Acculturation and Alcohol Consumption among Mexican ... - NCBI

4 downloads 162 Views 735KB Size Report
icans conducted in the San Antonio, Texas area are utilized to examine the influence of acculturation into the larger society on alcohol consumption.
Acculturation and Alcohol Consumption among Mexican Americans: A Three-Generation Study KYRIAKOS S. MARKIDES, PHD, NEAL KRAUSE, PHD, AND CAiLos F. MENDES

DE

LEON, PHD

Abstract: Data from a three-generation study of Mexican Americans conducted in the San Antonio, Texas area are utilized to examine the influence of acculturation into the larger society on alcohol consumption. Acculturation was not related to alcohol consumption in the older generation. In the middle generation, it was related to lower alcohol consumption among men, as well as among

women. In the younger generation, acculturation was related to more drinking among women, but not among men. Within-family analysis showed that the alcohol consumption of members of the younger generation was associated with the consumption of their parents, particularly in the case of younger women. (Am JPublic Health 1988; 78:1178-1181.)

Introduction In recent years, there has been an increase in interest in the drinking behavior of Mexican Americans who, in general, have been found at the extreme ends of the distribution of alcohol consumption: there is a higher percentage of both abstainers (particularly among women) and a higher percentage of heavy drinkers among men.'-2 It also has been found that there are wider differences in alcohol consumption between men and women among Mexican Americans than among other ethnic groups.2-7 Researchers studying the drinking behavior of Mexican Americans have also shown an interest in the influence of the process of acculturation on drinking levels. According to Gilbert and Cervantes,5 this literature has basically foilowed two theoretical models: the first is an "acculturative stress" model, according to which more frequent and higher drinking result from the stresses accompanying acculturation into the larger society."7` A second approach, called the "acculturation" model by Gilbert and Cervantes,5 suggests that patterns of alcohol consumption among Mexican Americans reflect the extent to which they have adopted the norms and practices of the larger society surrounding alcohol consumption.'2"13 Women, for example, would be expected to drink more as they become more acculturated and assume the drinking practices of women in the general population. In the analysis reported here, we attempt to shed light on the association between acculturation and alcohol consumption with data from a three-generations study of Mexican Americans consisting of older people, their middle-aged children, and adult grandchildren. In addition, since the three generations are intergenerationally linked, we are able to examine the extent to which there is intergenerational aggregation of alcohol consumption in this population.

families in San Antonio were selected first using area probability sampling. 14 Information on their children and married or previously married adult (18 years+) grandchildren was subsequently obtained. Three-generation lineages including the older person, a middle-aged child, and a grandchild were selected randomly. This yielded a sample of 1,125, with 375 in each generation. Approximately two-thirds of the sample were women, owing to a large extent to women's greater longevity in the older generation, and their tendency to marry and bear children at younger ages, whereas the men married somewhat later in life. The mean ages were 74 for the older generation, 49 for the middle, and 26 for the younger generation. There was minimal overlap in age among successive generations.

Methods The Sample The data employed in this investigation were collected through interviews with 1,125 Mexican Americans during 1981 and 1982 in the San Antonio, Texas area. Older Mexican Americans (aged 65-80) with three-generationally linked From the Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77550. Address reprint requests to Kyriakos S. Markides, PhD, at that address; Dr. Mendes de Leon is also affiliated with that department; Dr. Krause is with the School of Public Health, University of Michigan, Ann Arbor. This paper, submitted to the Journal August 11, 1987, was revised and accepted for publication February 19,

