to patiently share their expertise and guidance, as well as
their care and support. This truly would not have been possible without my mentor,
Luanne Rohrbach. Dr. Rohrbach encouraged me to follow my research interests and
provided painstaking reviews of many drafts throughout this entire endeavor. I am
forever grateful to her for providing the freedom for my ideas to develop, countless
opportunities for me to pursue them and patient guidance throughout. Dr. Steven
Sussman gave me thorough, honest and constructive feedback and always helped me to
see the bigger picture. Dr. Jennifer Unger remained a source of reassurance, strength and
guidance from the inception of an idea to the writing of the final draft. Dr. Ping Sun
shared his seemingly endless reservoir of patience and good humor with me, which is
almost as helpful as his brilliance in statistics. Dr. Helen Land generously shared her
time, expertise and careful consideration of my ideas that helped to improve this
dissertation.

I am indebted to the entire community of people at USC’s Institute for Health Promotion
and Disease Prevention Research (IPR), who provided an academic home in which to
learn, thrive, and excel for these past six years. I am grateful for the tireless efforts of the
faculty who taught me and guided me through the entire process. I would like to extend a
special thank you to Marny Barovich. The incredible amount of guidance and patience
she extended to me was unwavering and vital for accomplishing my goals.

In addition, this project would not be possible without the literally thousands of willing
adolescent research participants who gave their time and shared their lives with us so that
we can accomplish our research. I am ever-grateful for their participation and honesty.

I owe a huge debt of gratitude to all of my friends in school, at work, near and far, for
being immense sources of encouragement, care, and support throughout the entire
process. You couldn’t have been more encouraging and made this journey more
enjoyable.

Finally, to my mother, Laurie Grana, and sister, Susie Carey, I am eternally grateful to
you both for being absolutely the best, most loving and supportive family anyone could
ever have.

This research is supported by TRDRP dissertation grant 17DT-0190.
iii
TABLE OF CONTENTS

Acknowledgements ii

List of Tables v

List of Figures vii

Abstract viii

Chapter 1: Introduction 1
Specific Aims 1
Background and Significance 5
Overview of the dissertation studies 21

Chapter 2: Study 1: Emerging adulthood transition as a stress factor, coping
styles and acculturation among Hispanic/Latino continuation high school
students in Southern California
Chapter 2 Abstract 24
Chapter 2 Introduction 25
Methods 30
Measures 32
Data Analysis 34
Results 36
Chapter 2 Discussion 43

Chapter 3: Study 2: Cultural stress factors and coping in the prediction of cigarette
smoking, alcohol and marijuana use from 9
th
to 11
th
grade among Hispanic/Latino high
school students
Chapter 3 Abstract 51
Chapter 3 Introduction 52
Methods 56
Measures 58
Data Analysis 62
Results 64
Chapter 3 Discussion 68

Chapter 4: Study 3: Does depressive symptomatology mediate the longitudinal
relationships between cultural stress factors, coping and cigarette smoking among
Hispanic/Latino high school students?
Chapter 4 Abstract 76
Chapter 4 Introduction 77
iv
Methods 82
Measures 84
Data Analysis 88
Results 92
Chapter 4 Discussion 98

Chapter 5: Discussion, Limitations, Strengths and Future Directions 105

Bibliography 114

Appendix I: Coping items (study 1, chapter 2) 124

Appendix II: Coping items (studies 2 and 3, chapters 3 and 4, respectively) 125

v
LIST OF TABLES

Table 1: Demographics of study sample and descriptive statistics of
independent variables (n=1046) 37

Table 2: Multilevel linear regression of each past 30-day drug use
outcome (cigarettes, alcohol and marijuana) on independent variables
(n=1046) 38

Table 3: Multilevel linear regression of each past 30-day drug use
outcome (cigarettes, alcohol and marijuana) on independent variables
and interaction effects between emerging adulthood transition stress
and coping 38

Table 4: By acculturation status: multilevel linear regression of each
past 30-day drug use outcome (cigarettes, alcohol and marijuana)
on independent variables 40

Table 5: By acculturation status: multilevel linear regression of each
past 30-day drug use outcome (cigarettes, alcohol and marijuana)
on independent variables with interaction effects between
emerging adulthood transition stress and coping 42

Table 6: Demographics of study sample and predictor variables
(n=1546) 65

Table 7: Multilevel linear regression of predictors of each past
30-day drug use outcome (cigarettes, alcohol and marijuana) 66

Table 8: Multilevel linear regression of predictors of each past
30-day drug use outcome (cigarettes, alcohol and marijuana),
with interactions effects 68

Table 9: Demographics of study sample and descriptive statistics of
predictors and outcome variable (n=1501) 93

Table 10: Multilevel linear regression of predictors of past 30-day
cigarette smoking at two-year follow-up (total effect) 94

Table 11: Multilevel linear regression of predictors of depressive
symptoms at one-year follow-up (indirect effect) 95

Table 12: Multilevel linear regression of predictors (including
depressive symptomatology) of past 30-day Cigarette Smoking at
vi
two-year follow-up (direct effect) 96

Table 13: Multilevel linear regression of predictors of depressive
symptomatology (one-year follow-up), with interaction effects 97

Table 14: Multilevel linear regression of predictors (depressive
symptomatology) of past 30-day smoking at two-year follow-up,
with interaction effects 98
vii
LIST OF FIGURES

Figure 1: Theoretical Model 31

Figure 2: Mediated Moderation Model 91

viii
ABSTRACT

Introduction: Adolescent substance use remains a major cause of concern in the U.S.
and Hispanic/Latino adolescents are at particular risk for substance use at an early age.
California data show that Hispanic/Latino youth initiate substance use earlier (in 8
th

grade) at higher rates than youth who identify as white. This dissertation research
integrated theories of emerging adulthood, acculturation, stress and coping to investigate
the etiology of substance use among Hispanic/Latino adolescents in Southern California.
Specifically, three studies were conducted to investigate the relationships among three
sociocultural stress factors (acculturative stress, parent-adolescent acculturation
discrepancy, perceived stress and emerging adulthood transition stress), depressive
symptomatology, and coping styles (engagement and disengagement) in the etiology of
substance use (cigarette, alcohol and marijuana) among Hispanic/Latino adolescents in
Southern California.

Methods: The three studies comprising this dissertation were conducted with self-report
survey data originating from two large school-based studies examining drug use among
high school students in the Los Angeles metropolitan area. Only data from participants
who identified as Hispanic/Latino were used in these dissertation studies. The first study
in this dissertation was conducted with baseline data from a randomized, controlled trial
testing the effectiveness of an intervention, Project Towards No Drug Abuse (TND) in
preventing substance use among continuation high school students (n=1046). The second
and third studies in this dissertation were conducted with data from a longitudinal study
ix
of cultural determinants of substance use among a sample of primarily Hispanic/Latino
regular high school students (n=1546). In all studies, multilevel linear regression analyses
were conducted to estimate the associations and longitudinal predictions of the past 30-
day use of all three substances (cigarettes, alcohol and marijuana) by the sociocultural
stress factors and coping (chapters 2, 3, and 4). The interaction effects of engagement and
disengagement coping styles on the relationships between the sociocultural stress
variables and substance use were investigated (chapters 2, 3 and 4). In addition, the
mediation of the cultural stress, coping and substance use relationships by depressive
symptomatology and the potential moderation of the mediated effect by coping styles
were examined in study 3 (chapter 4).

Results: The findings from the three studies showed that sociocultural stress factors are
associated with and predict past 30-day substance use, especially cigarette smoking.
Study 1 (chapter 2) analyses showed that emerging adulthood transition stress was
statistically significantly associated with the past 30-day use of all three substances
(cigarettes, alcohol and marijuana). Stratified analyses by acculturation level
demonstrated that emerging adulthood transition stress was only associated with cigarette
smoking among more highly acculturated youth and only associated with alcohol and
marijuana use among less acculturated youth (chapter 2). Engagement coping was
inversely associated with substance use across studies (chapters 2, 3 and 4), while
disengagement coping was positively associated with only alcohol and marijuana use in
study 1 (chapter 2) and alcohol use in studies 2 and 3 (chapters 3 and 4). Acculturative
stress statistically significantly predicted past-30-day cigarette smoking but not alcohol or
x
marijuana use. Parent-adolescent acculturation discrepancy was only a marginally
significant predictor of past 30-day smoking, and not the past-30-day use of alcohol or
marijuana (chapter 3). Across the three studies several interaction effects were found
between both coping styles and all three sociocultural stress factors (acculturative stress,
parent-adolescent acculturation discrepancy, emerging adulthood transition stress) and
perceived stress in the substance use models (chapters 2, 3, and 4). Aside from the
statistically significant buffering of engagement coping on the relationship between
perceived stress and cigarette smoking (chapter 2), the interaction effects did not support
a stress-buffering role of coping (chapters 2, 3, and 4). Acculturative stress (measured at
baseline) predicted depressive symptomatology at one-year follow-up. Depressive
symptomatology (at one-year follow-up) was positively associated with the past 30-day
use of all three substances at two-year follow-up, but was not found to mediate the
relationship between acculturative stress and substance use. In study 3 (chapter 4), there
was no evidence for the hypothesized mediated moderation effects.

Conclusion: Overall, this research demonstrated that social and cultural influences on
adolescent substance use may be important determinants of substance use among
Hispanic/Latino adolescents, especially cigarette smoking. However, among these
samples of Hispanic/Latino youth, the psychosocial construct of coping interacts with
sociocultural stress factors in unique ways that counter findings of previous stress-coping
research. Additional research should include coping measures that assess aspects of the
coping process such as perceived threat and controllability of the stressor. Findings
across the three studies suggest that more research is warranted to investigate the
xi
simultaneous contribution of the sociocultural stress factors and coping to substance use
across the emerging adulthood transition.
1
CHAPTER 1: INTRODUCTION
Specific Aims
This dissertation project addresses gaps in the literature with respect to the
sociocultural stress factors and coping strategies that play a role in the etiology of
substance use among Hispanic/Latino adolescents in the Los Angeles metropolitan area.
Hispanic/Latino adolescents are at higher risk for substance use than their White
counterparts (Suarez-Moralez & Lopez, 2009). Nationally, Hispanic/Latino adolescents
have substance use prevalence rates exceeding those of White and African American
adolescents in the 8
th
grade and their rates accelerate to reach levels similar to Whites and
remain comparable to Whites throughout high school (Johnston, O’Malley, Bachman &
Schulenberg, 2008). Over the past four years in California, the prevalence of past 30-day
cigarette smoking among the Hispanic/Latino adolescents has not decreased as it has
among other ethnic/racial groups (14.3% to 14.0% from 2002-2006; CSTATS), and past
30-day alcohol and marijuana use remain high (37% and 16%, respectively; CHKS 2005-
7). Despite the abundance of research on the etiology of substance use among
adolescents in general, research about the specific intrapersonal and sociocultural factors
contributing to adolescent substance use among Hispanic/Latino youth is less conclusive
(Baezconde-Garbanati, 2002; Unger et al., 2000; Caplan, 2007; Zamboanga, Schwartz,
Jarvis & Van Tyne, 2009).
The three studies in this dissertation build on recent research suggesting that the
stress produced by navigating the balance between acculturating to U.S. culture and
retention of one’s own ethnic culture will influence an adolescent’s choice of coping
methods (Unger et al., 2004; Romero & Roberts, 2003), which affects the likelihood of
2
substance use (Sussman et al., 1993). Researchers in the field of adolescent drug use have
called for the application of the stress-coping model to investigate the relationship
between acculturative stress and substance use (Unger et al., 2004). The study of
emerging adulthood needs to include more research investigating hypotheses about this
time period among diverse samples of adolescents in order to more fully understand this
transitional stage of life.
Specifically, this dissertation project investigates the effect of coping strategies on
the relationship among three types of variables: (a) two sociocultural identity formation
stressors (acculturating to U.S. culture and perceptions of emerging adulthood), (b)
depressive symptomatology, and (c) substance use among two school-based samples of
Hispanic/Latino adolescents. One sample is comprised exclusively of continuation high
school students and one includes students attending regular high schools. Continuation
high schools in California were created as an alternative education format for students
who have not been successful in achieving credits for graduation in the regular
comprehensive high school system (Rohrbach, Sussman, Dent & Sun, 2005). Typically
these students have engaged in problem behaviors, such as cigarette smoking, at school
that resulted in their removal from the regular high school (Rohrbach et al., 2005;
Grunbaum, Lowry & Kann, 2001). It is important to investigate hypotheses about
substance use among Hispanic/Latino adolescents enrolled in continuation high schools
because studies consistently report relatively higher rates of current and lifetime
substance use among continuation high school students (Sussman et al., 1995; Unger et
al., 2000). Moreover, research is needed that investigates the potential link between
perceptions of emerging adulthood as stressful and substance use among Hispanic/Latino
3
continuation high school students, as a few studies have demonstrated Hispanic/Latino
adolescents (and other racial/ethnic minorities) take on adult roles and enter emerging
adulthood earlier than white adolescents

(Phinney, 1996; Rohrbach et al., 2005).
The theoretical foundation of these dissertation studies originates from stress-
coping theory (Cohen and Wills, 1985; Folkman and Lazarus, 1985; Wills, 1986; Wills
Sandy, Yaeger, Cleary & Shinar, 2001) to investigate the role of sociocultural stress
constructs in the etiology of cigarette smoking, alcohol use and marijuana use among
Latino adolescents, as well as the potential for engagement (e.g., problem-solving) and
disengagement (e.g., avoidant) coping styles to moderate these associations. In addition,
we examine depressive symptomatology as a mediator of the sociocultural stress and
substance use relationships. To the best of the author’s knowledge, none of the studies in
the Hispanic/Latino adolescent substance use literature have investigated the role of
coping in these relationships. The ultimate goal of this research is to identify etiological
factors that might be targets for drug abuse prevention interventions for Hispanic/Latino
adolescents (e.g., sociocultural stress, coping, cultural, mental health constructs). These
issues are very important, especially given that 40% of Hispanic/Latinos in the U.S. are
under age 20, therefore exploring these pathways may be particularly applicable to
Hispanic/Latino adolescent health from a demographic as well as a developmental
perspective (Zamboanga et al., 2009).
Study 1, presented in chapter 2, explores the relationship between the
Hispanic/Latino adolescents’ perceptions of emerging adulthood as stressful, perceived
stress, self-reported substance use, and the role of coping in exacerbating or attenuating
these hypothesized relationships. Study 1 compares these relationships among
4
Hispanic/Latino adolescents by level of English language use (one measure of
acculturation to the U.S.). Study 2, presented in chapter 3, explores the relationships
between sociocultural identity factors of acculturation, acculturative stress, parent-child
acculturation discrepancy, cultural identity and substance use among Hispanic/Latino
adolescents. This study also examines the moderation effect of engagement and
disengagement coping strategies. Study 3, presented in chapter 4, examines hypotheses to
determine mediation of the sociocultural stressors, coping and substance use relationships
by depressive symptomatology. That is, a mediated-moderation analysis was conducted
to assess the full range of effects.

Across the three papers, the specific aims of the dissertation are:
Study 1
1) To investigate the relationship between perceptions of emerging adulthood as
stressful and substance use.
2) To explore coping strategies as potential moderators of the relationship
between perceptions of emerging adulthood as stressful and substance use.
3) To examine whether the relationships among perceptions of emerging
adulthood as stressful, coping, and substance use differ by level of
acculturation (i.e., high- and low-acculturated youth).
Study 2
4) To investigate the relationship between measures of sociocultural stress and
substance use among Hispanic/Latino adolescents.
5
5) To explore coping strategies as potential moderators of the relationship
between sociocultural stress and substance use.
Study 3
6) To determine if depressive symptomatology mediates the relationship between
sociocultural stressors and substance use.
7) To explore the potential moderation by coping strategies of the mediated
relationship between sociocultural stress, depressive symptomatology and
substance use.

Background and Significance
Substance Use as a Public Health Problem
Substance use and abuse is a serious public health problem in the U.S. with
numerous negative health consequences to both the individual and society at large
(Johnston et al., 2008). The health, emotional and legal consequences of drug use among
adolescents is of particular importance to the public’s health. Results from the
Monitoring the Future study show that by 12
th
grade, 75% of high school students have
tried alcohol, 46% have tried cigarettes and 32% have tried marijuana (Johnston, 2008).
Moreover, among 12
th
graders, the past 30-day use of alcohol is 44%, past 30-day use of
cigarettes is 22% and past 30-day marijuana use is 30%. Alcohol use is the most
commonly used substance, with 39% and 55% of 8
th
and 12
th
graders, respectively,
reporting having been drunk at least once in their lifetime. However, since 2005, lifetime
alcohol use has shown modest declines among all 8
th
, 10
th
and 12
th
graders. In the late
1990’s and early 2000’s past 30-day cigarette use decreased dramatically among 12
th

6
graders (from 33% to 28%), yet since 2006 it has declined very slowly with current use
among 12
th
graders showing no change since 2006 (Johnston et al., 2008). This is
possibly due to decreased funding for state tobacco control programs and fewer price
increases (Johnston et al., 2008). Past 30-day marijuana use among 12
th
graders declined
from peak prevalence of 34% in 1980, until 1992 when it reached 12% (Johnston et al.,
2008). However, by 1998 the prevalence had reached 24%, and it declined to 19% in
2007 (Johnston et al., 2008).
The health consequences of adolescent substance use are very significant and
potentially very detrimental to successful transition to young adulthood (Masten, 2004).
Several physical consequences are associated with substance use such as cancer,
emphysema, cirrhosis, increased susceptibility to colds and flues, and neurological
impairment (CDC, 2004). Cigarette smoking is the leading cause of preventable death in
the U.S. due to increased cardiovascular diseases, lung diseases such as chronic
obstructive pulmonary disorder (COPD) and emphysema, and increased risk for several
cancers, including lung, bladder, pancreas, and stomach (CDC, 2004). Approximately
87% of regular cigarette smokers initiate smoking before age 18 (CDC, 2004). More
adolescents die from unintentional injuries than of any other cause and motor vehicle
accidents are the most prevalent cause (30%; CDC, 2008). Substance use is also often
associated with psychological symptomatology, such as depression and stress (NIDA,
Coogan et al., 1998, Goodman & Capitman, 2000; Chilcoat, 2003; Steuber & Danner,
2006). In particular, cigarette smoking has been associated with depression in several
studies of adolescents; however, research is inconclusive as to whether substance use
precedes or follows the onset of psychological symptoms (Goodman & Capitman, 2000;
7
Steuber & Danner, 2006). The developmental ramifications of adolescent substance use
are serious. Brain and other physical development is still occurring into late adolescence
(19-21 years), and using substances may hinder or change that development in
fundamental ways that affect the sensitivity and affinity for substance use as adults
(Volkow & Li, 2004).
Prevalence of Substance Use among Latino Adolescents
The Hispanic/Latino population is the most rapidly growing ethnic minority group
in the United States. Moreover, 35.9 percent of California’s population is
Hispanic/Latino, comprising one of the largest populations of Hispanic/Latinos in the
U.S. (U.S. Census, 2008). As with all adolescents in the U.S., tobacco use remains a
prominent negative health behavior among Hispanic/Latino adolescents that has severe
morbidity and mortality consequences (Johnston et al., 2008). Tobacco, alcohol and
marijuana use are higher among Hispanic/Latino adolescents in 8
th
grade than White and
African American 8
th
graders (Johnston et al., 2008).
National data show that Hispanic/Latino adolescents smoke more than their White
and African American counterparts in 8
th
grade, while in 10
th
and 12 grades their use falls
behind that of Whites but stays above that of African Americans. Nationally, Mexican
American youth, a subpopulation of Hispanics/Latinos, have higher rates of susceptibility
to initiate cigarette smoking than whites and other race/ethnic groups (28.8% v. 20.8%
for whites; CDC, 2006). In California, Hispanic/Latino adolescents have the second-
highest prevalence rate of past-month smoking, while Whites have the highest rate:
14.0% and 18.3%, respectively (CDHS, 2007). Also in California, Hispanic/Latino
adolescents reported the highest rate of ever trying smoking of all ethnicities: 45.4% as
8
compared to 41.2% for Whites and 30.1% of African-Americans (CDHS, 2007).
Furthermore, Hispanic/Latino youth are being targeted by the tobacco industry for their
potential contribution of rapidly growing population of new smokers (Acevedo-Garcia,
Barbeau, Bishop, Pan & Emmons, 2004; Glantz & Ling, 2002).
Alcohol has by far been the most widespread used substance among middle
school and high school students; 39% have used by 8
th
grade and this proportion
increases to 72% by 12
th
grade. Importantly, Hispanic/Latino adolescents appear to be at
higher risk for use at younger ages than their White and African-American counterparts,
with Hispanic/Latino adolescents reporting the highest past-month alcohol use and binge
drinking rates in 8
th
and 10
th
grades, compared to Whites and African-Americans. In 12
th

grade their rates remain above that of African-Americans, and just below Whites
(Johnston et al., 2008). Past thirty-day marijuana use by high school students shows a
similar trend nationally as the other substances, where use increases dramatically from 8
th

grade, 10.3%, to 12
th
grade, 31%, (Johnston et al., 2008). Hispanic/Latino adolescents use
marijuana at higher rates than both White and African-American adolescents (Johnston et
al., 2008). Taking all of these results into account, research into the sociocultural
determinants of smoking and other substance use behavior should be conducted to
understand the precocious (and higher) lifetime use of substances among Hispanic/Latino
adolescents compared to White and African American adolescents (Castro, Stein &
Bentler, 2009).

