Indiana Prevention Resource Center (IPRC)

Celebrating Hispanic Heritage Month, Part 2: Acculturation and Associated Risk and Protective Factors

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Published on November 09, 2014

Culture is dynamic and ever changing in subtle and not so subtle ways.  Our cultural identity is comprised of a multitude of components.   It includes such things as our language, ethnicity, education, socioeconomic situation and history, race, religion, age, mental and physical capacity, and family migration history. (Pedersen, et al, 2008)  [Note:  All of the electronic sources cited in this article can be found in the Hispanic-Latino Portal and in the HOME Library of e-Resources available from the IPRC homepage]

http://www.latino.prev.info

SAMHSA defines cultural competency as the ability to interact effectively with persons of different cultures. (SAMHSA's CAPT, nd)  To be culturally competent when working with immigrants, and particularly with Latino immigrants, it is important to understand the phenomenon of acculturation.  Being a nation of immigrants, acculturation has, to a greater or lesser degree, impacted our own or our ancestors' lives, whatever our ethnic heritage. 

Acculturation refers to "a dynamic and multidimensional process of adaptation that occurs when distinct cultures come into sustained contact."  (Organista, et al, 2010)  For new immigrants, especially first and second generation immigrants, the experience of acculturation is sufficiently recent to be palpable.  Acculturation can affect people's physical and mental health and is associated with risk and protective factors related to substance abuse and other health related behaviors.   Understanding acculturation is critical to understanding the Latino immigrant experience.  Latinos are diverse in a myriad of ways.  One is their widely varying experiences of acculturation.  The more recent the experience, the more salient its impact.

There are phases to the process of acculturation, and it can take a variety of forms.   For the Latino immigrant it begins with the context of his/her exit from the country of origin.  Personal circumstances range from escaping persecution, conditions of war, or extreme poverty, to migrating to study or to take a professional position, or to join family.  Some come alone, others with family or friends.   The immigration experience itself is a second component that can be peaceful and pleasant, or extremely traumatic. 

Trauma is a risk factor for substance abuse and mental illness.  We know, for example, that adverse childhood experiences have long term influences as risk factors for both substance abuse and physical and mental illness.  Physical conditions that disproportionately affect adults who suffered childhood trauma include cardiovascular disease, lung disease, hypertension, diabetes, liver disease, asthma and obesity.  Long-term mental health problems can include depression, relationship problems and low self-esteem.  (Childwelfare.gov, 2013)  

Historical trauma, which is multigenerational, can impact a population over many decades.   It can be experienced by "anyone living in families at one time marked by severe levels of trauma, poverty, dislocation, war, etc., and who are still suffering as a result." It can be expressed in such ways as unresolved grief, disenfranchisement, and internalized oppression.  Immigrants, (including Hispanic/Latinos), are a named population that has suffered this kind of trauma, which may be manifested by fear of the legal system and/or fear of losing (or of their children losing) their culture.  (SAMHSA's GAIN Center, 2013).  

Negative stress can be a risk factor for anyone.  Stress causes an increased release in the body of the hormone cortisol, which blocks the processing of information in the brain.  Stress affects attention, memory and learning.   It affects decision-making and judgment, and the quality of relationships (Marc Brackett, 2014).  For Latinos acculturation stress primarily affects first and second generation families.  Like stress in general, acculturation stress can be acute and can be chronic. (NIH, 2011)   

A higher percentage of Hispanics rate their health as fair or poor than any other race or ethnicity, and their rate is more than twice that of non-Hispanic whites (31% compared to 13.1%).  (CDC, 2013:107) Acculturation stress is a risk factor for depression and both play a role in health disparities for Latinos. The American Psychological Association emphasizes the need for healthcare providers to take into account the "shared impact of immigration and acculturative stress" to be culturally competent when treating their Latino clients for depression. (APA, 2014)  A study of the impact of acculturation stress on Latino men found that depression is associated with higher levels of substance use.  (Provencio-Vasquez, et al, 2011).  Rates of depression are nearly twice as high among Latino women as Latino men (46% vs. 19.6% (NAMI, nd).   Forster documents the association between acculturation stress and depression in youth.  (Forster, et al, 2013)

Depression and substance abuse are the two leading risk factors for suicide.  Although the suicide rate for Hispanics of all ages is a little less than half that of the general US population (5.9% vs. 12%), suicide behaviors, like suicidal thoughts and attempts, occur at similar rates to the total US population.  Reflecting the diversity of the Hispanic population, rates vary among Latino subgroups. Latinos born in the U.S. have higher suicide rates than foreign-born immigrants.  Puerto Ricans have the highest rate of attempts.  Rates are higher among US-born Hispanics.  Among foreign-born immigrants, those entering as children have higher rates than those who entered as adolescents or adults.  (SPRC, 2013)   