1988. © 1988 American Journal of Public Health 0090-0036/88$1.50

1178

Measures Two questions provided the information on alcohol consumption: * "During the past two months, how often have you drunk wine, beer, or drinks containing alcohol?" (coded 1-6, from never to once a day or more); * "When you drink wine, beer or drinks containing alcohol, about how many glasses (drinks) do you usually have in one day?" (the exact number was coded up to seven or more drinks). We analyzed these two measures separately and also by combining them to form a frequency by volume measure. In addition, we created a dummy (dichotomous) variable to capture high levels of drinking by assigning a value of one to persons consuming six or more drinks (four or more for women) on a given day, and zero to those who drink less (persons who drank less than once a month were not asked the number of drinks they consumed). The literature suggests that an important indicator of acculturation is language use.15",6 We developed a scale utilizing four items relating to language of television programs, language of radio programs, language used with one's spouse, and language used with friends (scored 1 for Spanish only; 2 for mostly Spanish; 3 for Spanish and English about equally; 4 for mostly English; and 5 for only English). The four items were summed to yield a total possible score ranging from 5 (only Spanish) to 20 (only English). The scale had an alpha reliability of .74. Analysis

The acculturation measure was regressed on five separate alcohol measures: frequency, volume, the frequency by volume measure, the high drinking measure, and whether one was a drinker vs an abstainer. We employed ordinary least AJPH September 1988, Vol. 78, No. 9

ALCOHOL CONSUMPTION, ACCULTURATION IN MEXICAN AMERICANS TABLE 1-Frequency and Volume of Alcohol Consumption (per cents) among Three-Geration Mexican Americans Middle Generation

Older Generation Male

Frequency Once a day or more Several times a week Onceaweek Afewtimesamonth Once a month or less frequently Never Number of Glasses (drinks) 1 2 3 4 5 6 7+

Younger Generation

(N = 105)

Female (N = 269)

6 7 9 12

2 1 2 2

12 19 23 11

2 3 7 16

3 22 20 22

39 28 (N = 34) 33 29 6 21 6 3 3

14 80

24 10

34 38

(N = 14) 33 53

27 7

(N = 76) 13 17 16 12 5 34 3

(N = 63) 20 29 20 9 9 9 3

(N = 87) 8 18 21 9 7 28 9

Male (N

-

13 -

=

Female (N = 264)

125)

Male (N

=

Female (N = 233)

142)

1 8 16

40 34 (N = 60) 20 27 28 10 3 8 3

NOTE: Mean age for younger generation was 26 years (SD = 4.8); for middle generation was 49 years (SD = 6.1); and for older generation was 74 (SD = 4.7). Number of drinks refers average number per occasion by people who drank at least a few times a month.

squares regression analysis for the first three and logistic regression for the last two which are dichotomous variables."' In the subsequent within-family analyses predicting alcohol consumption of children from the consumption of their parents, we also employ multiple logistic regression analysis when predicting a dichotomous variable. In all regressions, the following were included as control variables: age, marital status (married = 1), number of years of school completed, and a seven-item traditional values scale that controls for the value dimension of acculturation.'8

frequent drinkers than the other groups. In addition, they appear to consume considerably larger quantities of alcohol. Of those who drank at least a few times a month, 36.8 per cent of middle-aged and 36.8 per cent of younger men reported having six or more drinks per occasion. When abstainers and infrequent drinkers are taken into consideration, 22.4 per cent of all middle-aged and 22.4 per cent of all younger men had six or more drinks per occasion, rates that are considerably higher than those observed in the general population. 19 Table 2 presents the results of a series of multiple regression analyses of the five measures of alcohol consumption on the acculturation measure controlling for other relevant variables for each generation. Among older generation men and women, there were no associations of note between acculturation and any of the alcohol measures. Among middle-generation men, the negative associations between acculturation and both the frequency and frequencyby-volume measures suggest that less acculturated (more Spanish) middle-generation men drink more. Among middlegeneration women, there is a trend suggesting that less acculturated women are also heavier consumers of alcohol, at least as measured by the volume and the frequency-byvolume measures. Among younger women, acculturation is

Results Table 1 presents data on frequency of alcohol consumption in the two months prior to the interview and number of drinks consumed on a given day by those who said they drank at least a few times a month. The table makes clear that women and older people drink considerably less frequently and consume less alcohol than men and middle-aged and younger people. The percentage of abstainers, for example, ranges from 7 per cent among younger men to over 80 per cent among older women. Older men, middle-aged women, and younger women consume alcohol at relatively low frequencies. Middle-aged and younger men are considerably more TABLE 2-Results of Multiple Regression Analysis

