RESUMEN
Este artículo es un trabajo de investigación etnográfica en el campo sanitario. Sus objetivos son reconstruir trayectorias de personas con trastornos mentales y de comportamiento por uso de alcohol y visibilizar representaciones y prácticas en los tratamientos brindados en el Hospital Vilardebó (Uruguay), en torno a dichos itinerarios. Las narrativas de los pacientes estudiados dan cuenta de una ruptura biográfica ocurrida mayoritariamente en la adolescencia, cuando comienza un consumo problemático de alcohol que lleva a una reorganización de la identidad social de orden simbólico; refirieren también, la mayoría de ellos, estar disconformes con la asistencia que se les brinda, y reclaman ser más escuchados. Por otra parte, en lo referente a las representaciones formuladas por los funcionarios entrevistados, a mayor formación y experiencia de ejercicio profesional, hay mayores críticas a la atención que se brinda a estos usuarios. De ahí que la confluencia de Antropología y Salud, ensamblando cultura y cuidado, permite integrar a las dimensiones físicas los aspectos emocionales, familiares, culturales y sociales.
This article is carries out ethnographic research in the sanitary field. Its objectives are to reconstruct the trajectories of people with mental and behavioral disorders due to alcohol use and to make visible representations and practices in treatments provided at Hospital Vilardebó (Uruguay). Patients' narratives show a biographical rupture occurring mainly during adolescence. Problematic alcohol use begins soon after, leading to a reorganization of symbolic social identity. Most patients are not satisfied with care provided, and demand to be listened to more extensively. As for health care workers' representations, the greater the training and professional expertise, the greater the criticism of provided care. Hence, the confluence of Anthropology and Health, combining culture and care, makes possible the emotional, family, cultural and social aspects to be integrated into the physical ones.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Personal de Salud/psicología , Trastornos Relacionados con Alcohol/psicología , Enfermos Mentales/psicología , Atención a la Salud Mental , Alcohólicos/psicología , Trastornos Relacionados con Alcohol/etnología , Investigación Cualitativa , Antropología MédicaRESUMEN
OBJECTIVE: To compare prevalence rates of alcohol, nicotine, and other drug use and major psychiatric disorders (major depressive disorder, persistent depression, bipolar I disorder, agoraphobia, social and specific phobias, and antisocial, schizotypal, and borderline personality disorders) between US-born and foreign-born Mexican Americans and non-Hispanic whites and between early entry versus later-entry foreign-born Mexican Americans and non-Hispanic whites. METHODS: Data were derived from face-to-face interviews in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (N = 36,309). RESULTS: US-born Mexican Americans and US-born non-Hispanic whites were at greater risk (P < .05) of alcohol, nicotine, and any drug use and their associated disorders and other DSM-5 psychiatric disorders relative to their foreign-born counterparts. US-born non-Hispanic whites were more likely (P < .05) to use substances and develop many psychiatric disorders relative to US-born Mexican Americans. Foreign-born Mexican Americans < 18 years old at immigration were at greater risk of drug use, drug use disorders, and nicotine use disorder compared with foreign-born Mexican Americans ≥ 18 years old at immigration. Foreign-born non-Hispanic whites < 18 years old at immigration were more likely to use substances and to develop many psychiatric disorders relative to foreign-born non-Hispanic whites ≥ 18 years old at immigration. CONCLUSIONS: Taken together, the findings of this study support the healthy immigrant hypothesis and adverse role of acculturation for US-born and foreign-born Mexican Americans and non-Hispanic whites. Further research is warranted on immigration status and age at arrival into the United States and those processes underlying differential exposure to substances and development of psychiatric conditions. An understanding of these processes can be invaluable to clinicians in guiding culturally sensitive and informed prevention and intervention efforts.
