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U.S. Latinx youth development and substance use risk: adversity and strengths

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U.S. Latinx youth development and substance use risk: adversity and strengths

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U.S. LATINX YOUTH DEVELOPMENT AND SUBSTANCE USE RISK:
ADVERSITY AND STRENGTHS
by
Carolina Villamil Grest, MSW, Ph.D. Candidate

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
(SOCIAL WORK)

August 2020

2020 Carolina Villamil Grest

ii
Dedication
To my Grandparents – The spirit of this dissertation and this journey is dedicated to you. You
lived your lives pridefully, honestly, and heartfully. Stories, memories and most of all –
your love, will forever be part of the reason for pursing this work.
To my daughter Sophia Elena – You have taught me the value of time and joy of living in the
present moment. Thank you for making all of this worthwhile.
To my husband Chris – You have taught me about loyalty, love, kindness and steadfast support.
Thank you for being my partner and biggest support throughout this journey.
To my Mom – You have taught me about hard work, dedication, and perseverance. Thank you
for your unbelievable energy and zest for living and working.
To my Stepfather – You have taught me about integrity and scholarship. Thank you for being a
constant and dependable figure in my life.
To my sister Elena – You have taught me about inner strength, acceptance and love. Thank you
for being my inspiration and reminding me of all there is to be grateful for in the world.

iii
Acknowledgements
To my Cohort – This will be a time to remember. Thank you for joining me on this journey and
for your support throughout. We have all developed our research skills and grown within
our own personal lives. I will remember this time with each of you and enjoy watching us
grow together as colleagues throughout our careers.

To Dr. Julie Cederbaum – Thank you for believing in me and empowering me to believe in
myself. You have been my biggest champion in this journey. This project of mine – and
all those that came before it – are a testament to your mentorship and friendship.

To Dr. Olivia Lee – Thank you for your guidance, experience and keen eye for the numbers.
Your work ethic and methodical approach encourage and inspire me to continue learning.

To Dr. Jennifer Unger – Thank you for your openness and willingness to share your data. Your
research has been a source of encouragement and inspiration.

To all Project RED participants, especially those from my qualitative study – Thank you for your
courage and willingness to meet with me and share so openly about your personal lives.
Those Saturday and Sunday interviews in May-June 2019 were among the best
experiences during my doctoral program journey.

iv
Table of Contents
Dedication ....................................................................................................................................... ii
Acknowledgments.......................................................................................................................... iii
List of Tables and Figures............................................................................................................. vii
Abstract ........................................................................................................................................ viii
Chapter 1: Overview of the Three Studies .......................................................................................1
Introduction and Significance ....................................................................................................1
Conceptual Background .......................................................................................................1
Cultural Factors and Substance Use ....................................................................................2
Substance Use and Latinx ....................................................................................................4
ACE and Latinx Youth ........................................................................................................4
Discrimination, Acculturative Stress and Latinx Youth ......................................................5
Contributions to the Literature .............................................................................................6
Methodology ..............................................................................................................................7
Overview ..............................................................................................................................7
Data Source and Procedures – Quantitative.........................................................................8
Measurement ........................................................................................................................9
Data Source and Procedures – Qualitative.........................................................................11
Overview of Analytic Procedures ......................................................................................11
Summary of the Three Studies ...........................................................................................13
References ................................................................................................................................15

Chapter 2: (Study 1): Adverse Childhood Experiences and the Substance Use Behaviors of
Latinx Youth ..................................................................................................................................27
Abstract ....................................................................................................................................27
Introduction ..............................................................................................................................29
Sociodemographic Factors and Substance Use..................................................................30
Cultural Factors and Substance Use ..................................................................................31
Adversity and Substance Use.............................................................................................32
Current Study .....................................................................................................................33
Method .....................................................................................................................................34
Measurement ......................................................................................................................35
Analytic Procedure.............................................................................................................38
Results ......................................................................................................................................40
Discussion ................................................................................................................................41
Conclusions ........................................................................................................................46
References ................................................................................................................................47

Chapter 3: (Study 2): ACE and Discrimination Resources and Risks of Substance Use among
Latinx Youth ..................................................................................................................................64
Abstract ....................................................................................................................................64

v
Introduction ..............................................................................................................................66
ACE and Latinx Youth ......................................................................................................66
ACE and Substance Use ....................................................................................................67
Discrimination, Acculturative Stress and the Latinx Population .......................................68
Current Study .....................................................................................................................69
Method .....................................................................................................................................71
Sample Participants ............................................................................................................71
Measures ............................................................................................................................72
Analytic Procedure.............................................................................................................75
Results ......................................................................................................................................77
Discussion ................................................................................................................................79
Limitations .........................................................................................................................83
Conclusions ........................................................................................................................84
References ................................................................................................................................85

Chapter 4: (Study 3): Contextualizing Adversity, Culture and Support: Experiences of First,
Second and Third+ Generation Latinx Youth ..............................................................................101
Abstract ..................................................................................................................................101
Introduction ............................................................................................................................103
ACE..................................................................................................................................103
Latinx Youth Adversity ...................................................................................................104
Discrimination as Adversity ............................................................................................105
Cultural Norms and Latinx Heritage ................................................................................105
Social Support ..................................................................................................................106
Current Study ...................................................................................................................107
Method ...................................................................................................................................108
Participant Sampling ........................................................................................................108
Sample..............................................................................................................................109
Qualitative Interviews ......................................................................................................109
Analytic Procedure...........................................................................................................109
Results ....................................................................................................................................110
Adversity ................................................................................................................................111
Traditional ACE ...............................................................................................................111
Discrimination Experiences .............................................................................................113
Other Forms of Adversity ................................................................................................115
Cultural Norms.......................................................................................................................117
Subtheme: Biculturalism ..................................................................................................118
Subtheme: Bilingualism ...................................................................................................120
Subtheme: Traditional Gender Roles ...............................................................................121
Social Support ........................................................................................................................122
Subtheme: Family Support ..............................................................................................122
Subtheme: Other Adult Support/Mentor ..........................................................................124
Discussion ..............................................................................................................................126
References ..............................................................................................................................130

vi
Chapter 5: Conclusions, Implications and Future Directions ......................................................142
Summary of the Three Studies ...............................................................................................142
Study 1 .............................................................................................................................144
Study 2 .............................................................................................................................145
Study 3 .............................................................................................................................146
Limitations .............................................................................................................................147
Major Findings and Implications for Practice and Policy .....................................................148
Future Directions ...................................................................................................................149
References ..............................................................................................................................151

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List of Tables and Figures
Table 1.1. Sample and Variable Characteristics ...........................................................................58
Table 1.2. Hierarchical Negative Binomial Regression Estimates for Past 30-Day Tobacco
Use Frequency .............................................................................................................60
Table 1.3. Hierarchical OLS Regression Estimates for Past 30-Day Alcohol Use Frequency.....61
Table 1.4. Hierarchical Negative Binomial Regression Estimates for Past 30-Day
Problematic Alcohol Use .............................................................................................62
Table 1.5. Hierarchical Negative Binomial Regression Estimates for Past 30-Day Marijuana
Use ...............................................................................................................................63

Table 2.1. Sample Characteristics .................................................................................................96
Table 2.2. Fit Information for One through Five-Class Latent Class Models ..............................98
Table 2.3. Profiles of Traditional ACE and Discrimination Experiences in Young Adulthood...99
Table 2.4. Regression Models of the Association between Class Membership on Past 30-Day
Substance Use Behaviors ...........................................................................................100

Table 3.1. Qualitative Sample Characteristics ............................................................................138
Table 3.2. Matrix of Qualitative Study Themes and Subthemes ................................................139
Figure 3.1. Themes and Subthemes of Adversity, Culture and Social Support among Latinx
Youth..........................................................................................................................141

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Abstract
Substance use research among Latinx youth identifies several cultural factors associated
substance using behaviors, most commonly these are intertwined with acculturation. As families
settle in the U.S., acculturative stress may be associated with low socioeconomic status,
discrimination, segregation, decreased family cohesion, and deteriorating family support. Over a
generation (or two), immigrant households are changing in complex ways, highlighting the
importance of examining additional factors driving these changes. Social processes broadening
our understanding of immigrant youth, such as strong social networks, are protective factors of
immigrant health. Stress-inducing experiences, such as access barriers related to discrimination
and structural inequities, are persistent social processes that contribute to behavioral health risk.
ACE and other adversities outline some of these conditions that are a part of immigrant youth
development and yet remain largely unexamined among this population. As such they guide the
research questions proposed and examined in the three dissertation studies herein. Examining
ACE in the context of the Latinx family environment is essential for further understanding
Latinx youth substance use.
This dissertation examines ACE among U.S. Latinx youth with the goal of understanding
the ways in which ACE, other adversities and risk and protective factors influence substance use
behaviors. By mapping adverse experiences collectively with cultural factors onto risk behaviors,
this dissertation further elucidates those aspects of Latinx culture and adversity that are assets or
risks of substance use behaviors. The studies described herein represent distinct research
questions and analytic approaches, with the overall aim being to identify potential targets for
prevention and intervention focused on closing the gap in health disparities and inequities among
U.S. racial and ethnic minority groups.

1
Chapter 1. Overview of the Three Studies
Introduction and Significance
The increasing ethnic heterogeneity in the U.S. is largely driven by second generation
individuals who spend childhood developing within an immigrant family context. The Latinx
population accounted for more than half of the U.S. population growth between 2008 and2018
(Flores et al., 2019) and this growth is anticipated to continue. Empirical research of U.S. Latinx
adolescents and families shows that while challenges are a normative part of adolescence and
young adulthood, for U.S. Latinx youth, there are additional aspects of development, such as
acculturation stressors and ethnic identity that influence individual development and adaptation
(Suarez-Orozco et al, 2018). Missing from this research is how adverse childhood experiences
(ACE) influence development for U.S. Latinx youth. Considering anticipated growth of the U.S.
Latinx population (Colby & Ortman, 2015), and concerns of accumulated risk exposure (Johnson
et al., 2013), understanding the influence of ACE on substance use behaviors will improve
knowledge of how ACE impacts an important subgroup of the U.S. Latinx population.
Conceptual Background
The immigrant paradox has been described as a reason for declining health across
generations of U.S. Latinx families. The paradox arises from the belief that first generation U.S.
immigrants (i.e., foreign-born), despite their greater socioeconomic disadvantage, are in better
health compared to their offspring (Marks et al., 2014). A healthy immigrant effect also attempts
to explain this initial health advantage as the result of selective migration of healthy individuals
(Acevedo-Garcia et al., 2012). Related hypotheses for unpacking the mechanisms of worsening
health among later generations (i.e., second and third+ generations) include acculturation stress
theory (Gil, Wagner, Vega, 2000), acculturation hypothesis (Scribner, 1996), erosion of

2
protective cultural values (Mogro-Wilson, 2008), and segmented assimilation (Portes & Zhou,
1993).
Connecting all these explanations are similar social processes that broaden our
understanding of immigrant health. For example, strong social networks that produce social
capital and provide support to immigrant families to cope with stress, are protective factors of
immigrant health. Stress-inducing experiences, such as encumbered social mobility, access
barriers related to discrimination, and structural inequities, are persistent social processes that
contribute to behavioral health risk (Alegría et al., 2017).
An integrative model of immigrant youth adaptation (Suarez-Orozco et al., 2018) is the
conceptual framework used in this dissertation. This model provides an outline and illustrates the
conditions and complexities of youth development, in relationship to their family, community,
and the larger societal/global environment. These conditions are some of the research gaps that
ACE and other adversities expand upon, and are a part of immigrant youth development, yet
largely unexamined among this population. These conditions guide the research questions
proposed and examined in the three studies described in this dissertation.
Cultural Factors and Substance use
Acculturation has multiple dimensions with changing combinations of endorsement
across heritage and dominant cultural norms and values (Santisteban et al., 2012). Ethnic
identity, an aspect of this multidimensional acculturation process, considers the subjective
exploration of, and identification with, one’s own cultural heritage (Liebkind et al., 2016;
Phinney, 1992). Identity is a fluid construct that can be a developmental strength during
adolescence (Quintana et al., 2006). However, associations between ethnic identity and
behavioral health show mixed findings. While some studies suggest ethnic identity buffers

3
against substance use among racial and ethnic groups across the U.S. (Fisher et al., 2017; Love et
al., 2006; Marsiglia et al., 2004; Zapolski et al., 2017), it has also been identified as a risk factor
for certain health behaviors, such as alcohol use (Zamboanga et al., 2006; Zamboanga et al.,
2009). Few studies include a multidimensional assessment of culturally relevant indicators.
Distinguished from immigrant generation, acculturation is a process encompassing the
normative cultural adaptation for youth through contact with people and groups from other
cultures (Berry, 1980). Acculturation consists of behaviors, attitudes and values (Schwartz et al.,
2014). Acculturation (Phinney et al., 2001; Sam & Berry, 2016) and enculturation, retainment of
Hispanic cultural values, are important pathways through which Latinx youth develop unique
identities. More acculturated (i.e., greater orientation toward U.S. societal values) individuals are
at greater risk for substance use (Marsiglia & Kiehne, 2020; Salas-Wright et al., 2015). This risk
is associated with acculturation processes within the family system, including family
functioning, cohesion, communication (Lau et al., 2005; Pasch et al., 2006; Smokowski et al.,
2008), parenting practices (Santisteban et al., 2012) and differential adoption of traditional
Latinx cultural values (Lorenzo-Blanco et al., 2013) among youth. Researchers suggest
involvement in one’s cultural heritage can serve as an asset (Smokowski et al., 2009; Suarez-
Orozco et al., 2018; Unger et al., 2009; Unger et al., 2009; Zamboanga et al., 2009). For
instance, acculturation to U.S. societal norms does not necessarily contribute to risky substance
use, instead enculturation, has been found to protect against substance use behaviors (Unger et
al., 2009; Unger et al., 2009). Therefore, emphasizing enculturation can potentially mitigate risk
behaviors. Acculturation studies assessed with proxy items suggest acculturation is the strongest
predictor of lifetime alcohol and drug use among adults (Blanco et al., 2013; Savage & Mezuk,

4
2014), indicating its relevance as a construct in health research among immigrant racial and
ethnic minorities.
Substance use and Latinx
By the eighth grade, Latinx youth report the highest substance use behaviors compared to
their Black and White-identified peers (Johnston et al., 2019). Substance use behaviors among
U.S. immigrants have been investigated through a healthy immigrant paradox lens (Almeida et
al., 2012; Salas-Wright et al., 2016) explaining the idea that as immigrants acculturate and adapt
to U.S. social norms, their substance use worsens. In fact, U.S.-born Latinx youth report more
substance use, compared to their foreign-born peers (Almeida et al., 2012; Bui, 2013; Perreira et
al., 2019; Salas-Wright et al., 2016). Beyond immigrant generation, other studies with
community samples of Latinx youth (Allem et al., 2015) and racial and ethnic minorities (Forster
et al., 2018) support an ACE—substance use link. Among Latinx families, examining additional
experiences, such as ACE in the context of the family environment, is essential for further
understanding Latinx substance use behaviors. This is particularly true given that immigrant
youth living in the U.S. for longer periods of time demonstrate poorer family functioning and
greater behavioral health risk (Alegría et al., 2017; Almeida et al., 2012; Salas-Wright et al.,
2016). These findings suggest there are additional factors to consider when assessing the health
and well-being of U.S. Latinx immigrant youth.
ACE and Latinx Youth
The prevalence of traditional ACE among U.S. racial and ethnic minorities is high, and
greater than their White peers (Sacks & Murphy, 2018; Slopen et al., 2016; Vaughn et al., 2017).
Further, patterns show differences in ACE across immigrant generation (Hughes et al., 2017),
with results generally suggesting an increase in ACE among second (i.e., U.S.-born individuals

5
with at least one foreign-born parent; Caballero et al., 2017; Loria & Caughy, 2018; Vaughn et
al., 2017) and third+ (Villamil Grest et al., in press) generation U.S. immigrants. However,
traditionally measured ACE do not fully capture potential adversities experienced by migrant
children and families, nor the contextual and environmental factors related to immigrant families,
such as exposure to discrimination and immigration-related problems (i.e., parental separation
due to deportation), across U.S. cities (Alegría et al, 2017; Cleary et al., 2018). Immigrants and
their offspring contend with additional adversities, such as compounded trauma at premigration,
and during migration and postmigration (Cleary et al., 2018), and acculturation-related stressors
such as language ability (Alegría et al., 2017). Other less examined roots of adversity among
U.S. Latinx immigrants and their families are structural forces that enhance vulnerability to
additional stressors, such as access to health care, legal support, adequate living and working
conditions, and federal policies (Castañeda et al., 2015).
Discrimination, Acculturative Stress and Latinx Youth
There is widespread understanding that discrimination experiences among racial and
ethnic minorities are associated with poor health outcomes, thus contributing to health
disparities. Beyond indirect or direct experiences of mistreatment, social environments with anti-
immigrant sentiment, and policies that increase exposure to discrimination, contribute to the
marginalization and stigmatization experienced by both first and second-generation immigrants
(Almeida et al., 2016). These social processes influence vulnerability and social exclusion,
restricting opportunities among immigrants and their offspring, and contribute to racial and
ethnic inequities (Alegría et al., 2017).
Several systematic literature reviews examining the link between perceived
discrimination among racial and ethnic minority adolescents and risky behaviors underscore the

6
persistent and negative association between discrimination and adolescent wellbeing cross-
sectionally (Benner et al., 2018) and longitudinally (Cave et al., 2020). Research including
discrimination experiences in their study of ACE, suggest racial and ethnic minority youth are
more likely to encounter racial discrimination (Macguire-Jack et al., 2019), which in turn
impacts overall health and wellbeing (Liu et al., 2018).
Discrimination research among U.S. Latinx populations has often examined stressors
related to acculturation (Alegría et al., 2017; Cervantes et al., 2016). Acculturative stress and
adaptation to U.S. societal norms, are associated with substance use risk among immigrant
minorities (Alegría et al., 2017, Smokowski et al., 2008). The stress from acculturation is
explained to arise from discordant acculturation behaviors, values, and practices with family,
friends, and community (Schwartz et al., 2010). However, discrimination-related acculturation
stress is only one of multiple stressors that can impact poor health outcomes (Alegría et al.,
2017). For instance, stress domains associated with substance use risk among Latinx youth
included family economics, acculturative gaps with parents, community/gang exposure, and
family/drugs (Cardoso et al., 2016).
Contributions to the Literature
As families settle in the U.S., acculturative stress may be associated with low
socioeconomic status, discrimination, segregation, decreased family cohesion, and deteriorating
family support (Detlaff & Johnson, 2011; Ibañez et al., 2015; Nguyen & Benet-Martínez, 2013;
Torres et al., 2012). Over a generation (or two), immigrant household environments are changing
in complex ways, highlighting the importance of continuing to examine additional factors
driving these changes (Villamil Grest et al., in press). Examining ACE in the context of the
Latinx family environment is essential for further understanding Latinx substance use outcomes.

7
This is particularly true given that immigrant youth living in the U.S. for longer periods of time
demonstrate poorer family functioning and greater behavioral health risk (Almeida et al., 2012;
Salas-Wright et al., 2016).
This dissertation examines ACE among U.S. Latinx youth with the goal of understanding
the ways in which ACE and risk and protective factors influence substance use behaviors. By
mapping adverse experiences collectively with cultural factors onto risk behaviors, this
dissertation further elucidates those aspects of Latinx culture and adversity that are assets or risks
of substance use behaviors. The studies described herein represent distinct research questions
and analytic approaches, with the overall aim being to identify potential targets for prevention
and intervention focused on closing the gap in health disparities and inequities among U.S. racial
and ethnic minority groups.
Methodology
Overview
A sequential explanatory mixed-Method design was used in this dissertation. First, two
secondary data analyses (Study 1 and 2) using data from Project RED (Unger et al., 2009), a
sample of Latinx youth, were investigated. To explore specific qualitative questions and make
meaning of some of the findings that arose, primary qualitative data collection (Study 3) of a
subsample (n = 40) of the original study population was conducted. The mixed Method approach
used in this work posits that neither quantitative nor qualitative data analysis in isolation is
enough to capture the nuances of this research, yet together these Method are complementary
and more robust (Creswell & Clark, 2017; Ivankova et al., 2006). Study 1 examines the
longitudinal association of culturally relevant factors of substance use behaviors among Latinx
youth, including acculturation, enculturation, and ethnic identity, collectively with ACE. Study 2

8
identifies intersections of adversity profiles drawn from traditional ACE and perceived
discrimination experiences, and their longitudinal association with substance use in young
adulthood. Study 3 presents exploratory and emergent themes from primary data collection of
individual qualitative interviews. The rationale for a concurrent mixed Method design is twofold:
1) to empirically and distinctly examine associations of adversity and cultural factors and
substance use; and 2) to gain a better understanding of the contextual processes that influence
substance use across generations, in a multicultural context, using qualitative exploration. The
concurrent integration of quantitative and qualitative data will aid interpretation and improve
understanding of the results.
Data Source and Procedures - Quantitative
This study is a secondary analysis of Project RED, a longitudinal study of acculturation
and substance use among Latinx adolescents from Southern California from 2005 to 2016
(Unger et al., 2009). Schools were invited to participate if 70% or more of their student
enrollment was Latinx. Sampling emphasized schools in Los Angeles County with a broad range
of socioeconomic characteristics. Using the 2000 census data, the median annual household
incomes in the school’s ZIP codes ranged between $29,000 and $73,000. Youth in ninth grade,
attending one of seven high schools in those ZIP codes, were invited to participate. A total of
seven timepoints (i.e., waves) were collected in Project RED.
The first of seven data collection timepoints began in 2005, with all students enrolled
invited to participate (N=3,218). Students returning written or verbal/telephonic parental consent
and student assent, were allowed participation. The initial survey was completed by 2,222
students (69%). Between 2010 and 2016, attempts were made to re-contact students who
identified as Hispanic/Latino (n=1,963; 88%), completed high school surveys, and had valid

9
contact information. Information about the sample included in each of the three studies is
presented in Chapters 2 through 4.
Measurement
Main Dependent Variables
Substance use. Continuous dependent substance use variables measured during young
adulthood in the Wave 7 (Mage = 23.9, S.D. = 0.41) of Project RED assessed substance use
behaviors. These included one item each assessing past 30-day use of: 1) tobacco (i.e., days you
smoked cigarettes), 2) alcohol (i.e., number of days drinking at least 1 drink), 3) problematic
drinking (i.e., number of day with 5 or more drinks in a row), and 4) marijuana (i.e., number of
times used). These substances were selected for analysis due to the low frequency of other illicit
drugs (i.e., other hard drugs such as cocaine, methamphetamine, ecstasy, hallucinogens,
inhalants) among sample participants.
Main Independent Variables
The main independent variable across Study 1 and 2 is ACE. The original CDC-Kaiser
ACE study assessed five categories of maltreatment (emotional and physical neglect,
psychological, physical, and sexual abuse) and five categories of family dysfunction (divorce,
substance use, mental illness, parental violence, and incarceration) (Felitti et al., 2019). Eight
items mapped onto the original ten ACE (excluding emotional and physical and neglect) and
were measured during early young adulthood at Wave 5 (Mage = 21.6, S.D. = 0.50) for
experiences prior to age 18. The only other variation from the original ACE study was the sexual
abuse question stem, which included sexual intercourse with any person at least 5 years older
(following the consent laws of California).