Hispanic youth are at higher risk of suicide than their elders.  The Center for Disease Control and Prevention's Youth Risk Behavior survey asks questions related to suicide.   In 2013 nearly 19% of Hispanic youth reported having considered attempting suicide, the highest rate of any race or ethnic group.   More than one in four Hispanic high school females (26%) reported having considered attempting suicide, the highest rate for either gender of any race or ethnic group.   For actually having attempted suicide, Hispanics also reported the highest rate at 11.3%, compared to 6.3% of whites and 8.8% of blacks.  Again, Hispanic females, at 15.6%, had the highest rate of either gender of any race or ethnic group. (CDC, YRBS, 2013)   

Having arrived in the new culture, the next phase of the acculturation process is often very stressful as the person struggles to learn how to behave, interact socially and conduct business transactions.  This can be an especially difficult for undocumented immigrants living in the shadow of the mainstream culture, often in almost constant fear of discovery, arrest and/or deportation.  Many Latino families include a mix of undocumented and U.S. born or naturalized individuals, where all share stress over the well-being of the undocumented family members.  Acculturation stress is an important influence on the physical and mental health of immigrants and creates increased risk and vulnerability to substance abuse and other health-related problems.   To be culturally competent, especially with first and second generation Latino immigrants, service providers need to understand and be sensitive to the individual's acculturation experience, positive or negative.  The service provider needs to be attentive to where the individual is in the process of acculturation and to associated risk and protective factors that may be affecting him/her, including family stress. 

As people move through the acculturation process, they will take different paths based on their circumstances and personal decisions.  For example, people can become highly acculturated in one area and be much less so in another (e.g., linguistic , behavioral and attitudinal).  One study grouped Latinos into five groups based on their degree and type of acculturation, from marginalized (maintaining isolation with little to no contact with the other culture), to a low degree of acculturation, to highly acculturated, moderately bicultural, or strongly bicultural.    (Nieri, et al, 2011).

In the 19th and early 20th century, the US viewed immigrants with an attitude of "E Pluribus Unum" "Out of Many, One," the melting pot theory  which advocated assimilation, understood to imply that immigrants would suppress or reject the values, attitudes and behaviors of their country and culture of origin, internalizing cultural characteristics perceived to represent mainstream US culture.   Over the years this view came to be considered ill-conceived and patronizing, inappropriately imposing ethnocentric demands without empathy and recognition of the right of people to retain their original cultural and ethnic integrity.   A more accurate term would be "segmented assimilation," referring to becoming acculturated to a particular social segment but not suggesting a complete internalization of the new culture's values and behaviors. (Organista, et al, 2010)

One option for acculturation is to integrate into the new culture without giving up the prior culture.  Biculturalism involves selective acculturation.  With this approach a person is knowledgeable about two different cultures and is comfortable in each, having become well integrated into the new culture, while maintaining the original or heritage culture. Research has shown that being bicultural is an asset for job market success. (Maddux, et al, 2014)   New immigrants can raise their children to be bicultural.   And children of mixed households, where the parents come from two different cultures, can become bicultural by learning about and engaging in two cultures.   Biculturalism has been found to be a protective factor against mental illness and substance abuse, and has contributed to success for many Latino immigrants (e.g., Cuban Americans).   It allows a person to maintain pride and a sense of belonging to the ancestral heritage, along with pride in her/his American identity.   The person is able to function and thrive in the new culture without giving up the connection and ties to the ancestral ethnicity and culture group.  ( Organista, et al, 2010;  Schwartz and Unger, 2010; ) 

Generational differences and confusion or ambivalence about cultural identity can result in cultural dissonance.  Cultural dissonance can lead to family conflict and contributes to such behavioral problems as discipline problems, substance abuse, or truancy in children of immigrants.  Acculturation can reduce pride in the family, an important protective factor (familismo) in Latino culture. (Smokowski, et al, 2005)  Where parents do not speak or read English well, children of immigrants often have better English skills and are better able to function in U.S. society than are their parents.   Role reversal can result.  Parents can become dependent upon the children and call on them to translate and to communicate information sometimes not appropriate for the child's age and circumstance (for example in medical or school settings).  The children become guides for the parents, upsetting the parent-child relationship and confusing roles and responsibilities.  Lack of English language competency and undocumented status are two major sources of acculturation stress.  (Organista, et al, 2010; Seitz de Martinez, Sadler, and Martinez, 2014)

Descendants of immigrants, who have not personally experienced the challenges and excitement of immigration and acculturation, often develops a nostalgia or curiosity about their cultural heritage.   This can derive from a sense of pride or interest in learning about the cultural heritage.  Pride in a person's cultural heritage can serve as a protective factor for mental health and against substance abuse.  Enculturation refers to the process through which a person learns about or affirms her/his culture of origin.  This process can be conscious or unconscious.   Often people want to rediscover their roots and incorporate aspects of their cultural heritage into their knowledge, attitudes or behaviors.   Travel, language study, experiencing the foods, dance, art, and literature of their ethnic and cultural heritage can all contribute to this cultural learning.    