Asunto(s)
Aculturación , Trastornos de Ansiedad/etnología , Trastorno Bipolar/etnología , Trastorno Depresivo Mayor/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Americanos Mexicanos/estadística & datos numéricos , Trastornos de la Personalidad/etnología , Trastornos Relacionados con Sustancias/etnología , Población Blanca/etnología , Adolescente , Adulto , Factores de Edad , Trastornos Relacionados con Alcohol/etnología , Europa (Continente)/etnología , Femenino , Humanos , Masculino , México/etnología , Persona de Mediana Edad , Tabaquismo/etnología , Estados Unidos/etnología , Adulto JovenRESUMEN
The present study examined measurement invariance of the 48-item, 8-factor, Young Adult Alcohol Consequences Questionnaire (YAACQ) across nationality in college students from the United States, Spain, and Argentina. We also compared latent mean differences and criterion-related validity (i.e., correlation with other alcohol-related outcomes) across countries. Last month drinkers (1,511) from the United States (n = 774, 70.5% female), Argentina (n = 439, 50.6% female), and Spain (n = 298, 72.1% female) completed an online survey measuring alcohol use, drinking motives, college alcohol beliefs, and negative alcohol-related consequences. Multigroup confirmatory factor analyses supported configural and scalar invariance of a 47-item, 8-factor YAACQ across countries. Overall, the correlation analysis supported criterion-related validity (i.e., strong bivariate correlations between the 8 subscales and alcohol consumption, drinking motives and college alcohol beliefs) across countries. Some nonsignificant bivariate correlations and differences in the magnitude of the correlations across countries are discussed. Our findings expand previous work, mostly focused on U.S. samples, by supporting the YAACQ as an adequate measure to assess alcohol-related consequences in youths across countries marked by unique cultural traditions, attitudes, and policies pertaining to alcohol. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Asunto(s)
Consumo de Alcohol en la Universidad/etnología , Trastornos Relacionados con Alcohol/diagnóstico , Trastornos Relacionados con Alcohol/etnología , Comparación Transcultural , Escalas de Valoración Psiquiátrica/normas , Psicometría/normas , Adulto , Argentina/etnología , Femenino , Humanos , Masculino , Psicometría/instrumentación , España/etnología , Estudiantes , Estados Unidos/etnología , Universidades , Adulto JovenRESUMEN
The current study identified alcohol and cannabis use trajectories among a sample of Mexican-origin youth and examined cultural and familial correlates from childhood to adolescence. Mexican-origin youth (N = 674) from Northern California were assessed annually from ages 10 to 17 (8 waves). Latent class growth modeling examined variability in developmental trajectories for last 3-month alcohol and cannabis use frequency. Analyses also examined between-trajectory differences in youth's cultural practices and values, family cultural conflict, general parent-child conflict, and parental monitoring at 4 time points from ages 10 to 16. Analyses resulted in a 4-class model for alcohol use, comprising nonusers (62%), early-increasing (10%), adolescent-limited (11%), and late-onset (17%) subgroups, and a 4-class model for cannabis use, including nonusers (74%), early-increasing (8%), occasional use (16%), and high-declining (2%) subgroups. Findings suggested that early language use (higher English at age 10 and lower Spanish at age 12) was a temporally distal marker for several alcohol and cannabis use trajectories, whereas lower traditional family values at ages 14 and 16 were associated with several classes characterized by early substance use. Elevations in familial (parent-child conflict, parental monitoring) risk factors co-occurred in time and generally suggested temporally proximal connections with substance use behavior. Further, there was evidence that a less prominent decline in certain protective factors (e.g., father monitoring) was associated with reductions in substance use. These findings inform the literature by describing youth subgroups with variable risk for substance use development, and suggest modifiable risk factors associated with more frequent substance use trajectories. (PsycINFO Database Record
Asunto(s)
Consumo de Bebidas Alcohólicas/etnología , Consumo de Bebidas Alcohólicas/psicología , Fumar Marihuana/etnología , Fumar Marihuana/psicología , Americanos Mexicanos/psicología , Adolescente , Conducta del Adolescente/etnología , Trastornos Relacionados con Alcohol/etnología , Trastornos Relacionados con Alcohol/psicología , California , Niño , Cultura , Conflicto Familiar/psicología , Femenino , Humanos , Lenguaje , Estudios Longitudinales , Masculino , Abuso de Marihuana/etnología , Abuso de Marihuana/psicología , México/etnología , Relaciones Padres-Hijo , Responsabilidad Parental/psicología , Psicología del Adolescente , Factores de RiesgoRESUMEN
BACKGROUND: Alcohol consumption patterns on the U.S.-Mexico border and their relationships with DSM-5 alcohol use disorders (AUD) have been understudied. Yet, the effects of drinking by Mexican-origin individuals may differ between cities on versus off the border both in the United States and in Mexico. We characterize prior 12-month drinking patterns and examine their relationships with AUD, in border and off-border cities of Texas and adjacent Mexican states. METHODS: Data come from the U.S.-Mexico Study of Alcohol and Related Conditions involving 2,336 Mexican Americans in Texas and 2,460 Mexicans in bordering states of Nuevo Leon and Tamaulipas in Mexico. Drinking pattern was defined as an interaction between volume and maximum amount, or intensity (never vs. ever 5+/4+ [men/women], 8+, and 12+ drinks in a day). DSM-5 AUD was assessed using an adaptation of the Alcohol Section of the World Health Organization Composite International Diagnostic Interview core. Separately by gender, 5 logistic regressions models controlling for age were estimated predicting symptoms in 2 or more AUD criteria domains from volume, heavy pattern and, successively, effects of country, and (by country) residing on vs. off the border, or in each of 3 cities/country. RESULTS: A segmentation analysis for Texas males based on rate of experiencing AUD generated several distinct volume groups, each partitioned by an empirically selected maximum, and helped identify a drinking-pattern typology. In gender-stratified models of AUD rates using this typology, adjusting for age, significant volume and intensity effects were seen, more strongly in the United States. Border versus interior differences implied more AUD for given patterns at the border in the United States and the reverse in Mexico, with some city differences also evident. CONCLUSIONS: Drinking-pattern analyses confirm that border proximity may affect drinking problems but in opposite directions in the United States and Mexico, possibly related to economic and psychological stresses specific to respective communities.