10
Study 2 of this dissertation assessed perceived discrimination using a 10-item measure of
adolescents’ perception of experienced everyday discrimination (Guyll et al., 2001), as an
additional measure of adversity and main independent variable. Discrimination was measured
across all waves of Project RED however, Study 2 utilized the measurement from Wave 5 to
correspond with the measurement of ACE in the same timepoint. Additional information about
this variable is provided in Chapter 3.
Culturally relevant variables assessed in Study 1 and 2 were acculturation and ethnic
identity. Acculturation and enculturation were measured during adolescence in Wave 2 (Mage =
15.5, S.D. = 0.38) using a short form of the Revised Acculturation Rating Scale for Mexican
Americans-II (Cuéllar et al., 1995), a 13-item measure asking respondents to assess statements of
cultural behaviors such as language use and preferences, cultural heritage and ethnic behavior,
and ethnic interaction. Ethnic identity was measured with the Multi-Group Ethnic Identity
Measure (Phinney, 1992), a 12-item instrument assessing the multidimensional construct of
ethnic identity. Comprised of two interrelated, yet independent aspects of ethnic identity, this
measure assessed: 1) ethnic identity search/achievement (cognitive), and 2) ethnic identity
affirmation (affective). Specific information about these measures are provided in Chapters 2 and
3.
Other demographic covariates in Study 1 and 2 of this dissertation include sex
(female/male; 0/1), household composition (a dichotomous measure of single or two parent
household; 0/1) and persons-per-room/house was used as a proxy of socioeconomic status.
Corresponding with each substance use outcome, reported past 30-day tobacco, alcohol,
problematic alcohol and marijuana use in Wave 2 were controlled for in all models. Given the
association between emotional distress and substance use, adolescent depression was assessed

11
using the 20-item Center for Epidemiological Studies Depression Scale (Radloff, 1977). All
covariates were measured in Wave 2.
Data Source and Procedures - Qualitative
Study 3 included 40 individual interviews using a subsample of participants from Project
RED to explore participant experiences growing up in the U.S. as first, second, and third
generation youth. The Project RED secondary data source was sorted by first, second, and third
generation to generate a list of participants for relocation and recruitment. A total of 411
participants were sent an email invitation to participate in the study. A second round of email
invitations were sent to participants who did not respond after two weeks. During this time, 51
participants responded with interest. A total of 44 in-person interviews were scheduled, 40 were
completed and 4 of these were cancelled due to participant no-shows. Semi-structured individual
interviews included questions about participant experiences growing up; specifically, about the
contexts that influenced childhood adaptation such as culture, family, community, childhood
adversities, discrimination experiences and substance use behaviors. Information about
qualitative sample participants and analytic procedures are provided in Chapter 4.
Overview of Analytic Procedures
Quantitative Data Analysis.
Study 1. Three of the four dependent variables (i.e., tobacco use, problematic drinking
and marijuana use) are count variables and did not meet assumptions for an ordinary least
squares (OLS) regression. A negative binomial (NB) regression was chosen to account for
overdispersion (Coxe et al., 2009). OLS regression was used for past 30-day alcohol use and a
series of NB models were conducted to assess associations of interest. The hierarchical
regressions proceeded in three stages corresponding to the research questions for Study 1.

12
Variables were estimated simultaneously in subsequent stages, as suggested by Cohen and
colleagues’ (2013).
Study 2. A latent class analysis (LCA) approach and regression models (as described for
Study 1) were estimated to examine the research questions in Study 2. Specific information
concerning the analytic approach for this study can be found in Chapter 3.
Qualitative Data Analysis.
Study 3. Qualitative interviews were audio-recorded and then transcribed verbatim. Data
analysis followed a multistage descriptive and exploratory process. A thematic analysis approach
was implemented following methodology described by Hsieh and Shannon (2005) with
interview transcripts analyzed in the following manner. First, two researchers each reviewed six
transcripts to develop a broad understanding of the content by documenting initial impressions of
specific codes. Lists of codes developed were matched and integrated into a final codebook
consisting of a list of codes and their definition, that relate to the study research questions. In the
next stage, all transcripts were independently coded by at least two researchers using the initial
codebook structure developed in the first step. Disagreements in assignment or description of
codes and their utility, were resolved through discussion and enhanced definition of codes. Based
on these codes, a computer software program was used to code data, primarily connecting text
segments grouped into separate codes. The process of condensing and developing codes into
broad themes involved determining which themes were most relevant to the study aims, in an
iterative and simultaneous process of analyzing the data, reviewing and collapsing the codes,
refining their definitions, and developing general themes through the process of discovering
patterns and meaning in the themes illustrated through the quotes (Braun & Clarke, 2006).
Further information about the analytic process of Study 3 is provided in Chapter 4.

13
Summary of the Three Studies
The overarching aim of this dissertation is to advance substance use research among
Latinx youth. By examining important measures as predictors of adversity and cultural
constructs relevant to the study of Latinx youth risk behaviors, this dissertation guides the reader
through several steps seeking to move the needle closer towards achieving health equity. Study 1
(Chapter 2) focuses on examining key sociodemographic, ACE, and culturally relevant
predictors of substance use behaviors among Latinx youth.
It is now widely understood that the traditional measurement of ACE excludes adversities
embedded in the contextual and environmental experiences of U.S. immigrant children and
families. Racial and ethnic minorities in the U.S., including immigrants and their offspring,
contend with additional adversities (Cleary et al., 2018), such as discrimination and
acculturation-related stressors (Alegría et al., 2017). As such, Study 2 (Chapter 3) uses a person-
centered approach to enhance the traditional ACE measurement by adding specific
discrimination experiences to examine the nexus of traditional ACE and discrimination
experiences and the substance use behaviors associated with them. This approach identifies
specific adversities reported by Latinx youth in this sample, with the aim of understanding those
experiences that inform substance use behaviors. Such specificity can be used to identify key
targets that inform and enhance prevention and intervention approaches.
Last, Study 3 (Chapter 4) supports and advances the quantitative studies. Despite extant
literature focused on the relationship between ACE and adulthood substance use, little is known
about how childhood adversities, considered with culturally relevant variables such as
acculturation, enculturation, and ethnic identity, influence Latinx youth substance use behaviors.
While the quantitative studies (Study 1 and 2) in this dissertation focus on empirically

14
understanding the relationships among these variables, the qualitative study (Study 3) narratively
describes how and why these constructs are connected through an understanding of the lived
experience of Latinx youth. Study 3 seeks to demonstrate risk and protective factors of substance
use, through personal reflections of adversity, Latinx cultural experiences, and social support
from family and community. This mixed Method approach provides a holistic understanding of
risk and protective factors and substance use and identifies key targets for prevention and
improving the health and wellbeing of U.S. Latinx populations.

15
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Zapolski, T. C., Fisher, S., Banks, D. E., Hensel, D. J., & Barnes-Najor, J. (2017). Examining the
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https://doi.org/10.1007/s10964-016-0605-0

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Chapter 2 (Study 1):
Adverse Childhood Experiences and the Substance Use Behaviors of Latinx Youth

Abstract
Purpose: Substantial research documents an association between Adverse Childhood
Experiences (ACE) and adult substance use, however the relationship between ACE and U.S.
Latinx youth substance use behaviors is less examined. Understanding the ACE—substance use
link has important implications for health equity. This study examines longitudinal associations
of important cultural factors relevant to Latinx youth substance use, including acculturation,
enculturation, and ethnic identity, collectively with ACE and the substance use behaviors of
Latinx youth.
Method: Survey data was collected at seven timepoints from 2005-2016; 1,179
respondents participated in follow-up ACE assessment in Wave 5 (Mage = 21.6 years) and
substance use measures in Wave 7 (Mage = 23.9 years). ACE included psychological, physical,
and sexual abuse, parental domestic violence, separation/divorce, household alcohol/drug use,
mental illness, and incarceration. A three-stage hierarchical regression estimated ordinary least
squares (i.e., alcohol use) and negative binomial (NB) models (i.e., tobacco, problematic alcohol,
and marijuana use) assessing associations of factors known to influence substance use among
Latinx youth.
Results: Initial models estimating sociodemographics indicated sex and adolescent
substance use predicted substance use outcomes in young adulthood. Sex was the single
predictive determinant of past 30-day tobacco use. Acculturation predicted alcohol use,
remaining statistically significant after adding ACE operationalizations: ACE sum (B = .03, p =
.01), maltreatment (B = .16, p < .01), and household dysfunction (B = .12, p = .03). NB models

28
of problematic drinking showed enculturation (IRR = 0.90, 95% CI: .81 – 1.00) predicted lower
expected count of past 30-day problematic alcohol use. After adding ACE, ACE sum (IRR =
1.13, 95% CI: 1.04, 1.22) significantly predicted past 30-day marijuana use. One additional
increase in child maltreatment (IRR = 1.23, 95% CI: 1.00, 1.53) predicted 23% higher count of
problematic alcohol use. Child maltreatment (IRR = 1.50, 95% CI: 1.05, 2.13), and household
(IRR = 1.66, 95% CI: 1.18, 2.32) subdomains predicted increased counts of past 30-day
marijuana use.
Conclusions: Results suggest a predictive relationship between ACE and substance use
among Latinx youth. Beyond acculturation and enculturation, both important cultural risk and
protective factors, ACE remain predictive of alcohol and marijuana, but not tobacco use. This
research informs health disparities prevention examining the substance use risk of cultural
factors and ACE. Future research must assess the community and societal context of risk and
protective factors among Latinx youth to close the health gap.

29
Introduction
Latinx youth have the highest rates of use for all substances in eighth grade; by tenth
grade, they surpass their White and Black peers in alcohol, marijuana, and cocaine use (Johnston
et al., 2019). Empirical research of U.S. Latinx adolescents and families shows that while
challenges are a normative part of adolescence and young adulthood, there are additional aspects
of development, such as acculturation and ethnic identity (Suarez-Orozco et al., 2018), that
influence individual adaptation and development. The growing ethnic diversity in the U.S. is
mostly driven by second generation individuals who spend childhood developing within an
immigrant family context. Between 2008 and 2018, the Latinx population grew by more than
half (52%; Flores et al., 2019), with continued growth anticipated (Colby & Ortman, 2015).
Substance use behaviors are higher among US-born Latinx youth, compared to their foreign-born
peers (Peña et al., 2008; Salas-Wright et al., 2016), which can impact psychosocial wellbeing.
Largely absent from the research is an understanding of the long-term role of adverse childhood
experiences (ACE) in childhood development among U.S. Latinx youth (Caballero et al. 2017;
Loria & Caughy, 2018; Slopen et al., 2016; Vaughn et al., 2017), and in turn, their substance use
behaviors (Salas-Wright et al., 2016; Salas-Wright et al., 2018; Vaughn et al., 2017). These
alarming substance use patterns, combined with concerns of accumulated risk exposure (Johnson
et al., 2013), and health disparities among U.S. Latinx immigrants (Alegría et al., 2017), compels
a greater understanding of the influence of ACE on Latinx substance use behaviors. Advancing
this research will improve ACE prevention among a growing minority subgroup of the U.S.
population. This research examines the longitudinal associations of acculturation, ethnic identity
and ACE on the substance use behaviors of U.S. Latinx youth.

30
Sociodemographic Factors and Substance Use
The substance use behaviors of Latinx youth are differentially related to
sociodemographics, such that youth from different generations are subject to variations in
functioning and adaptability (Rumbaut, 2006). Examining health advantage and disadvantage by
immigrant generation, especially among U.S. Latinx immigrants is important as there are
behavioral and attitudinal generational differences linked to development and the larger
historical context (Menjivar et al., 2016). Importantly, the healthy immigrant paradox suggests
that behavioral health varies across immigrant groups, indicating later U.S. Latinx generations,
may be more vulnerable to substance use (Alegría et al., 2017). Further, Latinx youth substance
use behaviors are associated with demographics such as age and gender. The latter is often
attributed to cultural norms around traditional gender roles. For instance, Latinx men, compared
to women, are more likely to smoke tobacco and develop an alcohol or drug use disorder in their
lifetime (Marsiglia & Kiehne, 2020). Socioeconomic status (Alegría et al., 2017) and youth
intersectionality/social positionality (Suarez-Orozco et al., 2018) also dynamically contribute to
behavioral health.
Prior research has found a consistent patterning of Latinx substance use by nativity and
immigrant generation (Alvarez et al., 2019; Bui, 2013; Peña et al., 2008; Salas-Wright et al.,
2018; Salas-Wright et al., 2014; Salas-Wright et al., 2016; Vaughn et al., 2017). Later
generations (or third+; i.e., U.S. born with U.S. born parents) of U.S.-born adolescents (Peña et
al., 2008) and adults (Salas-Wright et al., 2018) are more likely to report problematic substance
use, compared to second generation (i.e., individuals with at least one foreign-born parent;
Alvarez et al., 2019; Peña et al., 2008) and to a larger extent foreign-born (i.e., first generation)
immigrants (Alvarez et al., 2019; Salas-Wright et al., 2014; Salas-Wright et al., 2016; Salas-

31
Wright et al., 2018). Although conducted among large, national adolescent samples, many of
these studies do not assess culturally relevant factors, beyond nativity, using validated measures
(e.g., Peña et al., 2008; Salas Wright et al., 2016).
Cultural Factors and Substance Use
Acculturation has multiple dimensions with varying combinations of endorsement across
heritage and dominant cultural norms and values (Santisteban et al., 2012). Ethnic identity, an
aspect of this multidimensional acculturation process, considers the subjective exploration of and
identification with one’s own cultural heritage (Liebkind et al., 2016; Phinney, 1992). Identity is
a fluid construct, with ethnic group identity tending to decline across generations (Lu et al.,
2020; Phinney, 1992), yet it can be a developmental strength during adolescence (Quintana et al.,
2006). However, associations between ethnic identity and behavioral health show mixed
findings. While some studies suggest ethnic identity buffers against substance use among U.S.
regional racial/ethnic groups (Fisher et al., 2017; Love et al., 2006; Marsiglia et al., 2004;
Zapolski et al., 2017), it has also been shown to be a risk factor for certain health behaviors such
as alcohol use (Zamboanga et al., 2006; Zamboanga et al., 2009). Few studies include a
multidimensional assessment of culturally relevant indicators (i.e., Fisher et al., 2017; Love et
al., 2006; Marsiglia et al., 2004; Zapolski et al., 2017).
Distinguished from immigrant generation, acculturation is a process encompassing the
normative cultural adaptation for youth, through contact with people and groups from other
cultures (Berry, 1980). Acculturation consists of behaviors, attitudes and values (Schwartz et al.,
2014). Acculturation (Phinney et al., 2001; Sam & Berry, 2016) and enculturation, retainment of
Hispanic cultural values, are important pathways through which Latinx youth develop unique
identities. More acculturated (i.e., greater orientation toward U.S. societal values) individuals are

32
at greater risk for substance use (Marsiglia & Kiehne, 2020; Salas-Wright et al., 2015). This risk
is associated with acculturation processes within the family system, including family
functioning, cohesion, communication (Lau et al., 2005; Pasch et al., 2006; Smokowski et al.,
2008), parenting practices (Santisteban et al., 2012) and differential adoption of traditional
Latinx cultural values (Lorenzo-Blanco et al., 2013) among youth. Studies assessing
acculturation with proxy items suggests it is the strongest predictor of lifetime alcohol and drug
use among adults (Blanco et al., 2013; Savage & Mezuk, 2014), indicating its relevance as a
construct immigrant in health research. Researchers suggest that involvement in one’s cultural
heritage can serve as an asset (Smokowski et al., 2009; Suarez-Orozco et al., 2018; Unger et al.,
2009; Unger et al., 2009; Zamboanga et al., 2009). For instance, acculturation to U.S. societal
norms does not necessarily contribute to risky substance use, instead enculturation, has been
found to protect against substance use behaviors (Unger et al., 2009; Unger et al., 2009).
Therefore, an emphasis on enculturation can potentially mitigate risk behaviors.
Adversity and Substance Use
Decades of research have demonstrated the link between early adverse life experiences
and subsequent health problems over the life course (Felitti et al., 2019). As ACE are purportedly
higher in racial/ethnic populations (Maguire-Jack et al., 2019; Mersky & Janczewski, 2018;
Slopen et al., 2015), this pattern has also been observed among racial/ethnic minority groups
(Salas-Wright et al., 2016; Salas-Wright et al., 2018; Vaughn et al., 2017). While ACE among
Latinx youth are also high (Caballero et al., 2017; Loria & Caughy, 2017; Vaughn et al., 2017),
existing national studies with a Latinx subpopulation have excluded important adversities such as
child abuse (Caballero et al., 2017; Loria & Caughy, 2017) and household dysfunction (Vaughn
et al., 2017). Further, literature linking childhood adversity and adolescent risk behaviors has

33
focused on single ACE measures (i.e., family incarceration; James et al., 2018; Grigsby et al.,
2018) or has primarily been cross-sectional (Allem et al., 2015; Forster et al., 2018).
Examining additional experiences, such as ACE in the context of the family environment,
among Latinx families is essential for further understanding Latinx substance use. This is
particularly true given that immigrant youth living in the U.S. for longer periods of time
demonstrate poorer family functioning and greater behavioral health risk (Almeida et al., 2012;
Salas-Wright et al., 2016). This includes an increase in psychiatric disorder rates, such as
depression, anxiety, and substance use (Alegría et al., 2017). Empirical findings suggest there are
additional factors to consider when assessing the health and well-being of U.S. Latinx immigrant
youth.
Current Study
The current study aims to advance health disparities research focused on predictors of
substance use behaviors among Latinx youth. Although literature informs us of the strong
association between ACE and adult substance use, little is known about how childhood
adversities, together with important culturally relevant variables such as acculturation,
enculturation, and ethnic identity, predict Latinx youth substance use behaviors. This paper uses
an integrative model for understanding the adaptation of immigrant-origin youth (Suarez-Orozco
et al., 2018). Though sociodemographic factors such as immigrant generation, race/ethnicity,
gender, and socioeconomic status are immutable, these factors are social positions that shape the
experiences of Latinx youth, and may be associated with their behavioral health, and potentially
contribute to mechanistic influences more susceptible to change (Suarez-Orozco et al., 2018). In
addition to considering known sociodemographic correlates of substance use, this study
examines the longitudinal association of culturally relevant factors of substance use behaviors

34
among Latinx youth, including acculturation, enculturation, and ethnic identity, collectively with
ACE.
This study is guided by the following research questions: 1) In what ways do
acculturation, enculturation and ethnic identity predict substance use behaviors among Latinx
youth in young adulthood; 2) Are ACE uniquely associated with Latinx substance use behaviors
after considering the impact of culturally relevant variables? 3) Are there unique associations
between subdomains (i.e., household dysfunction and child abuse) of ACE and Latinx substance
use behaviors, after considering culturally relevant variables? Hypotheses for the relationships
examined in this study are based on existing research as follows: 1) As acculturation increases,
substance use will increase (positive relationship); as enculturation increases, substance use
behaviors will decline (negative relationship). The relationship between ethnic identity and
substance use behaviors are mixed, thus remain exploratory. Hypotheses for research questions
2) and 3) anticipate that ACE will be associated with substance use behaviors beyond the
culturally relevant factors for Latinx youth. Specific hypothesis concerning ACE subdomains are
not considered because these have not been previously examined among U.S. Latinx youth.
Method
This study is a secondary analysis of Project RED (Unger et al., 2009), a longitudinal
study of acculturation and substance use among Latinx adolescents from Southern California.
Adolescents in 9th grade who were attending one of seven high schools in Los Angeles.
Participating schools all had a 70% or greater enrollment of Latinx students. The median
household incomes in the ZIP codes served by the participating schools ranged from $29,000 to
$73,000. Details on student recruitment and survey procedures have been published elsewhere
(Unger et al., 2009). The University’s Institutional Review Board approved all procedures.