9
Sociocultural Identity Formation, Coping and Substance Use among Hispanic/Latino
Adolescents
Because adolescence is a developmental period characterized by experimentation
with risk-taking behaviors, yet is also a period of increased autonomy and experimenting
with adult roles, it is important to prevent the initiation and regular use of substances
during this period in order to prevent the morbidity and mortality caused by substance use
(Petraitis, Flay & Miller, 1993; Masten, 2004). In order to investigate the complex
etiology of substance use among Hispanic/Latino adolescents, this dissertation applies
stress-coping theories to investigate the relationships among sociocultural stressors (e.g.,
acculturation, acculturative stress, and parent-child acculturation discrepancy) and
substance use in a population of Hispanic/Latino adolescents enrolled in Los Angeles
area high schools. This dissertation project also tests hypotheses of sociocultural stress
factors, coping and substance use in continuation high school students; adolescents who
are at particularly high risk for substance use (Grunbaum, Lowry & Kann, 2001).
The concept of acculturation is complex; there are many ways to define it and
various perspectives to assume in analyzing its effect on the uptake and promotion of
substance use among adolescents. The most basic variable used to measure acculturation
among Hispanic/Latino adolescents is level of English and Spanish language use.
However, the field of acculturation research has progressed rapidly in the past twenty
years and most scholars in this field recognize the multidimensionality and complexity of
acculturation and ethnic identity (Schwartz, Pantin, Prado, Sullivan & Szapocznik, 2005).
Acculturation is now more often defined as a complex, “dynamic and multidimensional”
process involving language acquisition and adaptation to cultural normative beliefs and
10
practices of the new country, while maintaining some of one’s beliefs and practices of the
country of origin (Kaplan, Napoles-Springer, Stewart & Perez-Stable, 2001; Epstein,
Botvin, & Diaz, 1998). Findings from several research studies conducted with youth and
adults of Latino/Hispanic descent in the U.S. have found that being more highly
acculturated to U.S. culture is a risk factor for several negative health behaviors,
including substance use (Abraido-Lanza, 2005; Unger, 2004; Epstein et al., 1998;
Escobar & Vega, 2000; Unger et al. 2000; Bethel & Schenker, 2005).
One pathway from acculturation to drug use may be through the experience of
culturally-based stress, which may include acculturative stress, perceived discrimination
and parent-child acculturation discrepancy (Rodriguez, Myers, Mira, Flores &
Hernandez, 2002; Vega, Zimmerman, Warheit & Gil, 2003). Acculturative stress is
defined as stress produced by efforts to adopt the host culture and integrate into the host
culture. These efforts may be fraught with challenges in learning a new language and
customs, or surmounting effects of discrimination by the host community (Berry & Kim,
1988). This construct has been conceptualized in several ways, with the predominant
concept being one’s perceptions of how stressful it is to adapt to the host culture and
assimilate new values and belief systems into one’s own cultural perspective. While
acculturative stress and its relationship to maladaptive internalizing states (i.e.,
depression, anxiety) has been investigated with Hispanic/Latino adults over the past 10
years (Hovey & Magana, 2000; Crocket et al., 2007), fewer studies have examined these
constructs among adolescent populations and in relation to substance use (Hovey & King,
1996; Szapocznik, Rio, Perez-Vidal & Kurtines, 1986; Siqueira, Diab, Bodian &
Rolnitzky, 2000; Unger et al., 2009).
11
The few studies investigating acculturative stress and substance use among
Hispanic/Latino adolescents demonstrate a significant relationship between acculturation,
acculturative stress and substance use (Szapocznik et al., 1986; Gil, Wagner & Vega,
2000; Vega, Zimmerman, Warheit & Gil, 2003). The mediators and moderators of these
relationships and the characterization of the antecedent cultural stressors have not been
established. There is a dearth of research on the relationships of stress and coping factors
to substance use among diverse populations, especially Hispanic/Latino adolescents, and
studies on cultural factors that may influence the selection of coping strategies (Suarez-
Moralez & Lopez, 2009, Dillon & Szapocznik, 2007; Rasmussen, Aber & Bhana, 2004;
Compas et al., 2001; Zaff, Blount, Phillips & Cohen, 2000). As suggested by Unger et al.
(2004) these stress and coping relationships may be important pathways to the initiation
and maintenance of substance use among Hispanic/Latino adolescents. Stress and coping
theory has not yet been applied to investigate the relationships among acculturative
stressors and substance use and among emerging adulthood-related stressors and
substance use in Hispanic/Latino youth (Suarez-Moralez & Lopez, 2009; Dillon &
Szacopznik, 2007). As noted in a recent special issue on acculturation, acculturative
stress and health (Suarez-Moralez & Lopez, 2009), studies have found that minority
youth, including Hispanic/Latino, experience more stressors than White youth due to
their concentration in moderately disadvantaged situations. Moreover, acculturative stress
(perceived discrimination and immigrant-related stress) and daily hassles have been
found to be significantly and positively related to anxiety symptoms among
Hispanics/Latinos (Suarez-Moralez & Lopez, 2009).
12
Another understudied and important aspect of acculturation that causes stress for
the adolescent is a discrepancy in the parent’s and adolescent’s acculturation level or
respective views on the extent to which they are acculturated (Szapocznik et al., 1986;
Romero & Roberts, 2003) The difference between adolescents’ and their parents’ level of
acculturation to U.S. culture or level of retention of Hispanic/Latino culture is associated
with depressive symptomatology (Romero & Roberts, 2003) and substance use among
Hispanic/Latino adolescents (Romero & Roberts, 2003; Caplan, 2007; Guinn & Vincent,
2002). Hispanic/Latino adolescents in California are primarily first or second generation
offspring of Mexican or Latino immigrants. Their experience of the process of
acculturation to U.S. society involves integrating their ethnic identity with the cultural
values of the U.S. (Nezami, et al., 2005). Although many Hispanic/Latino adolescents in
California have been born in the U.S., they are aware of the acculturation challenges
faced by their parents and other relatives, which may influence the experience of their
own acculturation process (Szapocznik et al., 1986). Adolescents explore and determine
how to reconcile their experiences of acculturating in the U.S. culture with that of their
parents (Unger et al. 2004; Escobar & Vega, 2000; Szapocznik et al., 1986).

These
experiences may be stressful to the adolescent, particularly if a significant perceived or
actual discrepancy in acculturation status between themselves and their parents causes
them emotional distress, which may result in internalizing (e.g., depression) or
externalizing (e.g., substance use) behaviors (Unger et al. 2004; Szapocznik et al., 1986;
Guinn & Vincent, 2002; Nezami et al., 2005). Moreover, despite having been born here,
these youth are often put in adult or care-taking roles by their less acculturated parents,
many of whom have language barriers (Schwartz et al., 2005). Therefore, these youth are
13
likely to be expected to take on a greater responsibility for caring for the family or
helping their parents navigate and fulfill adult roles than non-Hispanic youth of their age
(Schwartz et al., 2005). Adolescents who are bilingual and more acculturated may have
additional stressors because they are expected to help their parents function in U.S.
society and have a greater responsibility for the entire family’s success in the U.S.
(Szapocznik et al., 1986; Schwartz et al., 2005).
The traditional Hispanic cultural values such as familism, the centrality of the
family in decision making and focus on family connectedness, and respeto, respect for
one’s elders and authority figures, are important aspects of Hispanic/Latino ethnic
identity (Unger et al., 2004). The discrepancy in an integration of these values between
adolescents and their parents may cause family conflict and may be a source of
acculturative stress (Unger et al., 2004; Romero & Roberts, 2003; Zaff et al., 2002;
Caplan, 2007). This particularly may occur if there is an impairment of the traditional
Hispanic/Latino value of familism, which has been found to be protective against
smoking and other drug use for young Latinos (Gil, Wagner & Vega, 2000; Unger et al.,
2004; Farley, Galves, Dickinson & de Jesus Diaz Perez, 2005; Rasmussen, Aber &
Bhana, 2004; Caplan, 2007). The contextual variable of family conflict has been found to
mediate the relationship between acculturative stress and substance use among Latino
adolescents in previous research (Smokowski & Baccallao, 2006).
Stress and Coping Theory
The basic tenets of theories of stress and coping posit that the effects of
experiencing a stressor engender the use of coping strategies, and deficiencies in these
strategies, or poor choice of strategies, may result in negative health states and behaviors,
14
such as depression and substance use (Cohen & Wills, 1985; Wills, 1986; Folkman &
Lazarus, 1986). Often, the physical actions to mitigate stress involve the individual taking
action or seeking support from others to reduce the effects of, or remove the stressor. In
the stress-coping theory proposed by Folkman and Lazarus (“Ways of Coping”), these
actions are referred to as problem-focused coping, while coping attempts that focus on
ameliorating the emotional results of stressors are called emotion-focused coping
(Folkman & Lazarus, 1985). Billing and Moos (1981) further elucidated the
conceptualization of stress and coping relationships and potential strategies. They
dichotomized coping strategies into approach and avoidant dimensions, which closely
resemble the problem-focused and emotion-focused dimensions of the Ways of Coping
(Folkman & Lazarus, 1985), the active and avoidant dimensions of the Carver et al.
(1989) model, and the engagement and disengagement strategies of the Wills et al. (2001)
model. Research has shown that positive coping strategies, particularly the use of
engagement strategies such as seeking parent support, trying to solve the problem, and
cognitive reframing, ameliorate the effects of stressors and reduce the resulting
psychological distress or substance use (Carver, Scheier & Weintraub, 1989; Wills, 1986;
Wills, Sandy, Yaeger, Cleary & Shinar, 2001). Conversely, disengagement coping
strategies, such as avoidance, escape, and withdrawal, increase the risk for adolescent
substance use (Wills, 1986). For example, Sussman and Dent (2000) found that avoidant
coping strategies were associated with increased use of cigarettes. Wills and colleagues
found that avoidant coping strategies were positively related to initiation of substance use
and use over time (Wills et al., 2001).

Perceiving the stressor as uncontrollable and
15
seeking support from substance using peers may be contextual influences that
significantly affect the relationships among stress, coping and substance use (Compas,
Malcarne & Fondacaro, 1988).
There is a dearth of research on the stress-coping relationship to substance use
among ethnically diverse populations and cultural factors that may influence the selection
of coping strategies (Suarez-Moralez & Lopez, 2009; Dillon & Szapocznik, 2007;
Rasmussen et al., 2004; Compas et al., 2001). Farley et al., 2005 compared stress, coping
strategies and quality of life among three adult groups. These were Mexican citizens
living in the U.S., Hispanic/Latino U.S. citizens and White U.S. citizens. The Mexican
citizens were more likely to use coping strategies (e.g., positive reframing, religion)
associated with positive health outcomes and less likely to use coping strategies (e.g.,
self-distraction and substance use) associated with negative health outcomes than the
other two groups. Farley et al.’s (2005) findings suggest that as Mexican immigrants
acculturate to U.S. culture they may change their selection of coping strategies in
response to stress from more adaptive engagement strategies to more avoidant strategies,
perhaps as a reaction to discrimination, which may contribute to increased involvement in
substance use. However, most research on the relationships between stress, coping and
drug use has been conducted with adults, and research with adolescents is inconclusive
with regard to the nature of and contributing factors in these relationships (Unger et al.,
2004; NIDA Monograph, 1993).
A limited number of studies have applied stress-coping theory to sociocultural
stressors among Hispanic/Latino adults and provide some basis for exploring these
relationships among adolescents. For example, Crockett et al. (2007) investigated the role
16
of coping in the relationship between acculturative stress and depression. They found that
acculturative stress is positively associated with depression and is moderated by active
coping strategies, in that less depression was experienced with higher levels of active
coping (Crockett, et al. 2007). It is important to determine which types of coping
strategies (often termed active, approach, cognitive, and engagement versus avoidant,
passive, and disengagement) are employed by adolescents and that may diminish the
likelihood of recreational drug use or abuse (Siqueira et al., 2000; Finkelstein,
Kubzansky, Capitman, & Goodman, 2007). It is crucial to understand these processes in
order to inform future targets for prevention interventions with Hispanic/Latino youth.
This research contributes significantly to the field of etiological adolescent substance use
research by examining the relationships among acculturative stress, coping strategies,
depression and substance use among Hispanic/Latino adolescents in one model.
Acculturative Stress and the Stress-Coping Model
With respect to the stress-coping model, coping strategies used by
Hispanic/Latino adolescents to manage acculturative stress will likely depend on the
adolescent’s perception of the family as supportive or his/her own role in the family. In
other words, family context is important for determining coping mechanisms employed
by Hispanic/Latino adolescents, and it may facilitate or discourage the use of certain
coping strategies that are typically associated with less substance use (Wills, 1986;
Spirito

et al, 1991; Stark et al., 1989). Using parent support as a strategy to cope with
stress may be associated with decreased levels of substance use via a buffering effect,
thus Hispanics/Latinos who maintain the cultural value of familism, and have lower
acculturation discrepancy with their parents, may be less likely to use drugs. As
17
mentioned above, research shows that high levels of family conflict are associated with
increased risk of smoking and other drugs, (Caplan, 2007; Rodriguez

et al., 2007).
Conversely, a relatively strong ethnic identity may be a proxy for a more embedded and
cohesive family or community context, which may buffer adolescents from experiencing
psychological distress and discourage cigarette smoking and other drug use.
Emerging Adulthood and the Stress-Coping Model
Emerging adulthood has been defined as the period between adolescence and
young adulthood (18-25 years old) that is characterized by greater independence from
family and by adult role-taking behaviors (Arnett 1997, 2000). The emerging adulthood
period typically includes new stressors, such as seeking to form intimate partner
relationships and financial independence, demonstrating increased reliance on self and
identity formation independent of one’s family. Studies of resilience and emerging
adulthood indicate that the process of taking on adult roles and having increased
autonomy over one’s self is perceived as a positive challenge rife with opportunity
(Masten, 2004; Chassin, Presson, Rose & Sherman, 1996). However, these processes
may also engender a sense of instability and insecurity about the future that is distressing
to adolescents and may cause maladaptive internalizing and externalizing states as well as
deviant behaviors (e.g., cigarette and other substance use; Tucker, Ellickson, Orlando,
Martino & Klein, 2005). It is very important to determine which coping strategies will
decrease or aid in the management of the uncertainty and stress produced in this period of
the life span. In the little published research examining coping strategies in emerging
adulthood, good coping skills predicted better adjustment in young adulthood, including
less cigarette use and depression (Masten, 2004). In one study investigating markers of a
18
successful transition from adolescence to adulthood, depression and anxiety in
adolescence were associated with nicotine dependence in young adulthood (Grunbaum,
Lowry & Kann, 2001).
Arnett, the researcher who conceptualized and coined the term “emerging
adulthood,” has conducted seminal work attempting to classify and define the hallmarks
of emerging adulthood. He established construct validity of his conception of emerging
adulthood through two simultaneous studies of two different populations, one sample was
a group of 18-21 year old undergraduates and the other sample was a group of 21-28 year
olds from the community at large (Arnett, 1997). These two study populations were both
over 90% white, but differed with respect to several characteristics related to becoming
an adult; level of enrollment in college (100% in sample 1 vs. 28% in sample 2), marital
status (1% vs. 60%), number of children (2% vs. 27%), employment (48% vs. 91%) and
father’s education level (20% with high school diploma or less vs. 32% with high school
diploma or less) (p values not presented in the paper) (Arnett, 1997). In conducting these
two studies of persons potentially in emerging adulthood, and by giving them the same
questionnaire by which to categorize benchmarks of emerging adulthood, he allowed the
concept to be informed equally by two samples that differed with respect to education
and being in adult roles. He found remarkable overlap in what the two samples identified
as benchmarks of becoming an adult, such as the ability to decide one’s own personal
beliefs, form a relationship with one’s parents as an equal, achieve financial
independence, and live away from one’s parents. Importantly, only one of the forty
identified hallmarks of emerging adulthood differed by social class, whereby persons in a
lower social class were more likely to endorse the belief that “a man should be able to
19
financially care for his family.” These findings suggest that the emerging adulthood
construct may be operationalized across socioeconomic status (SES) strata in the United
States. The finding that the hallmarks of emerging adulthood do not differ significantly
by social class addresses a concern that the concept of emerging adulthood may only
apply to late adolescents and young adults who fall in higher SES strata. The findings of
this study indicate that the construct and perceptions of emerging adulthood may hold
across groups that differ in terms of having taken on adult roles and SES. However, since
both samples were majority white, it is still unclear how members of different
racial/ethnic groups interpret the emerging adulthood construct. However, in a later
study, Arnett (2003) found significant differences by SES, where low-SES emerging
adults were more likely to endorse interdependence, norm compliance and family
capacities dimensions as hallmarks of reaching adulthood.
Because this period is defined within U.S. culture by members of U.S. culture, it is
possible that individuals in non-Western countries or immigrants to the U.S. from non-
Western countries may not have the same conception of this developmental period
(Arnett, 2003). Most Hispanic/Latino persons in Southern California originated from
Mexico and Central America, where cultures are quite different from the U.S. with
respect to social institutions and family structures, which are much more collectivist than
the U.S culture. However, for Hispanic/Latino adolescents growing up in America and
being exposed to U.S. cultural values and beliefs, including those normative beliefs about
what it means to become an adult in the US, they are may experience emerging adulthood
in a similar manner as any other resident of the U.S. Therefore, Hispanic/Latinos who
were born in the U.S. or lived here most of their lives can be expected to ascribe to the
20
same definition of emerging adulthood as other Americans, but the retention of their
Hispanic/Latino heritage and enmeshment in their native culture may affect the level of
the salience of the hallmarks of emerging adulthood and their experience of emerging
adulthood. The one study explicitly testing the difference in conceiving of emerging
adulthood by ethnicity (Arnett, 2003) compared African-American, Latino, Asian
American and Whites on their perceived markers of becoming an adult across 7
dimensions of emerging adulthood he had established through previous research (Arnett,
1997; 2000): independence, role transitions, interdependence, norm compliance,
biological transitions, chronological transitions, and family capacities. He only found
significant differences between Latinos compared to Whites on two emerging adulthood
dimensions: role transitions (becoming a parent, getting married) and family capacities
(supporting a family, caring for children) These perceptions may be due to the much
greater proportion of Latinos than Whites in this study who were married (30% and 6%,
respectively) and have at least one child (32% vs. 4%, respectively). He found cross-
cultural salience of the independence, interdependence and norm compliance dimensions
(Arnett, 2003). This study provides some indication that Hispanic/Latinos’ perceptions of
the different aspects of emerging adulthood and the extent to which these aspects are
experienced may differ by acculturation status. It is likely that the more acculturated one
is to the U.S., the more likely it is that one will identify closely with some of these
emerging adulthood constructs. Furthermore, the perception of and potential effects of
stress associated with emerging adulthood may vary by demographic, cultural subgroup
and also the coping styles with which they manage the stress. In addition, Phinney et al.’s
(1996) research shows that members of ethnic minority groups take on adult roles earlier
21
than their White counterparts, potentially creating a psychosocial burden that may
overtax their coping resources and thus possibly increase their likelihood of substance
use. Although, at least one published study has been conducted to investigate the
applicability of the emerging adulthood construct to Hispanic/Latino emerging adults
(Arnett, 2003), no published empirical study investigates how intrapersonal experiences
of emerging adulthood influence substance use among late adolescents.

Overview of the Dissertation Studies
Study 1 investigated the relationship between perceptions of emerging adulthood
as stressful and substance use, and whether coping strategies moderate the relationship,
among Hispanic/Latino youth in a continuation (alternative) high school setting. The
continuation high school setting presents a unique opportunity to study these
relationships among a subgroup of Latino youth that is likely to have higher rates of
substance use

(Grunbaum, Lowry & Kann, 2001; Ellickson et al.,

2004) and increased
perceptions of emerging adulthood as stressful, than youth in regular high schools
(Phinney, 1996; Rohrbach et al., 2005). Rohrbach and colleagues (2005) showed that
youth who attended continuation (alternative) high schools in California were more likely
than national samples of youth to have taken on adult roles such as getting married,
having kids, and full-time employment in their 20’s (Rohrbach, et al., 2005). In addition,
youth attending continuation high school experiment with and use drugs regularly more
than youth attending regular high school. Sussman and colleagues (1995) found that
continuation high school students report past-month cigarette, alcohol and marijuana use
at a much higher rate than regular high school students. A growing body of literature has
22
demonstrated the importance of the emerging adulthood period in the lives of middle and
upper middle class, primarily White adolescents. However, only few published studies
have been conducted to establish the generalizability of this construct to ethnically
diverse adolescents (Arnett, 2003). Moreover, no published study investigates how
intrapersonal experiences of emerging adulthood influence substance use among
adolescents of different ethnic groups. This dissertation applies theories of stress and
coping to explore the relationship between a socioculturally-determined construct of
perceptions of emerging adulthood transition stress, acculturation and substance use
among Hispanic/Latino continuation high school students.
Studies 2 and 3 in this dissertation address the gaps in the literature with regard to
how the micro-sociocultural context interacts with intrapersonal motivators on the
initiation and development of cigarette smoking, alcohol and marijuana use among
Hispanic/Latino adolescents. Two socioculturally-determined constructs (acculturative
stress, parent-child acculturation discrepancy) are explored for their impact on the
etiology of cigarette smoking, alcohol and marijuana use. Moreover, this model seeks to
determine potential intervention targets by exploring likely moderators and mediators of
these hypothesized relationships. Specifically, study 3 investigates the potential
mediating role of depressive symptomatology in the relationship between stress, coping
and substance use Previous research has found that depression is linked with cigarette
smoking among Hispanic/Latino youth (Nezami et al., 2005) and acculturative stress is
positively associated with depression (Romero and Roberts, 2003). However, no study to
date has examined the interrelationships among these constructs through the application
of stress-coping theory simultaneously in one model. These dissertation studies
23
investigate associative and causal pathways among stress and coping factors to determine
potential substance use prevention targets for intervention by exploring main effects and
likely moderators and mediators of these hypothesized relationships.
24
CHAPTER 2: STUDY 1: EMERGING ADULTHOOD TRANSITION
AS A STRESS FACTOR, COPING STYLES AND ACCULTURATION AMONG
HISPANIC/LATINO CONTINUATION HIGH SCHOOL STUDENTS IN
SOUTHERN CALIFORNIA

Chapter 2 Abstract
Introduction: This study addressed gaps in the emerging adulthood literature with respect
perceptions of emerging adulthood and its relationship to substance use in a sample of
Hispanic/Latino older adolescents. Specifically, this study investigated the prediction of
past 30-day substance use from emerging adulthood transition stress, perceived stress and
coping styles. A model of stress and coping was applied to evaluate the role of coping
strategies to buffer the effect of emerging adulthood transition stress on substance use.
Methods: Study participants were drawn from continuation high school students enrolled
in a larger study schools participating in an intervention trial of Project Towards No Drug
Abuse (TND). The analyses conducted for the present study utilized baseline data
collected from participants who identified as Hispanic/Latino (n=1046). Multilevel
regression equations were modeled separately for the prediction of each past 30-day
substance use variable. Analyses of main and interaction effects among the predictors
and coping were conducted separately for each substance use outcome.
Results: Findings provided mixed support for the stress-buffering model proposed
in this study. Emerging adult transition stress was statistically significantly positively
associated with past 30-day use of cigarettes, alcohol and marijuana (all p’s<0.01), but
perceived stress was only statistically significantly associated cigarette smoking.
Engagement coping was statistically significantly inversely associated with past 30-day
use of cigarettes, alcohol and marijuana (all p’s < 0.05) and disengagement coping was
25
statistically significantly positively associated with past 30-day use of cigarettes, alcohol
and marijuana (all p’s< 0.05). Interaction effects reveal a statistically significant
interaction in the expected direction for perceived stress and disengagement coping and
unique findings with respect to emerging adulthood stress and coping. At levels of high
perceived stress, study participants who reported using more disengagement coping were
more likely to have used cigarettes in the past 30-days than those who reported less use of
disengagement coping. We found that at high levels of emerging adulthood transition
stress, adolescents who used more disengagement coping reported less marijuana use
than those who reported lower levels of disengagement coping.