Asunto(s)
Consumo de Bebidas Alcohólicas/etnología , Trastornos Relacionados con Alcohol/etnología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Emigración e Inmigración , Americanos Mexicanos , Adolescente , Adulto , Anciano , Consumo de Bebidas Alcohólicas/psicología , Consumo de Bebidas Alcohólicas/tendencias , Trastornos Relacionados con Alcohol/diagnóstico , Trastornos Relacionados con Alcohol/psicología , Estudios Transversales , Emigración e Inmigración/tendencias , Femenino , Humanos , Masculino , Americanos Mexicanos/psicología , México/etnología , Persona de Mediana Edad , Distribución Aleatoria , Texas/etnología , Estados Unidos/etnología , Adulto JovenRESUMEN
BACKGROUND: U.S. border populations have been found to be at high risk for alcohol problems. However, results from the U.S.-Mexico Study on Alcohol and Related Conditions (UMSARC) revealed surprisingly large variation in alcohol outcomes even among Texas border sites, with alcohol use disorder (AUD) prevalence ~1.5 to 1.6 times greater in the border city of Laredo compared to both San Antonio and the border site of McAllen/Brownsville. Because a better understanding of this variation is important to identifying environmental influences on AUD, we developed and tested a conceptual model addressing variation in AUD prevalence across Texas UMSARC sites. METHODS: Surveys involved in-person, household interviews with Mexican-origin residents of the Texas border cities Laredo (n = 751) and McAllen/Brownsville (n = 814), with San Antonio as an off-border comparison (n = 771). Interviews assessed past-year DSM-5 AUD; past-year heavy drinking; coping and enhancement motives; and 7 indicators of substance use climate and stress exposure hypothesized to mediate site effects. Analyses, conducted separately by gender, included regressions and structural equation modeling with Mplus. RESULTS: Preliminary analyses revealed that site effects on AUD prevalence were, unexpectedly, exclusive to men, and that Laredan men were similar to McAllen/Brownsville men on demographics, acculturation, and cross-border mobility. However, sites differed dramatically on most of the hypothesized risk factors. Structural equation models confirmed that site effects on AUD were partially mediated via effects of site on indicators of a permissive climate (i.e., permissive drinking norms, high drug availability) and stress exposures (i.e., high exposure to violence/crime, low family support), and via downstream effects on drinking motives and heavy drinking. CONCLUSIONS: Findings of very high rates of past-12-month AUD among Laredan men (35%) suggest the possibility of significant heterogeneity even within demographically similar border areas and underline the need for additional study of the border region. Findings regarding our conceptual model suggest that this model may constitute a useful initial framework for future research on alcohol problems at the border. However, additional research using representative samples is needed to confirm and expand this model to comprehensively address relevant individual and community factors.
Asunto(s)
Aculturación , Trastornos Relacionados con Alcohol/etnología , Trastornos Relacionados con Alcohol/psicología , Emigración e Inmigración , Americanos Mexicanos/psicología , Características de la Residencia , Trastornos Relacionados con Alcohol/diagnóstico , Emigración e Inmigración/tendencias , Femenino , Humanos , Masculino , México/etnología , Prevalencia , Distribución Aleatoria , Estrés Psicológico/diagnóstico , Estrés Psicológico/etnología , Estrés Psicológico/psicología , Encuestas y Cuestionarios/normas , Texas/etnologíaRESUMEN
AIMS TO: Test the dimensionality and measurement properties of lifetime DSM-5 AUD criteria in a sample of adults from the metropolitan area of San Juan, Puerto Rico. DESIGN: Cross-sectional study with survey data collected in 2013-2014. SETTING: General population. PARTICIPANTS: Random household sample of the adult population 18 to 64years of age in San Juan, Puerto Rico (N=1510; lifetime drinker N=1107). MEASUREMENT: DSM-5 alcohol use disorder (2 or more criteria present in 12months). RESULTS: Lifetime reports of AUD criteria were consistent with a one-dimensional model. Scalar measurement invariance was observed across gender, but measurement parameters for tolerance varied across age, with younger ages showing a lower threshold and steeper loading. CONCLUSIONS: Results provide support for a unidimensional DSM-5 AUD construct in a sample from a Latin American country.
Asunto(s)
Trastornos Relacionados con Alcohol/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Trastornos Relacionados con Alcohol/etnología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Puerto Rico/epidemiología , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: Little epidemiological evidence exists on alcohol use and related problems along the U.S.-Mexico border, although the borderlands have been the focus of recent media attention related to the escalating drug/violence "epidemic". In the present study, the relationship of proximity of living at the border and alcohol use disorders (AUDs) is analyzed from the U.S.-Mexico Study on Alcohol and Related Conditions (UMSARC). METHODS: Household surveys were conducted on 2336 Mexican Americans in Texas (771 in a non-border city and 1565 from three border cities located in the three poorest counties in the U.S.) and 2460 Mexicans from the states of Nuevo Leon and Tamaulipas in Mexico (811 in a non-border city and 1649 from three cities which are sister cities to the Texas border sites). RESULTS: Among current drinkers, prevalence of AUD was marginally greater (p<0.10) at the U.S. border compared to the non-border, but the opposite was true in Mexico (p<0.001), and these trends continued on both sides across volume and 5+ drinking days. Prevalence was greater in Laredo/Nuevo Laredo relative to their respective sister city counterparts on the same side. Border effects appeared greater for males than females in the U.S. and the opposite in Mexico. CONCLUSION: The data suggest that border proximity may affect AUD in both the U.S. and Mexico, but in the opposite direction, and may be related to the relative perceived or actual stress of living in the respective communities.