35
The first wave of data collection began in 2005, with all students enrolled in selected
grades invited to participate (N=3,218); 2,222 students (69%) completed the initial survey.
Between 2010 and 2016, attempts were made to re-contact students identifying as
Hispanic/Latinx (n=1,963; 88%) who completed high school surveys and had valid follow-up
contact information. A total of 1,303 participants completed follow-up data in one or more of
four additional waves (W4-W7). Self-report data for these analyses included information from
participants completing study measures at Waves 2, 5 and 7 with a final n = 1,179. Complete-
case data analysis using chi-square tests assessed participant retention across analysis variables.
Participants lost to follow-up were more likely to be from a single parent household (χ2 (1, N =
1125) = 25.66, p < .01). No differences were observed for gender and persons per room/house,
study covariates.
Measurement
Main Dependent Variables
Substance use. Substance use variables measured in the final wave (Wave 7; Mage =
23.9) of Project RED were used to assess substance use behaviors. These included one item each
assessing past 30-day use of the following: 1) tobacco (i.e., number of days you smoked
cigarettes), 2) alcohol (i.e., number of days drinking at least 1 drink), 3) problematic drinking
(i.e., number of days with 5 or more drinks in a row), and 4) marijuana (i.e., number of days of
use). Continuous substance use variables were coded as follows for past 30-day tobacco and
alcohol use: 0 days (0), 1-2 days (1), 3-5 days (2), 6-9 days (3), 10-19 days (4), 20-29 days (5),
all/30 (6); past 30-day problematic alcohol use: 0 days (0), 1 day (1), 2 days (2), 3-5 days (3), 6-9
days (4), 10-19 days (5), 20+ (6); and past 30-day marijuana use: 0 times/never (1), 1-2 days (2),
3-9 days (3), 10-19 days (4), 20-39 days (5), 40+ days (6). These substances were selected for

36
analysis due to the low frequency (at least 95% of the sample reported no use) of other illicit
drugs (i.e., other hard drugs such as cocaine, methamphetamine, ecstasy, hallucinogens,
inhalants) among sample participants.
Main Independent Variables
Adverse childhood experiences. The original CDC-Kaiser ACE study assessed five
categories of maltreatment (emotional and physical neglect, psychological, physical and sexual
abuse) and five categories of family dysfunction (divorce, substance use, mental illness, parental
violence, and incarceration) (Felitti et al., 2019). The eight items mapped onto the original 10
ACE (excluding emotional and physical neglect) and were measured at Wave 5 for experiences
prior to age 18. The only other variation from the original ACE study was the sexual abuse
question stem, which included sexual intercourse with any person at least 5 years older
(following the consent laws of California). Several dependent variables were created to address
our research aim, with specific groupings of adversity based on conceptual similarity and prior
operationalizations (Dong et al., 2004). First, a continuous summative ACE score was created (0-
8). Next, dichotomous (0/1) variables were created examining the absence/presence of ACE by
categories, including: (1) combined maltreatment (i.e., psychological/emotional, physical, and
sexual abuse), (2) psychological/emotional maltreatment only, (3) physical maltreatment only,
(4) sexual abuse only, (5) combined household dysfunction (i.e., parental violence, substance
use, mental illness, divorce, and incarceration), and (6) parental violence (7) parent substance
use, (8) parent divorce, (9) parent mental illness, and (10) parent incarceration.
Acculturation/Enculturation. Acculturation was measured in Wave 2 (Mage = 15.5, S.D.
.38) using a short form of the Revised Acculturation Rating Scale for Mexican Americans-II
(Cuéllar et al., 1995), which assesses cultural behaviors such as language use and preferences,

37
cultural heritage and ethnic behavior, and ethnic interaction. This 13-item measure asks
respondents to assess cultural statements using a Likert-type scale with response items ranging
from 1 (not at all) to 5 (almost always or extremely often). Items include: “I enjoy listening to
English language music” and “My thinking is done in the Spanish language.” For the final
analysis, responses were used to create two mean acculturation scores, with six items drawn from
the Hispanic orientation (i.e., enculturation; α = .91) and seven items drawn from the U.S.
orientation (i.e., acculturation; α = .74) subscales.
Ethnic Identity. The Multi-Group Ethnic Identity Measure (MEIM; Phinney, 1992) is a
12-item instrument comprised of two interrelated, yet independent aspects of ethnic identity: 1)
ethnic identity search/achievement (cognitive), and 2) ethnic identity affirmation (affective).
Ethnic identity search/achievement involves the exploration of one’s ethnic heritage along a
spectrum ranging from low to high and is assessed with five items such as “I have spent time
trying to find out more about my ethnic group, such as its history, traditions, and customs.”
Ethnic identity affirmation (affective) assesses feelings of ethnic pride in one’s own background
and belonging to an ethnic group and is assessed with seven items such as “I feel a strong
attachment to my ethnic group.” Response options ranged from 1 (strongly disagree) to 4
(strongly agree); separate mean scores (cognitive and affective) for each dimension of ethnic
identity were created, with higher scores indicating higher ethnic identity attainment. In the
current sample, Cronbach alpha was α = .73 for search/achievement and α = .84 for affirmation
subscales.
Immigrant Generation. Distinguished from nativity (dichotomous representation of
foreign-born vs. US-born) immigrant generation categorizes immigrant people into first, second
and third+ generations (Zong et al., 2019). First generation are immigrants who were foreign

38
born and migrated to the U.S., second generation immigrants are U.S.-born, but have at least one
foreign born parent. The parents of third+ generation youth have parents who were both U.S.
born (second generation themselves).
Ratio of Persons Per Room Per House. Persons-per-room/house, measured in Wave 2,
was used as a proxy measure of socioeconomic status. A common measure of overcrowding,
persons-per-room/house (Myers et al., 1996) is a ratio estimate of the total number of persons
living in the participants’ home divided by the total number of rooms (excluding bathroom and
kitchen) in the home. Persons-per-room/house is used at the governmental level (Blake et al.,
2007) and in urban planning, population, and housing policy research (Krivo, 1995). A
household with more than one person/per room is classified as overcrowded (Myers et al., 1996).
Early substance use and depression. Corresponding with each substance use outcome,
reported past 30-day tobacco, alcohol, problematic alcohol, and marijuana use in Wave 2 were
controlled for in all models. Given the association between emotional distress and substance use,
depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D;
Radloff, 1977). Consisting of 20-items, the CES-D has been validated for use with Latinx youth
(Crockett, Randall, Shen, Russell & Driscoll, 2005) and has been used as a screening tool for
depression with a clinical cut-off score of 16 indicating risk (Crockett et al., 2005; Radloff,
1977). A dichotomous variable was created to indicate a clinical cut-off (0 = ≤ 15 and 1 = ≥ 16).
Other demographic covariates in this study include sex (female/male; 0/1) and household
composition (a dichotomous measure of single parent or both/two parent household; 0/1).
Analytic Procedure
Univariate analyses were conducted to derive descriptive statistics for the sample
provided in Table 1. As count variables, three of the four dependent variables (i.e., tobacco use,

39
problematic drinking and marijuana use) did not meet assumptions for an ordinary least squares
(OLS) regression, were positively skewed and kurtotic, and were overdispersed (i.e., the variance
was larger than the mean). The negative binomial (NB) regression accounts for this
overdispersion by considering the unexplained heterogeneity within the sample (Coxe et al.,
2009). An NB model was chosen due to overdispersion, a high proportion of zero counts
(72.99%, 52.37% and 75.79% for tobacco use, problematic drinking and marijuana use,
respectively), and a dispersion parameter indicated NB (i.e., Poisson vs. NB) as the optimal
count model.
An OLS regression (i.e., alcohol use) and a series of NB models were conducted to assess
associations of multiple factors that have been known to influence substance use behaviors
among young adults. The hierarchical regressions proceeded in three stages to examine the ways
in which ACE is associated with substance use behaviors corresponding to the study research
questions. The first stage estimated the predictive associations of demographic variables,
including immigrant generation, sex, persons-per-room/house, household composition, early
alcohol use, and early depressive symptoms. The second stage built on the first, adding culturally
relevant variables such as acculturation, enculturation, ethnic identity search/achievement, and
ethnic identity affirmation, known correlates of substance use. The third and final stage assessed
the predictive associations of a summative measure of ACE, and separate regression models also
assessed ACE domains, child abuse and household dysfunction. This final step allowed for the
evaluation of ACE on substance use behaviors after accounting for demographic and culturally
specific correlates of substance use among Latinx youth.
Variables were estimated simultaneously in subsequent stages, as suggested by Cohen
and colleagues’ (2013). A recommended approach to handle missingness (Schlomer et al., 2010),

40
full-information maximum likelihood (FIML), was used to address missing data. Results for NB
models are presented as incident rate ratios, the percentage change in expected counts, the most
common approach to interpreting count models (Atkins & Gallop, 2007). OLS regression model
is presented using unstandardized parameter estimates. All models were estimated using Mplus
version 7.4. To address possible clustering issues (i.e., students nested within schools), intra-
class correlation was evaluated with its maximum value of .05, suggesting potential bias in
standard errors is negligible, thus ruling out the need for a multi-level model and proceeded with
individual level (Muthén & Satorra, 1995).
Results
Demographic results with means and standard deviations are presented in Table 1. The
sample has a higher number of females (59%) and are predominantly second generation (74%)
immigrants. Table 2-5 present results of the hierarchical regression models for each of the past
30 day count outcomes, tobacco (Table 2), alcohol (Table 3), problematic alcohol (Table 4), and
marijuana (Table 5) use for three stages including: (1) demographic correlates (immigrant
generation, sex, persons-per-room/house, household composition, early substance use and
depressive symptoms); (2) culturally relevant variables, acculturation, enculturation, ethnic
identity search/achievement and ethnic identity affirmation; and (3) three ACE
operationalizations: (3a) ACE summative score; (3b) ACE child abuse domain; and (3c)
household dysfunction domain.
OLS and NB regression models were estimated for demographic variables in Stage 1,
followed by culturally relevant variables in Stage 2, and ACE in Stage 3, the two latter stages
resulted in non-significant predictors of past 30-day tobacco use among Latinx young adults (see
Table 2). Sex was the strongest predictor of past 30-day substance use, including tobacco,

41
alcohol, problematic alcohol, and marijuana in young adulthood, with males at higher risk. Sex
was the strongest predictor of past 30-day tobacco across all stages of the hierarchical NB
regression models.
OLS regression results from Stage 2 indicated higher acculturation (B = .10, p < .03)
predicted increased past 30-day alcohol use (see Table 3). After including ACE in the Stage 3
model, the three operationalizations of ACE – ACE sum score (B = .03, p = .01), child abuse (B
= .16, p < .01), and household dysfunction (B = .12, p = .03) domains all significantly predicted
past 30-day alcohol use frequency. Importantly, acculturation remained a significant predictor of
alcohol use frequency in all Stage 3 models. NB regression models estimating problematic
drinking (Table 4), showed enculturation (IRR = 0.90, 95% CI: .81 – 1.00) predicted lower
expected counts of past 30-day problematic alcohol use in Stage 2. When adding ACE to the
Stage 3 model, one additional increase in ACE sum (IRR = 1.05, 95% CI: 1.00, 1.11)
significantly predicted 5% higher count of problematic alcohol use and one additional experience
of child abuse (IRR = 1.23, 95% CI: 1.00, 1.53) predicted 23% higher count of problematic
alcohol use. Enculturation became non-significant once ACE were added to Stage 3 models.
Results of NB regression models for marijuana use (Table 5) in Stage 2 indicated no
predictive associations of cultural relevant variables for marijuana use. After adding ACE in
Stage 3, increases in the three ACE operationalizations – ACE sum score (IRR = 1.13, 95% CI:
1.04, 1.22), child abuse (IRR = 1.50,95% CI: 1.05, 2.13), and household dysfunction (IRR =
1.66, 95% CI: 1.18, 2.32) predicted increased counts of past 30-day marijuana use (see Table 5).
Discussion
The overarching aim of this study is to advance ACE and health disparities research
among U.S. Latinx youth by examining known correlates of substance use, including

42
sociodemographics and culturally relevant variables, concurrently with common ACE
operationalizations, to better understand the individual and combined impact of these variables
on the substance use behaviors of Latinx youth. This study suggests that after adding ACE,
acculturation was the only culturally relevant measure positively associated with substance use –
solely for alcohol use frequency – in the expected direction. All other cultural variables were
either not associated with substance use or became non-significant (i.e., enculturation for
problematic alcohol use) after adding ACE. Study results provide evidence of the predictive
nature of ACE on substance use behaviors among Latinx youth. Over and above important
cultural risk and protective factors, ACE remain associated with increased substance use among
Latinx youth, particularly for past 30-day alcohol, problematic alcohol, and marijuana use in
young adulthood. These findings mirror existing research examining the ACE—substance use
link among populations with representative samples of ethnic minority youth (Allem et al., 2015;
Forster et al., 2018) and adults (Vaughn et al., 2017). Similarly, these results are consistent with
extant research examining the influence of acculturation as risk (Salas-Wright et al., 2015) and
ethnic identity as protective (Fisher et al., 2017; Love et al., 2006; Marsiglia et al., 2004;
Zapolski et al., 2017) of alcohol use frequency among U.S. Latinx youth. This study extends
prior research by examining the longitudinal associations and combined effects of culturally
relevant variables and ACE on the substance use behaviors of U.S. Latinx youth in young
adulthood further elucidating the specific ACE operationalizations associated with each
substance use behavior.
The first hypothesis related to the relationships between acculturation, enculturation, and
substance use was partially supported, for specific substance use outcomes. Participants
reporting higher acculturation were predicted to engage in more substance use behaviors; only

43
for alcohol use was this association significant in Stage 3 estimating the additional effects of
ACE. These findings concur with existing research indicating more acculturated individuals are
at risk for substance use (Marsiglia & Kiehne, 2020; Salas-Wright et al., 2015). In accordance
with this hypothesis, higher enculturation was predicted to be associated with decreased
problematic alcohol use in young adulthood and thus, protective; this relationship was not
significant in the final models estimating the additional effects of ACE. Prior research has shown
enculturation to buffer against risky substance use behaviors (Unger et al., 2009; Unger et al.,
2009). Before this study, the effects of culture-based variables, together with ACE, had not been
identified. This study indicates that after including ACE, the influence of acculturation remains
significant. The second hypothesis concerning effects of ACE on substance use in young
adulthood, after considering cultural variables, was partially supported. After accounting for
acculturation, enculturation, and ethnic identity, the sum of ACE significantly predicted alcohol,
problematic alcohol, and marijuana use frequency, but not tobacco use, in young adulthood.
Study results correspond with prior literature examining the ACE—substance use link among
samples of ethnic minority youth (Allem et al., 2015; Forster et al., 2018), and advance this
knowledge by accounting for important sociodemographic and cultural variables that have
previously been associated with substance use (Marsiglia & Kiehne, 2020).
Additional noteworthy results identify important explanations related to the longitudinal
study of behavioral health disparities among U.S. ethnic minorities. All models examined
relevant covariates such as immigrant generation and sex. Immigrant generation was not
significant in any Stage l models, however generation is a relevant covariate to study in the
context of immigrant health as previous research has shown that youth substance use (Bui, 2013;
Peña et al., 2008; Salas-Wright et al., 2016), suicidal behaviors (Peña et al., 2008) and risky

44
sexual behaviors (Becker et al., 2014) worsen across generations. As previously mentioned,
immigrant generation is a valuable indicator of health as it relates to adolescent and young adult
development, adaptability, and positionality.
Next, culturally relevant variables, acculturation, enculturation, and ethnic identity were
examined in Stage 2 for each substance use outcome, but not all were significantly associated
with Latinx substance use in young adulthood after adding ACE. As previously mentioned, an
aspect of immigrant youth adaptation includes behavioral and affective expressions of ethnic
identity. A recent study suggests declining behavioral ethnic identity among youth could indicate
there are social and contextual factors associated with the heritage cultural distance suggested by
decreasing ethnic identity (Lu et al., 2020). Ethnic identity measured in this study was not
associated with substance use in any stage. There were likely unexamined factors related to
ethnic identity and social context that were not assessed in this study. Further, this study
measured ethnic identity in adolescence and outcomes were assessed in young adulthood. It is
possible adolescent ethnic identity attributions are unrelated to young adult health behaviors.
Future studies should consider examining cultural identity factors in the same timepoint as the
outcome measures to obtain more precise information about proximal individual-level variables
possibly associated with risk behaviors. Nonetheless, the inextricable link between cultural
variables and outcomes in behavioral health disparities research, must be taken into account to
better understand how ACE influences Latinx youth development and adaptation, and to
ultimately enhance prevention approaches among ethnic minorities.
In this study, alcohol and marijuana use were the two outcomes with significant
predictive associations between all three ACE operationalizations and substance use.
Problematic alcohol use was predicted by ACE sum score and child maltreatment. Therefore, the

45
impact of ACE on substance use behaviors in this study suggest that not only is this link well-
defined among Latinx youth, it appears to depend on the substance use outcome examined. This
reinforces the importance of examining different operationalizations of ACE that can be used as
specific targets for prevention and intervention. This is particularly relevant for providers using
the ACE score as a prevention screening and/or in the use of trauma-informed care models.
Results further indicate that substance use behaviors may be context specific as suggested
by health disparities research (Alegría et al., 2017). For example, while acculturated youth with
higher ACE reported more frequent alcohol use in this study, solely more ACE was predictive of
marijuana use; cultural variables were not significant. Among Latinx high school youth, parent-
child communication and family cohesion predicted lower marijuana use two years later (Lac et
al., 2011). Together with study findings, research suggests that marijuana use in young adulthood
may indicate strained family relationships or a history of childhood challenges and signify self-
medicating behavior as a coping response. Considering that these youth are already parents, or
may one day become parents themselves, their experiences of adversity and associated substance
use behaviors may have cascading effects on their offspring and later generations (LaBrenz et al.,
2020).
Results from this study must be considered in the context of limitations. ACE
measurement was typical, but not exhaustive, excluding other adversity that may be correlated
with traditional ACE and cause similar adversity (Mersky et al., 2017). Although findings related
to various ACE operationalizations reported in this study are important descriptors of this
population, readers must use caution when drawing inferences about behavioral health risk based
upon an ACE score (Anda et al., 2020). There are additional protective factors buffering long-
term consequences of ACE that was not able to be captured in this work. It is important to note

46
that individual, social, cultural and community strengths can support positive coping, buffering
individuals who experience ACE from poor outcomes (Suarez-Orozco et al., 2018). Self-report
may present threats to validity, however participant ACE were assessed when youth were on
average 21.6 years, thus limiting memory recall bias. Although ACE assessed in young adult
data collection surveys were web-based, the lack of complete anonymity may have
underestimated ACE reported.
Conclusion
This study advances our understanding of adolescent substance use behaviors identifying
acculturation and ACE as predictors of Latinx substance use behaviors in young adulthood.
Alcohol use increased among participants with higher acculturation, even after adding ACE,
reinforcing current understanding about cultural factors of Latinx youth substance use. Study
findings build on existing knowledge of the longitudinal association between ACE and substance
use behaviors, specifically for alcohol, problematic alcohol, and marijuana use among Latinx
young adults. Examining individual and family-level predictors of substance use behaviors
among ethnic minority youth can assist in identifying key targets for intervention and prevention,
however, to truly achieve health equity, research must address community and societal level
factors that take a social determinants of health approach examining the larger structural effects
on immigrant health.