Chapter 2 Introduction
Adolescence is a period of life marked by identity exploration, experimentation,
and a rapid acquisition of new skills (Schwartz et al., 2005; Arnett, 1997). It is a time of
self-focus, independence and exerting one’s desire for autonomous decision-making.
These developmental tasks increase in the late adolescence transitional period to young
adulthood termed emerging adulthood (Arnett, 1997). Emerging adulthood as
conceptualized by Arnett (2000) is defined by the dimensions of time of exploration,
experimentation, feeling-in-between, instability and self-focus. In the theory of emerging
adulthood, Arnett proposes that the emerging adulthood years involve experimenting
with several new occupational goals through the pursuit of college and post-graduate
education and careers, beginning to form serious romantic relationships and getting
married and having children.
26
Although much of this developmental activity can be viewed as advantageous, the
experience of identity exploration, experimentation and taking on adult roles may also
engender stress as it is occurring without the immediate supervision and guidance of
one’s parents and other trusted authority figures. As demonstrated in the developmental
psychology literature, transition points typically involve some amount of stress
experienced by the individual (Chassin et al., 1996; Masten, 2004). Thus it is reasonable
to propose that the more salient one’s experience of the life transition of emerging
adulthood, the more it may be perceived as stressful. In accordance with stress-coping
theory (Lazarus & Folkman, 1980; Carver et al, 1993; Wills, 1986), one would expect an
individual to utilize coping strategies to deal with the stress produced by navigating this
transition and its emotional and behavioral ramifications, as with other types of stressors.
The perception of increased stress, as well as the experimental nature inherent in this
transition, may result in an increased risk of substance use among emerging adults. In
fact, tobacco industry documents show that the tobacco industry capitalized on the
transition from late adolescence to young adulthood as a period in which to solidify the
use of cigarettes as a tool for stress-relief and creating camaraderie amongst new friends
(Ling & Glantz, 2005). This study applies stress-coping theory to explore how
engagement (e.g., problem-solving) and disengagement (e.g., avoidant) coping styles
moderate the relationship between the stress factors and substance use (cigarettes, alcohol
and marijuana) (Cohen & Wills, 1985; Wills et al., 2001).
Importantly, the concept of emerging adulthood was defined by Arnett (2000)
through observations and research conducted in the U.S. and through the lens of
American society. As such, it has been thought of as a phenomenon unique to
27
Westernized cultures where a focus on individualistic achievement and delayed
reproduction are normative (Arnett, 1997, 2000). A growing body of literature has
demonstrated the importance of the emerging adulthood period in the lives of middle and
upper middle class, primarily White adolescents (Arnett, 2000). However, to our
knowledge, only one published study has been conducted to establish the generalizability
of this construct to ethnic subgroups (Arnett, 2003). Moreover, no published study
investigates how intrapersonal experiences of emerging adulthood influence substance
use among adolescents of different ethnic groups.
At least one study has demonstrated Hispanic/Latino adolescents (and other
racial/ethnic minorities) take on adult roles and enter emerging adulthood earlier than
white adolescents

(Rohrbach et al., 2005). Moreover, Hispanic/Latino adolescents are at
higher risk for substance use than their White counterparts (Suarez-Moralez & Lopez,
2009). Nationally, Hispanic/Latino adolescents have substance use prevalence rates
exceeding those of White and African American adolescents in the 8
th
grade and their
rates accelerate to reach levels similar to Whites and remain comparable to Whites
throughout high school (Johnston et al., 2008). Despite the abundance of research on the
etiology of substance use among adolescents in general, research about the specific
intrapersonal and sociocultural factors contributing to adolescent substance use among
Hispanic/Latino youth has been scarce (Unger et al., 2000; Caplan, 2007; Zamboanga et
al., 2009).
Since the values of individualism and independence and autonomy in American
society typically begin to be explored in earnest in adolescence, Hispanic/Latino teens
who are more acculturated to U.S. society may perceive the concept of a period of
28
emerging adulthood as more relevant to their lives than less acculturated teens (Arnett,
2003). The present study applies a psychosocial theoretical model, the stress-coping
model, to explore the relationship between the socioculturally-determined construct of
identity formation in adolescence, perceptions of emerging adulthood transition stress,
and substance use (cigarette smoking, alcohol use, and marijuana use) among
Hispanic/Latino continuation (alternative) high school students.
The continuation high school setting presents a unique opportunity to study these
relationships among a subgroup of Hispanic/Latino youth. Rohrbach and colleagues
(2005) showed that youth who attended continuation (alternative) high schools in
California were more likely than national samples of youth to have taken on adult roles
such as getting married, having kids, and full-time employment in their 20’s (Rohrbach,
et al., 2005). In addition, youth attending continuation high school experiment with and
report past-month cigarette, alcohol and marijuana use at a much higher rate than regular
high school students (Sussman et al., 1995). Therefore, Hispanic/Latino adolescents
attending continuation high schools are more likely to have higher rates of substance use

and increased emerging adulthood transition stress than youth in regular high schools
(Phinney, 1996; Rohrbach et al., 2005). Findings from the present study may be used to
identify new identity formation and stress-coping determinants of substance use among
Hispanic/Latino adolescents in Southern California that can be used to develop substance
use prevention interventions (Unger et al., 2004).

29
This study seeks to address the following research questions:
1) Does the stress-coping model apply to the relationships between perceived stress,
coping and substance use among this sample of Hispanic/Latino high risk youth?
We hypothesize that coping style will moderate the association between perceived
stress and substance use. Specifically, higher levels of engagement coping
strategies will attenuate the relationship between perceived stress and substance
use. Greater use of disengagement coping will strengthen the relationship between
perceived stress and substance use.

2) Does the stress-coping model apply to the relationships between emerging
adulthood transition stress, coping and substance use among this sample of
Hispanic/Latino high risk youth? We postulate that coping style will moderate the
association between emerging adulthood transition stress and substance use.
Specifically, higher levels of engagement coping strategies will attenuate the
relationship between emerging adulthood transition stress and substance use. The
relationship between emerging adulthood transition stress and substance use will
be stronger among students with higher levels of disengagement coping.

3) Are the relationships among emerging adulthood transition stress, coping and
substance use the same across levels of acculturation in this sample of
Hispanic/Latino high risk youth? We postulate that the relationships between
emerging adulthood transition stress and substance use will be different for highly
acculturated versus less acculturated youth. Among more highly acculturated
30
youth, the relationship between emerging adulthood transition stress and
substance use will be stronger than that among less acculturated youth. Moreover,
the effect of coping on the relationship between stress and substance use may
differ between more highly and less acculturated youth.

Methods
Design
The data for the proposed study are drawn from a current trial of Project Towards
No Drug Abuse (TND). Project TND is a nationally recognized high school drug abuse
prevention program. Previous trials of TND have shown short and long-term effects of
this program on reducing cigarette smoking and other drug use among teens (Sussman,
Dent & Stacy, 2002).

The current randomized trial of project TND (Sussman, PI;
Rohrbach, Co-PI) is a longitudinal study examining the impact of a drug use prevention
program (TND) and motivational interviewing techniques on predictors of drug use
behavior from adolescence into the period of emerging adulthood. Twenty-four
continuation high schools were enrolled in the trial. Schools are grouped into clusters of 3
that are similar in enrollment, academic achievement scores, SES and percent White, and
these clusters were assigned to one of the program arms: control, TND only, TND plus
motivational interviewing. Only baseline data will be used for the purposes of this paper
and thus intervention effects will not be accounted for in our analyses.

31
Data collection
Data were collected in accordance with USC-IRB practices. Students provided
informed consent if aged 18 years and older, or provided informed assent and their
parents provided informed consent if under 18 years old. A paper and pencil survey was
administered by trained data collectors in one 50 minute classroom period at pre-
intervention. Students who were absent on the day of the survey but had provided assent
and parental consent were telephoned to complete the survey verbally with a USC data
collector.

Sample
The baseline sample size is 1671 students, which yields a sample size of 1046
Hispanic/Latino students for the proposed research (Table 1). Approximately 90% of the
students are 16-19 years old at pretest, with a mean age of 16.8 years (see Table 1). The
students are low-moderate SES with an average of less than one room per person in their
residences.

Figure 1: Theoretical Model

Emerging
Adulthood Stress
Perceptions
Perceived Stress
Disengagement Coping Engagement Coping
Marijuana Use
Alcohol Use
Cigarette Use
32

Measures

Dependent Variables. Past 30-day Cigarette, Alcohol and Marijuana Use. Each substance
used (cigarette, alcohol, marijuana) was assessed with one question asking how many
times in the past 30 days the students used it (Sussman, et al. 1995). Response options on
a Likert scale ranging from 0=none to 7=more than 100 times.

Demographics. Information was collected on age (in years), gender (male=0, female=1),
and ethnicity. Ethnicity was assessed with one question that asks the student to check
only the category that best describes their ethnic background from a choice of: “Asian or
Asian American,” “Latino or Hispanic,” “African-American or Black,” “White,
Caucasian or Anglo, European; Not-Hispanic,” “American Indian or Native American,”
“Mixed: My parents are from two different groups,” and “Other.” Only those students
who indicated that they are of Latino or Hispanic ethnic background were included in the
sample for analyses. Socioeconomic status (SES) is assessed through self-reported ratio
of rooms in home to household occupancy; response choices are on a 7-point scale from
1 to 7 for number of people with “1=I live alone,” to “7= 7 or more people” and a 7-point
response scale from 1=one room to 7=7 or more rooms.”

Perceived Stress. This scale is comprised of 4 items from Cohen et al.’s (1983) Perceived
Stress Scale, which assesses the level of perceived stress in the student’s life on a 5-point
Likert scale with responses ranging from 0=never to 4=very often (Cronbach’s
alpha=0.83).
33

Emerging Adulthood Transition Stress. This is assessed by the inventory of the
dimensions of emerging adulthood (IDEA; Reifman et al, 2001). The IDEA is a 31-item
instrument assessing six dimensions characterizing the period of emerging adulthood:
time of identity exploration, experimentation, possibility, self-focus, other-focus and
feeling in-between. Each item is on a 4 point Likert scale ranging from 1=”strongly
disagree” to 4=”strongly agree”. This study employed a 21-item version of the scale
which assessed the five dimensions of time of identity exploration, experimentation,
possibility, self-focus and feeling in-between. Bivariate correlation analyses show that
this measure is statistically significantly positively associated with perceived stress
(r=0.16, p<0.001), indicating this is a related, yet distinct construct.

Coping. This construct is assessed by a 12-item measured adapted from Wills (1986).
Students are instructed to think of how they usually handle a problem when they
encounter one and are asked to mark how often they use each strategy listed. This
measure assesses four dimensions of coping: behavioral, parent support, anger, and
avoidant. Three items represent each dimension, with response options ranging from
1=“never do this” to 5=”almost always do this”. These scales are combined into two
scales reflecting coping styles: engagement (behavioral and parent support) and
disengagement (avoidant and anger) coping, and both demonstrate high internal
consistency (Cronbach’s alpha=0.82 and 0.78, respectively).

34
Acculturation. Acculturation status was measured by four items derived from a scale by
Marin and Marin (1991) that assesses English and other language use. Items that
comprise the scale: “In general, what language(s) do you most often read and speak?”
“What language(s) do you usually speak with your friends?” “In what language(s) are the
movies, TV and radio shows you like to watch and listen to?” “What language(s) do you
usually speak at home?” The response scale ranges from 1= only English to 5=only
another language, which was reversed so that increasing value corresponds to increasing
English language use. An average of the four items is taken to indicate the extent to
which the student uses English and orients towards English-speaking media.

Control variables. Adult role taking behaviors were included as covariates for their
potential to confound the associations between the independent and dependent variables.
Parental status (yes=1, no=0), marital status (yes=1, no=0), and job status (working full-
time or part-time=1, not employed=0).

Data Analysis
SAS version 9.2 was used to conduct the analyses of basic univariate, bivariate
statistics and regression analyses. The dataset utilized in this study was cleaned (e.g.,
elimination of duplicate ID’s, uncoded responses) and organized prior to undertaking any
statistical analyses. Descriptive statistics were estimated and used to describe the
characteristics of the sample (Table 1). Bivariate relationships were estimated to
determine collinearity among independent variables and establish unique relationships
among the variables of interest. No evidence of collinearity was found among the
35
independent variables as none of the correlations is above 0.60. The covariates of age,
gender, and SES were chosen because they are known to be associated with drug use
among adolescents and are typical control variables in studies of drug use among
adolescents. Also, adult role-taking variables of having a job, being married, and being a
parent are included as covariates due to precedence from another study of emerging
adulthood with Hispanic/Latino emerging adults (Arnett, 2003) and due to significant or
marginally significant associations with past 30-day cigarette smoking.
Each of the dependent variables was analyzed as a continuous variable. Although
this sample has a relatively high prevalence of past 30-day use of each of the three drug
use outcomes (38.7% for cigarettes, 59.8% for alcohol, and 45.7% for marijuana, Table
1), the distribution remains skewed toward no or very little use in the past 30-days, thus a
log transformation of each outcome variable was employed. The independent variables
are a mixture of continuous and dichotomous. Due to the type of design for this study,
which includes data from high school students nested within schools, multilevel linear
regression techniques using PROC MIXED in SAS (v. 9.2) (Singer, 1998) were
employed. To test the moderation by coping strategies of the relationship between
emerging adulthood transition stress and substance use the methodology in Baron and
Kenny (1986) was utilized. This methodology entails including interaction terms of each
coping variable and perceived stress (Disengagement coping*perceived stress,
engagement coping*perceived stress) and emerging adulthood transition stress
(Disengagement coping* emerging adulthood transition stress, engagement coping*
emerging adulthood transition stress) into the multilevel regression equations. All
regression analyses are controlled for age, gender, adult role-taking and SES.
36
Results
Findings regarding how the stress-buffering model applies to perceived stress, emerging
adulthood transition stress and substance use among this sample
The multilevel linear regression provided mixed support for the stress-buffering
model proposed in this study. Perceived stress was statistically significantly associated
cigarette smoking but not with alcohol or marijuana use (table 2). Emerging adult
transition stress was statistically significantly positively associated with past 30-day use
of cigarettes, alcohol and marijuana (all p’s<0.01). Engagement coping was statistically
significantly inversely associated with past 30-day use of cigarettes, alcohol and
marijuana (all p’s < 0.05) and disengagement coping was statistically significantly
positively associated with past 30-day use of cigarettes, alcohol and marijuana (all p’s<
0.05). There was some support for the moderation of the relationship between perceived
stress and drug use by coping. There was only one significant interaction between
perceived stress and disengagement coping in the cigarette use model (p<0.01). At levels
of high perceived stress, study participants who reported using more disengagement
coping were more likely to have used cigarettes in the past 30-days than those who
reported less use of disengagement coping.

Findings regarding how the stress-buffering hypothesis applies to emerging adulthood
transition stress, coping and substance use among this sample
There was also some support for the stress-buffering hypotheses regarding
emerging adulthood transition stress and coping. There was a significant interaction
effect between disengagement coping and emerging adult transition stress in the model
37
examining past 30-day use of marijuana (p<0.05). However, this interaction is opposite
what was hypothesized a priori. We found that at high levels of emerging adulthood
transition stress, adolescents who used more disengagement coping had less marijuana
use than those who reported lower levels of disengagement coping.
Table 1: Demographics of Study Sample and Descriptive Statistics on Independent
Variables (n=1046)

Variable
Mean (SD),
Median or
Percent (%)
Gender (% Male) 57.3
Age (years) 16.8(0.95)
SES (rooms per person) 0.65(0.45)
Live with both parents (%) 56.7
Employed (%) 19
Married (%) <1
Is a parent (%) 5.9
Acculturation level (English Language Use)
1
(median) 4.0
High Acculturation Level
2
(mean) 4.51(0.40)
Low Acculturation Level
2
(mean) 3.25(0.44)
Perceived Stress
3
(mean) 2.78(1.06)
Emerging Adulthood Transition Stress (mean) 3.32(0.51)
Engagement Coping
3
(mean) 3.13(0.95)
Disengagement Coping
3
(mean) 2.41(0.84)
Past 30-day Cigarette Smoking (%) 38.7
Past 30-day Alcohol Use (%) 59.8
Past 30-day Marijuana Use (%) 45.7

1
Five-point scale (1=uses another language to 5=uses English only)
2
High acculturation group (n=448)= acculturation level is equal to or above the median of 4.0; low
acculturation group (n=454)=acculturation level is below the median of 4.0.
3
Five-point scale (low to high)
4
Four-point scale (low to high)

38
Table 2: Multilevel linear regression of each past-30 day drug use outcome:
cigarettes, alcohol and marijuana on independent variables (n=1046)

Predictor Past 30-day
Cigarette Use
1

Past 30-day
Alcohol Use
1

Past 30-day
Marijuana Use
1

Std. Beta (β)(se) Std. Beta (β)(se) Std. Beta (β)(se)
Perceived stress 0.05 (0.02)** 0.01 (0.01) 0.004 (0.02)
Emerging adulthood
(EA) transition
stress

0.04 (0.01)**

0.04 (0.01)***

0.04 (0.02)*
Engagement coping -0.05 (0.01)*** -0.05 (0.01)*** -0.06 (0.02)**
Disengagement
coping

0.02 (0.02)

0.04 (0.01)***

0.04 (0.02)*

NOTE:
1
Past 30-day drug use outcomes are log-transformed. All analyses are controlled for age,
gender, parental status, marital status, employment status, SES
*p<0.05, **p<0.01, ***p<0.001.

Table 3: Multilevel linear regression of each past-30 day drug use outcome:
cigarettes, alcohol and marijuana on independent variables and interaction effects
between emerging adulthood transition stress and coping

Predictor Past 30-day
Cigarette Use
1

Past 30-day
Alcohol Use
1

Past 30-day
Marijuana Use
1

Std. Beta (β)(se) Std. Beta (β)(se) Std. Beta (β)(se)
Perceived stress 0.04 (0.02)** 0.01(0.01) -0.001(0.02)
Emerging adulthood (EA)
transition stress
0.03(0.02)* 0.04(0.01)** 0.03(0.02)
Engagement coping -0.05(0.01)*** -0.05(0.01)*** -0.06(0.02)***
Disengagement coping 0.02(0.02) 0.05(0.01)** 0.06(0.02)**

Perceived stress x Engagement
Coping
-0.002(0.01) -0.01(0.01) -0.004(0.02)
Perceived stress x
Disengagement Coping
0.03(0.01)* 0.02(0.01) 0.03(0.02)
EA transition stress x
Engagement Coping
-0.002(0.01) -0.003(0.01) -0.003(0.02)
EA transition stress x
Disengagement Coping
-0.02(0.01) -0.02(0.01) -0.06(0.02)***
NOTE:
1
Past 30-day drug use outcomes are log-transformed. *p<0.05, **p<0.01, ***p<0.001.
All analyses are controlled for age, gender, parental status, marital status, employment status,
SES

39
Findings regarding how the stress-buffering model applies across levels of acculturation
in this sample
The results show a slightly different pattern between the two groups; however, the
analyses of interaction effects after stratifying by acculturation level reflect similar
relationships to the findings among the entire sample.

Less acculturated group
Among the less acculturated group, perceived stress was only statistically
significantly positively associated with past 30-day cigarette smoking (p<0.05).
Emerging adulthood transition stress was statistically significantly positively associated
with alcohol use (p<0.01) and marijuana smoking (p<0.05), but not with cigarette
smoking. Engagement coping was statistically significantly inversely associated with all
three drug use outcomes (all p’s<0.05). Disengagement coping was not statistically
significantly associated with any of the three drug use outcomes.