Asunto(s)
Trastornos Relacionados con Alcohol/diagnóstico , Trastornos Relacionados con Alcohol/etnología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Emigración e Inmigración , Americanos Mexicanos/etnología , Adulto , Trastornos Relacionados con Alcohol/psicología , Estudios Transversales , Femenino , Humanos , Masculino , Americanos Mexicanos/psicología , México/etnología , Encuestas y Cuestionarios , Texas/etnología , Estados Unidos/etnologíaRESUMEN
OBJECTIVE: Hispanics are the largest ethnic minority group in the USA and a fairly heterogeneous group. But this heterogeneity has usually been ignored by grouping them into a single category. The objective of this study is to challenge that practice by providing alcohol use disorders (AUD) incidence and risk estimates across Hispanic subgroups. METHODS: A subsample of Hispanics (n = 2371) and non-Hispanic whites (n = 7741) at risk for AUD who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions was analyzed. Weighted incidence for AUD was calculated across Hispanic subgroups. A weighted modified Poisson generalized linear model was used to estimate relative risks. RESULTS: Compared with non-Hispanic whites, Puerto Ricans have the highest AUD incidence (3.6%; 95% CI: 0.5, 6.7) followed by Mexican-Americans (2.5%; 95% CI: 1.5, 3.6), Other Hispanics (1.6%; 95% CI: 0.1, 3.1) and Cuban-Americans (0.6%; 95% CI: 0.1, 1.2). In contrast, weighted adjusted relative risk estimates for Mexican-Americans were (RR = 3.2; 95% CI: 1.7, 6.2) but for Puerto Ricans (RR = 2.2; 95% CI: 1.0, 5.0) it was somewhat attenuated but still significant (P = 0.049). No difference was found for Cuban-Americans or Other Hispanics. CONCLUSIONS: The annual incidence and risk for AUD varies greatly among Hispanic subgroups. Nonetheless, the practice of categorizing Hispanics as a homogenous ethnic group still continues. Our findings suggest that this practice is not only inappropriate, but also hinders a better understanding of AUD etiology, prevention, treatment and rehabilitation in the largest ethnic minority group in the USA.
Asunto(s)
Trastornos Relacionados con Alcohol/etnología , Trastornos Relacionados con Alcohol/epidemiología , Hispánicos o Latinos/etnología , Hispánicos o Latinos/psicología , Adolescente , Adulto , Femenino , Humanos , Incidencia , Masculino , Americanos Mexicanos/etnología , Americanos Mexicanos/psicología , Persona de Mediana Edad , Puerto Rico/epidemiología , Puerto Rico/etnología , Riesgo , Estados Unidos/epidemiología , Estados Unidos/etnología , Población Blanca/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVES: Although heavy drinking is considered a health risk, research demonstrates that some adults turn to alcohol in an effort to manage disabling stress or mental health problems. Race and nativity may be associated with such decisions to "self-medicate" with alcohol. This study identified and compared links between problem drinking and social structural and mental health-related factors for four race-nativity groups. METHODS: Using data from the 2009 National Health Interview Survey, the final sample comprised 7,905 US-born Whites, 390 foreign-born Whites, 2,110 US-born Blacks, and 193 foreign-born Blacks. Investigated were the social structural variables of demographic factors (age, gender), socioeconomic status (employment, income, education), and social integration factors (family size, living with a partner). Mental health-related variables included chronic mental illness and access to and use of mental health services. RESULTS: Overall, both types of variables were found to be associated with large-quantity drinking and frequent binging, with the strength of association varying-for some factors-by race and/or nativity. Further, the findings indicated that, in the presence of chronic mental illness, both US- and foreign-born Black Americans engaged in relatively frequent binge-drinking when health-care variables were controlled. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: These results underscore the need for mental health professionals to identify co-occurring mental illness and alcohol abuse among Black clients and, where it is found, to seek the root causes of the persistent stress that tends to accompany this co-occurrence.