47
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58
Table 1.1.
Sample and Variable Characteristics (n=1,179)
n (%) or M (SD) Range
10th grade (W2)
Age 15.48 (0.38) 13.9–17.8
Female 688 (58.95)
Persons per room/house
< 1.0
≥ 1.0
684 (58.02)
495 (41.98)

Household Composition
Single parent
Both/Two parents
225 (20.00)
900 (80.00)

Immigrant generation
First generation 169 (15.12)
Second generation 826 (73.88)
Third generation 123 (11.00)
Acculturation/Enculturation
Mexican orientation 3.23 (1.00) 1–5
U.S. orientation 3.94 (0.57) 1–5
Ethnic Identity
Search/achievement 2.67 (0.56) 1–4
Affirmation 3.05 (0.56) 1–4
Emerging adulthood (W5)
Age 21.65 (0.50) 20.22–24.23
Adverse Childhood Experiences (ACE) 2.62 (1.98) 0-8
First generation 2.66 (1.99) 0-8
Second generation 2.52 (1.96) 0-8
Third+ generation 3.35 (2.02) 0-8
Individual ACE
Any Child Abuse 808 (70.20)
Psychological Abuse 747 (64.51)
Physical Abuse 585 (50.43)
Sexual Abuse 183 (15.80)
Household Dysfunction 751 (64.91)
Separation/divorce 407 (35.24)
Parental Domestic Violence 267 (23.12)
Drug & Alcohol User 409 (35.05)
Mentally Ill 247 (21.17)
Incarceration 245 (21.14)
Emerging adulthood (W7)
Age 23.87 (0.41) 22.78–26.09
Substance use
Tobacco use frequency, past 30 days 0.72 (1.49) 0–6
Alcohol use frequency, past 30 days 1.74 (1.34) 0–6

59
Alcohol use-problematic
a
, past 30 days 1.10 (1.45) 0–6
Marijuana use frequency, past 30 days 0.62 (1.32) 0–5
a
Problematic drinking = 5 or more drinks in a row

60
Table 1.2.
Hierarchical Negative Binomial Regression Estimates for Past 30-day Tobacco Use Frequency
Stage 1:
Demographics
Stage 2:
Cultural Values
Stage 3:
ACE Sum Score
Stage 3:
Child Abuse
Domain
Stage 3:
Household
Domain
IRR (CI) IRR (CI) IRR (CI) IRR (CI) IRR (CI)
Immigrant Generation 1.31 (.92, 1.87) 1.25 (.85, 1.84) 1.25 (.85, 1.85) 1.27 (.86, 1.87) 1.29 (.87, 1.91)
Sex 2.55***
(1.77, 3.69)
2.59***
(1.78, 3.76)
2.67***
(1.84, 3.88)
2.63***
(1.81, 3.83)
2.74***
(1.88, 3.98)
Persons-per-room/house 1.04 (.71, 1.51) 1.07 (.73, 1.57) 1.07 (.73, 1.57) 1.06 (.72, 1.55) 1.10 (.75, 1.61)
Household Composition 0.91 (.58, 1.43) 0.91 (.58, 1.44) 0.96 (.61, 1.51) 0.90 (.57, 1.42) 0.99 (.62, 1.58)
Early SU 1.19 (.89, 1.59) 1.19 (.89, 1.60) 1.14 (.85, 1.54) 1.19 (.89, 1.60) 1.20 (.89, 1.61)
Depression 0.98 (.67, 1.45) 0.95 (.64, 1.41) 0.94 (.64, 1.40) 0.97 (.66, 1.45) 0.97 (.65, 1.44)
Acculturation 1.14 (.82, 1.60) 1.12 (.80, 1.56) 1.10 (.79, 1.55) 1.10 (.79, 1.54)
Enculturation 0.98 (.81, 1.18) 1.00 (.82, 1.21) 0.98 (.81, 1.19) 1.01 (.83, 1.22)
Ethnic Identity Search 0.85 (.55, 1.33) 0.81 (.52, 1.26) 0.88 (.56, 1.36) 0.84 (.55, 1.29)
Ethnic Identity Affirmation 1.21 (.79, 1.86) 1.26 (.82, 1.93) 1.18 (.76, 1.81) 1.22 (.79, 1.90)
ACE sum/CA/HD 1.09 (.99, 1.20) 1.02 (.67, 1.55) 1.46 (.96, 2.21)
Note. IRR = incident rate ratio; CA = child abuse domain; HD = household dysfunction domain.
*p < .05 **p < .01 ***p < .001

61
Table 1.3.
Hierarchical OLS Regression Estimates for Past 30-day Alcohol Use Frequency

Stage 1:
Demographics
Stage 2:
Cultural Values
Stage 3:
ACE Sum
Score
Stage 3:
Child Abuse
Domain
Stage 3:
Household
Domain
B B B B B
Immigrant Generation .102 .050 .047 .047 .045
Sex .191*** .188*** .194*** .173** .187***
Persons-per-room/house -.087 -.071 -.075 -.071 -.065
Household Composition -.044 -.041 -.014 -.036 -.018
Early SU .076*** .081*** .077*** .078*** .080***
Depression -.129* -.124* -.133* -.117* -.136*
Acculturation .099* .096* .096* .103*
Enculturation -.049† -.045 -.044 -.046
Ethnic Identity Search -.029 -.032 -.020 -.006
Ethnic Identity Affirmation -.004 -.008 -.013 -.030
ACE sum/CA/HD .031* .162** .120*
Note. CA = child abuse domain; HD = household dysfunction domain.
*p < .05 **p < .01 ***p < .001

62
Table 1.4.
Hierarchical Negative Binomial Regression Estimates for Past 30-day Problematic Alcohol Use

Stage 1:
Demographics
Stage 2:
Cultural Values
Stage 3:
ACE Sum
Score
Stage 3:
Child Abuse
Domain
Stage 3:
Household
Domain
IRR (CI) IRR (CI) IRR (CI) IRR (CI) IRR (CI)
Immigrant Generation 1.14 (.94, 1.37) 1.03 (.84, 1.27) 1.03 (.84, 1.26) 1.02 (.83, 1.25) 1.04 (.84, 1.27)
Sex 1.75***
(1.45, 2.12)
1.73***
(1.43, 2.09)
1.74***
(1.44, 2.10)
1.69***
(1.39, 2.04)
1.74***
(1.44, 2.10)
Persons-per-room/house 0.92 (.76, 1.12) 0.95 (.79, 1.15) 0.95 (.78, 1.15) 0.95 (.78, 1.15) 0.96 (.79, 1.16)
Household Composition 1.01 (.80, 1.28) 1.01 (.79, 1.28) 1.07 (.84, 1.36) 1.02 (.80, 1.29) 1.03 (.80, 1.32)
Early SU 1.14**
(1.05, 1.25)
1.15**
(1.05, 1.27)
1.14**
(1.04, 1.25)
1.15**
(1.04, 1.26)
1.15**
(1.05, 1.26)
Depression 0.90 (.74, 1.10) 0.88 (.72, 1.08) 0.87 (.71, 1.07) 0.89 (.73, 1.10) 0.89 (.72, 1.09)
Acculturation 1.13 (.95, 1.34) 1.13 (.95, 1.34) 1.12 (.94, 1.34) 1.13 (.95, 1.35)
Enculturation 0.90* (.81, 1.00) 0.91 (.82, 1.01) 0.91 (.82, 1.01) 0.91 (.82, 1.01)
Ethnic Identity Search 0.86 (.70, 1.06) 0.86 (.70, 1.05) 0.88 (.71, 1.09) 0.85 (.69, 1.05)
Ethnic Identity Affirmation 1.12 (.90, 1.29) 1.11 (.89, 1.38) 1.10 (.88, 1.36) 1.12 (.90, 1.39)
ACE sum/CA/HD 1.05*
(1.00, 1.11)
1.23*
(1.00, 1.53)
1.15 (.94, 1.41)
Note. IRR = incident rate ratio; CA = child abuse domain; HD = household dysfunction domain.
*p < .05 **p < .01 ***p < .001

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Table 1.5.
Hierarchical Negative Binomial Regression Estimates for Past 30-day Marijuana Use

Stage 1:
Demographics
Stage 2:
Cultural Values
Stage 3:
ACE Sum
Score
Stage 3:
Child Abuse
Domain
Stage 3:
Household
Domain
IRR (CI) IRR (CI) IRR (CI) IRR (CI) IRR (CI)
Immigrant Generation 1.28 (.95, 1.71) 1.19 (.86, 1.64) 1.19 (.86, 1.65) 1.23 (.89, 1.70) 1.17 (.85, 1.61)
Sex 1.65**
(1.20, 2.26)
1.66**
(1.21, 2.29)
1.64**
(1.19, 2.24)
1.69**
(1.23, 2.34)
1.61**
(1.17, 2.21)
Persons-per-room/house 1.00 (.72, 1.38) 1.06 (.76, 1.47) 1.03 (.74, 1.42) 1.07 (.77, 1.48) 1.05 (.76, 1.46)
Household Composition 0.86 (.59, 1.27) 0.88 (.60, 1.29) 0.95 (.65, 1.40) 0.85 (.58, 1.26) 0.93 (.63, 1.37)
Early SU 1.43**
(1.16, 1.77)
1.42**
(1.15, 1.76)
1.39**
(1.12, 1.73)
1.42**
(1.15, 1.76)
1.44**
(1.16, 1.78)
Depression 1.08 (.78, 1.50) 1.09 (.78, 1.52) 1.04 (.75, 1.45) 1.11 (.80, 1.55) 1.04 (.75, 1.45)
Acculturation 1.11 (.84, 1.47) 1.10 (.83, 1.46) 1.14 (.86, 1.52) 1.08 (.81, 1.43)
Enculturation 0.89 (.75, 1.06) 0.92 (.78, 1.09) 0.91 (.77, 1.08) 0.92 (.77, 1.09)
Ethnic Identity Search 0.80 (.56, 1.15) 0.80 (.56, 1.14) 0.81 (.56, 1.16) 0.81 (.57, 1.16)
Ethnic Identity Affirmation 1.31 (.92, 1.88) 1.23 (.86, 1.77) 1.22 (.85, 1.75) 1.23 (.85, 1.76)
ACE sum/CA/HD 1.13**
(1.04, 1.22)
1.50*
(1.05, 2.13)
1.66**
(1.18, 2.32)
Note. IRR = incident rate ratio; CA = child abuse domain; HD = household dysfunction domain.
*p < .05 **p < .01 ***p < .001

64
Chapter 3 (Study 2):
ACE and Discrimination: Resources and Risks of Substance Use Among Latinx Youth

Abstract
Purpose: Racial and ethnic minorities are more likely to experience ACE than their
White peers, suggesting ACE may be associated with Latinx youth substance use disparities.
Discrimination, an adverse experience, is associated with behavioral health disparities.
Traditional ACE excludes adversities experienced by immigrant youth, thus understanding the
co-occurrence of traditional ACE and discrimination can locate important predictors among
Latinx youth. This study examines profiles of adverse experiences and their association with
substance use behaviors, controlling for culturally relevant variables among Latinx youth.
Method: Survey data was collected at seven timepoints from 2005-2016; 1,179
respondents participated in follow-up ACE and perceived discrimination assessment in Wave 5
(Mage 21.6 years) and substance use measures in Wave 7 (Mage 23.9 years). ACE included
psychological, physical, and sexual abuse, parental domestic violence, separation/divorce,
household alcohol/drug use, mental illness, and incarceration. Latent class analysis (LCA)
examined heterogeneity across ACE and discrimination among Latinx youth with differential
outcomes. LCA identified profiles of traditional ACE and perceived discrimination experiences,
and their longitudinal association with substance use in young adulthood.
Results: A 4-class solution identified a combination of adversities profiles. The largest
class size was the “limited adversity” (n = 378; 32.06%) group, next was the highest adversity
class “psychological abuse and discrimination” (n = 361; 30.62%) group. Followed by “child
abuse and microaggression” (n = 258; 21.88%) and “microaggression” (n = 182; 15.44%) latent
class groups. Compared to the “microaggression” group, the “psychological abuse and

65
discrimination” group, was associated with alcohol use (B = .368; p = .02) in young adulthood.
Compared to the “limited adversity” class, the “psychological abuse and discrimination” group
was associated with lower tobacco use (IRR = .47; 95% CI: .29, .78). Acculturation was
associated with alcohol use frequency and ethnic identity affirmation was associated with higher
marijuana use. Sex was significant across all models.
Conclusion: Study results enhance understanding of intersecting patterns of adversity,
and their association with substance use behaviors in young adulthood among Latinx youth.
Findings indicate there are unique clusters of youth reporting variations in traditional ACE and
discrimination experiences and in turn, these are associated with alcohol use. Study results can
enhance prevention and intervention approaches. Considering the impact ACE on health and
wellbeing among racial and ethnic minorities, this study attempts to move closer toward
achieving an understanding of factors that potentially contribute to health disparities.

66
Introduction
Decades of research have demonstrated a link between early life experiences and health
problems throughout the life course (Felitti et al., 2019); this pattern has also been observed for
behavioral health outcomes among racial/ethnic minority youth (Allem et al., 2015) and adults
(Mersky et al., 2013; Vaughn et al., 2017), including substance use. By the 10th grade, Latinx
youth surpass their White and Black peers in alcohol, marijuana, and cocaine use (Johnston et
al., 2019). Adverse childhood experiences (ACE) may contribute to theses disparities, with
racial/ethnic minorities more likely to experience multiple ACE than their White peers (Liu et
al., 2018; Sacks & Murphy, 2018; Slopen et al., 2016). Beyond traditional domains of
maltreatment and family dysfunction found in prior ACE studies (Felitti et al., 2019), racism and
discrimination are widely accepted as additional adverse experiences, and are also associated
with behavioral health disparities (Benner et al., 2018; Cronholm et al., 2015; Liu et al., 2018).
Understanding the co-occurrence of traditional ACE combined with discrimination experiences
can locate important predictors of health disparities among immigrant youth.
ACE and Latinx Youth
The prevalence of traditional ACE among U.S. racial and ethnic minorities is common
(Caballero et al., 2017; Loria & Caughy, 2018; Slopen et al., 2016; Vaughn et al., 2017; Villamil
Grest et al., in press). Further, generational patterns show differences in ACE across immigrant
generation (Hughes et al., 2017), with results generally suggesting an increase in ACE among
second (Loria & Caughy, 2018; Vaughn et al., 2017) and third (Villamil Grest et al., in press)
generation U.S. immigrants. However, traditionally measured ACE do not fully capture potential
adversities experienced by migrant children and families, nor the contextual and environmental
factors related to immigrant families, such as exposure to discrimination, segregation,

67
immigration-related problems (i.e., parental separation due to deportation), language barriers,
and context of reception across U.S. cities (Alegría et al, 2017; Cleary et al., 2018). Immigrants
and their offspring contend with many adversities, such as compounded trauma at premigration,
and during migration and postmigration (Cleary et al., 2018), and acculturation-related stressors
(Alegría et al., 2017). Other less examined roots of adversity among U.S. Latinx immigrants and
their families enhance vulnerability to additional adversity such as access to health care, legal
support, adequate living and working conditions and policies (Castañeda et al., 2015).
ACE and Substance Use
Substance use behaviors among U.S. immigrants have been investigated through a
“healthy immigrant paradox” lens (Almeida et al., 2012; Salas-Wright et al., 2016) to explain the
idea that as immigrants acculturate and adapt to U.S. social norms, their substance use worsens.
Empirical studies of adolescents suggest that compared to Latinx immigrants, U.S. born youth
are at higher risk for alcohol and drug use (Almeida et al., 2012; Bui, 2013; Perreira et al., 2019).
Studies with community samples of Latinx youth (Allem et al., 2015) and other racial and ethnic
minorities (Forster et al., 2018) support an ACE—substance use relationships. Examining
additional experiences, such as ACE in the context of the family environment, among Latinx
families is essential for further understanding Latinx substance use behaviors. This is particularly
true given that immigrant youth living in the U.S. for longer periods of time demonstrate poorer
family functioning and greater behavioral health risk (Alegría et al., 2017; Almeida et al., 2012;
Salas-Wright et al., 2016). Findings from prior work suggest there are additional factors to
consider when assessing the health and well-being of U.S. Latinx immigrant youth.

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Discrimination, Acculturative Stress, and the Latinx Population
There is widespread understanding that discrimination experiences among racial and
ethnic minorities are associated with poor health outcomes, and contribute to health disparities.
Broadly defined, racism includes three levels: internalized, interpersonal and systemic (Priest et
al., 2013). Discrimination factors examined in this study are interpersonal experiences of
discrimination, and include occurrences of interpersonal mistreatment perceived to be based on
race, ethnicity, and physical appearance (Guyll et al., 2001Several systematic literature reviews
examining the link between perceived discrimination among racial and ethnic minority
adolescents and risky behaviors, underscore the persistent and negative association between
discrimination and adolescent wellbeing cross-sectionally (Benner et al., 2018) and
longitudinally (Cave et al., 2020). Research including discrimination experiences in their study
of ACE, suggest racial and ethnic minority youth are more likely to encounter racial
discrimination (Macguire-Jack et al., 2019), which in turn impacts overall health and wellbeing
(Liu et al., 2018). An earlier study of Project RED (Okamoto et al., 2009) identified an
association between perceived discrimination and lifetime substance use (tobacco, alcohol,
marijuana, inhalants), and past 30-day use of tobacco, alcohol, and marijuana among ninth
graders. In a nationally representative adult sample, discrimination was associated with increased
odds of alcohol and drug use disorders for specific groups including women, U.S.-born Latinos,
and Mexican Latinx subgroups (Otiniano Verissimo et al., 2014).
Discrimination research among U.S. Latinx populations has examined stressors related to
acculturation (Alegría et al., 2017; Cervantes et al., 2016). Acculturative stress and adaptation to
U.S. societal norms, is associated with substance use risk among immigrant minorities (Alegría
et al., 2017, Smokowski et al., 2008). The stress from acculturation is explained to arise from

69
discordant acculturation behaviors, values, and practices with family, friends, and community
(Schwartz et al., 2010). Among Mexican-heritage youth, perceived discrimination was indirectly
associated with tobacco, alcohol, and marijuana use through increases in acculturative stress
(Kam et al., 2010), suggesting these separate, yet interrelated constructs, can concomitantly
interfere with positive adaptation. Another study among two Latinx subgroups indicated similar
findings with cultural stress, including ethnic discrimination, associated with tobacco and binge
drinking (Cano et al., 2015). However, discrimination-related acculturation stress is only one of
multiple stressors that can impact poor health outcomes (Alegría et al., 2017). Another study of
stress associated with substance use risk among Latinx youth found that stress domains included
family economics, acculturative gaps with parents, community/gang exposure, and family/drugs
(Cardoso et al., 2016). Distinct from acculturative stress, understanding household-related
stressors measured by traditional ACE will enhance current knowledge around Latinx youth
substance use.
Current Study
Examining outcomes associated with adversity in the context of traditional ACE and
discrimination, among Latinx youth, may identify important risk and protective factors of
substance use in young adulthood and indicate potential targets for prevention and intervention
among U.S. ethnic and racial minorities. Among the subdomains of ACE (i.e., child
maltreatment and household dysfunction) and those of the discrimination items (covert vs. overt
mistreatment), there are potentially unexamined patterns of adversity reported by Latinx youth.
This study builds on prior research with data from the current study that found positive
associations between perceived discrimination, cultural factors, and substance use in young
adulthood (Rogers et al., 2020; Unger et al., 2014; Unger et al., 2016). It seeks to extend this

70
research and advance our understanding of known health risks of ACE and discrimination by
identifying combined profiles of traditional ACE and perceived discrimination experiences, and
their longitudinal association with substance use in young adulthood. Application of a latent
class mixture modeling approach assumes there may be unexamined experiences of ACE and
discrimination among Latinx youth that cluster in unique ways with differential outcomes.
Whereas, other approaches examining these associations may obscure risk sources, creating
challenges for identifying recommendations of specific targets of prevention and intervention.
This work is guided by an integrative risk and resilience model for understanding
immigrant-origin youth, which is concerned with the risk and protective factors associated with
the adaptation and development of immigrant youth. This model assumes that youth adaptation
occurs across developmental contexts, including proximal family factors and distal societal
factors (Suarez-Orozco et al., 2018). This paper examines concurrent profiles of family context
and discrimination-related adverse experiences and their association with substance use
behaviors, while also assessing the influence of culturally relevant, individual-level variables
pertinent to Latinx youth. Childhood adversity and discrimination represent the family, social,
political, and global forces that shape the experiences and outcomes of Latinx youth (Suarez-
Orozco et al., 2018). The study research questions are: 1) What are intersecting patterns of
conventional ACE, and perceived discrimination experiences?; and 2) Is exposure to adversity,
defined by traditional ACE and discrimination experiences, associated with elevated risk for
substance use among Latinx youth?

71
Method
Sample Participants
This study is a secondary analysis of Project RED (Unger et al., 2009), a longitudinal
study of acculturation and substance use among Latinx adolescents from Southern California.
Adolescents in 9th grade were enrolled in the study, attending one of seven high schools in Los
Angeles County. Schools were invited to participate if 70% or more of their student enrollment
was Latinx. Details on student recruitment and survey procedures have been published elsewhere
(Unger et al., 2009). The University’s Institutional Review Board approved all procedures.
The first wave of data collection began in 2005 (Year 1), with all students enrolled in
selected grades invited to participate (N=3,218); 2,222 students (69%) completed the initial
survey. Between 2010 and 2016, attempts were made to re-contact students identifying as
Hispanic/Latino (n=1,963; 88%) who completed high school surveys and had valid follow-up
contact information. A total of 1,303 participants completed follow-up data in one or more of
four additional waves (W4-W7). Self-report data for these analyses included information from
participants who completed study measures at Waves 2 (2006; Mage =15.5 years) and 5 (2012-
2013; Mage =21.6 years) (Final N=1,179). Sociodemographic variables were assessed in earlier
waves and ACE were queried in Wave 5. Complete-case analysis using chi-square tests assessed
participant retention across analysis variables. Participants lost to follow up were more likely to
be from a single parent household (χ2 (1, N = 1125) = 25.66, p < .01). No differences were
observed for gender and persons per room/house, study covariates. Baseline sample
characteristics can be found in Table 1.

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Measures
Dependent Variables
Substance use. Substance use variables measured in the final wave (Wave 7) of Project
RED included past 30-day use of: 1) tobacco (i.e., number of days you smoked cigarettes), 2)
alcohol (i.e., number of days with at least 1 drink), 3) problematic drinking (i.e., number of days
with 5 or more drinks in a row), and 4) marijuana (i.e., number of days of use). Continuous
substance use variables were coded as follows for past 30-day tobacco and alcohol use: 0 days
(0), 1-2 days (1), 3-5 days (2), 6-9 days (3), 10-19 days (4), 20-29 days (5), all/30 (6); past 30-
day problematic alcohol use: 0 days (0), 1 day (1), 2 days (2), 3-5 days (3), 6-9 days (4), 10-19
days (5), 20+ (6); and past 30-day marijuana use: 0 times/never (1), 1-2 days (2), 3-9 days (3),
10-19 days (4), 20-39 days (5), 40+ days (6). These substances were selected for analysis due to
the low frequency (at least 95% of the sample reported no use) of other illicit drugs (i.e., other
hard drugs such as cocaine, methamphetamine, ecstasy, hallucinogens, inhalants) among sample
participants.
Latent Class Indicators
Adverse childhood experiences. The original CDC-Kaiser ACE study assessed five
categories of maltreatment (emotional and physical neglect, psychological, physical, and sexual
abuse) and five categories of family dysfunction (divorce, substance use, mental illness, parental
violence, and incarceration; Felitti et al, 1998). Eight items that mapped onto the original 10
ACE (excluding emotional and physical neglect) were measured at Wave 5. One further
variation between the a measure in original ACE study and this one was that the sexual abuse
question stem in Project RED included sex with any person at least 5 years older (prior to the age
of 18; meeting the definition of sexual abuse of a minor by California consent laws).