Much of what has been discussed in this article about acculturation and the immigrant experience applies to persons of any cultural background, not only to Hispanic Americans.  The process of gaining and enhancing cultural competence is a rewarding and lifelong learning experience.  The IPRC HOME library and the Hispanic-Latino portal contain many online resources like websites, publications and videos that are very helpful and well worth exploring.  Enjoy!  

Bibliography

• Brackett, Marc. (2014). "Emotions Matter," National Prevention Network Annual Conference, Hartford, CT (Sept. 16)  [Presentation may be posted online on NPN website later this year.]
• Centers for Disease Control and Prevention. (2013). CDC Health Disparities and Inequalities Report – United States, 2013.   Morbidity and Mortality Weekly Report Supplement 62/3 http://www.cdc.gov/mmwr/pdf/other/su6203.pdf
• Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic.  Adverse Childhood Experiences (ACE) Study. (2014).  http://www.cdc.gov/ace/index.htm
• Childwelfare.gov, Child Welfare Information Gateway.   (2013). Long-Term Consequences of Child Abuse and Neglect.  https://www.childwelfare.gov/pubs/factsheets/long_term_consequences.pdf
• Forster, M., SR Cval, L Baezconde-Garbanati, CP Chou, DW Soto, and JB Unger. (2013). Bullying Victimization as a Mediator of Associations between Cultural/Family Variables Substance Use and Depressive Symptoms Among Hispanic Youth," Ethnicity and Health 18/4. http://www.ncbi.nlm.nih.gov/pubmed/23297708
• Harding, Fran. (2014). "Setting the Stage for Prevention's New Opportunities," National Prevention Network Annual Conference, Hartford, CT (Sept. 17)  [Presentation may be posted online on NPN website later this year.]
• Maddux, William W., Eliza Bivolaru, Andrew C. Hafenbrack, Carmit T. Tadmor and Adam D. Galinsky. (2014).  "Expanding Opportunities by Opening Your Mind: Multicultural Engagement Predicts Job Market Success Through Longitudinal Increases in Integrative Complexity," Social Psychological and Personality Science 5
• Nieri, Tanya, Chioun Lee, Stephen Kulis, and Flavio Francisco Marsiglia.  (2011).  "Acculturation among Mexican-heritage preadolescents: A latent class analysis,"  Social Science Research 40/4 (Jul):1236-1248.  http://media.samhsa.gov/Grants/archives.aspx
• Organista, Pamela Balls, Gerardo Marin, and Kevin M. Chun.  (2010). "Acculturation."  Chapter 4 of The Psychology of Ethnic Groups in the United States.  Sage.  http://www.sagepub.com/upm-data/30900_Chapter4.pdf
• Pedersen, Paul B., High C. Crethar, and Jon Carlson. (2008). Inclusive Cultural Empathy: Making Relationship Central in Counseling and Psychotherapy.  Washington, DC: American Psychological Association.
• Provencio-Vasquez, Elias, and  ....   (2011). Acculturation, Depression, Self-Esteem, and Substance Abuse among Hispanic Men, Issues in Mental Health Nursing 32/2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3182478/
• SAMHSA's GAINS Center for Behavioral Health and Justice Transformation.  [2013]. "How Being Trauma-Informed Improves Criminal Justice System Responses / Fact Sheet: Historical Trauma."  http://gainscenter.samhsa.gov/cms-assets/documents/93078-842830.historical-trauma.pdf
• SAMHSA's Center for the Application of Prevention Technologies (CAPT).  (nd). Cultural Competence. http://captus.samhsa.gov/prevention-practice/strategic-prevention-framework/cultural-competence
• Schwartz, Seth J. and Jennifer B. Unger.  (2010).  "Biculturalism and Context: What is Biculturalism, and When Is It Adaptive?" Human Development 53/1 (Mar).  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840244/
• Seitz de Martinez, Barbara, Katharine Sadler, and Guillermo Martinez.  (2014). "Holding Hands: Synergy for Advancing Community Health and Prevention Science; The Case of New Hispanic/Latino Immigrants," National Prevention Network Annual Conference, Hartford, CT (Sept. 17)  [Presentation may be posted online on NPN website later this year.]
• Smokowski, Paul R., and Mimi V. Chapman, and Martica L. Bacallao. (2010). Acculturation Risk and Protective Factors and Mental Health Symptoms in Immigrant Latino Adolescents.  Greensboro: University of North Carolina at Greensboro.  http://ncace.web.unc.edu/files/2010/12/Acculturation-Risk-and-Protective-Factors-and-Mental-Health-Symptoms.pdf
• Suicide Prevention Resource Center. (2013). Suicide among racial/ethnic populations in the U.S.: Hispanics. Waltham, MA: Education Development Center, Inc.  http://www.sprc.org/sites/sprc.org/files/library/Hispanics%20Sheet%20Aug%2028%202013%20Final.pdf