More highly acculturated group
In the first set of multilevel linear regression models, perceived stress was not
statistically significantly associated with any of the three drug use outcomes (cigarettes,
alcohol and marijuana). However, emerging adulthood transition stress was statistically
significantly positively associated with past 30-day cigarette smoking (p<0.05).
Engagement coping was statistically significantly inversely associated with cigarette
smoking (p<0.01) and marijuana use (p<0.05). Disengagement coping was statistically
40
significantly positively associated with alcohol use (p<0.001) and marijuana smoking
(p<0.05) but not statistically significantly associated with cigarette smoking.
Table 4: By acculturation status: multilevel linear regression of each past-30 day
drug use outcome: cigarettes, alcohol and marijuana on independent variables
Predictor Past 30-day
Cigarette Use
1

Past 30-day
Alcohol Use
1

Past 30-day
Marijuana Use
1

Std. Beta (β)(se) Std. Beta (β)(se) Std. Beta (β)(se)
High Acculturation
Group (n=448)

Perceived stress 0.03(0.01) -0.01(0.01) 0.01(0.02)
Emerging adulthood
(EA) transition
stress
0.04(0.01)* 0.03(0.01) 0.01(0.02)
Engagement coping -0.05(0.01)** -0.03(0.01) -0.06(0.02)*
Disengagement
coping
0.03(0.01) 0.08(0.01)*** 0.07(0.02)*

Low Acculturation
Group (n=454)

Perceived stress 0.05(0.01)* 0.03(0.01) -0.01(0.02)
Emerging adulthood
(EA) transition
stress
0.04(0.01) 0.05(0.01)** 0.05*
Engagement coping -0.05(0.01)* -0.06(0.01)*** -0.06(0.02)*
Disengagement
coping
0.02(0.01) 0.01(0.01) 0.03(0.02)
NOTE:
1
Past 30-day drug use outcomes are log-transformed. *p<0.05, **p<0.01, ***p<0.001.
All analyses are controlled for age, gender, parental status, marital status, employment status,
SES

Interaction Effects in the Stratified Analyses by Acculturation Level
Less acculturated group
In the model predicting past 30-day cigarette smoking, there was a statistically
significant positive interaction between perceived stress and disengagement coping
(p<0.001). Among the high users of disengagement coping, increased perceived stress
was associated with increased cigarette smoking. Similar to the more highly acculturated
41
group, in the model predicting past 30-day use of marijuana, we found a significant
negative interaction between emerging adulthood transition stress and disengagement
coping (p<0.05). Among high users of disengagement coping, increased emerging
adulthood transition stress was associated with less marijuana use.

More highly acculturated group
In the model predicting past 30-day alcohol use, there was a statistically
significant positive interaction between perceived stress and disengagement coping
(p<0.05). Among the high users of disengagement coping, increased stress was
associated with increased alcohol use. Also, in the model predicting past 30-day use of
marijuana, there was a significant negative interaction between emerging adulthood
transition stress and disengagement coping (p<0.05). Among high users of
disengagement coping, increased emerging adulthood transition stress was associated
with less marijuana use.

42

Table 5: By acculturation status: multilevel linear regression of each past-30 day
drug use outcome: cigarettes, alcohol and marijuana on independent variables with
interaction effects between emerging adulthood transition stress and coping
Predictor Past 30-day
Cigarette Use
1

Past 30-day
Alcohol Use
1

Past 30-day
Marijuana Use
1

Std. Beta (β)(se) Std. Beta (β)(se) Std. Beta (β)(se)
High Acculturation Group
(n=448)

Perceived stress 0.04(0.01) -0.02(0.01) 0.004(0.02)
Emerging adulthood (EA)
transition stress
0.04(0.01) 0.02(0.01) 0.004(0.02)
Engagement coping -0.06(0.01)** -0.03(0.01) -0.06(0.02)*
Disengagement coping 0.03(0.01) 0.08(0.01)*** 0.08(0.02)**
Perceived stress x Engagement
Coping
0.03(0.01) -0.03(0.01) 0.01(0.02)
Perceived stress x
Disengagement Coping
-0.01(0.01) 0.04(0.01)* 0.03(0.02)
EA transition stress x
Engagement Coping
0.004(0.01) -0.02(0.01) -0.02(0.02)
EA transition stress x
Disengagement Coping
-0.03(0.01) -0.03(0.01) -0.07(0.02)*

Low Acculturation Group
(n=454)

Perceived stress 0.05(0.01)* 0.04(0.01) 0.01(0.02)
Emerging adulthood (EA)
transition stress
0.03(0.01) 0.04(0.01)* 0.04(0.02)
Engagement coping -0.05(0.01)** -0.06(0.01)*** -0.06(0.02)*
Disengagement coping 0.02(0.01) 0.01(0.01) 0.04(0.02)
Perceived stress x Engagement
Coping
-0.02(0.01) -0.01(0.01) -0.01(0.02)
Perceived stress x
Disengagement Coping
0.06(0.01)*** 0.005(0.01) 0.03(0.02)
EA transition stress x
Engagement Coping
0.00002(0.01) 0.004(0.01) -0.01(0.02)
EA transition stress x
Disengagement Coping
-0.01(0.01) -0.01(0.01) -0.05(0.02)*
NOTE:
1
Past 30-day drug use outcomes are log-transformed. *p<0.05, **p<0.01, ***p<0.001.
All analyses are controlled for age, gender, parental status, marital status, employment status,
SES

43
Chapter 2 Discussion
The results of this study demonstrate that the salience of the emerging adulthood
transition, conceptualized as a stressor, is statistically significantly associated with the
three most common types of substance use in adolescence, after controlling for relevant
socio-demographic factors (Table 2). In addition, the finding that perceived stress is
positively associated with perceptions of the emerging adulthood transition supports this
stress-framing of this emerging adulthood construct.

Relationship between perceived stress, coping and substance use
This study applied stress-coping theory to the relationship between perceived
stress, emerging adulthood transition stress and substance use. Two types of coping were
tested: engagement and disengagement coping. In accordance with previous findings in
the adolescent substance use literature, the main effects of both types of coping were
statistically significantly associated with each of the three substance use outcomes in the
expected directions (Wills, 1986; Wills et al., 2001; Sussman & Dent, 2000).
Disengagement coping was found to be positively associated with all three substance use
outcomes. Conversely, engagement coping was inversely associated with the use of all
three substances in that greater use of engagement coping mechanisms was associated
with less substance use.
Moreover, a stress-buffering model extrapolated from stress-coping theory
(Cohen & Wills, 1985) was operazationalized to investigate stress-buffering effects of
engagement coping; whether greater engagement coping weakened the relationship
between stress and substance use. There were no statistically significant interactions
44
between engagement coping and either perceived stress or emerging adulthood transition
stress in any of the stress-buffering substance use models (cigarettes, alcohol, marijuana).
However, we also investigated the potential exacerbating effect of disengagement coping
on the relationship between perceived stress and substance use and emerging adulthood
transition stress and substance use and found some significant results (Tables 2 and 3).
With respect to perceived stress and cigarette use, the results were in the expected
direction, with high levels of disengagement coping exacerbating the relationship
between perceived stress and cigarette use. However, in the model predicting marijuana
use, the statistically significant interaction effects between emerging adulthood transition
stress and disengagement coping showed an opposite effect than hypothesized.

Emerging Adulthood Transition Stress, Coping and Substance Use
We were surprised to find that at higher levels of emerging adulthood transition
stress, adolescents who used more disengagement coping had less marijuana use than
those who reported lower levels of disengagement coping. However, this finding may be
explained by a particular aspect of Folkman and Lazarus’ stress coping theory and some
findings in the developmental psychology literature about the transition from adolescence
to emerging adulthood (Hussong & Chassin, 2004). Folkman and Lazarus’ (1980, 1985)
coping research that shows that when the stressor is perceived as more controllable, the
person is more likely to confront it with active or problem solving strategies. Conversely,
when the stressor is appraised as highly uncontrollable and at least moderately
threatening to the individual, one will employ avoidant coping strategies. In this way, the
selection of all coping strategies, and their effectiveness, will depend on appraisal of the
45
stressor as controllable or uncontrollable and its duration as acute or chronic (Folkman
and Lazarus, 1980). Although, in previous stress-coping and drug use studies with youth
higher stress and high levels of avoidant coping is associated (or predicts) greater
substance use, it is possible that the unique features of the emerging adulthood transition
engenders a different coping response and behavioral outcomes, where using more
avoidant coping is not a risk factor for engaging in substance use.
Also, it is possible that the adolescents in this study (mean age 16.8 years) have
not been experiencing the emerging adulthood period long enough to get an accurate idea
of the relationship between emerging adulthood transitions stress and substance use. In
the case of a chronic stressor of indeterminate duration, such as the emerging adulthood
transition, an adolescent may attempt the use of one coping strategy after another in order
to find those that meet the demands placed on him/her by the stressor. Eventually, if
demand for coping strategies exceeds the supply of coping strategies and if the coping
strategies are seen as ineffective at removing or managing the stressor, then
psychological distress and/or substance use may result (Lazarus and Folkman, 1984).
Since these adolescents are at the very beginning of this developmental period, the
salience of the construct may not be great enough, nor have coping strategies been
rendered ineffective yet. More research is needed to explore and test these relationships
to determine if these are anomalous findings. Moreover, these hypotheses should be
tested with all ethnic groups to determine the cross-cultural specificity of the findings.
Another potential explanation for these results can be found in the psychology
literature examining stress and coping, particularly by researchers studying in the
emerging adulthood transition. These investigators have examined the use of both
46
adaptive and maladaptive coping strategies to deal with the same stressor by examining
the flexibility in the use of coping styles and its relationship to adjustment and
psychological distress (Thoits, 1995; Frydenberg & Lewis, 1993, 1999). Cheng (2003)
examined the issue of flexibility in the use of coping strategies among adults and found
that persons who use more coping strategies tended also to be able to appraise the stressor
in a variety of ways. In the Cheng (2003) study this flexible coping style was positively
correlated to good adjustment. One study examined the relationship between coping
styles as well as the coping styles’ relationship to substance use among adolescents
(Wills et al., 2001). They find that at higher levels of stress, total coping efforts were
greater and behavioral coping buffered the effects of disengagement coping on substance
use. Thus, increasing one’s ability to muster a response and try several coping strategies
to resolve problems, even if they include disengagement strategies, may ameliorate the
exacerbating effects of disengagement coping on substance use risk. Hussong and
Chassin (2004) also provide support for the hypothesis that impact of high total coping
produces an overall adaptive process into young adulthood. In models predicting
substance use, there was a stronger relationship between major life stress and substance
use in young adulthood at low levels of both active and avoidant coping, thus indicating
that a greater comprehensive (total) coping response may be more protective against
substance use with this type of stressor (Hussong & Chassin, 2004).

Acculturation and the Emerging Adulthood Transition
With respect to the comparison of the two groups of adolescents, as defined by
English language acculturation, we find that perceived stress and emerging adulthood
47
transition stress have different relationships with the three drug use outcomes. In the less
acculturated group, emerging adulthood transition stress is statistically significantly
associated with alcohol and marijuana use. By contrast, emerging adulthood transition
stress is only associated with cigarette smoking among more highly acculturated youth.
Contrary to what we hypothesized, our findings suggest that the emerging adulthood
transition stress is a more important factor to explain alcohol and marijuana use among
the less acculturated youth. Despite the departure from a priori hypotheses, findings in
the sociocultural stress and drug use literature may assist in contextualizing these results
(Szapocznik et al., 1986; Schwartz et al, 2005). It is possible that going through this
transition with a language barrier leads to one perceiving more stress from the entire
experience and thus strengthens the stress and substance use relationship. Although the
more highly acculturated youth may be taking on more adult responsibilities in the home,
such as interpreting and reading English for their parents, it is possible that the
experience may be less stressful because of their English language skills. More research
is needed with additional acculturation and family constructs to further investigate and
contextualize these findings.
Among less acculturated adolescents, engagement coping was consistently
inversely associated with all three drug use outcomes but avoidant coping was not
statistically significantly associated with any of the three drug use outcomes. A few
studies have examined the ethnic differences in use of coping strategies. For example,
Vaccaro and Wills’ (1998) found that African American and Hispanic/Latino youth use
less avoidant coping than youth of other racial/ethnic groups in the study. Among
traditional Hispanic/Latino families, the extended family is a source of support and
48
structure and parents are to be respected and obeyed (Unger et al., 2004). The extended
family structure is typically collectivist in nature, ensuring the respect and care of elders
and extended family members living together for much of their lives. In Hispanic/Latino
cultures, the values of respeto, deference to adults and elder authorities, and the value of
familismo, serving the family’s needs above others (peers, strangers) would likely
influence an adolescent’s selection of coping strategies when dealing with most problems
(Unger et al., 2000). The engagement coping style, particularly the strategy of seeking
social support from parents or family would likely be used frequently, while the anger
coping strategy would likely be used less frequently because it could be seen as
disrespectful (if done in front of adults). Therefore, it is plausible that less acculturated
Hispanic/Latino adolescents would be more likely to use more adult support-seeking
strategies and less anger/ventilating coping strategies than White teens, as acting out
against parents would be considered more unacceptable and disrespectful in the
Hispanic/Latino culture. Further support is provided in the finding that disengagement
coping was statistically significantly associated with alcohol and marijuana use among
the more highly acculturated youth. These results suggest that use of disengagement (i.e.,
avoidant) coping may be more relevant to the etiology of substance use among more
highly acculturated youth.

Limitations
This study is cross-sectional and thus we cannot control for predisposing factors
or pre-existing levels of the substance use variables that could contribute to the
49
associations we found. Thus these findings should not be used to extrapolate a trajectory
of use.
The study employs a novel conceptualization of the salience of the emerging
adulthood transition as a stress factor, and although its positive correlation with the short-
form of the Perceived Stress Scale (Cohen et al., 1983) employed in this study provides
some validation, further research is needed to test this measure psychometrically,
especially through construct validity tests with validated stress measures. I developed the
hypotheses of these perceptions as a stress factor through a careful examination of the
sociocultural stress literature and the burgeoning literature on the emerging adulthood
period.
The coping scales used in this study may not capture the entire range of coping
mechanisms used by our adolescent participants, as they were truncated to reduce burden
on participants. Also, the use of the coping strategies was not assessed in specific
reference to how one copes with the emerging adulthood transition as a stressor.
Therefore, we are inferring that an adolescent’s usual coping activities are applied with
equal frequency across stressors, which may not be the case. The stress-coping literature
indicates that a person may employ different coping mechanisms based on the
characteristics of the stressor and the level of perceived threat posed by the stressor
(Lazarus & Folkman, 1984). It is possible that assessing a general coping style across
stressors may obscure some associations between the use of certain coping strategies and
the relationship between emerging adulthood transition stress and substance use.
This study was conducted only with Hispanic/Latino adolescents in continuation
high schools and thus the findings are only generalizable to similar populations of
50
adolescents. More research should be conducted investigating comparisons among
different race/ethnic groups and among regular high school students. In addition, English
language use was the sole measure of acculturation level in this study. Although this is a
robust and validated indicator variable for acculturation level (Marin & Marin, 1991), we
may have not been able to detect all significant effects due to the unmeasured aspects of
the acculturation construct. Moreover, considering that identity exploration during the
emerging adulthood transition occurs in a context of the increasing importance of peers
and peer relationships, future research should also incorporate peer-context variables.

Conclusion
To the best of the author’s knowledge, this study represents the first examination
of the salience of the transition to emerging adulthood among high-risk Hispanic/Latino
adolescents. Based on the findings of this study we can conclude that the transition from
late adolescence to emerging adulthood may be a vulnerable period for adolescents with
regard to their experimentation with substances and possibly escalation of drug use.
Although this study provides some limited evidence on which to base future intervention
efforts with late adolescents, further research should be conducted to determine the extent
of the stress perceptions and possible effects later into the period of emerging adulthood.

51
CHAPTER 3: STUDY 2: CULTURAL STRESS FACTORS AND
COPING IN THE PREDICTION OF CIGARETTE SMOKING, ALCOHOL AND
MARIJUANA USE FROM 9
TH
TO 11
TH
GRADE AMONG HISPANIC/LATINO
HIGH SCHOOL STUDENTS

Chapter 3 Abstract
Introduction: This study investigated the prediction of past 30-day substance use from a
set of sociocultural stress factors (acculturative stress, parent-adolescent acculturation
discrepancy) among a Hispanic/Latino sample of regular high school students. A model
of stress and coping was applied to evaluate the role of coping strategies to buffer the
effect of cultural stress on substance use.
Methods: Students enrolled in the larger parent study, Project RED, were administered a
survey annually, from 9
th
to 11
th
grade. The analyses conducted for the present study
utilized data collected at baseline and two-year follow-up (n=1546). Multilevel regression
equations were modeled separately for the prediction of each past 30-day substance use
variable. Analyses of main and interaction effects among the predictors and coping styles
were conducted separately for each substance use outcome.
Results: Acculturative stress statistically significantly predicted past 30-day smoking
(p<0.05) and parent-adolescent acculturation discrepancy marginally predicted cigarette
smoking (p<0.10). Analyses of interaction effects between the stressors and coping
revealed that engagement coping moderates the relationship between acculturative stress
and cigarette smoking and marijuana use There were also statistically significant
interaction effects between disengagement coping and parent-adolescent acculturation
discrepancy in all three substance use models.

52
Chapter 3 Introduction
The Hispanic/Latino population is the most rapidly growing ethnic minority group
in the United States and California has one of the largest populations of Hispanic/Latinos
in the U.S. (39.5%, U.S. Census, 2010). This ethnic group has a very high proportion of
children and teens compared to non-Hispanic whites (33.4% v. 22.4%, Census Bureau,
2010). Given the projected demographic increases in the U.S. Hispanic/Latino
population, it is of increasingly vital importance to improve our understanding of the
factors that affect health behaviors among Hispanic/Latino adolescents. Much of the
health behavior research with this population has focused on acculturation as a
determinant of health behavior, such as substance use. Several studies have found an
association between increasing acculturation and increased substance use among
Hispanics/Latinos in the U.S. (Unger et al., 2000; Epstein, Botvin & Diaz, 2001; De La
Rosa, 2002). Substance use remains a prominent negative health behavior among
Hispanic/Latino adolescents that has severe morbidity and mortality consequences
(Johnston et al., 2008). Tobacco, alcohol and marijuana use are higher among
Hispanic/Latino adolescents in 8
th
grade than White and African American adolescents in
8
th
grade (Johnston et al., 2008). In California, Hispanic/Latino adolescents have the
second-highest prevalence rate of past-month smoking, while Whites have the highest
rate: 14.0% and 18.3%, respectively (CDHS, 2007).
Research investigating the culturally-based factors in the etiology of substance
use among adolescent Hispanics/Latinos is important to the discovery of effective
prevention strategies for this group. There are several understudied and important aspects
of culturally-based stress, especially the experience of acculturative stress, which may be
53
examined from a stress-coping perspective. This paper investigates two aspects of
culturally-based stress that have been found to be associated with substance use:
acculturative stress and parent-adolescent acculturation discrepancy. There is a dearth of
research on the stress-coping relationship to substance use among ethnically diverse
populations and cultural factors that may influence the selection of coping strategies
(Suarez-Moralez & Lopez, 2009; Dillon & Szapocznik, 2007; Compas et al., 2001).
Moreover, stress-coping theory (Folkman & Lazarus, 1985; Wills, 1986; Wills & Hirky,
1996) has not yet been applied to investigate the relationships among acculturative
stressors and substance use in Hispanic/Latino youth (Suarez-Moralez & Lopez, 2009,
Dillon & Szacopznik, 2007).
One pathway from acculturation to drug use may be through the experience of
culturally-based stress, which may include acculturative stress and parent-child
acculturation discrepancy (Rodriguez et al., 2002). As noted in a recent special issue on
acculturation, acculturative stress and health (Suarez-Moralez & Lopez, 2009),
Hispanic/Latino youth, experience more stressors than White youth due to their
concentration in moderately disadvantaged situations. Acculturative stress is defined as
stress produced by efforts to adopt the host culture and integrate into the host culture.
These efforts may be fraught with challenges in learning a new language and customs, or
surmounting effects of discrimination by the host community (Berry & Kim, 1988). This
construct has been conceptualized in several ways, with the predominant concept being
one’s perceptions of how stressful it is to adapt to the host culture and assimilate new
values and belief systems into one’s own cultural perspective. Although studies have
investigated acculturative stress and its relationship to maladjustment and negative health
54
behaviors with Hispanic/Latino adults over the past 10 years (Hovey & Magnana, 2000;
Crocket et al., 2005; Suarez-Moralez & Lopez, 2009), few studies have examined these
constructs among adolescent populations (Hovey & King, 1996; Szapocznik et al., 1986;
Siqueira et al., 2000; Vega et al., 2003; Unger et al., 2009).
Another culturally-based stressor that may contribute to Hispanic/Latino
adolescents’ risk of substance use is the discrepancy between the parent’s and
adolescent’s acculturation levels, or their respective views on the extent to which they are
acculturated (Szapocznik et al., 1986; Romero & Roberts, 2003) Adolescents explore and
determine how to reconcile their experiences of acculturating in the U.S. culture with that
of their parents (Unger et al. 2004; Escobar & Vega, 2000; Szapocznik et al., 1986).