Predicting Alcohol Consumption from Language Acculturation by Generation and Sex

Frequency

Older Generation (N = 105)

Males (N = 105) Females (N = 270) Middle Generation (N = 128) Males (N = 128) Females (N = 247) Younger Generation (N = 142) Males (N = 142) Females (N = 233)

Volume

Frequency x Volume

High Drinking b

SE

b

SE

.077 .062

.089 .058

b

SE

b

SE

b

SE

.025 .008

.055 .018

-.009 -.012

.084 .028

1.507 -.165

.764 .206

-.160 -.018

.057 .027

-.042 -.099

.098 .058

-4.313 -.739

.006 .091

.050 .026

-.032 .132

.096 .064

-.477 .417

Drinkers vs Abstainers

-

-

-

-

1.585 .376

-.005 -.148

.121 .107

-.070 .044

.127 .050

1.275 .223

-.015 .115

.107 .133

.097 .182

.139 .062

NOTE: b's are OLS regression coefficients for Frequency, Volume, and Frequency x Volume and iogistic coefficients for High Drinking and Drinkers vs Abstainers. Coefficients are computed with age, years of school, marital status (married = 1), and tradHtional values scale controlled.

AJPH September 1988, Vol. 78, No. 9

1179

MARKIDES, ET AL. TABLE 3-Results of Multiple Regression Analysis Predicting Frequency, Volume, and Frequency x Volume of Alcohol Consumption in Younger Generation from Middle Generation Consumption by Type of Sex Linkage

Frequency All Cases (N = 373) All Sons (N = 143) All Daughters (N = 232) Father-Son (N = 58) Father-Daughter (N = 69) Mother-Daughter (N = 163) Mother-Son (N = 85) Volume All Cases (N = 88) All Sons (N = 48) All Daughters (N = 40) Frequency x Volume All Cases (N = 373) All Sons (N = 143) All Daughters (N = 232) Father-Son (N = 58) Father-Daughter (N = 169) Mother-Daughter (N = 163) Mother-Son (N = 85)

b

SE

.179 .023 .141 .015 .146 .187 .107

.045 .073 .046 .124 .076 .069 .122

.307 .224 .169

.116 .146 .176

.054 -.040 .045 -.059 .060 .010 .059

.043 .080 .024 .099 .049 .028 .214

drinkers in both generations are paired together, the sample sizes are substantially reduced. Table 4 shows the results of intergenerational aggregation with regard to the probability of being a drinker (versus an abstainer) and with regard to being a high volume drinker (6+ drinks for men and 4+ drinks for women). With regard to all cases, younger people whose parents are drinkers are 2.85 times more likely to be drinkers than younger people whose parents are not drinkers. Those whose parents are high volume drinkers are approximately three times more likely to be high volume drinkers than younger people whose parents are not high volume drinkers. As with the frequency measure, daughters appear to be more influenced by their parents' drinking than do sons. Discussion

Our failure to find any relationship between acculturation and alcohol consumption in the older generation might result from restricted variation on both the alcohol variables and the acculturation measure. Most older generation members, for example, are Spanish-speaking on the language acculturation scale. In the middle generation, however, where subjects are concentrated around the middle of the acculturation scale, acculturation is related to lower alcohol consumption by middle-generation men. These findings are consistent with those of Neff, et al,20 who found higher drinking rates among the least acculturated second generation men. These findings support the "acculturative stress" hypothesis since middle-generation men who are more Spanish-speaking tend to be closer to the middle of the overall language acculturation continuum. We expected acculturation to be associated with greater drinking among middle-generation women which would be consistent with the "acculturation model" hypothesis.5 Since more acculturated middle-generation women would be more likely to violate traditional norms sanctioning alcohol consumption by women, we expected them to drink more than less acculturated women. However, our results tend to be in the opposite direction: less acculturated middle-generation women appear to be more frequent drinkers and to consume higher quantities of alcohol, although these associations are not particularly strong. Is it possible that these