73
Dichotomous (0/1) variables were created to examine the absence/presence of ACE by each of
the eight individual latent class indicator variables, including: (1) psychological/emotional child
abuse, (2) physical child abuse, (3) sexual abuse, (4) parental violence, (5) parent substance use,
(6) parent mental illness, (7) parent divorce, and (8) parent incarceration.
Perceived interpersonal mistreatment/discrimination. Perceived discrimination was
measured across all waves of Project RED, however, this study utilized the measurement from
Wave 5 to correspond with the measurement of ACE. Assessed using a 10-item measure of
adolescents’ perception of experienced everyday discrimination (Guyll et al., 2001) and preceded
by the following, “Sometimes people feel they are treated differently because of their
ethnic/cultural background, do people treat you?” Sample items included, “You are treated with
less respect than other people,” and “People act as if they’re better than you.” The frequency of
each experience was recoded from a 4-point scale (1 = never to 4 = often) to a dichotomous
variable assessing the presence/absence of each item for a total of 10 indicators of latent class
models. A Cronbach α = .92, for the full scale, subtle factor subscale (e.g., being ignored or
treated with less courtesy than others) α = .92 and blatant factor subscale (e.g., being threatened,
harassed, or insulted) α = .82, all indicated strong reliability in this sample.
Independent Variables
Acculturation/Enculturation. Acculturation was measured in Wave 2 using a short
form of the Revised Acculturation Rating Scale for Mexican Americans-II (Cuéllar et al., 1995),
which assesses cultural behaviors such as language use and preferences, cultural heritage and
ethnic behavior, and ethnic interaction. This 13-item measure asks respondents to assess cultural
statements using a Likert-type scale with response items ranging from 1 (not at all) to 5 (almost
always or extremely often). Items include: “I enjoy listening to English language music” and

74
“My thinking is done in the Spanish language.” For the final analysis, responses were used to
create two mean acculturation scores, with six items drawn from the Hispanic orientation (α =
.91) and seven items drawn from the U.S. orientation (α = .74) subscales.
Ethnic Identity. The Multi-Group Ethnic Identity Measure (MEIM; Phinney, 1992) is a
12-item instrument comprised of two interrelated, yet independent aspects of ethnic identity: 1)
ethnic identity search/achievement (cognitive), and 2) ethnic identity affirmation (affective).
Ethnic identity search/achievement involves the exploration of one’s ethnic heritage along a
spectrum ranging from low to high and is assessed with five items such as “I have spent time
trying to find out more about my ethnic group, such as its history, traditions, and customs.”
Ethnic identity affirmation (affective) assesses feelings of ethnic pride in one’s own background
and belonging to an ethnic group and is assessed with seven items such as “I feel a strong
attachment to my ethnic group.” Response options ranged from 1 (strongly disagree) to 4
(strongly agree); separate mean scores (cognitive and affective) for each dimension of ethnic
identity were created, with higher scores indicating higher ethnic identity attainment. In the
current sample, Cronbach alpha was α = .73 for search/achievement and α = .84 for affirmation
subscales.
Covariates. Immigrant Generation. Distinguished from nativity (dichotomous
representation of foreign-born vs. US-born) immigrant generation categorizes immigrant people
into first, second and third+ generations (Zong et al., 2019). First generation are immigrants who
were foreign born and migrated to the U.S., second generation immigrants are U.S.-born, but
have at least one foreign born parent. The parents of third+ generation youth have parents who
were both U.S. born (second generation themselves).

75
Ratio of Persons Per Room Per House. Persons-per-room/house, measured in Wave 2,
was used as a proxy measure of socioeconomic status. A common measure of overcrowding,
persons-per-room/house (Myers, Baer, & Choi, 1996) is a ratio estimate of the total number of
persons living in the participants’ home divided by the total number of rooms (excluding
bathroom and kitchen) in the home. Persons-per-room/house is used at the governmental level
(Blake, Kellerson, & Simic, 2007) and in urban planning, population, and housing policy
research (Krivo, 1995). A household with more than one person/per room is classified as
overcrowded (Myers et al., 1996).
Early substance use and depression. Corresponding with each substance use outcome,
reported past 30-day tobacco, alcohol, problematic alcohol, and marijuana use in Wave 2 were
controlled for in all models. Given the association between emotional distress and substance use,
depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D;
Radloff, 1977). Consisting of 20-items, the CES-D has been validated for use with Latinx youth
(Crockett, Randall, Shen, Russell & Driscoll, 2005) and has been used as a screening tool for
depression with a clinical cut-off score of 16 indicating risk (Crockett et al., 2005; Radloff,
1977). A dichotomous variable was created to indicate a clinical cut-off (0 = ≤ 15 and 1 = ≥ 16).
Other demographic covariates in this study include sex (female/male; 0/1) and household
composition (a dichotomous measure of single parent or both/two parent household; 0/1).
Analytic Procedure
Latent class analysis empirically locates subgroups of individuals who are likely to
provide similar responses to the variables included in the model. A two-step process was
implemented to address study research questions. Latent class analysis was first applied to
identify unobserved groups of individuals based on indicators of adversity (i.e., eight types of

76
ACE) and perceived discrimination experiences (i.e., ten items of interpersonal mistreatment).
Selection of the number of classes was informed by multiple model fit statistics, including lower
values in Akaike information criterion (AIC), Bayesian information criterion (BIC), Lo-Mendell-
Rubin adjusted likelihood ratio test (LMR), and the bootstrapped likelihood ratio test (BLRT;
Nylund, Asparouhov, & Muthén, 2007). Lower AIC and BIC scores and statistical significance
of LMR and BLRT indicate a better fitting model. Entropy, an indicator of quality classification,
was also examined (ranges from 0 to 1 with higher values indicating better fit) with scores over
.7 signifying good classification (Celeux & Soromenho, 1996). Considerations, such as
meaningfulness of the number and types of classes and their analytic utility (e.g., the proportion
of the sample assigned to each class), were evaluated for substantive interpretation and selection
of the best solution with consideration of entropy value (Muthén & Muthén, 2000). Latent class
analysis models were estimated using Mplus version 7.4.
Sensitivity analyses examined possible differences in group membership by immigrant
generation, gender, persons-per-room/house, and household composition (all demographic study
covariates), by adding each of these variables to the base LCA model as an additional covariate.
The class classification and composition remained unchanged in additional models, suggesting
that immigrant generation, gender, persons-per-room/house and household composition did not
significantly influence group membership. As a result, the original group membership variable
was maintained.
In the second step, regression models were estimated with each of the four outcomes:
past 30-day use of (1) tobacco (2) alcohol (3) problematic drinking and (4) marijuana. As count
variables three of the four dependent variables (i.e., tobacco use, problematic drinking and
marijuana use) did not meet assumptions for ordinary least squares (OLS) regression, were

77
positively skewed and kurtotic, and were overdispersed (i.e., the variance was larger than the
mean). The negative binomial model (NB) accounts for this overdispersion by considering the
unexplained heterogeneity in the sample (Coxe et al., 2009). A NB model was chosen due to
overdispersion, a high proportion of zero counts (72.99%, 52.37% and 75.79% for tobacco use,
problematic drinking, and marijuana use, respectively) and a dispersion parameter indicated NB
(i.e., Poisson vs. NB) as the optimal analytic strategy. Results for NB models are presented as
incident rate ratios (IRR), the percentage change in expected counts, the most common approach
to interpreting count models (Atkins & Gallop, 2007). OLS regression model is presented using
unstandardized parameter estimates. Cultural variables (i.e., acculturation, enculturation, ethnic
identity search/achievement and ethnic identity affirmation) and covariates (i.e., sex, persons-
per-room/house, household composition, early substance use and depression) were controlled for
in both models. Regression models were estimated in Mplus, which uses full information
maximum likelihood (FIML) approach for missingness. To address possible clustering issues
(i.e., students nested within schools), intra-class correlation was evaluated with its maximum
value of .05, suggesting potential bias in standard errors is negligible, thus ruling out the need for
a multi-level model and proceeded with individual level (Muthén & Satorra, 1995).
Results
Identifying distinct patterns of childhood adversity (eight items mapped onto the
traditional 10 items defined in the CDC-Kaiser ACE study) and perceived discrimination (10
items describing a range from subtle to blatant experiences of unfair interpersonal mistreatment)
a series of 1-, 2-, 3-, 4- and 5- latent class models were estimated. Model fit statistics (see Table
2) and were used to determine the best fitting class. BIC value reductions of six or greater
(Raftery, 1995) were observed up to and including the fifth latent class solution. Entropy, an

78
indicator of classification quality, was high (< .8) in all models. The LMR likelihood ratio test
was significant up to and including the four-class solution. Model selection was also evaluated
using substantive meaningfulness, with the four-class solution providing an additional distinct
class compared to the three-class solution. Based on these criteria a four-class model of adversity
and discrimination was selected.
The smallest class (see Table 3) was the “microaggressions” (n = 182; 15.44%) group
whose inclusion was driven by endorsement of primarily subtle types of interpersonal
mistreatment. The next class, “child abuse and microaggressions” (n = 258; 21.88%) class
consisted of participants endorsing psychological and physical child abuse, and microaggression.
The second largest class “psychological abuse and discrimination” (n = 361; 30.62%), included
participants who had a high endorsement of psychological abuse experiences combined with the
full range of perceived discrimination (i.e., overt and covert forms of unfair interpersonal
mistreatment) experiences. The largest class solution resulted in the “limited adversity” group (n
= 378; 32.06%), reporting low-levels of traditional ACE and perceived discrimination
experiences. Additional detail of the latent class profiles, including proportions, are provided in
Table 3.
The second step estimated regression models to examine the second research question,
whether the resulting latent class membership predicted substance use behavior in young
adulthood, controlling for culturally relevant and sociodemographic covariates (see Table 4).
Although the low-risk group is commonly selected as the reference group in LCA models, this
group did not yield significant results, therefore the “microaggression” class (those endorsing
primarily covert interpersonal mistreatment experiences and the smallest group) was selected as
the final referent group. OLS regression estimated the association of class membership for

79
alcohol use frequency. Compared to the “microaggression” group, the “psychological abuse and
discrimination” (B = .368, p = .02) class reported higher past 30-day alcohol use in young
adulthood. NB regression model results showed that compared to the “limited adversity” group,
the “psychological abuse and discrimination” group was associated with a 53% lower count of
past 30-day tobacco use (IRR = .47; 95% CI: .29, .78) in young adulthood (not shown).
Regression models initially estimated the largest class, “limited adversity”, as the reference
group however, there were no significant findings using this comparison group, in the expected
direction (i.e., for tobacco use). Among covariates, more acculturated youth reported higher
alcohol use, youth with higher ethnic identity affirmation reported higher marijuana use, sex was
consistently significant across all substance use behaviors examined, with males reporting higher
use.
Discussion
This study is believed to be the first to use a longitudinal person-centered analysis of a
community sample of Latinx youth to examine the intersection of traditional ACE and perceived
discrimination and associated substance use behavior in young adulthood. Study results enhance
our understanding of the intersecting patterns of traditional ACE and perceived discrimination
experiences, and the association of these constellations of combined adversity exposure, on
substance use behaviors in young adulthood among a community sample of Latinx youth.
Findings indicate there are unique clusters of youth reporting variations in traditional ACE and
discrimination experiences and these are associated with specific substance use behaviors,
particularly alcohol use. Among those substance use behaviors examined in this study, alcohol
use was the only substance use predicted by latent class membership in this study. Consistent
with prior work (Cardoso et al., 2016; Rogers et al., 2020; Unger et al., 2014; Unger et al., 2016),

80
suggesting that a combination of stressors and perceived discrimination, is associated with poor
health outcomes. This study indicates the “psychological abuse and discrimination” group, that
is, the highest adversity group, reported higher alcohol use in the past 30-day in young
adulthood, compared to the “microaggression” group. Results advance our understanding of how
combined forms of adversity – traditional ACE and discrimination measures – produce unique
clusters of adversity and longitudinal associations with substance use. Findings from this study
extend existing research providing more precise indicators of traditional ACE and discrimination
experiences that can inform key targets for prevention and interventions that seek to achieve
health equity among racial and ethnic minorities.
Results from this study broaden current understanding about the possible constellations
of childhood adversity combined with perceived discrimination, and their association with
substance use. While the co-occurrence of ACE and substance use has been well documented
(Hughes et al., 2017), the current study advances the ACE literature in several ways. First, this
study attempts to expand on the limitations of a summative risk score by identifying specific risk
sources of adversity and substance use behaviors among Latinx youth, providing identifiable
information for prevention research. Second, the combination of eight traditional ACE measures
together with ten items of both covert and overt manifestations of perceived discrimination
broaden our understanding of the specific adversity ethnic minorities experience, and their
associated risk behaviors in young adulthood. Third, the additive effect of including detailed
discrimination items to assess adversity draws from the current literature calling for expansion of
ACE assessment, particularly among racial and ethnic minorities (Cronholm et al., 2015; Mersky
et al., 2017; Wade et al., 2014). Last, final latent class solutions identified a limited number of
traditional ACE among the final groups, perhaps reflecting a relatively disadvantaged sample;

81
notably missing from the classes were household dysfunction items. Psychological and physical
abuse were the only highly endorsed traditional ACE items and became a feature of two classes
(i.e., “psychological abuse and discrimination” and “child abuse and microaggressions”). This
suggests that among this Latinx youth sample, the type of adversity driving substance use
behavior outcomes are the “psychological abuse and discrimination” class, of which nearly 1 in 3
participants in the sample endorsed.
A strength of the study findings is informed by the longitudinal association of adversity
profiles with the substance use behaviors of young adults. Study results support existing research
examining the relationship between ACE and problematic health behaviors (Allem et al., 2015;
Forster et al., 2018) and health conditions (Liu et al., 2018; Vaughn et al., 2017), as well as
perceived discrimination and health behaviors (Rogers et al., 2020; Unger et al., 2014, Unger et
al., 2016). Moreover, study findings are concurrent with systematic reviews of the persistent
relationship between discrimination and risky outcomes (Benner et al., 2018; Cave et al., 2020).
Study results were unexpectedly limited to specific substances. The association of the
highest adversity group, the “psychological abuse and discrimination” class with greater past
month alcohol use was in the expected direction. Given its prevalence, alcohol is a normative
part of adolescence and adulthood across U.S. culture and is widely accessible. Considering its
widespread use, strategies for reducing risk behaviors among youth (adolescents and young
adults), must consider the availability and accessibility of alcohol and the social acceptability of
alcohol use across the U.S. cultural sphere. A surprising result from this study was the higher
count of past 30-day tobacco use among the “limited adversity” group – the lowest risk profile
group – compared to the “psychological abuse and discrimination” class (results not shown). One
explanation for this may be that tobacco use in young adulthood is motivated by factors

82
occurring during an earlier developmental period and possibly the result of cumulative factors
overtime – that is prior to when the traditional ACE and discrimination items were measured –
and thus were unexamined in the current study. For example, a study assessing culture, family,
and discrimination experiences with tobacco use among youth in high school, found
discrimination to be a predictor of smoking in 11th grade (Lorenzo-Blanco et al., 2013).
Among racial and ethnic minorities, the discrimination—risk behavior link has been
considered through an acculturative stress lens (Cano et al, 2015; Cardoso et al., 2016; Kam et
al., 2010). Corresponding with existing literature (Alegría et al., 2017), study results showed
higher acculturation was associated with increased alcohol use frequency in young adulthood.
This study identified a significant association between ethnic identity affirmation and higher
marijuana use, such that youth who felt a greater sense of pride and belonging to their ethnic
group in high school, reported a higher count of marijuana use in young adulthood. A meta-
analysis examining the role of racial and ethnic identity on discrimination and youth adjustment
indicates that a strong ethnic identity buffers the consequences of discrimination (Yip et al.,
2019). Although seemingly contrary to study findings, it is likely be that ethnic identity measures
in high school change by the time youth reach young adulthood. Conceptually, Phinney and Ong
(2007) discuss the ongoing process of ethnic identity search/commitment and affirmation, such
that individuals identifying a strong affirmation or sense of pride for their cultural heritage at a
given time, are likely engaging in further exploration and questioning about their ethnic
background.
Immigrant generation was not distinguished by adversity profiles, nor substance use
behaviors across latent classes. Despite prior work on the immigrant health paradox, it may be
that stress associated with contextual factors, such as child abuse and discrimination experiences,

83
outweigh the effect of other cultural factors previously identified as relevant among racial and
ethnic minorities (Alegría et al., 2017; Peña et al., 2008). This confirms prior research suggesting
that experiences of discrimination occur consistently across all generations (Cervantes et al.,
2013), and are mostly focused on minority or racial status (Savage & Mezuk, 2014). Results
from this study suggest there are multiple contextual and interpersonal factors to consider
beyond traditional ACE and interpersonal discrimination experiences. Future studies would
benefit from a closer examination of additional experiences of adversity to address the deeper
contextual (i.e., community violence, systemic discrimination) positions and socially based
determinants of health among racial and ethnic minorities.
There are important implications suggested by study findings. From a prevention and
intervention perspective, results can inform new and existing approaches to reduce substance use
behaviors among Latinx youth through individual or family-level programs, and also address
discrimination issues at the school and community levels (Kam et al., 2010). Given the positive
and protective nature of providing and enhancing positive childhood experiences, increasing the
pool of nonparent mentors available to youth and to ensure youth feel supported by their friends
and community (Bethell et al., 2019), expanding availability and access to these promotive
factors across all ecological domains can support racial and ethnic minority youth to have
optimal outcomes in adulthood (Liu et al., 2019).
Limitations
Study results must be considered in the context of limitations. Measurement of ACE was
typical, but not exhaustive, excluding other adverse experiences that may be correlated with
traditional ACEs and cause similar experiences of adversity (Mersky et al., 2017). Self-report
can present threats to validity, however, participant ACE were assessed when youth were

84
average age of 21.6 years, thus limiting memory recall bias to relatively recent events prior to 18
years. Although this was a longitudinal analysis, the study design does not lend to making causal
inferences. Future research needs to include designs to understand the causal pathways between
adversity and poor outcomes. Despite these limitations, findings can be used to enhance our
understanding of the possible distribution of ACEs across three generations of U.S. Latinx youth.
Conclusion
The ACE literature is expanding to include important findings among racial and ethnic
minorities – groups who are at significant risk for poor health. This study contributes to the
health disparities research by identifying specific profiles of adversity, including discrimination,
and associated substance use behaviors among a community sample of Latinx youth.
Considering that adversity can severely impact health and wellbeing, particularly among racial
and ethnic minorities, despite promotive factors (Liu et al., 2020), this study attempts to move
closer toward achieving health equity. Study results can be used to inform enhancement and
development of prevention and intervention approaches at the clinical, school, community and
policy levels.

85
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Table 2.1.
Sample Characteristics (n=1,179)
n (%) or M (SD) Range
10th grade (W2)
Age 15.48 (0.38) 13.9–17.8
Female 688 (58.95)
Persons per room/house
< 1.0 684 (58.02)
≥ 1.0 495 (41.98)
Household Composition
Single parent 225 (20.00)
Both/Two parents 900 (80.00)
Immigrant generation
First generation 169 (15.12)
Second generation 826 (73.88)
Third generation 123 (11.00)
Acculturation/Enculturation
Mexican orientation 3.23 (1.00) 1–5
U.S. orientation 3.94 (0.57) 1–5
Ethnic Identity
Search/achievement 2.67 (0.56) 1–4
Affirmation 3.05 (0.56) 1–4
Emerging adulthood (W5)
Age 21.65 (0.50) 20.22–24.23
Adverse Childhood Experiences (ACE) 2.62 (1.98) 0-8
First generation 2.66 (1.99) 0-8
Second generation 2.52 (1.96) 0-8
Third+ generation 3.35 (2.02) 0-8
Individual ACE
Any Child Abuse 808 (70.20)
Psychological Abuse 747 (64.51)
Physical Abuse 585 (50.43)
Sexual Abuse 183 (15.80)
Household Dysfunction 751 (64.91)
Separation/divorce 407 (35.24)
Parental Domestic Violence 267 (23.12)
Drug & Alcohol User 409 (35.05)
Mentally Ill 247 (21.17)
Incarceration 245 (21.14)
Perceived Discrimination
Treated with less respect than others 717 (61.86)
Treated with less courtesy than others 707 (60.84)
People act as if they think you are not smart 718 (61.84)
People act as if they’re better than you 838 (72.18)
You receive poorer service than others 624 (53.75)

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People ignore/act as if you are not there 558 (48.06)
You are threatened or harassed 302 (26.03)
You/your family are called names/insults 358 (30.84)
People act as if they think you are dishonest 500 (43.03)
People act as if they are afraid of you 442 (38.17)
Emerging adulthood (W7)
Age 23.87 (0.41) 22.78–26.09
Substance use
Tobacco use frequency, past 30 days 0.72 (1.49) 0–6
Alcohol use frequency, past 30 days 1.74 (1.34) 0–6
Alcohol use-problematic
a
, past 30 days 1.10 (1.45) 0–6
Marijuana use frequency, past 30 days 0.62 (1.32) 0–5
a
Problematic drinking = 5 or more drinks in a row

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Table 2.2.

Fit Information for One through Five-Class Latent Class Models (n=1179)
Model AIC
a
BIC
b
SABIC
c
LMR LRT
d
(p) BSLRT
e
(p) Entropy
1-class 25938.02 26029.32 25972.15

2-class 20957.14 21144.82 21027.30 <.001 <.001 0.92
3-class 19996.07 20280.13 20102.25 <.001 <.001 0.88
4-class 19666.65 20047.09 19808.86 <.001 <.001 0.87
5-class 19427.86 19904.67 19606.09 0.15 <.001 0.85
a
Akaike information criterion.
b
Bayesian information criterion.
c
Sample adjusted Bayesian information criterion.

d
Lo-Mendell-Rubin adjusted likelihood ratio test.
e
Parametric bootstrapped likelihood ratio test.