Asunto(s)
Consumo de Bebidas Alcohólicas/etnología , Trastornos Relacionados con Alcohol/etnología , Consumo Excesivo de Bebidas Alcohólicas/etnología , Emigrantes e Inmigrantes/estadística & datos numéricos , Trastornos Mentales/etnología , Adulto , África/etnología , Negro o Afroamericano , Consumo de Bebidas Alcohólicas/psicología , Trastornos Relacionados con Alcohol/psicología , Asia/etnología , Consumo Excesivo de Bebidas Alcohólicas/psicología , Emigrantes e Inmigrantes/psicología , Europa (Continente)/etnología , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Modelos Lineales , Masculino , Servicios de Salud Mental/estadística & datos numéricos , México/etnología , Persona de Mediana Edad , Medio Oriente/etnología , Automedicación , Factores Socioeconómicos , Estados Unidos/epidemiología , Indias Occidentales/etnologíaRESUMEN
OBJECTIVE: Problem drinking during college is a well-known phenomenon. However, predictors of progression to problematic drinking, particularly among ethnic minorities such as Mexican Americans, have received limited research attention. METHOD: The current study compared the rates and predictors of problem drinking progression from the first to the second year of college among four groups: Mexican American men, Mexican American women, White European men, and White European women (N = 215). At baseline, participants were all first-year college students who scored as nonproblem drinkers on the Young Adult Alcohol Problems Screening Test (YAAPST). Participants were classified as progressors or stable nondrinkers/nonproblem drinkers based on YAAPST scores 12 months later. Hypothesized predictors of progression included behavioral undercontrol, negative emotionality, alcohol use expectancies, and cultural orientation (Mexican American sample only). Differences were anticipated between gender and ethnic groups in both progression rates and predictors of progression. RESULTS: Twenty-nine percent of the sample progressed to problematic drinking; however, no differences emerged by gender or ethnicity. For the full sample, higher behavioral undercontrol and higher negative emotionality significantly predicted progression. Differences in predictors were not found across gender and ethnic subgroups. CONCLUSIONS: The hypothesis that rates of progression to problem drinking would differ among the four gender and ethnic groups was not supported. Thus, although White European men are most often identified as at high risk for alcohol use problems, the present findings indicate that women and Mexican American students also should be targeted for prevention and/or intervention.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/etnología , Trastornos Relacionados con Alcohol/epidemiología , Americanos Mexicanos/estadística & datos numéricos , Población Blanca/estadística & datos numéricos , Adolescente , Comparación Transcultural , Femenino , Humanos , Masculino , Factores Sexuales , Estudiantes/estadística & datos numéricos , Universidades , Adulto JovenRESUMEN
OBJECTIVE: Adult male Hispanics, particularly those born in the United States, are more likely to drink frequently and to consume larger quantities of alcohol than Whites or Blacks. Because alcohol and other substance-use disorders are frequently associated with disturbances in sleep, this study investigated measures of sleep quality and substance use disorders in a select sample of young-adult Mexican Americans. METHOD: Diagnoses of alcohol-use disorders and other psychiatric disorders (based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised), results from the Pittsburgh Sleep Quality Index (PSQI), family history of alcohol dependence, and measures of acculturation stress were obtained from 294 Mexican American young adults, ages 18-30, who were literate in English and were residing legally in San Diego County. RESULTS: Lifetime diagnoses of alcohol-use disorders, family history of alcohol dependence, acculturation stress, and lifetime diagnoses of major depressive disorder were all correlated with significantly poorer quality sleep as indexed by the global score on the PSQI. Regression analyses also revealed that gender was correlated with habitual bedtime, whereas drug dependence (cannabis, stimulants, and/or opiates) was significantly correlated with how long it took to fall asleep, major depressive disorder with the number of hours spent sleeping a night, and anxiety disorders and major depressive disorder with waking up in the early morning or middle of the night. CONCLUSIONS: These data suggest that alcohol-use disorders are significantly associated with poorer quality of sleep in this population of young adults and that substance-use disorders may affect different aspects of sleep than anxiety and depressive disorders do. These findings may be helpful in designing prevention and intervention programs for alcohol-use disorders in this high-risk population.
Asunto(s)
Trastornos Relacionados con Alcohol/etnología , Americanos Mexicanos/etnología , Trastornos del Sueño-Vigilia/etnología , Adolescente , Adulto , Trastornos Relacionados con Alcohol/complicaciones , Trastornos Relacionados con Alcohol/psicología , Femenino , Humanos , Masculino , Americanos Mexicanos/psicología , Vigilancia de la Población , Trastornos del Sueño-Vigilia/etiología , Trastornos del Sueño-Vigilia/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: Adding a craving criterion--presently in the International Classification of Diseases, 10th Revision, diagnosis of alcohol dependence--has been under consideration as one possible improvement to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and was recently proposed for inclusion by the DSM Substance-Related Disorders Work Group in the Fifth Revision of diagnostic criteria for alcohol use disorders. To inform cross-cultural applicability of this modification, performance of a craving criterion was examined in emergency departments in four countries manifesting distinctly different culturally based drinking patterns (Mexico, Poland, Argentina, United States). METHOD: Exploratory factor analysis and item response theory were used to examine psychometric properties and individual item characteristics of the 11 DSM-IV abuse and dependence criteria with and without craving for each country separately. Differential item functioning analysis was performed to examine differences in the difficulty of endorsement (severity) and discrimination of craving across countries. RESULTS: Exploratory factor analysis found craving fit well within a one-dimensional solution, and factor loadings were high across all countries. Results from item-response theory analyses indicated that both discrimination and difficulty estimates for the craving item were located in the middle of the corresponding discrimination and difficulty ranges for the other 11 items for each country but did not substantially increase the efficiency (or information) of the overall diagnostic scheme. Across the four countries, no differential item functioning was found for difficulty, but significant differential item functioning was found for discrimination (similar to other DSM-IV criteria). CONCLUSIONS: Findings suggest that, although craving performed similarly across emergency departments in the four countries, it does not add much in identification of individuals with alcohol use disorders.