The
experience of the parent-adolescent acculturation discrepancy may be stressful to the
adolescent, and may result in internalizing (e.g., depression) or externalizing (e.g.,
substance use) behaviors (Unger et al. 2004; Romero & Roberts, 2003; Szapocznik et al.,
1986; Guinn & Vincent, 2002; Nezami et al., 2005). Hispanic/Latino adolescents in
California are primarily first or second generation offspring of Mexican or Latino
immigrants. Their experience of the process of acculturation to U.S. society involves
integrating their ethnic identity with the cultural values of the U.S. (Nezami, et al., 2005).
The traditional Hispanic/Latino cultural values such as familism, the centrality of the
family in decision making and focus on family connectedness, and respeto, respect for
one’s elders and authority figures are important aspects of Hispanic/Latino ethnic identity
(Unger et al., 2004). Acculturative stress caused by the perceived difficulty of
acculturating or by parent-adolescent acculturation discrepancies may occur through an
impairment of familism, which has been found to be protective against smoking and other
55
drug use for young Hispanic/Latinos (Gil, Wagner & Vega, 2000; Unger et al., 2004;
Farley et al., 2005; Rasmussen, Aber & Bhana, 2004; Caplan, 2007). In addition,
acculturative stress may be produced in very concrete, less subjective, ways. Despite
having been born here, Hispanic/Latino youth are often put in adult or care-taking roles
by their less acculturated parents, many of whom have language barriers (Schwartz et al.,
2005). Therefore, these youth are likely to be expected to take on a greater responsibility
for caring for the family or helping their parents navigate and fulfill adult roles than non-
Hispanic youth of their age (Schwartz et al., 2005).
The current study attempts to address knowledge gaps in the field of etiological
adolescent substance use research by examining the relationships among acculturative
stress, coping strategies, and substance use among Hispanic/Latino adolescents.
Specifically, this study tests the following hypotheses:
• Acculturative stress and parent-child acculturation discrepancy at baseline will
be positively and directly related to substance use (past 30-day cigarette, alcohol
and marijuana use) at two-year follow-up.
• Reporting a greater degree of Hispanic/Latino cultural identity at baseline will be
a protective factor for substance use at 2-year follow-up.
• Coping styles will moderate the associations between acculturative stress at
baseline and substance use at 2-year follow-up. Greater use of engagement
coping strategies will attenuate the relationship between acculturative stress at
baseline and substance use at 2-year follow-up. Conversely, greater use of
disengagement coping will exacerbate the relationship between acculturative
stress at baseline and substance use at 2-year follow-up.
56
• Coping styles will moderate the association between parent-child acculturation
discrepancy at baseline and substance use at 2-year follow-up. Greater use of
engagement coping strategies will attenuate the relationship between parent-child
acculturation discrepancy at baseline and substance use at 2-year follow-up.
Whereas, greater use of disengagement coping will exacerbate the relationship
between parent-child discrepancy at baseline and substance use at 2-year follow-
up.

Methods
Subjects and Procedure
These data were collected as part of an etiological study, Project RED
(Reteniendo y Entendiendo Diversidad para Salud), which is a longitudinal study of
acculturation and psychosocial correlates of substance use among Hispanic/Latino
adolescents in Southern California. The respondents in Project RED were 9
th
grade
students attending seven high schools in the Los Angeles area. Because the study focuses
on Hispanic/Latino adolescents, schools were approached and invited to participate if
they contained at least 70% Hispanic students, as indicated by data from the California
Board of Education. Efforts were also made to obtain a sample of schools with a wide
range of socioeconomic characteristics. The median annual household incomes in the
ZIP codes served by the schools we approached ranged from $29,000 to $73,000,
according to 2000 U.S. Census data. Of the 31 schools approached, eight agreed to
participate and one school was eliminated due to scheduling conflicts. Therefore,
students from the remaining seven schools participated in the study. Approval was
57
obtained from the school principals and/or district superintendents, according to their
established procedures.
The surveys conducted for this longitudinal study began in the Fall of 2005 and
ended the Fall of 2008. At baseline, in 2005, all ninth-grade students in the school were
invited to participate in the survey. Trained research assistants visited the students'
classrooms, explained the study to the students, and distributed parental consent forms
and student assent forms. To increase the return rate of consent forms, each classroom
was offered a pizza party if every student in the class returned the forms, regardless of
whether the parents said yes or no. Parents who did not return the consent forms were
contacted by telephone in the evenings by a bilingual research assistant to obtain verbal
consent or refusal. Students were allowed to participate if they provided written or verbal
parental consent and student assent. All procedures, including informed consent, were
approved by the university's Institutional Review Board.
Across the seven schools, 3218 students were invited to participate. Of those,
2420 (75%) provided parental consent and student assent. Of those, 2225 (92%)
completed the survey at pretest. Of those, 1967 (86%) self-identified as Hispanic or
Latino or reported a Latin American country of origin. Of those, 1546 (79%) provided
data at both baseline and two-year follow-up for the variables in the present study
For each assessment session, the data collectors administered surveys to all
students who had provided parental consent and student assent. The classroom teachers
were present during survey administration, but the data collectors instructed them not to
participate in the survey process to ensure that they would not inadvertently see the
students' responses. To help students with low literacy skills, the data collectors also read
58
the entire survey aloud during the class period. Surveys were available in English and
Spanish; however, only 17 students (0.8%) chose to complete the survey in Spanish.

Measures
Outcome variables
Past 30-day cigarette smoking, alcohol, and marijuana use. At both baseline and two-
year follow-up, three separate questions measured how many times in the past 30 days
the students used each substance. For cigarette and alcohol use, the response options were
on a Likert scale ranging from 0=zero days to 2=1-2 days to 6 =all 30 days. For
marijuana smoking, the response options was on a Likert scale ranging from 0=none to
6=40 or more times.
Independent Variables
Acculturative stress. This variable was measured at baseline with two questions: “I have
problems with my family because I like to do things the American way” and “I get upset
with my parents because they don’t understand the American lifestyle.” Students
provided responses on a 4 point Likert scale of how often this applies to them (1=never to
4=very often). Internal consistency was high between these items (Cronbach’s
alpha=0.75).
Parent-Adolescent Acculturation Discrepancy.
Adolescents’ and Perceived Parents’ Cultural Orientations. A measure was
created by adapting questions from existing self-report acculturation scales. Adolescents
responded to 12 items from the ARSMA-II (Cuellar, Arnold, & Maldonado, 1995): 7
from the Anglo orientation subscale and 5 from the Hispanic orientation subscale. These
59
12 items were selected based on a pilot study in a similar school, in which these items
had the highest factor loadings on their respective scales. Recently, a shorter version of
the ARSMA-II was validated among adolescents (Bauman, 2005). Sample items include
“I speak English at home” “I follow the American way of life” “I follow the Hispanic or
Latino way of life.” Response options were code from 1 to 4, where 1=“strongly
disagree,” to 4=“strongly agree.” Students provided assessment of their parents’
U.S./White cultural orientation and Hispanic/Latino cultural orientation. These were
assessed using the same questions as the students’ self-assessment items. The following
items assessed parents’ U.S./White cultural orientation: “My parents want me to speak
English at home,” “My parents want me to speak English outside the home,” “My parents
want me to live by or follow the U.S./White way of life,” “My parents want me to be a
success in the U.S./White way or life.” The following items assessed parents’ Hispanic
cultural orientation: “My parents want me to speak Spanish at home,” “My parents want
me to speak Spanish outside the home,” “My parents want me to live by or follow the
Hispanic or Latino way of life,” and “My parents want me to be a success in the Hispanic
or Latino way or life.” Response options were code from 1 to 4, where 1=“strongly
disagree,” to 4=“strongly agree.” The Cronbach’s alphas were .69 for the parents’
U.S./White cultural orientation scale and .86 for the parents’ Hispanic orientation scale.
Parent-Adolescent Acculturation Discrepancy Score.
The adolescents’ self-reported acculturation scores and their perceptions of their
parents’ acculturation were used to compute parent-child acculturation discrepancy
scores. Two scores were calculated: discrepancy in U.S. orientation and discrepancy in
Hispanic orientation. The U.S. discrepancy score was the adolescent’s U.S. orientation
60
minus the students’ perceived parents’ U.S. orientation. The Hispanic discrepancy score
was the adolescent’s Hispanic orientation minus the students’ perceived parents’
Hispanic orientation. Thus, a higher U.S. discrepancy score indicates that the adolescent
is more U.S.-oriented than the parents. A higher Hispanic discrepancy score indicates
that the parents are more Hispanic-oriented than the adolescent. The absolute value of
each discrepancy score was taken and then summed to create a total acculturation
discrepancy score. Calculating the absolute value of the differences on the Hispanic and
U.S. orientation scales is important because it preserves the actual magnitude of the
discrepancies when you combine them into a total discrepancy score. This mathematical
operation needed to be performed so that positive and negative discrepancies could count
equally in creating the estimate of the parameter. The method for creating this construct
through the adolescents’ report of their and their parents’ cultural orientations was
validated in a study by Unger et al. (2009). This study retained the two discrepancy terms
as separate variables, yet provides evidence for the psychometric reliability of the
adolescent’s report of their parent’s cultural orientation. Therefore we may refer to this
construct in terms of actual discrepancy between parents’ and adolescents’ acculturation
instead of perceived discrepancy.

Cultural Identity. Twelve items from the Multi-group Ethnic Identity Measure (MEIM;
Phinney, 1992), measured at baseline, address the extent to which one identifies with
his/her ethnic heritage and customs (e.g., “I have a clear sense of what my ethnic
background is and what it means for me” “I have spent time trying to find out more about
my ethnic group” and “I have a lot of pride in my ethnic group”). Response options range
61
from 1=strongly disagree to 5= strongly agree. This scale has high internal consistency
(Cronbach alpha=0.88).

Family conflict. This variable was derived from Olson, et al.’s (1982) Family
Adaptability and Cohesion Scales (FACES-II) instrument and was measured at baseline
with one subscale of items representing family conflict. The family conflict subscale is
comprised of 6 items that assess the degree to which family members argue or do not
communicate positively. A higher score indicates a greater amount of family conflict.
Responses range from 1=“almost never” to 4=“almost always.” The scale exhibits good
internal consistency (Cronbach’s alpha=0.74).

Coping. This construct was measured at two-year follow-up by 10-item Kidcope (Spirito
et al., 1991), which assesses 10 dimensions of coping: distraction, self-criticism, blaming
others, cognitive restructuring, problem solving, social withdrawal, wishful thinking,
emotional regulation, social support and resignation (Spirito, et al., 1991). Each
dimension is measured with one item, on a five-point Likert scale for frequency of using
the strategy when one has a problem, and response options range from 1=“not at all” to
5=“all the time”. Two scales, engagement and disengagement coping, were created by
averaging four items and six items, respectively. These scales exhibit adequate internal
consistency (engagement, Cronbach’s alpha=0.64 and disengagement, Cronbach’s
alpha=0.56).

62
Demographic characteristics. These variables were assessed at baseline: age (years),
gender, and socioeconomic status (SES). Socioeconomic status was a composite measure
consisting of 7 indicators: parents’ education (rated on a 6-point scale ranging from “8
th

grade or less” to “advanced degree”; each respondent’s score indicates the maximum of
mother’s and father’s education if both were reported), number of rooms per person in
home, median household income in the respondent’s Zip code (from 2000 U.S. Census
data), eligibility for free/reduced price lunch at school (1=no, 0=yes), homeownership
(1=family owns its home, 0=family rents home from a landlord), presence of a computer
in the home (1=yes, 0=no), and availability of the Internet at home (1=yes, 0=no). These
items were standardized to a mean of 0 and a standard deviation of 1 and averaged
together to create an SES score (Cronbach’s alpha=.56).

Data analysis
SAS v. 9.2 was used to conduct all data analyses. Descriptive statistics were
estimated and used to describe the characteristics of the sample and substance use rates
were established (Table 6). Bivariate relationships were estimated to determine
collinearity among independent variables and to establish unique relationships among the
variables of interest before controlling for covariates in the proposed model. There was
no evidence for collinearity among the independent variables as none of the correlations
was above 0.60.
Since the data are not normally distributed for any of the three past 30-day
substance use outcomes (cigarettes, alcohol and marijuana), a log-transformed continuous
measure of each substance was calculated and used as the final outcome variable for all
63
regression analyses. The independent variables are a mixture of continuous and
dichotomous. Due to the type of design for this study, which includes data from high
school students nested within schools, we employed multilevel linear regression
techniques the PROC MIXED procedure in SAS (v. 9.2) to control for the multilevel data
structure with the school substance use intercepts modeled as the random effects (Singer,
1998). Separate multilevel linear regression models were created for past-30-day
smoking, past-30-day alcohol use, and past-30-day marijuana use. Since the study was
longitudinal, each model included baseline measures predicting two-year follow-up
substance use measures (cigarettes, alcohol and marijuana) and controlled for the baseline
past 30-day substance use of each particular substance use outcome variable (i.e.,
baseline past 30-day cigarette use in the model predicting two-year follow-up past 30-day
cigarette use).
To test the moderation by coping strategies of the relationship between
acculturative stress, parent-adolescent acculturation discrepancy and substance use we
employed the methodology in Baron and Kenny (1986). This methodology entails
including interaction terms of each coping variable and acculturative stress
(Disengagement coping*acculturative stress, engagement coping*acculturative stress)
and parent-adolescent acculturation discrepancy (Disengagement coping* parent-
adolescent acculturation discrepancy, engagement coping* parent-adolescent
acculturation discrepancy) into the multilevel regression equations. All variables utilized
to create interaction terms are centered on their means and standardized to a standard
deviation of 1 before generating the interaction term.
64
In addition to the random effect of schools, all models were controlled for age,
gender, and SES. The covariates of age, gender and SES were chosen because they are
known to be associated with drug use among adolescents and are typical control variables
in studies of drug use among adolescents.
Assessment of Bias Due to Attrition
Attrition analyses were conducted to compare students who provided data at
baseline and were lost to follow-up (n=422) and the students retained at two-year follow-
up (n=1545). Analyses were conducted to compare means and frequencies between the
two samples for all three past 30-day substance use outcome variables (cigarettes, alcohol
and marijuana), independent predictor variables, and demographic covariates. Of the 13
substance use, cultural stress and demographic variables assessed at baseline, 7 variables
were found to be statistically significantly different by attrition status. Relative to those
lost-to-follow-up, the analytic sample was more likely to be younger (t=3.21, p=0.001),
living with both parents (t=-6.18, p<0.0001), report lower acculturative stress (t=2.17,
p=0.03) and higher Latino-oriented cultural identity (t=2.40, p=0.02). Those students
lost-to-follow-up were more likely to use all three substances (cigarettes, alcohol or
marijuana) at baseline (all p’s <0.05).

Results
The demographic characteristics of the respondents are shown in Table 6. The
students’ mean age was 14.0 years (SD=0.4), slightly over one-half (53.5%) were female
and about 68% lived with both parents. The sample was low to middle income as
determined by the mean of less than one room per person.
65
Table 6: Baseline demographics of study sample and predictor variables
Variable
Mean (SD) or
Percent (n=1546)
Age (years)
1
13.9 (0.39)
Gender (% male)
1
53.5
SES (rooms per person)
1
0.86(0.44)
Live with Both Parents (%)
1
67.7
Acculturative Stress
1,3
1.4(0.67)
Parent-Adolescent Discrepancy
1,5
0.46(0.23)
Cultural Identity
1,4
2.80(0.53)
Engagement Coping
2,4
3.18(0.99)
Disengagement Coping
2,4
2.18(0.81)
Family Conflict
1,3
2.20(0.74)
Cigarette prevalence at follow-up 9
Alcohol use at follow-up 40
Marijuana use at follow-up 17
1
Assessed at baseline
2
Assessed at one-year follow-up
3
Four-point scale (low to high)
4
Five-point scale (low to high)
5
Difference between adolescent’s acculturation and adolescent’s
perception of parents’ acculturation

The linear regression provided mixed support for the stress-buffering model
proposed in this study. Acculturative stress statistically significantly predicted past-30-
day cigarette smoking but not alcohol or marijuana use (table 7). The relationship
between parent-adolescent acculturation discrepancy and past-30-day cigarette smoking
was only marginally significant (p<0.10), and it did not predict past-30-day use of
alcohol and marijuana. Engagement coping inversely predicted use of all three 30-day
substance use outcomes (cigarettes, alcohol and marijuana; all p’s < 0.05). However,
disengagement coping was a statistically significant predictor of only 30-day use of
alcohol (p< 0.05). The inverse relationship between cultural identity and all three
66
substance use outcomes was evident, but cultural identity was not a statistically
significant predictor in any of the models. Family conflict was a statistically significant
predictor of past-30-day cigarette use (p<0.05) and a marginally significant predictor of
marijuana use (p<0.10), but it failed to predict alcohol use. All models controlled for past
30-day substance use at baseline, which was a significant predictor of past 30-day
substance use at two-year follow-up in all of the models (modeled separately for each of
the three drug use outcomes).
Table 7: Multilevel linear regression of predictors of each past-30 day drug use
outcome: cigarettes, alcohol and marijuana
1

Predictor Past 30-day
Cigarette Use
2
Past 30-day
Alcohol Use
2
Past 30-day
Marijuana Use
2
Std. Beta (β)(se) Std. Beta (β)(se) Std. Beta (β)(se)
Acculturative stress 0.03(0.01)** 0.02(0.02) 0.004(0.01)
Parent-Adolescent
Acculturation
Discrepancy
0.01(0.01)† -0.005(0.01) 0.01(0.01)
Cultural Identity 0.001(0.01) -0.02(0.01) 0.01(0.01)
Family Conflict -0.001(0.01) 0.001(0.02) 0.02(0.01)†
Engagement coping -0.02(0.01)* -0.05(0.02)** -0.04(0.01)**
Disengagement
coping
0.01(0.01) † 0.04(0.02)* 0.01(0.01)
Baseline past 30-
day cigarette
smoking
0.05(0.02)*** -- --
Baseline past 30-
day alcohol use
-- 0.12(0.01)*** --
Baseline past 30-
day marijuana
smoking
-- -- 0.13(0.02)***
NOTES:
1
Each multilevel regression model was run separately. Each model was controlled for age,
gender, SES, and the random effect of school.

2
Baseline and follow-up past 30-day drug use outcomes are log-transformed.
†p<0.10, *p<0.05, **p<0.01, ***p<0.001.

67
As shown in Table 8, there was some support for the moderation of the
relationship between acculturative stress and substance use by engagement coping. There
were two significant interactions between acculturative stress and engagement coping in
the cigarette and marijuana use models (p<0.05). At levels of high acculturative stress,
study participants who reported using more engagement coping were more likely to have
used cigarettes and marijuana in the past 30-days than those who reported lower levels of
engagement coping. In addition, among persons in the high engagement coping group, at
lower levels of stress, reported less cigarette and marijuana use. Moreover, there were
statistically significant interactions between parent-adolescent acculturation discrepancy
and disengagement coping in all three substance use models (cigarettes, alcohol and
marijuana; p’s<0.05). At higher levels of parent-adolescent discrepancy, teens who
reported using more disengagement coping strategies were less likely to have used
cigarettes, alcohol or marijuana.

68
Table 8: Multilevel linear regression of predictors of each past-30 day drug use
outcome: cigarettes, alcohol and marijuana, with interactions effects
1

Predictor Past 30-day
Cigarette Use
2

Past 30-day
Alcohol Use
2

Past 30-day
Marijuana Use
2

Std. Beta (β)(se) Std. Beta (β)(se) Std. Beta (β)(se)
Acculturative stress 0.03(0.01)** 0.01(0.02) 0.004(0.01)
Parent-Adolescent
Acculturation Discrepancy
0.01(0.01) -0.01(0.01) 0.01(0.01)
Cultural Identity 0.0003(0.01) -0.02(0.01) 0.01(0.01)
Family Conflict -0.001(0.01) 0.001(0.02) 0.02(0.01) †
Engagement coping -0.02(0.01)† -0.05(0.02)** -0.03(0.01)**
Disengagement coping 0.01(0.01) 0.04(0.02)** 0.01(0.01)
Baseline past 30-day cigarette
smoking
0.05(0.02)*** -- --
Baseline past 30-day alcohol
use
-- 0.12(0.01)*** --
Baseline past 30-day marijuana
smoking
-- -- 0.13(0.02)***

Acculturative stress x
Engagement Coping
0.02(0.01)* -0.002(0.01) 0.03(0.01)**
Acculturative Stress x
Disengagement Coping
-0.01(0.01) -0.005(0.01) -0.01(0.01)
P-A Acc Discrep x Engagement
Coping
-0.004(0.01) -0.001(0.02) 0.01(0.01)
P-A Acc Discrep x
Disengagement Coping
-0.02(0.01)* -0.03(0.02)* -0.03(0.01)**
1
Each multilevel regression model was run separately. Each model was controled for age,
gender, SES, and the random effect of school.

2
Baseline and two-year follow-up past 30-day drug use outcomes are log-transformed.
†p<0.10, *p<0.05, **p<0.01, ***p<0.001.