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Table 2.3.

Profiles of Traditional ACE and Discrimination Experiences in Young Adulthood (n = 1,179)

Microaggression
Child Abuse &
Microaggression
Psychological
Abuse &
Discrimination
Limited
Adversity

n = 182 n = 258 n = 361 n = 378
Indicator variables 15.44% 21.88% 30.62% 32.06%
Traditional ACE
Psychological abuse .27 .97 .78 .47
Physical abuse .08 .86 .64 .34
Sexual abuse .03 .29 .16 .13
Parental DV .05 .41 .32 .11
Drug/alcohol use .17 .54 .42 .24
Mental illness .08 .35 .27 .13
Separated/divorce .21 .43 .38 .35
Incarceration .10 .27 .28 .16
Perceived Discrimination
Less respect/others .82 .79 .99 .05
Less courtesy/other .80 .77 1.00 .03
Not smart .79 .80 1.00 .04
Better than you .94 .97 1.00 .18
Poorer service/others .67 .56 .98 .03
Ignore you/not there .50 .46 .98 .01
Threatened/harassed .06 .09 .76 .01
Insults (self/family) .14 .19 .77 .04
Dishonest .35 .37 .95 .02
Afraid of you .25 .28 .87 .06

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Table 2.4.

Regression Models of the Association between Class Membership on Past 30-Day Substance Use Behaviors
Tobacco Use
(n = 640)

Alcohol Use
(n = 847)
Problematic
Alcohol Use
(n = 849)
Marijuana Use
(n = 932)
Microaggressions (Referent group)
IRR (95% CI) B IRR (95% CI) IRR (95% CI)
Psychological Abuse & Discrimination .77 (.38, 1.54) .368* 1.36 (.97, 1.91) 1.75 (.98, 3.12)
Child abuse & Microaggressions 1.27 (.61, 2.67) .174 1.04 (.71, 1.52) 1.52 (.81, 2.89)
Limited adversity 1.63 (.83, 3.19) .235 1.16 (.82, 1.64) 1.67 (.94, 2.96)
Covariates
Acculturation 1.12 (.79, 1.60) .202* 1.17 (.98, 1.41) 1.10 (.83, 1.47)
Enculturation 1.01 (.82, 1.24) -.079 .91 (.82, 1.02) .86 (.72, 1.04)
Ethnic identity search/achievement .70 (.45, 1.11) -.087 .84 (.68, 1.04) .76 (.53, 1.10)
Ethnic identity affirmation 1.48 (.94, 2.34) .021 1.15 (.92, 1.45) 1.47* (1.01, 2.15)
Immigrant generation 1.24 (.82, 1.88) .053 1.01 (.82, 1.24) 1.20 (.86, 1.67)
Sex (0/1) 2.67***(1.80, 3.96) .268** 1.65*** (1.36, 2.01) 1.58** (1.13, 2.21)
Persons per room/house (0/1) 1.09 (.73, 1.62) -.074 .95 (.78, 1.16) 1.03 (.74, 1.46)
Household composition (0/1) .90 (.56, 1.44) -.179 .91 (.71, 1.16) .92 (.61, 1.38)
Early substance use 1.07 (.78, 1.46) .148** 1.15** (1.04, 1.26) 1.44** (1.15, 1.81)
Early depression symptoms 1.03 (.68, 1.57) -.281** .84 (.68, 1.03) 1.11 (.78, 1.57)
Note. IRR = incident rate ratio. CI = confidence interval.
*p < .05 **p < .01 ***p < .001

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Chapter 4 (Study 3):
Contextualizing Adversity, Culture & Support:
Experiences of first, second, and third+ generation Latinx Youth

Abstract
Purpose: Literature concerning adversity among U.S. Latinx has largely focused on
trauma across migratory periods. Limited is immigrant research focusing on adversity during the
period of adaptation to U.S. life. Cultural strengths and social capital are Latinx features that can
mitigate such adversities. Qualitative research is needed to bridge the gap between empirical
traditional ACE research and the lived experiences of adjustment among U.S. Latinx youth and
their families. This paper qualitatively describes the adversities and cultural strengths of U.S.
Latinx youth across individual, family, and community spheres.
Method: Purposive sampling selected participants completing follow up data in a
longitudinal study forming a subset (n = 40) of first, second and third+ generation participants.
Data analysis followed a multistage descriptive and exploratory process, implementing a
thematic analysis approach. Themes were condensed and developed into broad themes most
relevant to the study aims, iteratively and simultaneously analyzing, reviewing, refining codes
and their definitions, developing general themes, patterns and meanings in the themes illustrated
through the quotes. Subsequently, themes were linked to an ecological systems theoretical
model.
Results: The qualitative sample included 24 females and 16 males distributed across the
three generations (first n = 15; second n = 14; third n = 11 generation). Respondents were mean
age of 27 years at individual interviews. Most participants were from Mexican heritage (n = 36;
90%) Three main themes emerged from participant narratives: adversity, cultural norms and

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social support. Subthemes described specific thematic experiences across generations with some
differences and similarities observed across themes and subthemes.
Conclusions: Exploring themes of adversity, cultural norms and social support across
three generations of U.S. Latinx youth illustrated detailed accounts of personal struggles of
adversity overlapping with cultural strengths, individual fortitude, perseverance and wellbeing
among U.S. Latinx youth. This qualitative work elucidates the specific adversities, strengths and
resources of U.S. Latinx youth and families that can be used to inform prevention and
intervention approaches across research and clinical settings.

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Introduction
The long-term risks of childhood adversity in the general population have been widely
studied (Felitti et al., 2019). More recent empirical research suggests U.S. Latinx youth are
disproportionately impacted by adverse childhood experiences (ACE; Caballero et al., 2017;
Loria & Caughy, 2018; Sacks & Murphy, 2018), with increases observed across immigrant
generations (Caballero et al., 2017; Loria & Caughy, 2018; Slopen et al., 2016; Vaughn et al.,
2017; Villamil Grest et al., in press). Adversity in the Latinx immigrant health literature has
largely focused on trauma across premigration, migration and post migration (Cleary et al., 2018;
Porter & Haslam, 2005). Limited is research focuses on the adversity immigrants (and
subsequent generations) experience during the period of adjustment and adaptation to U.S. life.
There are many Latinx cultural strengths, such as strong social capital, identified by research
(Aleimda et al., 2009; Almeida et al., 2013, Viruell-Fuentes et al., 2013). However, much
continues to remain unknown about the adversity experienced across ecological contexts, the
cultural strengths that mitigate adversities, and the overall health and wellbeing of U.S. Latinx
youth. Qualitative research is needed to bridge the gap between empirical traditional ACE
research and the lived experiences of adaption among U.S. immigrant youth and their families.
This paper is a first step towards describing the adversities and cultural strengths of U.S. Latinx
youth across individual, family, community and societal spheres.
ACE
The impact of ACE on health has traditionally included examining childhood adversities
in two domains, childhood maltreatment and family dysfunction (Felitti et al., 2019). Clinicians
and scholars suggest an expanded definition of ACE (Afifi, 2020) that is inclusive of urban racial
and ethnic minorities who more frequently experience specific adversities not assessed by the

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traditional ACE instrument (Cronholm et al., 2015), including bullying, exposure to community
violence and economic hardship (Wade et al., 2014). In response, discrimination experiences
have recently been included in clinical ACE questionnaires, notably in the Center for Youth
Wellness instrument developed by Bucci and colleagues (2015) and by Cronholm and colleagues
(2015).
Latinx Youth and Adversity
Prior research focused on traditional ACE has shed light on specific adversities impacting
racial and ethnic minorities (Caballero et al., 2017; Loria & Caughy, 2018; Maguire-Jack et al.,
2019; Slopen et al., 2016; Vaughn et al., 2017; Villamil Grest et al, in press). Existing research
suggests specific household adversities increase in second and third generations, such as
divorce/separation (Caballero et al., 2017; Villamil Grest et al., in press), and incarcerated or
substance using household members (Villamil Grest et al., in press). Across immigrant
generations, U.S.-born Latinx children, compared to foreign born, are more likely to reside in
households with alcohol/drug use (Dettlaff & Johnson, 2011). In turn, adverse experiences
among racial and ethnic minority youth are associated with substance use (Allem et al., 2015;
Forster et al., 2018; Grigsby et al., 2018). Evidence suggests adversity tends to worsen across
generations of U.S. Latinx immigrants; as such, increased stressors and trauma experiences
across generations may be the driver of substance use among Latinx young adults (Salerno et al.,
2019). Traditional conceptualizations of ACE do not fully capture the wide range of experiences
likely to impact racial and ethnic minorities (Mersky et al., 2017; Cronholm et al., 2015; Wade et
al., 2014), and specifically immigrant populations such as Latinx youth (Caballero et al., 2017;
Loria & Caughy, 2018; Slopen et al., 2016). Alternate explanations for the higher occurrence of

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household dysfunction in later generations suggest there may be multiple dimensions of
prolonged and cumulative stress related to the immigrant adaptation process in the U.S.
Discrimination as Adversity
Discrimination research among racial and ethnic minority youth suggest its prevalence
(Macguire-Jack et al., 2019) and impact on health (Liu et al., 2018). A recent meta-analysis of
perceived discrimination and adolescent well-being underscores the persistent effects of
discrimination on depression and substance use among youth (Benner et al., 2018). Further
evidence indicates discrimination increases risk of substance use among U.S.-born ethnic
minority youth (Rogers et al., 2020; Unger et al., 2014; Unger et al., 2016).
First and second-generation immigrants experience the marginalization and
stigmatization created by social environments with anti-immigrant sentiment and policies
increasing exposure to discrimination (Almeida et al., 2016), including intergenerational racism
(Williams & Mohammed, 2009), historical trauma, and concentrated poverty (Annie E. Casey
Foundation, 2019). Similarly, studies suggest experiences of discrimination occur consistently
across all generations (Cervantes et al., 2013) and are mostly focused on racial status (i.e., non-
White; Savage & Mezuk, 2014). Qualitative narratives have detailed the processes by which first
and second-generation Mexican immigrant women navigate and shape their cultural identities
amid U.S. racialized structural inequities, and subsequent negative health outcomes attributed to
these stressful processes (Viruell-Fuentes, 2011). These stories provide a revealing window of
the discrimination experiences of Latinx immigrants in the U.S.
Cultural Norms and Latinx Heritage
As families settle in the U.S., acculturative stress may be associated with low
socioeconomic status, discrimination, segregation, decreased family cohesion, and deteriorating

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family support (Cervantes et al., 2016; Ibañez et al., 2015; Smokowski et al., 2008; Torres et al.,
2012). Cultural “loss” by generation, possibly an outcome of racial and ethnic stratification (such
as minoritized status and “othering”; Viruell-Fuentes, 2007), is suggested by qualitative work.
Familism is generally perceived to be a protective factor strengthening family cohesion (Savage
& Mezuk, 2014), and strong social networks of extended family and communities, buffering the
consequences associated with poverty (Landale et al., 2006). However, the structural (e.g.,
family size, structure, fertility) aspect of familism (i.e., strong commitment to family life; Vega,
1995) among U.S. Hispanic families tends to decline across generations; as families assimilate,
their household composition, particularly among Mexicans, changes such that they begin to
engage in less traditional family behaviors (Vega, 1995). This has implications for first vis-a-vis
second and third+ generation children.
Social Support
Social support from family and community, and the social capital it promises, has
benefits and shortcomings (Portes, 1998). Support from family and friends can be a strength of
the Latinx community (Concha et al., 2013) and protective of negative health outcomes among
first generation Latinx immigrants (Lueck & Wilson, 2011). Over two decades ago, Portes
(1998) described the intersections of social life among Latinx youth based on their social
positions and other structural-related factors such as immigration status, context of reception and
the environmental settings in which adaptation takes place. More recently, Viruell-Fuentes et al.
(2009) qualitatively explored similar social factors among adult Latinas influencing Latinx
immigrant health. Although first generation women reported having limited informational and
emotional support, those with “secondary” ties (e.g., ties to community groups) expressed fewer
feelings of isolation. Second generation women expressed having a wider connection to

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“secondary” support resources, along with having greater community support overall. Despite
these strengths, second generation women were acutely aware of their minoritized or “racialized”
position (Viruell-Fuentes, 2009).
Foreign-born Mexicans, compared to non-Latino Whites, report greater family support –
possibly relying more on family support compared to non-Latino Whites. Cultural retention,
measured as primary language spoken at home, may be associated with higher family support
(Almeida et al., 2009). Viruell-Fuentes et al. (2013) suggest that immigrants reported having
fewer social ties, compared to U.S.-born, challenging the strong supportive ties explanation of
the healthy immigrant paradox. Nonetheless, these studies maintain the idea that living in ethnic
communities/enclaves is associated with larger social networks among all Latinx (Almeida et al.,
2013; Viruell-Fuentes et al., 2013).
Current Study
Drawing from an integrative risk and resilience model for understanding immigrant-
origin youth framework, this study explores U.S. immigrant youth adaptation through
developmental and acculturative domains by examining the ecological systems in which youth
navigate (Suarez-Orozco et al., 2018). This approach guides our understanding of the multiple
adaptive processes U.S. Latinx youth encounter throughout their development. These adaptative
processes take place in multiple contexts – family, community, and society (Suarez-Orozco et
al., 2018). The aim of this study is to expand current knowledge of the experiences of Latinx
youth, particularly in the context of self-described adversity, cultural experiences related to
family and community and discrimination, among three generations of Latinx young adults.
Specific research questions explored are as follows: 1) Are there distinct lived experiences across
first, second and third generation U.S. Latinx youth? a) In what ways do self-described adversity

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and cultural and family-related norms, impact health behaviors? b) Are there different
discrimination experiences across generations and how are they perceived? c) In what ways are
cultural norms and social support protective of substance use behaviors and overall wellbeing?
Method
Participant Sampling
Purposive sampling of those completing follow up data in a longitudinal study of
acculturation and substance use formed a subset (n = 40) of participants from Project RED
(Unger et al., 2009). The final analytic sample n = 1,179 of Latinx participants used in Study 1
and 2 was sorted by first, second, and third generation. Next, using a number randomizer
program (by participant ID number), a list of participants was identified for relocation and
recruitment.
Participant relocation and recruitment initially took place via email, with follow up
contact involving interview scheduling and confirmation emails. Beginning in April 2019, a total
of 411 participants were sent an email invitation to participate in the study. A second round of
email invitations were sent to participants who did not respond after two weeks. During this
time, 51 participants responded expressing participation interest (12.4%). A total of 44 in-person
interviews were scheduled 86.3%), 40 were completed (90.9%) and 4 (9.1%) of these were
cancelled due to participant no-shows. The remaining participants who initially expressed
interest (13.7%) did not reply to further follow up for interview rescheduling. Qualitative data
collection was completed in June 2019. To obtain a representative sample from each generation
and ensure a full range of voices from multiple perspectives, attempts were made to schedule and
complete a comparable number of interviews across each generation.

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Sample
The final qualitative sample was made up of 24 females and 16 males distributed across
the three generations. First generation had n = 15, second generation had n = 14 and third
generations had n = 11 total participants. Respondents had an approximate mean age of 27 years
at the time of the interviews. Most participants were from Mexican-heritage (n = 36; 90%) and
almost half had a high school diploma and completed some college courses (n = 19; 47.5%).
Specific information about the study sample is provided in Table 1.
Qualitative Interviews
Interviews were focused on learning about participant experiences growing up in the U.S.
as first, second, and third generation Latinx youth. Questions elicited details about the influence
of parental relationships in shaping their identification with cultural heritage, childhood
adversities experienced, substance use behaviors, and how experiences of discrimination or
prejudice affected their lives. Interviews lasted an average of 50 minutes in duration. Study
procedures were approved by the University’s Institutional Review Board.
Analytic Procedure
All interviews were audio-recorded and transcribed verbatim. Each transcript was read in
its entirety to get a sense of the whole interview, prior to coding. Data analysis followed a
multistage descriptive and exploratory process. A thematic analysis approach was implemented
following methodology described by Hsieh and Shannon (2005) with interview transcripts
analyzed in the following manner. First, two researchers each reviewed six transcripts to develop
a broad understanding of the content by documenting initial impressions of specific codes.
Segments of text ranging from a phrase to several paragraphs were assigned codes based on a

110
priori. Lists of codes developed were matched and integrated into a single final codebook
consisting of a list of codes and their definition, that relate to the study research questions.
In the next stage, all transcripts were independently coded by at least two researchers using the
initial codebook structure developed in the first step. Disagreements in assignment or description
of codes and their utility were resolved through discussion and enhanced definition of codes.
Based on these codes, the computer software ATLAS.Ti Version 8.4, was used to code data,
primarily connecting text segments grouped into separate codes. These codes were used in
selective coding of material to identify the existence of new, previously unrecognized categories,
and specific examples of co-occurrence illustrated with transcript texts. The process of
condensing and developing codes into broad themes involved determining which themes were
most relevant to the study aims, in an iterative and simultaneous process of analyzing the data,
reviewing and collapsing the codes, refining their definitions, and developing general themes
through the process of discovering patterns and meaning in the themes illustrated through the
quotes (Braun & Clarke, 2006). Subsequently, linking themes to a theoretical model (Ryan &
Bernard, 2003), results were organized into an ecological systems framework – by linking
emergent themes and subthemes with respective ecological systems guided by the integrative
model for understanding immigrant youth adaptation (Suarez-Orozco et al., 2018).
Results
Participant narratives yielded three emergent themes (see Figure 1) informed by study
research questions. The three themes and their corresponding subthemes are presented below.
Table 2 provides a detailed thematic matrix summarizing the themes and subthemes.

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Adversity
Adversity, used as an umbrella term, allowed participants to explore and discuss any
early life experiences they considered as influential to their health and wellbeing. A list of
traditional ACE was provided during individual participant interviews, and included all child
abuse (i.e., emotional and physical neglect, psychological, physical and sexual abuse) and
household challenges (i.e., divorce, substance use, mental illness, parental violence, and
incarceration). Participants also considered and discussed self-described adversity and previous
experiences they deemed traumatic. This theme represents the broad spectrum of ecological
systems, that is – family/community/societal – impacting the daily lives of youth. Traditional
ACE (family system), discrimination (community/society) and other adversities
(community/society) were all described in the following theme.
Traditional ACE
First generation participants discussed experiencing ACE using traditional
operationalizations (e.g., separation/divorce, child abuse), but also described traumatic
experiences typically absent from ACE literature.
“Emilia” a first generation female described abuse in her household:
My stepdad, he came into my life when I was like nine years old, and I did not have a
very good relationship with him. Extremely verbally abusive. Like culturally, very macho.
Just the worst kind. He was verbally abusive, never physically abusive.

“Lila” another first generation female described alcoholism in her household:
My dad would drink a lot. He still does. It was also another reason why he wasn't mostly
with us. He wouldn't spend time with us.

Second generation participants described a range of traditional ACE which were mostly
in the household dysfunction domain. Participants experienced household substance use (e.g.,

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mostly father’s alcohol use), mental illness (e.g., typically mother’s mental health) and
separation/divorce.
“Myra” a second-generation female discussed learning from her father’s alcoholism:
And I say functional alcoholic because he's able to do it and get up and go to work and
he's maintained that job for almost 15 years now. Like ninth or tenth grade I really saw it
when I came home early and I was, "Why is he all tired and sleepy?" My mom was an
enabler.

Third generation participants described their lived experiences in terms of awareness of
the multiple adversities in their lives. Some participants assumed multiple household roles due to
the struggles of their parents (e.g., one’s participant’s father was an alcoholic and mother was
chronically and physically ill) and became caretakers of their parents’ wellbeing.
“Edgar” a third-generation male participant describes the growth of inner strength from
adversity.
But I think it is because of the stuff that happened when I was younger. Mom leaving,
drugs, different little things. When we would live with her, there was abuse from her
partners or whatever. I mean, I just always feel like I could... That helped me be like,
strong, I guess. So you have no choice but to move forward.

“Alicia” a third generation female discusses compassion and gratitude for her parents.
I grew up with an alcoholic dad who ... I know emotionally he really tried to be there for
us, but at the same time I definitely always felt like ... I always felt bad because he gave
us so much love, but he didn't give himself that same love. They both went through tough
lives and they both have reasons to why they had their downfalls. Like my dad's
alcoholism, my mom's inability to, I don't know, be there 100%, emotionally, for her kids.
But she was there. She did her best. They both did their best, so I think for us growing up
that's all we can ever really ask for.

The above narratives covered experiences of traditional ACE in the childhood households
of immigrant youth. Traditional ACE were all experiences that occurred consistently across all
three generations, however among third generation participants, traditional ACE were discussed
as more predominant.

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Discrimination Experiences
Participants were asked about discriminatory experiences and mistreatment in their lives
including specific occurrences, feelings and reactions, and sources of mistreatment, if any.
Events described by participants were defined as perceived experiences of unjust or prejudicial
treatment (based on race, ethnicity, or other stigmatized identity) towards an individual, a
relative or an acquaintance. This theme describes examples of community and structural
inequities and related stressors occurring at interpersonal and systemic levels.
Nearly all first-generation participants talked about experiencing some form of
discrimination. Some talked about isolated incidents from their peers when they were younger –
such as experiences of bullying/name-calling, or more overt experiences that seemed to be
motivated by speaking the Spanish language or their phenotype (i.e., darker skin color). Others
were aware of U.S. structural inequities based on immigration-related policies (e.g., legal status
and paths to citizenship), however, overall many explained that discriminatory experiences were
rare due to their enclave communities and the diversity across a majority of the surrounding [Los
Angeles] region.
“Laura” a first generation female discussed when interpersonal mistreatment began in her life,
and her belief that it was related to her skin color.
When I was little I did experience a lot of discrimination, because I was a darker Latina.
So, that definitely did just kind of affect me. From my own parents, too. My mom wouldn't
let me go out in the sun for too long. She was scared that I was going to get darker.