Asunto(s)
Trastornos Relacionados con Alcohol/diagnóstico , Trastornos Relacionados con Alcohol/etnología , Conducta Adictiva/diagnóstico , Conducta Adictiva/etnología , Comparación Transcultural , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Argentina/etnología , Servicio de Urgencia en Hospital , Humanos , México/etnología , Polonia/etnología , Estados Unidos/etnologíaRESUMEN
Little is known about the comorbidity of alcohol use, anxiety, hopelessness, and trauma among Mexican Americans, especially those living in impoverished and often isolated communities or neighborhoods (colonias in Spanish) along the U.S.-Mexico border that may be particularly vulnerable due to stressful living conditions. The current study utilized a community participatory model to investigate the relationships of alcohol use, acculturation, anxiety, hopelessness, and trauma in 100 Mexican origin colonia residents. Significant comorbidity was expected and that anxiety, hopelessness, and post-traumatic symptoms were hypothesized to be associated with the severity of the alcohol use disorders of participants. Participants who met DSM-IV criteria for alcohol dependence reported significantly more symptoms of anxiety and post-traumatic stress, and symptoms of anxiety were significantly associated with alcohol use disorders. This study provides evidence of the need for further investigation of stress, trauma, anxiety, hopelessness, and alcohol abuse in Mexican American residents and to inform future prevention and treatment efforts to improve both the physical and mental health of this population.
Asunto(s)
Trastornos Relacionados con Alcohol/etnología , Ansiedad/etnología , Americanos Mexicanos/psicología , Trastornos por Estrés Postraumático/etnología , Aculturación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Trastornos Relacionados con Alcohol/etiología , Ansiedad/psicología , Diagnóstico Dual (Psiquiatría) , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Emociones , Femenino , Humanos , Masculino , México/etnología , Persona de Mediana Edad , Trastornos por Estrés Postraumático/psicología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: The clinical course of alcoholism has been described as a series of distinct, alcohol-related life events that occur in an orderly sequence. However, whether that sequence differs, depending on ethnicity and country of origin, is less clear. The purposes of this study were to investigate the sequence and progression of alcohol-related life events in individuals of East Indian (Indo) and African (Afro) heritage on the islands of Trinidad and Tobago, and compare those results with data reported previously by the Collaborative study for the Genetics of Alcoholism (COGA). METHOD: Participants who were alcohol dependent (based on Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria) and of Afro-Trinidadian and Tobagonian ancestry or Indo-Trinidadian ancestry were recruited from inpatient treatment facilities. A total of 148 alcohol-dependent men and women completed the Semi-Structured Assessment of the Genetics of Alcoholism, which assessed the physical, psychological, and social manifestations of alcohol dependence and other psychiatric disorders. RESULTS: A high degree of similarity in the sequence of alcohol-related life events was found between Indo-Trinidadian, Afro-Trinidadian and Tobagonian, and COGA participants. However, Trinidadian and Tobagonian alcoholics were more likely to endorse severe alcohol drinking in the form of binges (2 or more days of intoxication), blackouts, withdrawal, and medical consequences; however, they were less likely to endorse aggressive acts associated with drinking. Progression to alcohol dependence was significantly slower in Trinidadian and Tobagonian alcoholics than in the U.S. population of alcoholics, but severe alcohol symptoms were more commonly endorsed in Trinidadian and Tobagonians. CONCLUSIONS: Identifying ethnic and country of origin differences in the clinical course of alcohol dependence may assist in the development of culturally sensitive intervention and prevention programs.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Alcoholismo/epidemiología , Adulto , Consumo de Bebidas Alcohólicas/etnología , Trastornos Relacionados con Alcohol/etnología , Alcoholismo/etnología , Alcoholismo/rehabilitación , Pueblo Asiatico/estadística & datos numéricos , Población Negra/estadística & datos numéricos , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Centros de Tratamiento de Abuso de Sustancias , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND: Acculturation has been linked to an increased prevalence of alcohol-related problems. However, most of the research has been conducted with Hispanic populations in metropolitan areas of the United States, none of which is on the U.S.-Mexico border. This study examines the association between acculturation, heavy episodic drinking, and DSM-IV alcohol abuse and dependence among Hispanics in the Texas-Mexico border. METHODS: The study used data from a survey conducted (2002 to 2003) along the Texas-Mexico border and included 472 male and 484 female Hispanic adults from El Paso, the Rio Grande Valley, and colonias. Based on the Acculturation Rating Scale for Mexican Americans-II scale, respondents were coded into 4 acculturation categories: "very Mexican oriented,""Mexican bicultural,""Anglo bicultural," or "very Anglo/Anglicized.". RESULTS: Acculturation was related to lower rates of alcohol use disorders among men and a higher frequency of heavy episodic drinking among women. Multivariate analyses indicate that men who report heavy episodic drinking and those who are "very Mexican,""bicultural Mexican," or "bicultural Anglo" are more at higher risk for alcohol abuse and/or dependence compared with "very Anglo/Anglicized" men. For women, acculturation level did not predict alcohol disorders. Statistical analyses included testing for bivariate associations and multivariate logistic regression predicting heavy episodic drinking alcohol abuse or dependence. CONCLUSIONS: This study suggests that acculturation has different effects on drinking for men and women. This finding needs some attention as literature also indicates that women drink more and may develop more alcohol-related problems as they acculturate. This increase in women's drinking is probably because of U.S. society's more liberal norms governing female drinking. The "bimodal" distribution of risk, in which only men in "very Anglo" group are at a lower risk than the others, may be unique to the Border. The association between acculturation and alcohol use disorders does not appear to be linear and the effect of acculturation is not uniform on individuals' drinking behavior.