NOTE: All regressions were performed with marital status, education, and language-use scale controlled. Unstandardized coefficients are shown with standard errors.

positively associated with frequency of consumption, volume, and the probability of being a drinker. No associations were observed among younger men. Because of the low levels of consumption in the older generation, and because older people may have reduced their consumption from previously higher levels,19 we confined our within-family analysis to the two younger generations. Where the number of cases and lack of excessive skewness permitted, we performed the analysis by type of sex linkage. Table 3 illustrates that frequency of alcohol consumption in the younger generation is generally associated with frequency of consumption oftheir parents. This is most marked in the case of daughters. With regard to volume among drinkers, there is an association for all cases but not for sons and daughters separately which might reflect the small numbers of cases. Only drinkers are in these equations, and when TABLE 4-Odds Ratio Derived from Multiple Logistic Regression Analysis Middle Generation Drinking by Type of Sex Linkage

(N) All Cases All Sons All Daughters

Father-Son Father-Daughter

Mother-Daughter Mother-Son

(350) (138) (212) (57) (63) (149) (81)

Predicting Drinkers and High Volume Drinkers in Younger Generation from

Drinkers vs Abstainers Odds Ratio (95% Confidence Interval) 2.85

(1.69-4.82) .87

(.17-4.43) 2.79

(1.51-5.17)

High Volume Drinking Odds Ratio (95% Confidence Interval)

(N)

(84) (47) (37)

3.04

(1.20-7.74) 2.90 (.78-10.74) 1.80 (.39-8.26)

-

1.47 (.30-7.21) 3.43

(1.66-7.07) 2.10 (.25-17.87)

NOTE: Odds ratios are adjusted for younger generations marital status, education, and language use. Several regressions were not performed because of small numbers of cases.

1180

AJPH

September 1988, Vol. 78, No. 9

ALCOHOL CONSUMPTION, ACCULTURATION IN MEXICAN AMERICANS

middle-generation women are turning to alcohol in response to acculturative stress much like their male counterparts? Our data appear to point in that direction. Yet, as a group, these women are not heavy drinkers. However, given the sanctions against alcohol consumption among Mexican American women, it is possible that their consumption levels are underreported. In any case, we feel that this is an area of inquiry that needs further attention. With regard to the younger generation, we found no association between acculturation and alcohol consumption among men. Among younger women, however, language acculturation is associated with greater frequency of consumption, greater volume, and a higher probability of being a drinker. Thus, younger women behave according to the acculturation model hypothesis, i.e., adopting the drinking norms of the larger society which permit greater alcohol consumption by women, a finding which is consistent with previous literature.5"2 It should also be acknowledged that alcohol consumption has also increased among younger women in urban Mexico22 where the concept of acculturation has no relevance. It can be argued that higher consumption in both Mexican and Mexican American women is related to the process of urbanization and the broader process of

modernization. Finally, our within-family analyses indicate that some familial transmission of alcohol consumption from parents to children might take place, particularly with regard to daughters. As with our results on the familial transmission of smoking behavior,22 these sex differences suggest a greater role of the family in socializing young women, whereas extra familial factors such as peer group pressures might be more important among young men. ACKNOWLEDGMENTS This study was supported by grant AG04170 from the National Institute on Aging and by a grant from the Alcohol Beverage Medical Research Foundation.

REFERENCES 1. Alcocer AM: Alcohol use and abuse among the Hispanic American population. In: Alcohol and Health, Monograph No. 4, Special Population Issues. Rockville, MD: NIAAA, 1983. 2. Caetano R: Drinking patterns and alcohol problems among Hispanics in the US: A review. Drug Alcohol Depend 1983; 12:37-57.