Chapter 3 Discussion
This study explored pathways between cultural stressors, coping and the three
most commonly used substances by adolescents (cigarettes, alcohol and marijuana).
Although associations have been found between acculturation and substance use among
Hispanic/Latino adolescents (Unger et al., 2000; Epstein et al., 2001; De La Rosa, 2002),
this study investigates a causal pathway by which this association is produced. Across the
69
three substances, the proposed model of cultural stress and coping appears to be most
relevant to the etiology of cigarette smoking among this sample of Hispanic/Latino
adolescents. In the model predicting cigarette use, acculturative stress was a significant
predictor and parent-adolescent acculturation discrepancy was a marginally significant
predictor of cigarette use. These relationships were not detected in the alcohol and
marijuana use models. The measure of acculturative stress employed in this study
assesses the level of stress associated with feeling one’s parents and family are less
approving of the American way of life (i.e., assimilative acculturation). Although only
marginally significant, the parent-adolescent acculturation discrepancy variable also
measures a more direct discrepancy between the adolescent’s and the perceived parents’
orientation toward assimilative acculturation. The perception of acculturative stress due
to conflict with one’s family may be uniquely predictive of cigarette smoking, and not
alcohol or marijuana use, because of the long-standing American normative beliefs about
cigarette smoking. In the U.S., cigarette companies marketed their products as symbols of
independence and autonomy and tobacco control research has shown teens integrated
these messages into the meaning of cigarette smoking in society. Hispanic/Latino teens
may be more susceptible to these normative beliefs about cigarette smoking when
experiencing acculturative stress with their family and may smoke to signify their
independence and departure from their parents’ beliefs about acculturation.
With regard to the relationship between substance use and coping strategies, the
findings of this study are consistent with previous research in that engagement coping
was inversely associated with substance use (e.g., Galaif, Sussman, Chou & Wills, 2003;
Siqueira et al., 2000; Siqueira, Diab, Bodian & Rolinitsky, L., 2001; Wills et al., 2001,
70
2002, 2004), and avoidant coping was positively associated with substance use among
adolescents (e.g., Seiffge-Krenke, 1995; Dugan, Lucas & Lloyd, 2001; Galaif et al.,
2003; Johnson & Pandina, 2000; Wills et al., 2001, 2002). Specifically, we found that
engagement coping was inversely associated with past 30-day use of cigarettes, alcohol
and marijuana and disengagement coping significantly predicted alcohol use (p <.05) and
marginally significantly predicted cigarette use (p <.10).
Our findings are also consistent with the previous findings of studies that have
examined the ethnic differences in use of coping strategies. In concordance with our
results, Vaccaro and Wills’ (1998) found that Hispanic/Latino youth did not use avoidant
coping as frequently as youth of other racial/ethnic groups. In Hispanic/Latino cultures,
the social structural values of respeto, deference to adults and elder authorities, and the
value of familismo, serving the family’s needs above others (peers, strangers) would
likely influence an adolescent’s selection of coping strategies when dealing with most
problems (Unger et al., 2000). Problem-focused coping styles, particularly the strategy of
seeking social support from parents or family would likely be used frequently, while
disengagement methods of coping or ventilating feelings may be discouraged, since it
may be seen as disrespectful to parents or elders. Hispanic/Latino culture values the unit
of family as a source of support and structure and many Hispanic/Latino teens live with
extended family. This traditional view is supported by evidence that engagement coping
was a more consistent protective factor for substance use than disengagement coping
which was a less consistent risk factor for substance use in these models.
The results of the models investigating the interaction between cultural stressors
and substance use indicate that these stressors may be perceived as uncontrollable and
71
coping mechanisms inadequate to ameliorate them. For both cigarettes and marijuana, we
found that at low levels of acculturative stress, greater use of engagement coping resulted
in less use. However, at higher acculturative stress, the protective effect of the
engagement coping was not found, as those youth were more likely to report greater use.
In the stress-coping literature, the buffering effect of engagement coping on the stress and
substance use relationship may not be present when the stressor is perceived as
uncontrollable, or as posing a threat that exceeds one’s ability to muster a coping
response. It is possible that the more the adolescents perceive their cultural stress as
intractable and unchangeable, the more likely they are to turn to deviant forms of
behavior, such as cigarettes and marijuana use, in order to ameliorate the stress. The
engagement coping strategies, such as trying to talk to someone about the problem and
trying to feel better by spending time with others, may not appear to be logical ways in
which to deal with a problem one perceives as highly uncontrollable or stressful.
The finding that at high levels of parent-adolescent acculturation discrepancy, the
youth using more disengagement coping are less likely to use all three substances, is
somewhat perplexing. However, this might be the corollary to the findings regarding the
interaction between the acculturative stress and engagement coping. It may be that both
stressors are perceived as uncontrollable and disruptive to youth, but those who are not
confronting the problem might experience less perceived stress due to it and thus not
confronting it is somewhat protective for substance use over time. Hence the finding that
at higher levels of perceived acculturative stress and engagement coping, the higher the
substance use and the finding that at higher levels of parent-adolescent discrepancy and
disengagement coping, the lower the substance use.
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Prevailing theories of family functioning and health behavior among
Hispanic/Latino adolescents posit that the degradation of the family leads to negative
health outcomes among Hispanic/Latino youth (Szapocznik et al., 1986; Romero &
Roberts, 2003). However, the present study found that family conflict was only a
marginally significant predictor of marijuana use. This anomalous finding may be due to
the low mean level of family conflict in this sample, where the mean frequency of
conflict was “once in a while.” Although the construct was statistically significantly
correlated with the past 30-day use of all three substances, I may not have had enough
variance in the responses to detect an effect once other relevant constructs are included.
In addition, it is possible that the relationship between one’s assessments of conflict in
his/her family is temporally dependent, in that the baseline family conflict may be more
statistically significantly related to baseline drug use than follow-up substance use. Since
this study is longitudinal and family conflict is included as a baseline predictor of two-
year follow-up substance use, the effect might not be strong enough to be detected in this
sample. Given the significant finding that acculturative stress predicts past 30-day
cigarette smoking, perhaps among Hispanic/Latino youth, the perception of stress due to
a difference in a youth’s desire to acculturate and the family’s level of acculturation is a
more salient predictor of cigarette smoking than the perception of general family conflict.

Limitations
This study provides important new information into the potential stress-coping
and cultural antecedents of substance use among Hispanic/Latino high school students.
However, future research should improve upon some of the potential limitations of
73
constructs employed in this study. This study utilized a brief 10-item coping measure that
does not represent the universe of coping mechanisms employed by adolescents.
Although the instrument has been validated in several samples of adolescents, it is
possible that it did not adequately measure the intended dimensions of coping as well as
longer, more established instruments such as in Wills et al. (2002). The generalized
format of the coping measure may not have been optimal for determining the relationship
to the culturally-based stressors. Asking the adolescent to think about his/her experience
of culturally-based stress, and respond about the coping strategies used to deal with it,
may have provided more directly relevant information to the relationship between
culturally-based stress and coping among this group.
Another limitation to the generalizability of the findings is the attrition from the
study at two-year follow-up. The students retained at two-year follow-up were less likely
to have used all three substances at baseline. Therefore these findings may not apply to
adolescents at higher risk for substance use in 9
th
grade. In addition, the analytic sample
may have been in more stable family environments than those lost-to-follow-up in that
they were more likely to be living with both parents. Also the analytic sample was at
lower risk at baseline for culturally-based stress, in that they reported lower levels of
acculturative stress and higher Hispanic/Latino-oriented cultural identity than the
students who were lost by eleventh grade.
The generalizeability of the findings may be hampered by an intentional aspect of
the research design of the parent study. In order to obtain an adequate sample size for
testing hypotheses, the sample was drawn from schools that are in neighborhoods with
>75% Hispanic/Latino populations (according to 2000 Census figures). Thus, the fact
74
that the youth are concentrated in ethnic enclaves may diminish their perception of the
acculturation discrepancy between them and their parents and their perception of
acculturative stress. Thus, the social normative perceptions of the experience of
acculturative stress or acculturation discrepancy with parents, may lead youth in this
context to underreport their cultural stress perceptions.

Conclusion
Our findings suggest that Hispanic/Latino adolescents are experiencing culturally-
based stress and it is associated with substance use over time. Based on the findings in
this study, more research is warranted into the experience of culturally-based stressors
and substance use among Hispanic/Latino adolescents. Models of stress and coping
provide useful paradigms by which to examine the problem, yet needs further refinement
based on this and future work. Although the moderation results indicate complex
relationships between coping styles and cultural stress and substance use, these results
may be used as a step toward discovering additional targets for substance use prevention
interventions with Hispanic/Latino adolescents. Coping-based interventions that promote
communication about culture and family expectations about acculturation may be
beneficial to prevent cigarette and marijuana use among Hispanic/Latino adolescents.
According to existing interventions with Hispanic/Latino teens designed to prevent
problem behaviors, interventions that strengthen communication and engagement coping
strategies to the whole family are effective (Pantin, Scwartz, Sullivan, Coatsworth &
Szapcznik, 2003). Thus addressing aspects of the family context that can be strengthened
may encourage parents to model active coping strategies and give support about family
75
and self-identity development issues. One example intervention is the Familias Unidas
intervention that sought to prevent and/or reduce the erosion of traditional
Hispanic/Latino family values and structure in order to prevent problem behaviors
(Pantin et al., 2003). This type of intervention may help to reduce acculturative stress and
parent-child discrepancy in acculturation by strengthening parent-child communication,
providing parenting sessions directly to parents, and other family-based strategies
involving the teen and the parent (Pantin et al., 2003).

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CHAPTER 4: STUDY 3: DOES DEPRESSIVE SYMPTOMATOLOGY
MEDIATE THE LONGITUDINAL RELATIONSHIPS BETWEEN CULTURAL
STRESS FACTORS, COPING AND CIGARETTE SMOKING AMONG
HISPANIC/LATINO HIGH SCHOOL STUDENTS?

Chapter 4 Abstract
Introduction: This study builds on the study presented in chapter 3 to investigate the
mediation of acculturative stress, parent-adolescent discrepancy and substance use by
depressive symptomatology among a sample of Hispanic/Latino regular high school
students. The potential buffering effects of two types of coping (engagement and
disengagement) on the mediated model were evaluated.
Methods: Students enrolled in the parent study, Project RED, were administered a survey
annually, from 9
th
to 11
th
grade. The analyses conducted for the present study utilized
data collected at baseline, one-year follow-up and two-year follow-up (n=1501). Based
on previous findings showing null findings for the prediction of alcohol and marijuana
use from the sociocultural stress factors, the multilevel regression equation was estimated
and the mediation by depressive symptomatology conducted for past 30-day cigarette
smoking.
Results: Acculturative stress at baseline statistically significantly predicted cigarette
smoking at two-year follow-up and depressive symptomatology at one year follow-up.
Depressive symptomatology statistically significantly predicted past 30-day cigarette
smoking at two-year follow-up. However, the indirect effects that were tested in the
mediation model were not statistically significant, indicating that there is no mediation by
depressive symptomatology. In addition, parent-adolescent acculturation discrepancy
marginally predicted cigarette smoking. Analyses of interaction effects between the
77
stressors and coping revealed that engagement coping moderates the relationship between
acculturative stress and cigarette smoking and disengagement coping moderates the effect
of parent-acculturation discrepancy on cigarette smoking.

Chapter 4 Introduction
The Hispanic/Latino population is the most rapidly growing ethnic minority group
in the United States and has a very high proportion of children and adolescents compared
to non-Hispanic whites (33.4% v. 22.4%, U.S. Census Bureau, 2010). In the research that
has focused on the relationship between acculturation and health status among
Hispanic/Latino adolescents in the U.S., several studies have found that Hispanic/Latino
adolescents experience higher rates of depression than teens identifying with other ethnic
backgrounds (Hovey & King, 1996). Several studies have been conducted to identify the
causal factors and pathways that may explain this disproportionate risk (Mikolajczyk et
al., 2007; Cespedes & Huey, Jr., 2008; Polo & Lopez, 2009, Garcia & Lindgren, 2009). A
major focus of the psychological underpinnings of this disproportionate risk may be
through erosion of the traditional Hispanic/Latino family structure and values and several
aspects of the acculturation process may contribute (Unger et al., 2000; Epstein et al.,
2001; De La Rosa, 2002; Rivera, 2007).
This potential vulnerability with respect to mental health may leave
Hispanic/Latino youth at disproportionate risk for other health risk behaviors in
adolescence, such as substance use (Unger et al., 2004; Cespedes & Huey, Jr., 2008;
Garcia & Lindgren, 2009). Since depression and other psychological distress have been
found to be comorbid with substance use in adults (Swendsen & Merikangas, 2000) , the
78
elevated risk for depression among Hispanic/Latino adolescents might result in increased
substance use in this population compared to other racial or ethnic minorities. In fact, data
at the national and California state level suggest a higher level of risk factors for cigarette
smoking, alcohol and marijuana use among Hispanic/Latino adolescents and this
disparity appears early on in adolescent development. The prevalence of all three most
commonly used drugs (cigarettes, alcohol and marijuana) is higher among
Hispanic/Latino adolescents in 8
th
grade than White and African American students in 8
th

grade (Johnston et al., 2008). Research has shown that adolescent drug use follows a
steadily increasing trajectory of increasing experimentation from middle school to high
school and into early adulthood (Rohrbach, Sun, & Sussman, 2005, Botvin et al. 1995).
Substance use is associated with several negative mental health outcomes and other
problem behaviors, such as depression, anxiety, and deviant behaviors (Sussman, et al.,
1993; Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995; Merinkangas et al., 1998;
Oetting & Donnermeyer, 1998; White, Johnson & Horowitz, 1996; Hawkins, Catalano &
Miller, 1992).
This paper investigates a potential causal pathway for the etiology of substance
use among Hispanic/Latino adolescents through examining a culturally-based stress-
coping model. Adolescence is a period of significant biological, psychological and social
development that presents many opportunities an individual to attempt different strategies
to cope with stressors (Wills, 1986; Frydenberg & Lewis, 1993). Adolescents, like adults,
cope with the psychological, emotional and environmental effects of stressors in various
ways (Wills & Shiffman, 1985; Byrne, Byrne & Reinhart, 1995). These efforts to manage
the psychological and structural effects of stressors are critical to the resulting impact on
79
behaviors, such as substance use. Coping efforts are frequently conceived as adaptive and
maladaptive for psychological distress and substance use. Research with adolescence has
shown that engagement coping strategies (e.g., problem-focused, support-seeking) are
inversely associated with depression and substance use and disengagement strategies
(e.g., wishful thinking, emotion-focused and avoidance) are positively associated with
depression and substance use (Galaif et al., 2003; Pederson, Koval & O’Connor, 1997;
Pederson, Koval, McGrady & Tyas, 1998; Siqueira et al., 2000; Sussman et al.,
1993;Wills & Cleary, 1996; Wills et al., 2001, 2002, 2004).
This study addresses a major gap in the research literature about the etiology of
substance use among Hispanic/Latino adolescents by examining the way cultural stress
and coping behaviors may influence one’s development of depressive symptomatology
and, in turn, one’s substance use (Suarez-Moralez & Lopez, 2009; Dillon & Szapocznik,
2007; Rasmussen et al., 2004; Compas et al., 2001). Moreover, stress-coping theory has
not yet been applied to investigate the relationships among acculturative stressors,
coping, depressive symptomatology and substance use in Hispanic/Latino youth (Suarez-
Moralez & Lopez, 2009, Dillon & Szacopznik, 2007). Several researchers speculate
about the sociocultural factors that may determine the elevated mental health and
substance use risk among this group (Hovey & Magnana, 2000; Garcia & Lindgren,
2009; Cespedes & Huey, Jr., 2008; Romero & Roberts, 2003; Unger et al., 2004). Two
sociocultural stressors have been consistently hypothesized to produce negative
internalizing states and psychological distress among immigrant and minority
adolescents: acculturative stress and a discrepancy between the teen and his/her parents’
acculturation level. Acculturative stress is defined as stress produced by efforts to adopt
80
the host culture and integrate into the host culture. Adolescents explore and determine
how to reconcile their experiences of acculturating in the U.S. culture with that of their
parents (Unger et al. 2004; Escobar & Vega, 2000; Szapocznik et al., 1986). This
acculturative stress and a discrepancy between the parent’s and adolescent’s acculturation
levels, or their respective views on the extent to which they are acculturated, may affect
adolescents’ levels of psychological distress and engagement in deviant behaviors
(Szapocznik et al., 1986; Romero & Roberts, 2003) The experience of the parent-
adolescent acculturation discrepancy may be stressful to the adolescent, and may
produce internalizing (e.g., depression) or externalizing (e.g., substance use) behaviors
(Unger et al. 2004; Romero & Roberts, 2003; Szapocznik et al., 1986; Guinn & Vincent,
2002; Nezami et al., 2005; Koval, Pederson, & Chan, 2004). While acculturative stress
and its relationship to maladaptive internalizing states (i.e., depression, anxiety) has been
investigated with Hispanic/Latino adults over the past 10 years (Hovey & Magnana,
2000; Crocket et al., 2005; Suarez-Moralez & Lopez, 2009), fewer studies have examined
these constructs among adolescent populations and in relation to substance use (Hovey &
King, 1996; Szapocznik et al., 1986; Siqueira et al., 2000; Unger et al., 2009). These
studies demonstrate a significant relationship between acculturation, acculturative stress
and substance use among Hispanic/Latino adolescents (Szapocznik et al., 1986 Vega et
al., 1993; Gil, Wagner & Vega, 2000; Unger et al., 2009). Moreover, study 2 (chapter 3)
showed that acculturative stress predicts cigarette smoking and parent-adolescent
acculturation discrepancy and coping exert interactive effects in the prediction of alcohol
and marijuana use.
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The present study applies the stress-coping model (Cohen & Wills, 1985, Wills,
1986, Wills et al., 2002), to explore the potential causal pathways between two
socioculturally determined constructs (acculturative stress, parent-child acculturation
discrepancy) and substance use among Hispanic/Latino adolescents. Previous research
has found that depression is linked with cigarette smoking among Hispanic/Latino youth
(Nezami et al., 2005) and acculturative stress is positively associated with depression
(Romero & Roberts, 2003). Stress-coping studies have shown the relationship between
stress, avoidance coping, depression and alcohol use (Windle & Windle, 1996). However,
no study to date has examined the interrelationships among these constructs through the
application of theory simultaneously in one model. This study builds on a study 2
(chapter 3) by exploring the mediating role of depression on the relationship between the
sociocultural stressors and substance use. Specifically, this study attempts to answer the
following research questions:
• Are acculturative stress and parent-adolescent acculturation discrepancy at
baseline predictors of past 30-day substance use (cigarettes, alcohol and
marijuana) at two-year follow-up among Hispanic/Latino adolescents?
• Does depressive symptomatology at one-year follow-up mediate the relationship
between acculturative stress at baseline and substance use (cigarettes, alcohol and
marijuana) at 2-year follow-up?
• Does depressive symptomatology at one-year follow-up mediate the relationship
between parent-child acculturation discrepancy at baseline and substance use
(cigarettes, alcohol and marijuana) at 2-year follow-up?
82
• Does coping style moderate the mediated relationship between acculturative stress
at baseline, depressive symptomatology at 1-year follow-up, and substance use 2-
year follow-up?
• Does coping style moderate the mediated relationship between parent-child
acculturation discrepancy at baseline, depressive symptomatology at 1-year
follow-up, and substance use 2-year follow-up?

Methods
Subjects
These data were collected as part of a larger etiological study, Project RED
(Reteniendo y Entendiendo Diversidad para Salud), which is a longitudinal study of
acculturation patterns and substance use among Hispanic/Latino adolescents in Southern
California. The respondents in Project RED were 9
th
grade students attending seven high
schools in the Los Angeles area. Because the study focuses on Hispanic/Latino
adolescents, schools were approached and invited to participate if they contained at least
70% Hispanic students, as indicated by data from the California Board of Education.
Efforts were also made to obtain a sample of schools with a wide range of socioeconomic
characteristics. The median annual household incomes in the ZIP codes served by the
schools ranged from $29,000 to $73,000, according to 2000 U.S. Census data. Of the 31
schools approached, eight agreed to participate. One school was eliminated because its
schedule would have required half of the students to be surveyed in fall and half in
spring, which could have introduced confounding. Therefore the remaining seven
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schools participated in the study. Approval was obtained from the school principals
and/or district superintendents, according to their established procedures.
The survey data collected for this longitudinal study began in the Fall of 2005 and
ended the Fall of 2007. At baseline, in 2005, all ninth-grade students in the school were
invited to participate in the survey. Trained research assistants visited the students'
classrooms, explained the study to the students, and distributed parental consent forms
and student assent forms. To increase the return rate of consent forms, each classroom
was offered a pizza party if every student in the class returned the forms, regardless of
whether the parents said yes or no. Parents who did not return the consent forms were
telephoned in the evenings by a bilingual research assistant to obtain verbal consent or
refusal. Research assistants returned to the school twice over a two-week period to pick
up signed consent forms and distribute new forms to students who had lost them.
Students were allowed to participate if they provided written or verbal parental consent
and student assent. All students who completed a baseline survey were asked to
complete a one-year follow-up questionnaire in the Fall of 2006 and the procedure was
repeated in the Fall of 2007 for two-year follow-up. Surveys were available in English
and Spanish; however, only 17 students (0.8%) chose to complete the survey in Spanish.
All procedures, including informed consent, were approved by the university's
Institutional Review Board.
Across the seven schools, 3218 students were invited to participate. Of those,
2420 (75%) provided parental consent and student assent. Of those, 2225 (92%)
completed the survey at baseline. Of those, 1922 (86%) self-identified as Hispanic or
Latino or reported a Latin American country of origin. Of the Hispanic/Latino
84
participants, 1501 (78%) provided data at all three timepoints (baseline, one-year follow-
up and two-year follow-up) and comprise the analytic sample.

Measures
Outcome variables
Past 30-day cigarette smoking. At both baseline and two-year follow-up, one question
measured how many times in the past 30 days the students smoked cigarettes. Response
options were on a Likert scale ranging from 0=zero days to 2=1-2 days to 6 =all 30 days.
Independent Variables
Acculturative stress. This variable was measured with two questions: “I have problems
with my family because I like to do things the American way” and “I get upset with my
parents because they don’t understand the American lifestyle.” Students provided
response on a 4 point Likert scale of how often this applies to them (1=never to 4=very
often). Internal consistency was high between these items (Cronbach’s alpha=0.75).
Parent-Adolescent Acculturation Discrepancy.
Adolescents’ and Perceived Parents’ Cultural Orientations. A measure was
created by adapting questions from existing self-report acculturation scales such as the
ARSMA-II. Adolescents responded to 12 items from the ARSMA-II (Cuellar, Arnold, &
Maldonado, 1995): 7 from the Anglo orientation subscale and 5 from the Hispanic
orientation subscale. These 12 items were selected based on a pilot study in a similar
school, in which these items had the highest factor loadings on their respective scales.
Recently, a shorter version of the ARSMA-II was validated among adolescents (Bauman,
2005). Sample items include “I speak English at home” “I follow the American way of
85
life” I follow the Hispanic or Latino way of life.” Response options were code from 1 to
4, where 1=“strongly disagree,” to 4=“strongly agree.” Students provided assessment of
their parents’ U.S./White cultural orientation and Hispanic/Latino cultural orientation.
These were assessed using the same questions as the students’ self-assessment items.
The following items assessed parents’ U.S./White cultural orientation: “My parents want
me to speak English at home,” “My parents want me to speak English outside the home,”
“My parents want me to live by or follow the U.S./White way of life,” “My parents want
me to be a success in the U.S./White way or life.” The following items assessed parents’
Hispanic cultural orientation: “My parents want me to speak Spanish at home,” “My
parents want me to speak Spanish outside the home,” “My parents want me to live by or
follow the Hispanic or Latino way of life,” and “My parents want me to be a success in
the Hispanic or Latino way or life.” Response options were code from 1 to 4, where
1=“strongly disagree,” to 4=“strongly agree.” The Cronbach’s alphas were .69 for the
parents’ U.S./White cultural orientation scale and .86 for the parents’ Hispanic
orientation scale.
Parent-Adolescent Acculturation Discrepancy Score.
The adolescents’ self-reported acculturation scores and their perceptions of their
parents’ acculturation were used to compute parent-child acculturation discrepancy
scores. Two scores were calculated: discrepancy in U.S. orientation and discrepancy in
Hispanic orientation. The U.S. discrepancy score was the adolescent’s U.S. orientation
minus the parents’ U.S. orientation. The Hispanic discrepancy score was the parents’
Hispanic orientation minus the adolescent’s Hispanic orientation. Thus, a higher U.S.
discrepancy score indicates that the adolescent is more U.S.-oriented than the parents. A
86
higher Hispanic discrepancy score indicates that the parents are more Hispanic-oriented
than the adolescent. The absolute value of each discrepancy score was taken and then
summed to create a total acculturation discrepancy score. Taking the absolute value of the
differences on the Hispanic and American orientation scales is important because it
preserves the actual magnitude of the discrepancies when you combine them into a total
discrepancy score. This mathematical operation needed to be performed so that positive
and negative discrepancies could count equally in creating the estimate of the parameter.
The method for creating this construct through the adolescents’ report of their and their
parents’ cultural orientations was validated in a study by Unger et al. (2009). This study
retained the two discrepancy terms as separate variables, yet provides evidence for the
psychometric reliability of the adolescent’s report of their parent’s cultural orientation.
Therefore we refer to this construct in terms of actual discrepancy between parents’ and
adolescents’ acculturation instead of perceived discrepancy.