Asunto(s)
Aculturación , Consumo de Bebidas Alcohólicas/etnología , Alcoholismo/etnología , Americanos Mexicanos/etnología , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Trastornos Relacionados con Alcohol/epidemiología , Trastornos Relacionados con Alcohol/etnología , Trastornos Relacionados con Alcohol/psicología , Alcoholismo/epidemiología , Alcoholismo/psicología , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Americanos Mexicanos/psicología , Americanos Mexicanos/estadística & datos numéricos , México/etnología , Análisis Multivariante , Factores Sexuales , TexasRESUMEN
BACKGROUND: Two of the class I alcohol dehydrogenase (ADH) genes located on chromosome 4 (ADH1B and ADH1C) encode for multiple isozymes that differ in their kinetic properties. At the ADH1B locus, 3 polymorphisms are present (ADH1B(*)1, ADH1B(*)2, ADH1B(*)3). ADH1B(*)2 (found mostly in individuals of East Asian and Jewish descent) and ADH1B(*)3 (found mostly in individuals of African decent) alleles encode for a more active enzyme variants than ADH1B(*)1 and the presence of these alleles has been associated with protection from alcohol dependence. The relationship between these alleles and alcohol-associated phenotypes has not been previously investigated in individuals living in the Caribbean. METHODS: One hundred thirty-three alcohol-dependent individuals of either East Indian or African ancestry and 98 controls matched by age, sex, education, and ethnicity participated in the study. A structured interview [the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA)] was used to gather information on demographics, psychiatric diagnoses, personal drinking, and drug use history. Leukocyte DNA extracted from a blood sample obtained from each participant was genotyped at the ADH1B locus. Serum levels of the liver enzymes alanine and aspartate aminotransferase (ALT, AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), and gamma-glutamyl transferase (GGT) as well as the presence of HIV, hepatitis B surface antigen, and antihepatitis C virus antibody were also assayed. The specific aim of the study was to investigate the associations between ADH1B alleles and alcohol dependence, drinking history, and liver function in individuals from the 2 major ethnic groups of Trinidad (individuals of African and East Indian ancestry). RESULTS: Twenty-eight of the Afro-Trinidadian (Afro-TT) participants (41%) and 1 Indo-Trinidadian (Indo-TT) (>1%) had at least 1 ADH1B(*)3 allele and 3 Afro-TT were homozygous for the allele. African participants with at least 1 ADH1B(*)3 allele were found to be significantly less likely to be alcohol dependent (p<0.018), and to have lower alcohol consumption levels (p<0.05). Among those participants who were alcohol dependent, ADH1B(*)3 was associated with significantly higher levels of ALT (p<0.05). CONCLUSIONS: This study suggests, in this sample of Trinidadians, that the ADH1B(*)3 allele is associated with protection from the development of alcoholism but is also associated with enhanced risk for elevated serum ALT levels in those individuals who do become alcohol dependent.