3. Paine HJ: Attitudes and patterns of alcohol use among Mexican Americans: implications for service delivery. J Stud Alcohol 1978; 39:894-902. 4. Maril RL, Zavaleta AN: Drinking patterns of low-income Mexican American women. J Stud Alcohol 1979; 40:480-484. 5. Caetano R: Ethnicity and drinking in northern California: A comparison among Whites, Blacks and Hispanics. Alcohol Alcoholism 1984; 19:31-44. 6. Gilbert MJ, Cervantes RC: Patterns and practices of alcohol use among Mexican Americans: a comprehensive review. Hispanic J Behav Sci 19 36; 8:140. 7. Neff JA: Alcohol consumption and psychological distress among US Hispanics and Blacks. Alcohol Alcoholism 1986; 21:111-119. 8. Gomberg EL: Special populations. In: Gomberg EL, White HR, Carpenter JA (eds): Alcohol, Science, and Society Revisited. Ann Arbor: University of Michigan Press, 1982. 9. Graves TD: Acculturation, access, and alcohol in a tri-ethnic community. Am Anthropol 1967; 69:306-321. 10. Madsen W: The alcoholic agringado. Am Anthropol 1964; 66:355-361. 11. Trotter RT: Mexican American experience with alcohol: South Texas examples. In: Bennet LA, Ames G (eds): The American Experience with Alcohol: Contrasting Cultural Perspectives. New York: Plenum, 1985. 12. Caetano R: Acculturation and drinking patterns among US Hispanics. Br J Addict 1987; 82:789-799. 13. Gilbert MJ: Mexican Americans in California: Intracultural variations in attitudes and behavior related to alcohol. In: Bennett LA, Ames G (eds): The American Experience with Alcohol: Contrasting Cultural Perspectives. New York, Plenum, 1985. 14. Markides KS, Hoppe SK, Martin HW, Timbers DM: Sample representatives in a three-generations study of Mexican Americans. J Marr Fam 1983; 45:911-916. 15. Burnam MA, Telles CA, Karno M, Hough RL, Escobar JI: Measurement of acculturation in a community population of Mexican Americans. Hispanic J Behav Sci 1987; 9:105-230. 16. Cuellar I, Harris LC, Jasso R: An acculturation scale for Mexican American normal and clinical populations. Hispanic J Behav Sci 1980; 2: 199-287. 17. Cox DR: The Analysis of Binary Data. London: Methuen, 1970. 18. Markides KS, Levin JS, Ray LA: Determinants of physician utilization among Mexican Americans: A three-generations study. Med Care 1985; 23:226-246. 19. Munch N, Lloyd N, Malin H, Coakley J, Kaelber C: How Americans say they drink: preliminary datafrom two recent national surveys. In: Galanter M (ed): Currents in Alcoholism: Volume III: Recent Advances in Research, New York: Grune and Stratton, 1981. 20. Meyers AR, Goldman E, Hingson R, Scotch N: Evidence for cohort or generational differences in the drinking behavior of older adults. Int J Aging Hum Dev 1981; 14:31-43. 21. Neff JA, Hoppe SK, Perea P: Acculturation and alcohol use: drinking patterns and problems among Anglo and Mexican American male drinkers. Hispanic J Behav Sci 1987; 9:151-181. 22. Medina-Mora E, Rascon L, Garcia-Zavala G, Ezban M: Patrones de consumo de alcohol y normas relacionadas condicho consumo, en una poblacion de Michoacan, Mexico. Salud Mental 1986; 9:87-91. 23. Markides KS, Coreil J, Ray LA: Smoking among Mexican Americans: a three-generation study. Am J Public Health 1987; 77:708-711.

Future APHA Meeting Dates/Sites 1988 NOVEMBER 13-17 BOSTON, MASSACHUSETTS 1989 OCTOBER 22-26 CHICAGO, ILLINOIS 1990 SEPTEMBER 30-OCTOBER 4 NEW YORK, NEW YORK 1991 NOVEMBER 10-14 ATLANTA, GEORGIA 1992 NOVEMBER 8-12 WASHINGTON, DC 1993 OCTOBER 24-28 SAN FRANCISCO, CALIFORNIA 1994 OCTOBER 30-NOVEMBER 3 WASHINGTON, DC 1995 NOVEMBER 12-16 SEATTLE, WASHINGTON

AJPH September 1988, Vol. 78, No. 9

1181