Cultural Identity. Twelve items from the Multi-group Ethnic Identity Measure (MEIM;
Phinney, 1992), measured at baseline, address the extent to which one identifies with
his/her ethnic heritage and customs (e.g., “I have a clear sense of what my ethnic
background is and what it means for me” “I have spent time trying to find out more about
my ethnic group” and “I have a lot of pride in my ethnic group”). Response options range
from 1=strongly disagree to 5= strongly agree. This scale has high internal consistency
(Cronbach alpha=0.88).

87
Family conflict. This variable was derived from Olson, et al.’s (1982) Family
Adaptability and Cohesion Scales (FACES-II) instrument and was measured at baseline
with one subscale of items representing family conflict. The family conflict subscale is
comprised of 6 items that assess the degree to which family members argue or do not
communicate positively. A higher score indicates a greater amount of family conflict.
Responses range from 1=“almost never” to 4=“almost always.” The scale exhibits good
internal consistency (Cronbach’s alpha=0.74).

Coping. This construct was assessed at two-year follow-up by 10-item Kidcope (Spirito
et al., 1991), which assesses 10 dimensions of coping: distraction, self-criticism, blaming
others, cognitive restructuring, problem solving, social withdrawal, wishful thinking,
emotional regulation, social support and resignation (Spirito, et al., 1991). Each
dimension is measured with one item, on a five-point Likert scale for frequency of using
the strategy when one has a problem, and response options range from 1=“not at all” to
5=“all the time”. Two scales, engagement and disengagement coping, were created by
averaging four items and six items, respectively. These scales exhibit adequate internal
consistency (engagement, Cronbach’s alpha=0.64 and disengagement, Cronbach’s
alpha=0.56).

Depressive Symptomatology. This construct is measured at one-year follow-up with the
full 20-item Centers for the Epidemiologic Study of Depression (CES-D) instrument,
adolescent version (Radloff, 1977).

The depression-related construct we intend to
measure with this instrument is conceptualized as depressive symptomatology, since we
88
are not employing structured clinical interviews necessary for making a clinical diagnosis
of depression (Cohen & Wills, 1985). The items measure how depressed, sad, lonely, etc.
one has felt over the last 7 days and item responses are on a 4 item Likert scale ranging
from 1=”less than 1 day or never” to 4=”5-7 days”. The scale exhibits high internal
consistency (Cronbach’s alpha=0.89).

Demographic characteristics included age, gender, and socioeconomic status (SES). Age
and gender were self-reported. Socioeconomic status was a composite measure consisting
of 7 indicators: parents’ education (rated on a 6-point scale ranging from “8
th
grade or
less” to “advanced degree”; each respondent’s score indicates the maximum of mother’s
and father’s education if both were reported), number of rooms per person in home,
median household income in the respondent’s Zip code (from 2000 U.S. Census data),
eligibility for free/reduced price lunch at school (1=no, 0=yes), homeownership
(1=family owns its home, 0=family rents home from a landlord), presence of a computer
in the home (1=yes, 0=no), and availability of the Internet at home (1=yes, 0=no). These
items were standardized to a mean of 0 and a standard deviation of 1 and averaged
together to create a composite SES score (Cronbach’s alpha=.56).

Data Analysis
SAS v. 9.2 was used to conduct all data analyses. Descriptive statistics were
estimated and used to describe the characteristics of the sample and substance use rates
were established (Table 9). Bivariate relationships were estimated to determine
collinearity among independent variables and to establish unique relationships among the
89
variables of interest before controlling for covariates in the proposed model. There was
no evidence for collinearity among the independent variables as none of the correlations
were above 0.60.
Since the data are not normally distributed for any of the three past 30-day
substance use outcomes (cigarettes, alcohol and marijuana), a log-transformed continuous
measure of each substance was calculated and used as the final outcome variable for all
regression analyses. The independent variables are a mixture of continuous and
dichotomous. Due to the type of design for this study, which includes data from high
school students nested within schools, we employed multilevel linear regression
techniques the PROC MIXED procedure in SAS (v. 9.2) to control for the multilevel data
structure, with the school substance use intercepts modeled as the random effects (Singer,
1998). Separate multilevel linear regression models were created for past 30-day
smoking, past 30-day alcohol use, and past 30-day marijuana use. Since the study was
longitudinal, each model predicting follow-up substance use (cigarettes, alcohol and
marijuana) included the baseline past 30-day substance use measure for that particular
substance use outcome variable (i.e., baseline past 30-day cigarette use in the model
predicting follow-up past 30-day cigarette use).
Baron and Kenny’s (1986) causal steps approach, which is a 3-step
methodological procedure for testing statistical mediation, was employed to determine
the potential mediation effects of depressive symptoms on the relationship between
cultural stressors and substance use (past 30-day cigarettes, alcohol, and marijuana).
First, acculturative stress, parent-adolescent acculturation discrepancy, family conflict,
cultural identity, engagement and disengagement coping and covariates were regressed
90
on each substance use outcome separately. This step establishes the direct effect of the
independent variables of interest (acculturative stress and parent-adolescent discrepancy)
on each substance use outcome. Second, the cultural stressors were regressed on the
hypothesized mediator, depressive symptoms. Third, the predictors and the mediator are
regressed on each substance use outcome to determine the potential mediation effects of
depressive symptoms on the relationship between cultural stressors and each substance
use outcome.
To test the mediated moderation by coping strategies of the relationships between
the cultural stress predictors (acculturative stress, parent-adolescent acculturation
discrepancy), depression and substance use we employed the methodology in Baron and
Kenny (1986) and Muller, Judd and Yzerbyt (2005). This methodology entails including
interaction terms of each coping variable and each predictor, as well as the coping
variable and the moderator into the multilevel regression equations. This allows one to
model the moderation of any of the pathways that contribute to the direct effects of the
predictor on the outcome by the coping variables. First, we created interaction terms for
acculturative stress and each coping variable (Disengagement coping*acculturative
stress, engagement coping*acculturative stress), parent-adolescent acculturation
discrepancy and each coping variable (Disengagement coping* parent-adolescent
acculturation discrepancy, engagement coping* parent-adolescent acculturation
discrepancy) and depression and each coping variable (Engagement coping*Depression
and Disengagement coping*Depression). All variables utilized to create interaction terms
are centered on their means before generating the interaction term. After the term was
created it was standardized along with the other independent variables in the analysis. In
91
order to test the mediated moderation, we assessed moderation effects on the indirect
effects between cultural stress and depressive symptomatology. Therefore we tested the
model predicting depressive symptomatology and included interaction terms for cultural
stress and coping (path a). Finally, we assess moderation effects of coping on the direct
effects of the relationship between the cultural stress variables and substance use and
between depression and substance use. Therefore, we tested the moderation effects of
stress*coping and depressive symptomatology*coping in the model predicting substance
use (paths b and c) (Figure 3). The product of paths a and b were calculated to determine
the indirect effects and Sobel’s calculation for the standard error of the ab product term
was used to determine the significance of the indirect effects (Baron & Kenny, 1986).
All models were controlled for age, gender, SES, and the random effect of school.
The covariates of age, gender and SES were chosen because they are known to be
associated with drug use among adolescents and are typical control variables in studies of
drug use among adolescents.

Figure 2: Mediated Moderation Model

Acculturative Stress and
Parent-Adolescent
Acculturation
Discrepancy
Depressive
Symptomatology
Past 30-day Cigarette
Smoking
Engagement Coping
Disengagement
Coping
a b
c
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Assessment of Bias Due to Attrition
Attrition analyses were conducted to compare students who provided data at
baseline and were lost to follow-up (n=466) and the students retained at two-year follow-
up (n=1501). Analyses were conducted to compare means and frequencies between the
two samples for all three past 30-day substance use outcome variables (cigarettes, alcohol
and marijuana), independent predictor variables, and demographic covariates. Of the 13
substance use, cultural stress and demographic variables assessed at baseline, 8 variables
were found to be statistically significantly different by attrition status. Relative to those
lost-to-follow-up, the analytic sample was more likely to be younger (t=3.27, p=0.001),
living with both parents (t=-5.91, p<0.0001), report lower acculturation discrepancy
(t=2.27, p=0.02), less family conflict (t=2.11, p=0.03) and higher Latino-oriented cultural
identity (t=2.60, p=0.01). The analytic sample also was less likely to use all three
substances (cigarettes, alcohol or marijuana) at baseline (all p’s <0.01).

Results
The sample at baseline was 53% female, students’ mean age was 14.0 years
(SD=0.4), and about 68% lived with both parents (Table 9). The sample was low to
middle income as determined by the mean of less than one room per person. Past 30-day
cigarette smoking was the least prevalent of the three drug use outcomes, with 9% of the
sample smoking (Table 9). Students’ mean depressive symptomatology was 0.78 on a
three-point scale, indicating they felt depressive symptoms about 1-2 days in the week
before assessment at one-year follow-up. In accordance with previous research with
adolescents using the CES-D to address past-week depressive symptomatology, a cutoff
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score of 20 on the CES-D qualifies an individual as likely to have depression as
diagnosed by clinical interview (Radloff, 1977). In this sample, 27% of the students met
this criterion.
Table 9: Demographics of study sample and descriptive statistics of predictors and
outcome variable (n=1501)
Variable
Mean (SD) or
Percent
Age (years)
1
14.0 (0.39)
Gender (% male)
1
53.5
SES (rooms per person)
1
0.86(0.44)
Live with Both Parents (%)
1
67.7
Acculturative Stress
1,3
1.4(0.67)
Parent-Adolescent Acculturation Discrepancy
1,5
0.46(0.23)
Cultural Identity
1,4
2.80(0.53)
Depressive Symptomatology
3
0.78(0.53)
Engagement Coping
2,4
3.18(0.99)
Disengagement Coping
2,4
2.18(0.81)
Family Conflict
1,3
2.20(0.74)
Past 30-day cigarette use at follow-up 9
Past 30-day alcohol use at follow-up 40
Past 30-day marijuana use at follow-up 17
1
Assessed at baseline
2
Assessed at one-year follow-up
3
Four-point scale (low to high)
4
Five-point scale (low to high)
5
Difference between adolescent’s acculturation and adolescent’s perception of
parents’ acculturation

The regression models predicting the effects of acculturative stress and parent-
adolescent acculturation discrepancy on substance use showed that the hypothesized
relationships among cultural stress and substance use applied only to the model
predicting past 30-day cigarette smoking. Neither acculturative stress, nor parent-
adolescent discrepancy was a statistically significant predictor of past 30-day alcohol use
or past 30-day marijuana use. Therefore the mediation and mediated moderation analyses
94
were only conducted with data on past 30-day cigarette smoking at two-year follow-up.
These results are discussed and shown in tables 10-14.
Acculturative stress was a statistically significant predictor of past 30-day
cigarette smoking at two-year follow-up (Table 10, p<0.01). Parent-adolescent
acculturation discrepancy approached statistical significance (Table 10, p<0.10) and as
hypothesized, the relationship to cigarette smoking was in the positive direction. Family
conflict and cultural identity were not statistically significant predictors of past 30-day
cigarette smoking (Table 10).
Table 10: Multilevel linear regression of predictors of past 30-day
cigarette smoking at two-year follow-up (total effect)
1

Effect
Std. Beta
(β)
Standard
Error Pr > |t|
Baseline cigarette smoking
2
0.06 0.008 ***
Parent-Adolescent Acculturation
Discrepancy 0.02 0.008 †
Acculturative Stress 0.03 0.008 **
Family Conflict 0.004 0.008
Cultural Identity -0.001 0.008
NOTES:
1
Each model was controlled for age, gender, SES, and the random effect of school.

2
Baseline and follow-up past 30-day drug use outcomes are log-transformed.
†p<0.10, *p<0.05, **p<0.01, ***p<0.001.

Mediation Analysis Results
The mediation of the cultural stress (acculturative stress and parent-adolescent
discrepancy) and substance use and by depressive symptomatology garnered some
support in the model predicting past 30-day cigarette smoking (Table 11). The total effect
of acculturative stress on past 30-day cigarette smoking was statistically significant
(Table 10). The regression model that tested the indirect effect of acculturative stress on
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the mediator, depressive symptomatology, showed that acculturative stress was a
statistically significant predictor of depressive symptomatology (Table 11). Both
acculturative stress and depressive symptomatology were statistically significant
predictors of past 30-day cigarette smoking when included in the model together
(p’s<0.05, Table 12). However, the standardized β for acculturative stress was reduced in
magnitude. We tested the direct effect of acculturative stress on past 30-day cigarette
smoking and found that evidence that suggests partial mediation by depressive
symptomatology, but the indirect effects were only marginally statistically significant
(t=1.33, p<0.10). The t score was obtained by calculating the product of ab and using
Sobel’s calculation for the standard error of ab, the product of the indirect effects. The
percentage of the total effect that was mediated by the indirect effect was only 7% and
was not statistically significant mediation.
Table 11: Multilevel linear regression of predictors of depressive
symptomatology at one-year follow-up (indirect effect)
1

Effect
Std. Beta
(β)
Standard
Error Pr > |t|
Baseline cigarette smoking
2
0.02 0.02
Parent-Adolescent Acculturation
Discrepancy 0.03 0.01 †
Acculturative Stress 0.03 0.02 *
Family Conflict 0.10 0.02 ***
Cultural Identity 0.004 0.02
NOTES:
1
Each model was controlled for age, gender, SES, and the random effect of school.
2
Baseline and follow-up past 30-day drug use outcomes are log-transformed.
†p<0.10, *p<0.05, **p<0.01, ***p<0.001.

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Table 12: Multilevel linear regression of predictors (including depressive
symptomatology) of past 30-day cigarette smoking at two-year follow-up

(direct effect)
1

Effect
Std. Beta
(β)
Standard
Error Pr > |t|
Baseline cigarette smoking
2
0.06 0.009 ***
Parent-Adolescent Acculturation Discrepancy 0.01 0.008
Acculturative Stress 0.02 0.009 *
Family Conflict -0.003 0.009
Cultural Identity -0.01 0.009
Depressive Symptomatology (1-yr follow-up) 0.07 0.02 ***
NOTES:
1
Each model was controlled for age, gender, SES, and the random effect of school.
2
Baseline and follow-up past 30-day drug use outcomes are log-transformed.
†p<0.10, *p<0.05, **p<0.01, ***p<0.001.

Mediated Moderation Analysis Results
The procedure for analyzing the mediated moderation effects of coping on the
cultural stress and predictors and substance use was followed from Baron and Kenny
(1986) and Muller, Judd and Yzerbyt (2005). The moderation effect of the path between
acculturative stress and depressive symptomatology (a) by either engagement or
disengagement coping was not statistically significant (Figure 2; Table 13). However,
both coping styles were statistically significantly associated with depressive
symptomatology (Table 13). Moreover, in the model assessing the mediated moderation
effects of coping on the indirect effect of depressive symptomatology on cigarette
smoking (b) and the direct effect of acculturative stress on cigarette smoking (c), we only
found the previously established statistically significant moderation of the direct effect
(Figure 2; Table 14). Therefore the results do not demonstrate a statistically significant
moderation by coping on the indirect effects and thus do not provide evidence for
mediated moderation in our sample. However, these analyses do indicate that even after
97
controlling for depressive symptomatology, there is a statistically significant moderation
of the relationship between acculturative stress and past 30-day smoking (Table 14).
Table 13: Multilevel linear regression of predictors of depressive
symptomatology (one-year follow-up), with interaction effects
1

Effect
Std. Beta
(β)
Standard
Error Pr > |t|
Baseline cigarette smoking
2
0.02 0.02
Parent-Adolescent Acculturation Discrepancy 0.02 0.02
Acculturative Stress 0.03 0.02 †
Family Conflict 0.09 0.02 ***
Cultural Identity 0.02 0.02
Engagement Coping -0.08 0.02 ***
Disengagement Coping 0.11 0.02 ***

Acculturative Stress*E.C. 0.001 0.02
Acculturative Stress*D.C. 0.01 0.02
P-A A.D.*E.C. -0.007 0.02
P-A A.D.*D.C. 0.007 0.02
NOTES:
1
Each model was controlled for age, gender, SES, and the random effect of school.

2
Baseline and follow-up past 30-day drug use outcomes are log-transformed.
3
E.C.=Engagement Coping, D.C.=Disengagement Coping, P-A A.D.=Parent-adolescent
acculturation discrepancy
†p<0.10, *p<0.05, **p<0.01, ***p<0.001.

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Table 14: Multilevel linear regression of predictors (depressive
symptomatology) of past 30-day smoking at two-year follow-up, with
interaction effects
1

Effect
Std. Beta
(β)
Standard
Error Pr > |t|
Baseline Past 30-day Cigarette
Smoking
2
0.05 0.009 ***
Parent-Adolescent Acculturation
Discrepancy 0.01 0.009
Acculturative Stress 0.02 0.009 *
Family Conflict -0.004 0.009
Cultural Identity -0.004 0.009
Engagement Coping -0.01 0.009
Disengagement Coping 0.006 0.009
Depressive Symptomatology (1-yr
follow-up) 0.06 0.02 **

Acculturative Stress*E.C.
3
0.02 0.009 *
Acculturative Stress**D.C.
3
-0.02 0.009
P-A A.D.*E.C.
3
-0.003 0.009
P-A A.D.*D.C.
3
-0.02 0.009 *
Depressive Symptomatology*E.C.
3
0.002 0.009
Depressive Symptomatology*D.C.
3
-0.006 0.008
NOTES:
1
Each model was controlled for age, gender, SES, and the random effect of school.
2
Baseline and follow-up past 30-day drug use outcomes are log-transformed.
3
E.C.=Engagement Coping, D.C.=Disengagement Coping, P-A A.D.=Parent-adolescent
acculturation discrepancy
†p<0.10, *p<0.05, **p<0.01, ***p<0.001