Asunto(s)
Alcohol Deshidrogenasa/genética , Trastornos Relacionados con Alcohol/genética , Alelos , Fenotipo , Adulto , Alanina Transaminasa/sangre , Consumo de Bebidas Alcohólicas/genética , Consumo de Bebidas Alcohólicas/fisiopatología , Trastornos Relacionados con Alcohol/etnología , Trastornos Relacionados con Alcohol/fisiopatología , Alcoholismo/genética , Alcoholismo/fisiopatología , Aspartato Aminotransferasas/sangre , Población Negra/genética , Estudios de Casos y Controles , Femenino , Humanos , Hígado/enzimología , Hígado/fisiopatología , Masculino , Trinidad y Tobago/etnología , Población Blanca/genéticaRESUMEN
OBJECTIVE: This study examined the risk of lifetime substance use disorders and mood and anxiety disorders between Island-born Puerto Ricans, foreign-born Cuban Americans, and foreign-born non-Latino whites and their U.S.-born counterparts. METHOD: Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093) were used to derive lifetime prevalence rates of specific DSM-IV psychiatric disorders by subethnicity and nativity group. Logistic regression models were constructed to detect variation in the odds of each psychiatric disorder across groups. RESULTS: A protective effect of foreign-born nativity in risk for psychiatric disorders was present for all groups but varied according to the assessed disorder. For non-Latino whites, the effect was observed for most specific psychiatric disorders, whereas, for Puerto Ricans and Cuban Americans, the effect was only evident for specific substance use disorders. CONCLUSION: The protective effect of nativity against psychiatric morbidity found in other studies among Mexican Americans and non-Latino whites does not entirely generalize to Puerto Ricans and Cuban Americans and may not generalize to individuals of other origins. The results of this study are discussed in terms of potential mechanisms involved in variations in the risk of specific psychiatric disorders among groups defined by nativity and race-ethnicity and the importance of identifying specific cultural components that may serve as risk and protective factors of psychiatric morbidity.
Asunto(s)
Hispánicos o Latinos/estadística & datos numéricos , Trastornos Mentales/etnología , Población Blanca/estadística & datos numéricos , Adolescente , Adulto , Trastornos Relacionados con Alcohol/epidemiología , Trastornos Relacionados con Alcohol/etnología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/etnología , Estudios de Cohortes , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etnología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Prevalencia , Escalas de Valoración Psiquiátrica , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/etnología , Estados Unidos/epidemiología , Estados Unidos/etnologíaRESUMEN
AIMS: To compare two contrasting socio-cultural groups in terms of parameters relating to the stress - coping - health model of alcohol, drugs and the family, and to test hypotheses derived from the model in each of the two groups separately. DESIGN: Cross-sectional, comparative and correlational, using standard questionnaire data, supplemented by qualitative interview data to illuminate the findings. PARTICIPANTS: One hundred close relatives, mainly partners or parents, from separate families in Mexico City, and 100 from South West England. Data sources. Coping Questionnaire (CQ), Family Environment Scale (FES), Symptom Rating Test (SRT), Semi-structured interview. FINDINGS: Mean symptom scores were high in both groups, and not significantly different. The hypothesis that relatives in Mexico City, a more collectivist culture, would show more tolerant - inactive coping was not supported, but there was support for the prediction that relatives in South West England would show more withdrawal coping. This result may be as much due to differences in poverty and social conditions as to differences in individualism - collectivism. As predicted by the stress - coping - health model, tolerant - inactive coping was correlated with symptoms, in both groups, after controlling for family conflict, but there was only limited support for a moderating role of coping. Wives of men with alcohol problems in Mexico City, and wives of men with other drug problems in South West England, reported particularly high levels of both engaged and tolerant - inactive coping. CONCLUSIONS: Tolerant - inactive coping may be bad for relatives' health: causality may be inferred but is not yet proved. Certain groups are more at risk of coping in this way. Qualitative data help understand the nature of tolerant - inactive coping and why it occurs despite the view of relatives themselves that it is counter-productive.
Asunto(s)
Adaptación Psicológica , Trastornos Relacionados con Alcohol/psicología , Salud de la Familia , Trastornos Relacionados con Sustancias/psicología , Adulto , Anciano , Trastornos Relacionados con Alcohol/etnología , Análisis de Varianza , Estudios Transversales , Inglaterra , Análisis Factorial , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Padres/psicología , Análisis de Regresión , Religión , Factores Sexuales , Apoyo Social , Esposos/psicología , Trastornos Relacionados con Sustancias/etnologíaRESUMEN
OBJECTIVE: Research has demonstrated that alcohol outcome expectancies moderate the relationship between psychological states such as stress and negative affect and alcohol use. This study examined whether the relationship between expectancies and alcohol problems would be moderated by gender and ethnicity. METHOD: Using a household survey format, personal interviews were conducted with Puerto Rican and Irish American men and women. The final sample consisted of 412 (231 male) Puerto Ricans and 476 (252 male) Irish Americans. Alcohol expectancies were measured with the Effects of Drinking Alcohol Scale. All subjects resided in the New York metropolitan area. The original study was designed to compare the drinking behaviors and alcohol-related beliefs of groups with varied drinking practices and distinct drinking beliefs. RESULTS: Both gender and ethnicity moderated the links between aggressive and self-control expectancies and drinking problems. For example, anticipated loss of control from drinking was more negatively related to Puerto Rican and female alcohol problems than it was to Irish and male problems. CONCLUSIONS: The present findings suggest that whether an outcome expectancy is associated with more alcohol problems depends upon the particular meaning of the outcome. This meaning, in turn, depends upon an individual's particular sociocultural perspective which is associated with such personal characteristics as gender and ethnicity.