A first-generation male “Victor” described his experience and perspective:
Not really towards me directly, but I guess, as a whole in the country I guess, I feel it
more if I watch the news or if I read articles online. I feel like there is discrimination, but
like I said, in Los Angeles, I haven't really felt anyone deny me anything or treat me
differently because of my race or ethnicity.

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Described experiences of discrimination were less common among second generation
participants, with some reporting no personal experiences, while others recalled isolated events.
Those recalling no experiences of interpersonal mistreatment speculated it was because they
could pass as “white” due to their phenotype (i.e., lighter skin tone). Second generation
participants who discussed limited discrimination experiences realized they did not initially
identify certain interpersonal interactions as discriminatory. A few others talked about
discrimination experiences being limited to early school-age years such as name-calling/bullying
by peers.
“Esther” a second-generation female described ideas about why she may not have personally
experienced overt discrimination:
I can't think of any, which I feel like I'm sure there has been. But like I said, I felt like
since I am lighter skinned... people wouldn't discriminate against me if they saw me on
the street, because they would think that I'm not Mexican, or that I'm not a minority. So
yeah, I don't think that has been one of my experiences.

“Tony” a second-generation male described a discriminatory experience that he noticed after
some reflection:
We all sat there and we were definitely the only Hispanics in the whole restaurant. And I
guess everybody was staring at us. I didn't notice because I was eating and drinking. But
yeah, they were like, "Why is everybody staring at us?" They were staring us as soon as
we walked in, while we were eating.

Third generation participants generally discussed isolated microaggressions (i.e., covert
experiences of interpersonal mistreatment such as stares from other customers in stores,
restaurants, or bars) in their lives. Some participants talked about feeling the reason for
discrimination was founded on their phenotype (i.e., darker skin color), but these participants
were among the very few third generation youth that had experienced overt events in this study.

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A third-generation female “Karina” described her thoughts after feeling microaggressed when
she was followed by a retail store clerk:
I just felt like is it just because of how I look that that's why you're following me? Or is it
because it's something that I did that I know I haven't done anything. It just made me
think did I do something? I was confused like why is this happening? I just walked in and
started looking.

“Marisa” a third-generation female participant describes microaggressive experiences related to
her racial appearance:
I really feel sometimes it's the color of my skin because I'm a darker shade of brown that
I can't ... even though I'm fully assimilated into both cultures, I can't full assimilate
because of my skin color. They see me like you're brown, you're not from here.

The above narratives describe a range of experiences related to covert and overt
discriminatory events in the lives of Latinx youth. Although there were distinct differences in the
type of discrimination experienced by participants across generations, discrimination was
undeniably recognized in their lives.
Other Forms of Adversity
First and second-generation participants overlapped in their discussion of fears related to
their own undocumented status (first generation) or that of their parents (second generation).
Second and third generation participants coincided in their shared discussion as assuming adult
household responsibilities (parentification; Mika et al., 1987). Others described experiences
including family separation – for various migration related reasons (i.e., temporary cross border
parenting and deportation).
One first generation participant, “Juan” described how his father’s deportation compounded fear
around his own legal status, and the possibility of experiencing the same fate of his father:
I mean obviously I was illegal, and up until the whole DACA thing, when I got my whole
DACA and stuff, I was super paranoid of immigration. I was scared of police, I didn't
want to be involved. So that also too was what helped me to stay in line. My mom would

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always tell me, "You don't want to end up deported. You don't want to end up deported.
Because once you leave, you're not going to come back."

“Victor” a first-generation participant describes the limited pathways he could pursue due to his
undocumented status:
Another thing is just the opportunities. Like when I graduated from high school, they
didn't have as many programs available for undocumented students, and there wasn't
much awareness either.
“Emilia” a first-generation participant describes cross border separation from her mother as an
infant:
My mom left us in Mexico for a couple years when I was really little, so I don't know. I
know that there's something to it psychologically, but I was maybe two or three years old
when my mom came to the United States, and then we reunited.
“Pilar” a second-generation female participant recalls feelings of fear about her parents’
deportation while growing up.
They have their papers now, but when I was young I always knew since I was five, "Okay,
if they take me here's some money. Here's the place where the money is. This is the
money you're gonna use for the lawyer." Or, "This is the money that you're gonna use to
help me out to get out if they were even able to get out. So since I was really young until
the age of like 21, I've had the fear of my parents are gonna be taken away. So that has
caused me a lot of stress.

“Magda” a second-generation participant describes taking on parental household roles after her
mother became ill following childbirth:
My mom was really sick after pregnancy, bedridden for an entire year, and she couldn't
do a lot. So whenever I was home, I was doing a lot of the care for him as if I had a baby.
I would get up in the middle of the night when he was crying and things like that.

The experiences disclosed by participants exemplify the myriad struggles youth
encountered during their childhood due to their household, community and national context.
These challenges describe lived experiences of adaptation, balancing their needs alongside those

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of their parents and the demands of their community/society. Narratives reveal a range of
adversity that include direct and indirect experiences of actual or anticipatory family deportation.
Cultural Norms
Participants were asked about family relationships, rules and expectations in the
household, specifically around U.S. Latinx culture and how these were helpful or hurtful in their
lives. This theme focuses on the individual and family level systems in which Latinx youth grow
and adapt and develop their unique ethnic identities. First generation participants described
distinct cultural differences from those of their parents. Some differences created more tension
than others. For example, one participant valued education as a pathway toward eventually
becoming a business-owner, whereas his parent’s generation solely focused on work to earn
money.
A first-generation female “Maggie” described confusion about the way her mother showed love
and attributed it to cultural norms:
My mom didn't go like, "Oh, daughter, I love you so much." It's just like she'd provide the
food. I think it has to be maternal love ...Mexican culture ... In our culture the mom has to
do the food, so I don't know. I kind of connect it a little bit with love, like her providing us
food, but I don't know if it's an obligation for her to be cooking.
Second generation participants discussed cultural differences with their parents similar to
first generation participants, however – these differences went beyond the traditional (e.g.,
gender norms, cultural values) differences described by first generation participants. Second
generation participants talked more about unmet emotional needs and were aware of mental
health stigmas within their culture, which informed the way mental health was handled in the
household, in contrast to what they were learning in their community context.
For example, a second-generation male “Jorge” described how, as a household male, his parents
gave him more freedom compared to his sisters.

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I have two older ones and two younger ones [sisters]. They were more concerned about
them than with me. I don't know exactly why, but I guess I was the man. I guess it goes
back to my dad cared more about the ladies, the girls than the men. I think that's why my
mom cared more about me, that's just the mentality that they had back in Mexico. The
man just grew to be independent.
One third generation participant described his parents’ encouragement to assimilate and blend in,
adherence to cultural norms (i.e., speaking Spanish) was not fostered, but rather discouraged.
“Gabe” a third-generation male participant described how his parents’ own experience
influenced their limited emphasis on Latinx cultural norms:
They were discriminated a lot growing up because they were Mexican-Americans … but
still, I guess it was important for them. And they just wanted me, my brother, and my
sister to integrate real well into American culture.

There were not many other third generation participants discussing distinct and strict
adherence to cultural norms and values in their household. This may be because third generation
participants did not necessarily grow up with immigrant parents in the household, and perhaps
there were fewer traditional household cultural norms and experiences compared to first and
second-generation participants. Possible that existing household cultural norms did not create
tension because they were not strictly adhered to by both participants and their second-
generation parents.
Subtheme: Biculturalism
Biculturalism, a subtheme of cultural norms, was defined as being culturally adaptable
and comfortable existing in and across settings with people from one’s own culture, as well as
those from the dominant – U.S. society – setting. In essence, biculturalism was described by
participants as being able to navigate in and out of various cultural settings.
Overall, first generation participants discussed a sense of biculturalism that allowed them
to learn and adopt aspects of the different cultures (e.g., U.S. American vs. Mexican) that best
suited their needs and preferences. Some participants described a cultural nimbleness facilitating

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connections with people from diverse backgrounds. One first generation participant, “Emilia”
described leaving her “cultural bubble” for college; her freshman year became a process of
adaptation to “American” norms and values that she had not previously encountered in her
childhood community.
My neighborhood [redacted] is a cultural bubble. My mom has been here for 20 years
and she never had to speak English. She never learned it, really, because everywhere she
goes…everybody speaks Spanish and it's all Mexicans everywhere. So, when I went to
[name of university], that was a huge cultural shock. Not only the wealth, but also, I was
never around white people. I was never around anybody from any other culture.

A few second-generation participants’ experiences related to biculturalism overlapped
with those of the bilingualism subtheme. Overall, second generation participants discussed
widened opportunities due to their biculturalism. Being culturally adaptable exposed them to
new environments, friendships, perspectives and skill development (e.g. honing language skills).
A second-generation female participant described how being bilingual has exposed her to diverse
experiences:
I think speaking Spanish is important. It's a part of my culture. It helps me interact with
them. I don't know. It's who I am basically. So I think it's important because it opened a
lot of opportunities too in school, at work. It's just a way to connect with a different side.

Third generation participants’ discussion of biculturalism largely overlapped experiences
of bilingualism, similar to the second-generation group. However, third generation participants
talked about a connection to their roots through the cultural traditions of their family members as
well as connection to U.S. American cultural norms and values. “Alicia,” a third-generation
female participant articulated how biculturalism and bilingualism were linked due to the cultural
messages transmitted through the language.
…when you start working you start realizing the advantages of being fluent in at least
two languages. You just have the ability to communicate with more people. And it's not
just communicating, it's really understanding what the other person is saying. Because
when you're fluent, you understand, I feel like, where those words are coming from more

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than just ... you understand more than just the literal meaning of the word. You
understand more of the meaning behind it, or the meaning behind their intentions and all
that.

Subtheme: Bilingualism
Largely intertwined with biculturalism, bilingualism, defined as being fluent in both
English and Spanish languages, is a subtheme of cultural norms because of its centrality in
participants everyday lives. First generation participants mostly spoke about bilingualism as a
skill they learned would be helpful to them and one in practice in the context of their daily lives.
One first generation female participant “Sara” struggled learning English because there was no
one at home who could speak English to support her learning:
They did push me to speak English, because I had to know it. That was one of the
most difficult things to do because there was nobody at home that actually knew
English.
Second generation participants universally described being bilingual as
advantageous in many areas. This skill was helpful in obtaining and keeping employment.
Knowledge of English and Spanish facilitated a connection for second generation participants,
beyond helping others in their environment communicate, but it provided opportunities to
connect with a diverse array of people, learn new perspectives, and develop language skills more
fully.
“Tony” a second-generation male participant described learning how to speak English more
clearly when he went to an out of state college, where he was noticeably part of a small minority.
Also, it helped me with my vocabulary. Because over here is mostly slang. Or Spanglish,
you know, mixing English and Spanish. It's not educated conversation. And when you go
over there. I have to be more cognizant of what I say because the fact that Spanish was
my first language. I have to talk a little bit slower. My pronunciation has to be a little bit
better because now some people won't be able to understand me. I'll have to repeat
myself.

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Most third-generation participants did not speak Spanish at all, or well enough to
communicate effectively. These participants felt a sense of loss around not having Spanish
language skills and lamented that it precluded them from having a relationship with relatives and
speculated that perhaps their monolingualism limited job opportunities. The small amount of
third generation participants who did speak Spanish discussed how this skill presented
opportunities to communicate with grandparents and was helpful at work.
“Karina” a female participant described her experience:
They raised us just speaking English. That was really hard because I couldn't have a
close relationship with both my grandparents from each side. Me not being able to have
that close relationship like my other cousins have with them. I don't have that because I
can't really communicate.

Subtheme: Traditional Gender roles
Although there were fewer references to traditional gender norms compared to the
biculturalism and bilingualism subthemes, gender norms were discussed, with distinct
differences across generations. First and second-generation participants discussed adherence to
traditional gender role norms in their childhood households, although mainly put into place by
fathers, compliance and enforcement by mothers was discussed. There were starkly fewer
references related to traditional gender roles norms among third generation participants.
“Michelle” a first-generation participant described her mother’s conformity to traditional gender
norms:
As a woman my mom, she would tell me that, right now I'm your boss, I tell you what do
to. You're going to follow my rules, and you're never going to be the boss of yourself
because when you're a wife that's it, in a way you're your husband's property. He's going
to tell you what to do, and you're going to follow his rules….I don't like that. I don't think
that's fair.

“Alfred” a second-generation male discussed his father’s lack of emotional intimacy.

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… well my dad's more like that kind of machismo, Mexican. We don't say love you. We
just say, "Oh, thank you. Oh, thank you, thank you." He'll say it. But for me, it was kind of
like weird because he never said it when I grew up.

Altogether these subthemes offer narrative descriptions of participant beliefs and
experiences of Latinx cultural norms. Participants described slight differences across generations
in the adoption of cultural norms and values and clearly discussed their purpose in their lives.
Social Support
Social support was explored as it related to positive opportunities that buffered the
experience of ACE and other adversities discussed. Support came from different people in the
lives of participants across their networks, including immediate or extended family, or other
adult supports and mentors. This theme describes the multisystemic impact of positive and
supportive experiences across individual, family and societal levels at play in participants’ lives.
Subtheme: Family Support
Overall, first generation participants talked about receiving significant and beneficial
support – both instrumental and emotional– from nuclear and extended family, around education
and professional matters, with slight differences. A few participants described limited emphasis
from parents around pursuing an education beyond high school – in some cases this was
attributed to limited financial resources and immigrant status. First generation participants were
foreign born individuals without legal status, that is – legal documentation, upon high school
graduation (i.e., in 2009) participants necessitated a social security number to attend college and
apply for funding, thus impeding the number of available opportunities.
“Sara”, a first-generation female participant talked about the instrumental support she received
from her parents in high school:
Supported me by giving me time to study, materials, any field trips that I needed to go to.
Or if I needed a ride or anything like that. So, they wouldn't help me or tutor me because

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they didn't know, but they would ... If I needed tutoring, they're like okay, go ahead. Go to
tutoring.

“Albert” a first-generation male participant talked about the lack of instrumental support from
his parents due to limited resources however, their overall encouragement motivated him:
Well, on their part they weren't very pushy towards achieving something…. after high
school, going to college. Financially we weren't ready for…Because they were paying for
my sister at the time. So, there was money going to her college education. I felt that I
would be a burden to them, which is somewhat true because we all lived in one house… I
mean, that would mean that I would have to get a job and try to go to school, which to me
seemed kind of difficult at the moment because I'm an immigrant. They just encouraged
me to try and find a job.

Second generation participants described instrumental and emotional support from
family, with some participants describing a determination and desire to pursue goals seeing their
own immigrant parents’ hard work and sacrifice, despite limited resources. Participants also
described the value of education transmitted by parents. Others talked about receiving tangible
supports from family (i.e. financial maintenance, transportation, and food and rent provisions),
bolstering their ability to attend college. Generally, second generation participants talked about
how this support helped them pursue their academic and professional goals.
“Pablo” a second-generation male talked about how his father modeled hard work and his
parents’ migration history motivated him to pursue his goals:
Just seeing my dad work a lot just kind of put me into that mentality…because I think
that's what makes me who I am, from where he came from, to us living in an apartment,
and to them owning everything they have now. It just kind of ... if they could do it, then
why couldn't we?

Third generation participants overall discussed instrumental support provided to them by
family members. This support was often tangible, such as providing transportation to attend
college, other times there was emotional support – primarily in the form of set expectations.

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Some participants discussed a longing for more emotional support than what they had received,
and a few others were driven to pursue their own goals in the absence of support.
“Deena” a third-generation participant describes the support she received from her sister as being
the most meaningful:
She [sister] wants better for me …She was a single mom, she didn't finish high school...
She lives down the street with my nephew and she's doing everything by herself now and
she's like, "I never wanted this for you."

“Mari” a third-generation female participant talks about the limited support her mother provided:
Like my mom was given a house that got me to that place in life. So it was her that
brought me to that city that I ended up going to that high school. But I think ultimately it
was just me. ….I would say maybe my drive was from my mom because she did so much
with just four kids and no money and no job. And she always made us look semi-
presentable in the situation that we were in.

Subtheme: Other Adult support/mentor
First generation participants could very clearly identify some key adult supports in their
lives. Some of these supports were church adults, teachers, or mentors in youth programs that
were supportive in both emotional and instrumental ways. These adults supported their efforts to
succeed, potentially decreasing the likelihood of the intergenerational transmission of ACE and
other adversities.
Maggie, a first-generation female described how the support she received from high school staff
provided her with the tools (instrumental support) she needed to pursue her goals.
I think it had to do with the support that I got from them. It was because they saw that I
wanted it and they were like, "Okay, here's your application for college, apply here. Do
this scholarship." That was just through high school.

“Emilia” a second generation female talked about how her involvement in an intensive college
prep program was key to achieving a college education.
I was part of this program called College Match. … they identify the top students … They
kind of prim and prep them so that they can get into these elite schools. In tenth grade, I

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got into the program going into eleventh grade, so I got like SAT prep. I was mentored by
counselors and they helped me write my essays. They basically helped me get into school.
They're the ones that took me to the east coast and exposed me to all these schools
.
Second generation participants overwhelmingly talked about specific school-based
teachers, counselors, or mentors who provided both emotional and instrumental support around
pursuit of academic and professional goals as well as advice related to positive and healthy
behaviors. These supportive relationships provided participants with inspiration and motivation
to reach a goal and be more thoughtful about life choices.
“Lucy” a second-generation female described related support in high school:
There's someone specifically that I remember during high school. She helped me with all
the applying for college, applying for financial aid. She was really helpful, so I think that
also influenced me too because she set me up with all the applications to apply for
schools right after high school.

All third-generation participants, expect for one, discussed supportive relationships with
their community, including teachers, coaches, and family friends. This ranged from receiving the
following from adults: general advice around making positive choices in life, simple gestures of
kindness that made participants feel special, serving as a professional role model, or providing
legal advice around professional goals.
“Mari” a third-generation female:
I know that my best friend …that I met in elementary, her family took me in and that was
it….it was the second home. Because I didn't have a relationship with my sisters or my
mom, but I'd go to them and their sisters, their mom, their dad; I'd just be sitting there on
the couch with the dad, like I was their adopted daughter. So having that, it gave me an
idea of what, the type of family I wanted…they had that childhood, they had the structure.
Structure. I didn't have structure growing up, so having that was super important, and I
think very helpful.
The subthemes and quotes describing social support exemplify positive and supportive
relationships in the lives of participants. Support was derived from many sources inside and

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external to their families. These experiences denote the ways in which participants were able to
overcome some of the challenges in their lives.
Discussion
Through the lens of U.S. Latinx participant narratives, this paper explores the similar, yet
distinct differences in the life experiences of first, second and third generation young adults.
Applying an ecological systems approach (Suarez-Orozco et al., 2018) in which U.S. Latinx
youth navigate their lives, participants reflected on their life experiences, adversities, cultural
norms and supportive networks. Through these narratives, details about cultural and personal
strengths were revealed, in spite of the multiple adverse experiences encountered at the family
level (within their households), at the community-level (in school or at work), and in their
interaction with society at large. Participants lives were described as somewhat safeguarded by
the diversity within their immediate communities and across the greater region.
Although participants across all three generations described experiences of traditional
ACE, their descriptions were patterned across generations in a specific way. First and second-
generation participants discussed traditional ACE (i.e., psychological abuse, household substance
use), however third generation descriptions were compounded – their stories featured an
accumulation of ACE – they described more adversities compared to the singular experiences
told by first and second-generation peers. First, and to a lesser extent, second generation
participants shared other adversities related to their own, specifically their family’s immigration
status. These were felt realities, particularly among participants who experienced the barriers to
education after high school, or fear of being separated from their immigrant parents. These
narratives emphasize the importance of examining additional adversities of racial and ethnic

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minorities by considering the deeper environmental context and structures where U.S. Latinx
dwell and interact.
Consistent with empirical research (Cervantes et al., 2013) participants from all three
generations discussed some form of discrimination experience. However, their specific
encounters and familiarities differed by generation. First participants described awareness of the
larger structural-based discrimination and touched on discrimination, or lack thereof, related to
shade of skin. Second generation also discussed awareness of skin color, but to a lesser extent –
although they were aware of discrimination, they did not describe many direct experiences. Third
generation participants also talked about skin color and some more covert descriptions of
microaggressions. Personal narratives uncovered another dimension beyond protective and
supportive enclaves (Almeida et al., 2013; Viruell-Fuentes et al., 2013), that is, the shelter of
living in a diverse region. A few participants discussed how not only did their ethnic enclaves
protect them from discriminatory experiences, but living in a large and diverse urban city
provided a sense of shelter from these events. Although there were slight differences, most
participants across the three generations were aware of the privileges or challenges they met
based on their racial, ethnic or minoritized status.
Culture was a prominent aspect of participant narratives, however these varied in subtle
ways across generations. For instance, traditional gender roles were a feature in the lives of most
first and second generation participants, yet were largely absent from described experiences of
third generation interviews. Among third generation participants, this difference is similar to the
cultural “loss” described by Viruell-Fuentes et al. (2007). There were some examples of a
cultural distance being the outcome of racialization where second generation parents were
focused on assimilation given their own minoritized experience growing up in the U.S. There

128
were some cultural differences around expressions of emotional intimacy among first and
second-generation participants, which may be related to the cohesion participants experienced
within their own childhood families (Savage & Mezuk, 2014). In terms of biculturalism and
bilingualism, overall participants strongly connected with these aspects of their lives and those
who were not fluent in Spanish mostly lamented this as a loss. With the exception of adherence
to traditional gender role values, descriptions of cultural narratives were mostly positive and
supportive in the lives of participants. These stories oftentimes overlapped with discussions
around social resources and support.
Participants descriptions of social support revealed sources of strength from personal
support networks and inner resources to obtain needed support. Overall, participants from all
generations described support from family, despite limited economic and educational resources,
however the sources of family support seemed to be more limited, and less available, among
third generation participants. Familism, as described in prior research (Savage & Mezuk, 2014),
as a form of social support, seemed to be driven by cultural values around family relationships,
commitment to family life, and relationships with extended family and the community (Concha
et al., 2013; Savage & Mezuk, 2014; Vega, 1995). Although not expressly stated, participants
described “secondary” ties to community resources discussed in qualitative work (Viruell-
Fuentes, 2009), particularly among first, second and third generation participants who had
household stressors or limited supportive sources at home. Support literature suggests cultural
retention is associated with higher support (Almeida et al., 2009), a similar finding in this
qualitative work. Mostly first and second-generation participants described how their
biculturalism/bilingualism connected them to their community and allowed them to access others

129
outside of their own. In contrast, a third participant described a sense a loss not being able to
socially connect with her grandparents because she did not speak Spanish.
Taken together, the personal narratives described across forty qualitative interviews
discuss struggles of adversity combined with cultural strengths and fortitude and a general
perseverance and wellbeing among U.S. Latinx youth. This study aimed to explore differences
across three generations of U.S. Latinx youth around specific experiences – adversity, cultural
norms, and social networks. Exploring these themes across three generations and illustrating
detailed accounts of specific experiences, highlighted previously known and unknown facets of
the lives of U.S. Latinx youth. These qualitative descriptions shed light on the specific
adversities and fears of U.S. Latinx youth and families, regardless of their protective and diverse
environments. Even though these youth faced multiple stressors, most found comfort within their
supportive family communities and extended networks. This work is intended to inform future
research and clinical work with U.S. Latinx youth and families.