Chapter 4 Discussion
This study evaluated a causal pathway that may explain the prediction of cigarette
use by acculturative stress and the moderation effects by coping style found in Study 2
(chapter 3). The results of this study suggest some support for the mediation of
sociocultural stress variables and substance use by depressive symptomatology.
Acculturative stress statistically significantly predicted, and parent-adolescent
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acculturation discrepancy marginally predicted, depressive symptomatology and past 30-
day cigarette smoking. Parent-adolescent discrepancy was almost statistically significant
in the main effects model. This construct was found to statistically significantly predict
cigarette smoking at one-year follow-up (Unger et al., 2009). Thus it is possible that if a
larger sample had been retained at two-year follow-up, we would have found a
statistically significant prediction of past 30-day cigarette smoking at two-year follow-up.
Depressive symptomatology was a statistically significant predictor of past 30-day
cigarette smoking. Overall, this study is consistent with the hypothesized primacy of the
family unit as an important determinant of both depression and substance use among
teens through several direct and indirect pathways. Family conflict statistically
significantly predicted depressive symptomatology, yet failed to predict substance use.
This helps to elucidate the role of family dysfunction in the etiology of substance use
among Hispanic/Latino adolescents. The results of the main effects in our study indicate
that family conflict statistically significantly predicts depressive symptomatology and
depressive symptomatology statistically significantly predicts cigarette smoking at
follow-up; therefore family conflict may be an antecedent or facilitative factor in
cigarette smoking behavior, yet does not exert a direct influence on the substance use
behavior.
Regarding the interaction effects tested in this study, we found two interesting
statistically significant findings that implicate coping styles as important to the stress-
substance use relationship. The variation of the stress-buffering model (Cohen & Wills,
1985) applied in this study, postulated that proactive coping efforts act to buffer the effect
of the stress from producing the distressing emotional states, such as depression, and
100
negative health behaviors, such as substance use. Although we did not find any
moderation of the indirect effects of depression on substance use, we did confirm
previously found evidence of statistically significant moderation by engagement coping
of the relationship between acculturative stress and past 30-day cigarette smoking. At a
low level of engagement coping, teens with both low and high levels of acculturative
stress had higher past 30-day smoking than teens with low acculturative stress and high
engagement coping. However, teens with a high level of engagement coping and high
level of acculturative stress had higher past 30-day smoking than teens with low
engagement coping. In this study, we have controlled for depressive symptomatology,
which is a statistically significant predictor of substance use. Moreover, we found
evidence to confirm another previously demonstrated interaction effect of disengagement
coping on the relationship between parent-adolescent acculturation discrepancy and past
30-day smoking. We found that despite the lack of statistical significance of the total
effect of parent-adolescent acculturation discrepancy on past 30-day smoking in the
mediation analyses, there is a statistically significant moderation by disengagement
coping of this relationship. Although the moderation of the indirect effects was not found,
the moderation of the total effects that were detected indicates that the moderation of all
paths is occurring but power is limited to detect them separately.
In accordance with findings by Compas et al. (1988), these results imply that
when the stressor is perceived as uncontrollable, problem-solving or engagement coping
efforts may produce negative psychological and behavioral problems. Thus, it is plausible
that aspects of acculturative stress are overwhelming at high levels and attempting to deal
directly with that stress in a proactive way (through engagement coping) may exacerbate
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the risk for smoking. Overall, these findings may indicate that when one is feeling
isolated or in conflict with one’s parents, the stress may be perceived as uncontrollable
and unending, which would make the use of disengagement strategies seem more
appropriate and logical (Folkman et al., 1985; Compas, Malcarne & Fondacaro, 1988).
Similarly, the items in our engagement coping measure that address coping strategies of
“feeling better by spending time with others like family, friends or grown-ups” may
further exacerbate feelings of stress and isolation, thus increasing risk for ameliorating
the negative feelings through substance use. The moderation effect of disengagement
coping on parent-adolescent acculturation discrepancy that showed a lower risk for
substance use at high levels of discrepancy and disengagement coping also supports this
interpretation. It follows that higher the salience of the discrepancy between an
adolescent and his/her parent and the more one tries to avoid the problem or the
associated feelings, and the less they feel the desire to use substances. However, this is a
departure from previous stress-coping associations with substance use that show a risk
relationship between avoidance coping and substance use (Hussong & Chassin, 2004,
Johnson & Pandina, 2000, Wills et al., 2001). Although we used a validated measure of
coping, it is a shortened form of the scale (Spirito et al., 1991) and may not have captured
several aspects of the coping mechanisms that may better explain these relationships.
Future research should investigate how the coping mechanisms employed by
Hispanic/Latino teens directly relate to experiencing these culturally-based stressors by
asking teens what they do when they are dealing with that type of problem. Also, coping
measures implemented with this group should examine what they are doing as
alternatives to engaging the problem. It is likely that avoiding one’s feelings about the
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acculturative stress or discrepancy with one’s parents by playing sports or practicing a
musical instrument will be more adaptive than hanging out with friends in an
unstructured way. Hanging out coping has been found to be associated with substance use
among adolescents (Sussman et al., 1993, Dugan, Lucas & Lloyd, 1999).
The findings from this study demonstrate the salience of aspects of family
functioning and adolescents’ perception of his/her family environment as important
determinants of depression in Hispanic/Latino youth. As previously mentioned in Study
2, the traditional Hispanic/Latino cultural values such as familism and respeto are vital
aspects of traditional Hispanic/Latino ethnic identity (Unger et al., 2004). Acculturative
stress caused by perceived parent-adolescent acculturation discrepancies may impair of
familism, may leave the adolescent at risk for cigarette smoking. Also, despite having
been born here, Hispanic/Latino youth are often put in adult or care-taking roles by their
less acculturated parents, many of whom have language barriers (Schwartz et al., 2005).
As Garcia and Lindgren (2009) note, depression may develop through increased family
tension created by a discrepancy between Hispanic/Latino teens and their parents, where
the adolescents acculturate faster than their parents. Therefore, it is possible the stress
these youth experience in taking on greater responsibilities for caring for the family or
helping their parents navigate U.S. culture may result in the teen experiencing depressive
symptomatology, which in turn may increase his/her risk for substance use (Schwartz et
al., 2005; Cespedes & Huey, Jr., 2008).
The implications for prevention interventions from the results of this study may
be contrary to the foundations of previous substance use prevention interventions for the
general population of adolescents. It appears that for Hispanic/Latino adolescents, the use
103
of engagement coping at high levels of acculturative stress or feeling an acculturation
discrepancy with one’s parents may exacerbate substance use risk. In Vaccaro and Wills
(1998), White youth reported significantly greater use of avoidant coping than youth of
other ethnicities and in Siqueira et al. (2001) avoidant coping failed to predict marijuana
use in a primarily Hispanic and African American sample. Therefore, it is possible this
construct is not as relevant to the etiology of substance use among Hispanic or African
American youth. It is possible that among Hispanic/Latino adolescents, the use of
avoidant coping strategies may deter them from cigarette smoking in contrast to what has
been found with primarily White samples (Wills, 1986; Wills et al., 2001). However,
these results suggest a potential avenue for substance use prevention in this group may
reside in involving parents in an intervention to reduce the burden of the acculturative
stress and discrepancy their children are experiencing. Because the potential protection
from cigarette smoking by disengagement coping was found at high levels of stress but
not lower levels, it may be beneficial to help teens recognize their feelings and involve
parents in an intervention to facilitate communication about the process of acculturating
to U.S. culture. This type of intervention may diminish the parent-adolescent
acculturation discrepancy by adjusting expectations about retaining ethnic values and
beliefs and adapting to U.S. culture between the parent and adolescent.

Limitations
Although this study employed established methodology to test the mediation
effects in a temporally sequenced manner (Muller, Judd and Yzerbyt, 2005), it is possible
that the sample size was not large enough to detect the mediation and mediated
104
moderation effects. The generalizeability of this study is limited to Hispanic/Latino
adolescents in Southern California. In addition, our attrition analyses demonstrated that
students who were lost-to-follow-up were more likely to have used cigarettes, alcohol
and marijuana at baseline, which indicates that our results may not be generalizeable to
adolescents who are at higher risk for substance use. Those students who were lost-to-
follow-up were also more likely to live in single parent homes, have higher levels of
family conflict and parent-adolescent acculturation discrepancy. It is possible that not
being able to include these students with poorer family-functioning and higher level of
cultural stress limited our ability to detect statistically significant effects in our regression
analyses. Future research in the field of acculturative stress and substance use research
with Hispanic/Latino adolescents should include students who attend continuation high
schools where students are typically at higher risk for poor family functioning and
substance use and employ methodologies for retaining those students in research studies
(Sussman et al., 1993). These measures would potentially allow researchers to discover
more statistically significant effects and increase generalizeability.

105
CHAPTER 5: DISCUSSION

The studies that comprise this dissertation contribute to the empirical literature
investigating socioculturally-based determinants of substance use among Hispanic/Latino
adolescents. Findings from the three studies indicate that sociocultural influences play a
role in the etiology of mental health and substance use among Hispanic/Latino teens.
Several factors emerge as determinants of Hispanic/Latino adolescent substance use,
particularly cigarette smoking.
Chapter 2 presents the findings from study 1, which examine the transition to
emerging adulthood from a stress-coping perspective among Hispanic/Latino
continuation high school students. Findings showed that this transition appears to be
associated with increased stress and cigarette smoking, alcohol and marijuana use.
However, the associations varied by acculturation level, where emerging adulthood
transition stress was associated with only cigarette smoking in the more highly
acculturated group and was associated with alcohol and marijuana use among the less
acculturated group. This interesting result suggests that there are different meanings
associated with the use of three substances. It is possible that cigarette smoking holds
special prominence as a symbol of one’s increased acculturation to U.S. society.
Conversely, it may signify that one is more acculturated to U.S. society through adopting
the American normative belief that teens smoke to show their independence and
autonomy. Additional research that examines these potential explanations is needed to
further explain this novel finding.
106
The findings from study 2, as shown in Chapter 3, suggest that acculturative stress
is an important predictor of past-30-day cigarette smoking over the course of the high
school period, as the analyses tested these relationships from 9
th
to 11
th
grades,
controlling for baseline past 30-day smoking. Although we failed to show a statistically
significant longitudinal relationship between parent-adolescent acculturation discrepancy
and past 30-day cigarette, alcohol and marijuana use, we were able to detect a marginally
statistically significant prediction of smoking. The results of the effect of coping on
substance use showed that engagement coping inversely predicted use of all three 30-day
substance use outcomes (cigarettes, alcohol and marijuana) and disengagement coping
only predicted past 30-day use of alcohol.
In chapter 4, study 3 investigated three separate mediation models of acculturative
stress and parent-adolescent acculturation discrepancy and substance use (cigarette,
alcohol and marijuana use). However, as shown in study 2, the main effect of
acculturative stress and parent-adolescent acculturation discrepancy was not present for
alcohol and marijuana, thus the mediation was not tested. The results presented in
Chapter 4, show that there was no statistical mediation of acculturative stress and
cigarette smoking by depressive symptomatology. However, there was a small reduction
in the standardized Beta for the total effect of acculturative stress and past 30-day
cigarette smoking when depressive symptomatology was included in the model (the
standardized Beta for the direct effect was smaller than the standardized Beta for the total
effect). Moreover, the findings in Chapter 4 emphasize the importance of incorporating
measures of the family context in the prediction of cigarette smoking among
Hispanic/Latino adolescents, in that family conflict was the largest contributor to the
107
variance in depressive symptomatology and depressive symptomatology was the largest
contributor to the explanation of variance in past 30-day cigarette smoking (Chapter 4).
In studies 2 and 3 (Chapters 3 and 4, respectively), we found that engagement
coping inversely predicted use of all three past 30-day substance use outcomes:
cigarettes, alcohol and marijuana and the same results were found for the cross-sectional
associations tested in study 1 (Chapter 2). However, disengagement coping was only a
statistically significant positive predictor for 30-day use of alcohol in study 2, while it
was statistically significantly positively associated with the past 30-day use of all three
drugs in study 1. Moreover, when the analyses were stratified by acculturation level, the
positive association between disengagement coping and substance use only remained for
highly acculturated youth. There were no statistically significant associations between
disengagement coping and any of the three substances for less acculturated youth
(Chapter 2). This relationship is particularly significant given that the same pattern of
findings was found with two different measures of engagement and disengagement
coping in two different samples of Hispanic/Latino adolescents. The findings from the
stratified analyses by acculturation in Chapter 2 indicates that youth who are less
acculturated (as measured by level of English language use) may be more protected from
substance use by the use of engagement coping strategies than their more acculturated
counterparts. Moreover, this research suggests that disengagement coping may not be
operating the same way as among white adolescents. Previous research in the stress-
coping and substance use literature consistently finds the use of disengagement, or
avoidant, coping to be a statistically significant risk factor for substance use among
adolescents. However, these studies have been conducted predominantly with White
108
youth and typically have not included large proportions of ethnic minorities. In the few
studies that did examine avoidant coping among youth of other racial/ethnic groups
besides Whites, findings indicate less avoidant coping among those youth than Whites
(Vaccaro & Wills, 1998; Siqueira et al., 2000).
Cultural differences with respect to religion, beliefs and values about health and
relationships among family members may help to elucidate the anomalous findings with
respect to the associations between coping strategies and substance use among these
samples of Hispanic/Latino teens. American culture places an emphasis on individualism,
while traditional Hispanic/Latino cultures, as well as many traditional Asian cultures,
place a greater emphasis on family and community units. Therefore, it may be considered
more beneficial to employ avoidant coping strategies in dealing with problems to
preserve harmony in one’s important relationships and community. Moreover, religion
plays an important unifying role in Hispanic/Latino culture and is associated with the
value of fatalism, which assumes that life events are predestined by God (Farley et al.,
2005). Although the use of religious-based coping strategies are not measured in this
dissertation, one would expect that religious-based strategies would be associated with
more favorable health outcomes and less substance use in this population. Research
comparing Hispanic/Latino and White adolescents has shown that Hispanic/Latinos may
engage in spiritual support seeking and social activities (which may include spending
more time in their church) to cope with problems (Copeland & Hess, 1995). Although
disengagement coping at levels of high sociocultural stress appears to be associated with
less substance use it is possible that unmeasured aspects of the disengagement coping
(i.e., distraction) produced the findings among Hispanic/Latino youth. Other activities
109
such as participating in clubs, sports (organized or unorganized games) are not measured
in these dissertation studies and may be prosocial, behaviorally-based distraction coping
strategies that are likely to be employed by Hispanic/Latino adolescents.
Arnett (2005) postulates that identity exploration, one aspect of emerging
adulthood, may be particularly associated with substance use in that one may be seeking
new experiences through using substances or may be ameliorating feelings of confusion
and distress from the identity formation process through using drugs. Hispanic/Latino
adolescents may have the added burden of another dimension of identity exploration, the
pondering and pursuit of their ethnic identity, while they are in this stage of life.
Therefore, the identity formation and exploration characteristic of emerging adulthood
may be even more salient to Hispanic/Latino youth, who undergo the added
developmental task of reconciling their own attitudes and beliefs about their ethnic
culture and their family and friends’ attitudes and beliefs about their ethnic cultural
values (Syed, Azmittia & Phinney, 2007). Cultural meanings are transferred and
interpreted by adolescents through interactions at all levels of adolescents’ environment:
family, peers, his/her immediate community and society at large. Among
Hispanic/Latinos, the family and community-level factors may have more of an impact
on how the emerging adulthood period is experienced due to the collectivist nature of
traditional Hispanic/Latino communities and the potential discrimination or barriers to
full integration in larger U.S. society often experienced (Syed, Azmittia & Phinney,
2007). According to ethnic identity development theory, the late adolescents in this study
may not have had the opportunity to fully develop their ethnic identity because they may
not have changed contexts yet, such as moving out of one’s parents’ house, ethnic
110
enclave, or going to college. These events are times in emerging adulthood where a
reexamination of one’s ethnic identity and conception of oneself would likely take place
(Syed, Azmittia & Phinney, 2007). These departures and shifts should be examined
longitudinally across the period of emerging adulthood in future studies of identity
development and its relationship to health behaviors such as substance use. In addition,
the comparisons should be investigated cross-culturally in diverse samples of late
adolescents/emerging adults in future research.
Interestingly, the multivariate analyses of interaction effects among the
sociocultural stressors in these studies and engagement and disengagement coping
revealed several unique findings with respect to disengagement coping. This is
particularly intriguing in light of the lack of many statistically significant main effects
between these variables and the consistency of the findings in two different samples of
Hispanic/Latino youth. With respect to both emerging adulthood transition stress and
parent-adolescent acculturation discrepancy, among youth who reported higher levels of
disengagement coping, there was a decreased relationship between the levels of stressor
and marijuana use. This moderation effect was also present for the relationship between
parent-adolescent acculturation discrepancy and cigarette smoking and alcohol use in
study 2 (Chapters 3) and for cigarette smoking in study 3 (Chapter 4). It is also important
to note that these studies employed two different coping measures from which the
engagement and disengagement coping scales were derived, yet they provided consistent
results in their relationship with substance use in analyses of main effects and interaction
effects. However, due to space limitations in the surveys, only shortened coping measures
that assess coping style and not situation or stressor-specific coping were employed in
111
these studies. Additional research is needed that employs coping measures that assess
additional aspects of the coping process including perceived threat and controllability of
the stressor.

Limitations, Strengths and Future Directions
The generalizeability of these findings is limited to Hispanic/Latino adolescent
populations who are demographically similar to our sample which were drawn from the
Los Angeles Metropolitan area. Hispanic/Latinos make up 47.7% of Los Angeles County
(U.S. Bureau of the Census, 2000) and are primarily of Mexican-American and then
Central American descent. Other regions’ Hispanic/Latino populations have substantial
numbers of people of Cuban, Caribbean and Puerto Rican origin. The sociodemographic
composition of these sub-groups vary significantly from both Mexican-American and
Central American immigrant populations. It is possible that the hypotheses and models
tested in these studies, particularly in Chapters 3 and 4, may be more applicable to less
acculturated Hispanic/Latino adolescents than more highly acculturated Hispanic/Latino
youth. The cultural stressors and language acculturation would likely play a larger role in
determining the experience of those factors as stressful and causing psychological
distress among immigrant youth or youth with immigrant parents. Although self-reported
substance use by Hispanic/Latino adolescents have been found to be valid and reliable in
clinical samples (Dillon, Turner, Robbins & Szapocznik, 2005), it is possible that the use
of self report for the cigarette smoking, alcohol and marijuana use outcomes in this
dissertation research may have introduced measurement bias into our study.
112
Despite these limitations, this dissertation research attempts to address research
questions identified by researchers in this field (Unger et al., 2000; Baezconde-Garbanati,
2002) that explore sociocultural stressors, emerging adulthood and the use of coping
strategies among Hispanic/Latino adolescents. Overall, these studies provide
methodologically rigorous tests of theory-driven hypotheses about an understudied area
of research in a population that is increasingly demographically significant and culturally
significant to U.S. society. The longitudinal design of studies 2 and 3 are crucial to
determining the causal pathways and adequate testing of stress-coping theory. To the best
of the author’s knowledge, Study 1 represents the first examination of the salience of the
transition to emerging adulthood among high-risk Hispanic/Latino adolescents. Based on
the findings of this dissertation project we can conclude that the transition from late
adolescence to emerging adulthood may be a vulnerable period for adolescents with
regard to their experimentation with substances and possibly escalation of drug use.
Findings indicate that during the developmental period of late adolescence identity
formation processes and mental health states are playing a part in Hispanic/Latino
adolescents’ experimentation with substances.
Although this study provides some limited evidence on which to base future
intervention efforts with Hispanic/Latino youth in late adolescence, further research
should be conducted to determine the extent of the stress perceptions and possible effects
later into the period of emerging adulthood. Specifically, studies are needed that test
hypotheses about how the sociocultural stress variables and coping operate across the
emerging adulthood transition to influence substance use, while accounting for the
subjective experience of the transition as a source of potential stress. Substance use
113
prevention interventions focus on raising awareness of the effects of using substances on
physical, mental and social wellbeing, on realistic normative behaviors among peers, and
on increasing motivation to achieve in life. The results of these dissertation studies
suggest the need to create additional programs, or aspects of programs, for
Hispanic/Latino youth that involve the family and address the adolescents’ understanding
of their parents.

114

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APPENDIX I: COPING ITEMS (STUDY 1, CHAPTER 2)

The following instrument was derived from Wills (1986) coping scale for adolescents.
The following are things that people may do when they have a problem at
school or at home. Put an “X” in the box that shows how much you do
each thing when you have a problem.

Do you do this…

Never

A little

Sometimes

Pretty
much all
the time

Always

a.

I think hard about what
steps to take

b.

I think about the
choices before I do
anything

c.

I consider my actions
very carefully

d.

I daydream about
better times

e.

I tell people just leave
me alone

f.

I daydream about
other things

g.

I take it out on
someone else

h.

I do something bad,
cause trouble

i.

I yell and scream at
someone

j.

I get emotional support
from my mother/father

k.

I get sympathy and
understanding from
my parents

l.

I talk to my
mother/father

125
APPENDIX II: COPING ITEMS (STUDIES 2 AND 3, CHAPTERS 3
AND 4)

Now think of the ways you typically
deal with that kind of problem. Below
is a list of common ways teens deal
with a problem. Please mark one of
the five answer options for each of the
following:
Never do
this
Occasionally
do this
Sometimes
do this
Frequently
do this
Almost
always
do this
1. I did something like watch TV or
play a game to forget it.

1

2

3

4

5

2. I kept quiet about the problem.
1

2

3

4

5

3. I tried to see the good side of
things.

1

2

3

4

5

4. I blamed myself for causing the
problem.

1

2

3

4

5

5. I blamed someone else for causing
the problem.

1

2

3

4

5

6. I tried to fix the problem by doing
something or talking to
someone.

1

2

3

4

5

7. I yelled, screamed, or got mad.
1

2

3

4

5

8. I wished I could make things
different.

1

2

3

4

5

9. I tried to feel better by spending
time with others like family,
grownups, or friends.

1

2

3

4

5

10. I didn’t do anything because the
problem couldn’t be fixed.

1

2

3

4

5

Abstract (if available)

Abstract Introduction: Adolescent substance use remains a major cause of concern in the U.S. and Hispanic/Latino adolescents are at particular risk for substance use at an early age. California data show that Hispanic/Latino youth initiate substance use earlier (in 8th grade) at higher rates than youth who identify as white. This dissertation research integrated theories of emerging adulthood, acculturation, stress and coping to investigate the etiology of substance use among Hispanic/Latino adolescents in Southern California. Specifically, three studies were conducted to investigate the relationships among three sociocultural stress factors (acculturative stress, parent-adolescent acculturation discrepancy, perceived stress and emerging adulthood transition stress), depressive symptomatology, and coping styles (engagement and disengagement) in the etiology of substance use (cigarette, alcohol and marijuana) among Hispanic/Latino adolescents in Southern California.

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Asset Metadata

Creator Grana, Rachel (author)

Core Title Sociocultural stress, coping and substance use among Hispanic/Latino adolescents

School Keck School of Medicine

Degree Doctor of Philosophy

Degree Program Preventive Medicine (Health Behavior)

Publication Date 07/30/2010

Defense Date 05/21/2010

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Adolescents,coping,drug use,Hispanic,Latino,OAI-PMH Harvest,sociocultural,Stress,substance use

Place Name California (states), Los Angeles (counties)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Sussman, Steven Y. (committee chair), Land, Helen (committee member), Rohrbach, Louise A. (committee member), Sun, Ping (committee member), Unger, Jennifer B. (committee member)

Creator Email rachelgrana@gmail.com,rachelgrana@hotmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-m3235

Unique identifier UC177780

Identifier etd-Grana-3889 (filename),usctheses-m40 (legacy collection record id),usctheses-c127-353762 (legacy record id),usctheses-m3235 (legacy record id)

Legacy Identifier etd-Grana-3889.pdf

Dmrecord 353762

Document Type Dissertation

Rights Grana, Rachel

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Repository Name Libraries, University of Southern California

Repository Location Los Angeles, California

Repository Email cisadmin@lib.usc.edu