130
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Table 3.1.

Qualitative Sample Characteristics (n = 40)
n (%) or M (SD) Range
Age 27.89 (0.39)
Female 24 (60) 13.9–17.8
Education
Less than high school diploma 1 (2.5)
High school diploma 7 (17.5)
Some college 19 (47.5)
College degree 11 (27.5)
Advanced degree 2 (5.0)
Enrolled in school/college/vocational training 5 (12.5)
Employed 35 (87.5)
Race/ethnicity
Latinx/Hispanic 36 (90)
Other 4 (10)
Family’s country of origin
Mexico 36 (90)
El Salvador 1 (2.5)
Guatemala 1 (2.5)
US 1 (2.5)
Children 11 (27.5)
Current living situation
Biological parent 17 (42.5)
Spouse/partner 19 (47.5)
Grandparent 1 (2.5)
Alone 2 (5)
Adverse Childhood Experiences
Food Insecurity 1 (2.5)
Emotional Neglect 8 (20)
Psychological Abuse 10 (25)
Physical Abuse 7 (17.5)
Sexual Abuse 4 (10)
Separation/divorce 18 (45)
Parental Domestic Violence 6 (15)
Drug & Alcohol User 19 (47.5)
Mentally Ill 10 (25)
Incarceration 7 (17.5)

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Table 3.2.

Matrix of Qualitative Study Themes and Subthemes
Themes First generation
N = 15
Second generation
N = 14
Third generation
N = 11
Adversity
Traditional ACE Dispersed experiences of
separation/divorce, and child abuse
(e.g.).
Mostly in household dysfunction
domain, such as substance use by
parents/father’s use, mental illness
(mother’s), and separation/divorce.
Most in this generation discussed
household dysfunction such as
having an alcoholic father.
Discrimination All discussed some type of
discrimination ranging from bullying
experiences in grade school and
English language limitations; Most
underestimated occurrence and
severity of experiences attributing this
to shelter from enclave-like
communities.
Mix of no discrimination given lighter
phenotype (“white passing”) with
some experiences; overtly racist, yet
isolated events not initially identified
as discrimination; dispersed
microaggressions such as grade school
bullying.
Limited experiences of
microaggressions (e.g., silent
stares in public); Any
discriminatory experiences were
attributed to phenotype (i.e.,
darker skin color)
Other experiences
of adversity
Migration-related family separation
(cross-border parenting; deportation)
and fear related to undocumented
status of self/family.
Taking on “parental” household
responsibilities due to parental illness.
One participant discussed fear of
parental deportation (during
childhood.
Other experiences such as mother
with chronic physical illness, in
turn participants became their
parent’s caretakers.
Cultural norms Participants discussed differential
cultural values from their parents
related to education, income and
traditional gender roles.
Similar to first generation. One
exception were the cultural taboos
related to mental health their learned
in the home which conflicted with
values learned in school/community.
Fewer third generation participants
discussed distinct and strict
adherence to family cultural norms
and values.
Biculturalism Adopted different aspects of
American/Latinx cultures to suit
needs/preferences; Were culturally
nimble facilitating connections with
diverse people.
Discussed broadened opportunities
related to biculturalism such as
exposure to new environments and
friendships. Discussion overlapped
with bilingualism.
Discussed mutual connection to
cultural heritage roots and those of
U.S. culture. Overlapped with
bilingualism.

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Bilingualism Learned bilingualism would be
advantageous; A few participants
described challenges learning English
because of parental limited English
proficiency (LEP).
Universally believed bilingualism was
an advantage to obtain/retain
employment but also to facilitate
connections (communication and
diversity of perspectives) with others
within their own and across ethnic
communities.
Many did not speak Spanish or
well enough for communication;
created a sense of loss impeding
relationships with extended family
and perhaps job opportunities.
Gender roles Strict adherence to traditional gender
norms in household, directed by
paternal caregiver, with maternal
caregiver acquiescing.
Same as first generation. Notably less discussion around
adherence to traditional gender
norms in household.
Social Support
Family support Significant emotional and
instrumental support from family;
those without support had families
with limited financial/legal status
resources/social capital, yet discussed
intrinsic motivation.
Discussed instrumental and emotional
support from family (parents) in three
different ways and sometimes
altogether: observing parents’ hard
work for low wages motivated pursuit
of higher-earning career; motivation
came from immigrant parents’
sacrifice and the expectation/value of
education; instrumental supports
bolstered goal pursuit (e.g. transport).
Mostly instrumental support from
extended family; occasionally
emotional support around value-
laden expectations; desired more
emotional support; others
internally motivated and driven by
vacuum of emotional support and
insufficient external support from
family.
Community/
Other support
Key emotional and instrumental
supports, sometimes extended family,
otherwise church adults, teachers or
youth program mentors.
Overwhelmingly described specific
school-based adults/mentors offering
emotional and instrumental support
related to goal achievement and
choosing positive behaviors.
Participants described specific
supportive relationships that
provided mostly emotional support
(i.e., expressions of love and
professional advice).

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Figure 3.1.

Themes and Subthemes of Adversity, Culture and Social Support among Latinx Youth

142
Chapter 5: Conclusions, Implications and Future Directions
U.S. Latinx youth contend with multiple challenges during their developmental growth,
in addition to those related to the normative processes all adolescents and young adults endure
(Suarez-Orozco et al., 2018). While substantial research on the risk and protective factors of
youth substance use behavior has been conducted and replicated, health disparities and inequities
persist. This dissertation examined ACE and substance use behaviors among U.S. Latinx youth
with the goal of understanding the relationships between ACE, as a novel measure of adversity
among U.S. Latinx youth, discrimination, cultural factors and their association with substance
use behaviors. By mapping experiences of adversity, discrimination and cultural factors onto
substance use, this dissertation presents additional contextual factors to consider when designing
prevention and intervention approaches to substance use risk reduction for racial and ethnic
minorities. Further, this dissertation extends our understanding of specific adversities U.S. Latinx
youth experience in their households and their communities at large. Across all three studies, the
effects of U.S. acculturation were indicated, suggesting the relevance and influence of the social
milieu on Latinx youth individual development and adaptation. Additionally, results from the
qualitative study show the strength and power of positive relationships and experiences with
family and community (Bethell et al., 2019; Liu et al., 2019).
Summary of the Three Studies
As families adapt to U.S. life, acculturative stress may be associated with low
socioeconomic status, discrimination, segregation, decreased family cohesion, and deteriorating
family support (Detlaff & Johnson, 2011; Nguyen & Benet-Martínez, 2013; Ibañez et la., 2015;
Torres et al., 2012). Over a generation (or two), immigrant household environments are changing
in complex ways (Villamil Grest et al., in press), highlighting the importance of the quantitative

143
and qualitative findings in this dissertation. Advancing the current literature base, findings from
Study 1 (Chapter 2) identified associations between culturally-based Latinx factors
concomitantly with ACE, on substance use behaviors. As an extension of Study 1, Study 2
(Chapter 3) examined latent class profiles of traditional ACE and detailed discrimination
measures to assess their combined association on substance behaviors. Results from Study 2
identified unique clusters of maltreatment and discrimination and their associated alcohol use
prevalence in young adulthood. Together, quantitative findings can be used to inform key targets
for prevention and intervention to address health disparities. Further, these results signal possible
substance use coping strategies used in response to household stressors and community/societal
stressors among youth growing up in immigrant families. These are important findings that can
be used to inform community and structural inequities perpetuating discrimination and other
stressors, particularly among racial and ethnic minorities.
Study 3 (Chapter 4) supports and advances the quantitative studies by narratively
describing the interconnections between constructs examined in the quantitative studies (ACE,
discrimination, culture), and the lived experience of Latinx youth. Through personal reflections
of adversity, Latinx youth in Study 3 describe the specific household, community and societal
stressors they confront, and the ways in which these are fused with the strengths of their cultural
experiences and social support from family and community. This mixed Method approach
delivers a holistic understanding of the inextricable links between ACE, discrimination, culture
and substance use and identifies strategic targets for prevention to improve the health and
wellbeing of U.S. Latinx populations.

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Study 1
Study 1 was focused on identifying predictors of substance use behaviors among Latinx
youth. Although literature supports the association between ACE and adulthood substance use,
less is known about how ACE, together with important culturally relevant factors –
acculturation, enculturation, and ethnic identity – predict Latinx youth substance use behaviors.
Results suggest a predictive relationship between ACE and substance use among Latinx youth.
Beyond cultural risk and protective factors previously identified, ACE remain predictive of
alcohol and marijuana, but not tobacco use. This study informs health disparities prevention by
identifying ACE and its specific domains, specifically child maltreatment, as predictors of
problematic alcohol use. Further, beyond acculturation, these findings detect additional
household-related stressors to consider for understanding the unfolding of immigrant health
across generations.
Implications. There were likely unexamined factors related to ethnic identity and social
context that were not assessed in this study. Further, this study measured ethnic identity in
adolescence and outcomes were assessed in young adulthood. Possible that adolescent ethnic
identity attributions are unrelated to young adult health behaviors. Future studies should consider
examining cultural identity factors in the same timepoint as the outcome measures to obtain more
precise information about proximal individual-level variables associated with substance use
behaviors. Nonetheless, the inextricable link between cultural variables and outcomes in health
disparities research, must be accounted for to better understand how ACE influences Latinx
youth development and adaptation, and to ultimately enhance prevention approaches among
ethnic minorities.

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Study 2
ACE may contribute to substance use disparities given that racial and ethnic minorities
are more likely to experience multiple ACE than their White peers (Sacks & Murphy, 2018;
Slopen et al., 2016). Beyond traditional domains of maltreatment and family dysfunction in prior
ACE studies (Felitti et al., 2019), discrimination is widely accepted as an additional adverse
experience, and is also associated with behavioral health disparities (Benner et al., 2018;
Cronholm et al., 2015; Liu et al., 2018). Further, the traditional ACE measure does not fully
capture possible adversities experienced by immigrants, thus understanding the co-occurrence of
traditional ACE combined with discrimination experiences can locate important predictors of
health disparities among immigrant youth. To achieve this goal, Study 2 (Chapter 3) examined
intersecting patterns of traditional ACE, and perceived discrimination experiences and
subsequently estimated substance use outcomes of the latent class membership. A four-class
solution identified profiles representing a combination of adversities, including “limited
adversity”, “psychological abuse and discrimination” group, “child abuse and microaggression”,
and “microaggression” latent classes. Compared to the “microaggression” group, the highest
adversity group “psychological abuse and discrimination” was associated with alcohol use. The
“limited adversity” group was associated with tobacco use.
Implications. Findings from this study extend existing research by providing more
precise sources of adversity – indicators of traditional ACE and discrimination experiences – that
can be used to inform key targets for prevention and interventions seeking to achieve health
equity among racial and ethnic minorities. ACE and discrimination are necessary indicators to
examine in the context of immigrant health. Prior research identified acculturative stress as an
important component of changing health patterns among Latinx families. Considering its

146
widespread use, strategies for reducing risk behaviors among youth must consider the
availability and accessibility of alcohol, including the social acceptability of alcohol use across
U.S. society.
Study 2 findings have implications for health services, particularly for providers of
services to racial and ethnic minorities who use ACE as a screening tool (and subsequently
provide information or referrals for treatment). Equally important are the societal implications of
ACE and substance use outcomes associated with adversity profiles. Adversity profiles identify
family stressors within immigrant households, and stressors experienced at the
community/societal level, suggesting immigrant youth are coping with multi-systemic stressors.
Results from Study 2 show that not only is discrimination common, it clusters with other forms
of adversity and is associated with alcohol and tobacco use behaviors. Because of the growing
size of the U.S. Latinx population, addressing the health and wellbeing of racial and minorities
has long-term economic implications. The U.S. economy partly depends on an immigrant
workforce and there is a high cost to public health if disparities persist.
Study 3
Literature concerning adversity among U.S. Latinx has largely focused on trauma across
migratory periods. There is limited immigrant research focused on adversity during the period of
adaptation to U.S. life. Cultural strengths and social capital are Latinx features that can mitigate
such adversities. Qualitative research is needed to bridge the gap between what is empirically
indicated about traditionally defined ACE and the lived experiences of adjustment among U.S.
Latinx youth and their families. Study 3 (Chapter 4) qualitatively described the adversities and
cultural strengths of U.S. Latinx youth across individual, family, and community spheres.

147
Purposive sampling was used to select a subset (n = 40) of participants from a secondary
dataset. Data analysis followed a multistage descriptive and exploratory process, implementing a
thematic analysis approach. Three central themes emerged from participant narratives in Study 3:
adversity, cultural norms and social support. Subthemes of adversity were discrimination and
other adversities; subthemes of cultural norms were biculturalism/bilingualism and traditional
gender roles; and subthemes for social support were family and other adult support/mentor.
Altogether these themes described detailed experiences across generations with some differences
and similarities observed across themes and subthemes.
Implications. Exploring themes across three generations of U.S. Latinx youth illustrated
detailed accounts of personal struggles of adversity overlapping with cultural strengths,
individual fortitude, perseverance and wellbeing among U.S. Latinx youth. Findings from Study
3 can be used to inform future research focused on expanding our understanding of ACE.
Prevention and clinical work can also be informed by cultural strengths inherent in the lives of
U.S. Latinx youth and families.
Limitations
Results of this dissertation must be considered in the context of limitations. Despite the
associations identified in this dissertation, correlation does not imply causation. The design of
this dissertation did not lend itself to making inferences about causation, and thus results must be
interpreted with caution. Future studies could design causal models to examine specific
mechanisms underlying the relationships between ACE, discrimination, and substance use
behaviors. Although findings related to different operationalizations of ACE are important
descriptors of this population, readers must use caution when drawing inferences about
behavioral health risk based upon an ACE score (Anda et al., 2020). Importantly, there are

148
additional protective factors that can mitigate the long-term consequences of ACE not able to be
captured in this dissertation. Undoubtedly, there are additional individual, social, cultural and
community strengths can support positive coping, buffering individuals who experience ACE
from poor outcomes (Suarez-Orozco et al., 2018).
Major Findings and Implications for Practice and Policy
Findings from this dissertation have implications for the prevention and intervention of
health disparities among Latinx youth. Much attention has been placed on family-based clinical
interventions, cultural retention approaches, and drug refusal strategies for addressing youth
substance use among Latinx youth (Coatsworth et al., 2002; Kulis et al., 2005; Kumpfer et al.,
2002). Results from this dissertation suggest prevention and intervention approaches can be
informed by helping youth to build manageable responses to stress and coping, all which may be
associated with childhood experiences. Findings can be used to enhance trauma-informed care
models commonly used in social work practice that seek to reduce the impact of childhood
adversities by also addressing unexamined adversities, such as discrimination. Given the recent
emphasis on ACE screening and referral, social work providers of youth services, schools and
pediatric settings are well positioned to not only screen for the presence of ACE but to also
screen for protective factors and ensure youth have access to supportive resources at family,
school or community levels. Together with current research (Bethell et al., 2019; Liu et al., 2019;
Liu et al., 2020), findings related to the cultural strengths outlined in this dissertation support the
importance of protective factors in mitigating the adverse health consequences of adversity.
Dissertation study results show there are multiple and persistent community and
structural stressors in the form of discriminatory mistreatment and structural inequities impacting
Latinx youth and their families. Effective prevention and intervention strategies must be

149
implemented at the community and structural levels to enhance awareness and knowledge of the
persistent effects of discriminatory beliefs, practices and inequities confronted by racial and
ethnic minorities. Policies must focus on reducing discriminatory practices at the structural level,
by enacting inclusive legislation and making health equity a national priority.
Future Directions
Findings from the three studies will be used to inform several new lines of research.
Study 1 can be extended to examine additional substance use outcomes. For example, Allem et
al. (2015) identified an association between ACE and hard drugs (i.e., cocaine, prescription drug
use) – therefore, it would be important to identify additional substance use behaviors among
Latinx youth to further inform prevention and clinical interventions. While the relationships
between ACE, discrimination and poor health outcomes (Cave et al., 2020) have been examined,
mechanistic influences and etiological pathways linking these relationships to psychosocial
health among U.S. Latinx youth are not well understood.
Another future area of study would be to expand the definition of adversity in order to
better understand the influence of lesser examined adversities on psychosocial health, such as
peer victimization and neighborhood violence (Cronholm et al., 2015; Mersky et al., 2017;
Karatekin et al., 2019; Wade et al., 2014), potentially identified through qualitative work with
racial and ethnic minorities. A key area of future study would draw on social and structural
factors that influence psychosocial health among racial and ethnic minorities to empirically
identify the link between structural discrimination and psychosocial health among Latinx
immigrants and children. Future research among racial and ethnic minorities must apply a
socially-based determinants of health framework and link these studies to health disparities and
inequities.

150
In conclusion, this dissertation identified the substance use behaviors of Latinx young
adults who have experienced adversity but also have important strengths that potentially mitigate
risk behaviors. The three studies in this dissertation highlight key targets for prevention and
intervention that include specific experiences of adversity and cultural assets. Implications of
dissertation findings underscore important future areas to advance practice, prevention and
intervention approaches, research and policy.

151
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Abstract (if available)

Abstract Substance use research among Latinx youth identifies several cultural factors associated substance using behaviors, most commonly these are intertwined with acculturation. As families settle in the U.S., acculturative stress may be associated with low socioeconomic status, discrimination, segregation, decreased family cohesion, and deteriorating family support. Over a generation (or two), immigrant households are changing in complex ways, highlighting the importance of examining additional factors driving these changes. Social processes broadening our understanding of immigrant youth, such as strong social networks, are protective factors of immigrant health. Stress-inducing experiences, such as access barriers related to discrimination and structural inequities, are persistent social processes that contribute to behavioral health risk. ACE and other adversities outline some of these conditions that are a part of immigrant youth development and yet remain largely unexamined among this population. As such they guide the research questions proposed and examined in the three dissertation studies herein. Examining ACE in the context of the Latinx family environment is essential for further understanding Latinx youth substance use. ❧ This dissertation examines ACE among U.S. Latinx youth with the goal of understanding the ways in which ACE, other adversities and risk and protective factors influence substance use behaviors. By mapping adverse experiences collectively with cultural factors onto risk behaviors, this dissertation further elucidates those aspects of Latinx culture and adversity that are assets or risks of substance use behaviors. The studies described herein represent distinct research questions and analytic approaches, with the overall aim being to identify potential targets for prevention and intervention focused on closing the gap in health disparities and inequities among U.S. racial and ethnic minority groups.

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Asset Metadata

Creator Villamil Grest, Carolina (author)

Core Title U.S. Latinx youth development and substance use risk: adversity and strengths

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Philosophy

Degree Program Social Work

Publication Date 07/31/2020

Defense Date 06/03/2020

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

Tag acculturation,adolescence,adverse childhood experiences,Hispanic,Latino,OAI-PMH Harvest,Stress,young adulthood

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Cederbaum, Julie (committee chair), Lee, Jungeun Olivia (committee member), Unger, Jennifer (committee member)

Creator Email carovilla@gmail.com,cvillami@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-354956

Unique identifier UC11663918

Identifier etd-VillamilGr-8835.pdf (filename),usctheses-c89-354956 (legacy record id)

Legacy Identifier etd-VillamilGr-8835.pdf

Dmrecord 354956

Document Type Dissertation

Rights Villamil Grest, Carolina

Type texts

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

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA