Journal of Pediatric Nursing (2014) xx, xxx–xxx

Acculturation, Risk Behaviors and Physical Dating Violence Victimization Among Cuban-American Adolescents Rosa M. Gonzalez-Guarda PhD, MPH, RN, CPH a,⁎, Jessica R. Williams PhD, MPH, RN a , Mireille Merisier BSN, BS, RN b , Amanda M. Cummings PhD(c) c , Guillermo Prado PhD d a

The University of Miami School of Nursing and Health Studies, Coral Gables, FL University of Miami Hospital, Miami, FL c University of Miami School of Education and Human Development, Coral Gabes, FL d University of Miami Miller School of Medicine, Division of Prevention Science and Community Health, Miami, FL b

Key words: Latino; Adolescent health; Abuse; Drugs; Alcohol

The purpose of this study is to describe the relationships among acculturation, risk behaviors, and reported physical dating violence among Cuban-American ninth grade adolescents. Participants (N = 82) completed a questionnaire that assessed their level of acculturation to the U.S. (Americanism), their maintenance of the Hispanic culture (Hispanicism), binge drinking, drug use, sexual intercourse, condom use and physical dating violence victimization. Multiple logistic regression was conducted. Hispanicism was associated with a decrease in odds of reporting physical dating violence victimization. Drug use and not using a condom were associated with an increase in odds of reporting physical dating violence victimization. © 2014 Elsevier Inc. All rights reserved.

DATING VIOLENCE (DV), defined as physical, sexual and/or emotional abuse occurring in a past or present dating relationship, affects 1 out of 4 adolescents in the U.S. every year (Centers for Disease Control & Prevention [CDC], 2012a). DV is a significant problem not only because of its alarming prevalence and physical and mental health consequences (Callahan, Tolman, & Saunders, 2003; Coker et al., 2000), but also because it occurs at a life stage when romantic relationships are beginning. This is a pivotal point where interactional patterns are learned and that may carry over into adulthood (Wekerle & Wolfe, 1999). The Youth Risk Behavior Surveillance System (YRBSS; CDC, 2012b) results have indicated that a higher percentage of Hispanic students (11.4%) report physical DV victimization in the past 12 months when compared to non-Hispanic Whites (7.6%). ⁎ Corresponding author: Rosa M. Gonzalez-Guarda, PhD, MPH, RN, CPH. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.pedn.2014.03.001 0882-5963/© 2014 Elsevier Inc. All rights reserved.

These surveillance findings are consistent with research that has suggested that Hispanic adolescents experience health disparities related to DV (O’Keefe, 2005, Smokowski, DavidFerdon, & Stroupe, 2009). Attention must be given to understanding risk and protective factors associated with DV among this population given that Hispanics in the U.S. are the largest, fastest growing, and one of the youngest segments of the U.S. population and their youth are at higher risk for DV. Research is also needed to understand the diversity within the Hispanic community and the unique and common factors associated with DV across Hispanic subgroups. This knowledge can serve as the basis for culturally tailored interventions that aim to prevent DV among Hispanic adolescents. Adolescents who engage in one problem behavior are likely to engage in other problem behaviors (Basen-Engquist, Edmundson, & Parcel, 1996; Jessor, 1991), and this appears to be the case for DV. The use of alcohol and drugs has been consistently found to be strongly associated with the perpetration and victimization of DV for both males and

2 females (O'Keefe, 1997; Reyes, Foshee, Bauer, & Ennett, 2012; Silverman, Raj, Mucci, & Hathaway, 2001). Similar relationships have been documented between risky sexual behaviors and DV (Cutter-Wilson & Richmond, 2012). The clustering of behavior problems also appears true for Hispanic adolescents (Prado et al., 2010). The acculturation process appears to play an important role in adolescent risk behaviors (Gonzales, Deardorff, Formoso, Barr, & Barrera, 2006). However, there is limited research on the impact of the acculturation process on DV among Hispanic adolescents. The purpose of this study is to describe the relationships among acculturation, risk behaviors, and reported physical dating violence among Cuban-American 9th grade adolescents.

Background Acculturation to the U.S. and Risk Behaviors Among Hispanic Youth Acculturation, the process of acquiring the cultural elements of the host society, is a complex process for Hispanics in the U. S. that has been linked to health outcomes of public health significance (Lara, Gamboa, Kahramanian, Morales, & Hayes Bautista, 2013). Despite the large body of research examining the relationships among acculturation, risky behaviors such as substance abuse and dietary practices, and health for Hispanics, the substantive findings regarding its impact have been equivocal, with some studies showing positive effects of U.S. acculturation, some presenting negative effects, some exhibiting curvilinear effects, and others no effects (Lara et al., 2013). These inconsistent findings have been attributed to the acculturation measurement strategy employed, the outcomes being evaluated, and the diversity of the sample included (Cabassa, 2003; Rogler, Cortes, & Malgady, 1991). (See Tables 1 and 2). The acculturation process is particularly important among Hispanic adolescents, since this is a time where they seek to develop a socially-accepted identity (Leuven, 2011). Despite the ambiguity regarding the impact of the acculturation process on risky behaviors, research has more consistently suggested that for Hispanic adolescents, the acculturation process to the U.S. increases their risk for alcohol and drug use, and risky sexual behaviors (Martinez, McClure, Eddy, & Wilson, 2011; Schwartz et al., 2012). Although there is less research on the impact that the acculturation process has on risk for DV among Hispanic adolescents than in the area of substance abuse and risk sexual behaviors, similar trends have been noted. In a study conducted by Sanderson, Coker, Roberts, Tortolero, and Reininger (2004), Hispanic female adolescents who reported only speaking English at home were more likely to be victims of DV than females speaking both English and Spanish at home. In this same study, Hispanic females with both parents born outside of the U.S. and who identified strongly with their culture-of-origin (i.e., ethnic pride, language) were protected against DV (Sanderson

R.M. Gonzalez-Guarda et al. Table 1 Characteristics of 9th grade student participants (N = 82). M (SD) Age Gender Male Female Birthplace United States Cuba Honduras Venezuela Puerto Rico Americanism subscale Hispanism subscale Students currently dating Victim of physical DV in the past 12 months Risk behaviors Binge drinking at least once in the past 30 days Lifetime use of drugs Drug use in the past 30 days Sexual intercourse in the past 3 months No condom use during the last sexual intercourse

% (n)

14.34 (0.65) 56.1 (46) 43.9 (36) 47.6 (39) 47.6 (39) 2.4 (2) 1.2 (1) 1.2 (1) 3.40 (0.75) 2.86 (0.75) 28.0 (23) 14.7 (12)

14.6 (12) 37.8 (31) 34.1 (28) 18.5 (15) 15.0 (12)

et al., 2004). Other studies have suggested that low to moderate levels of acculturation may serve as a protective factor for DV victimization (Silverman, Decker, & Raj, 2006; Smokowski et al., 2009). For example, one study on immigration and acculturation in New Mexico found that Hispanic adolescent females were 25% less likely to experience DV when they were rated as having lower levels of acculturation in comparison to more highly acculturated females (Ramos, Green, Booker, & Nelson, 2011). What remains unclear when examining the relationship between acculturation and DV is whether U.S. acculturation is related to risk for DV, when the extent to which the Hispanic culture is maintained is also considered. This study will take on a multidimensional approach to the study of acculturation and DV by exploring both the impact that acculturation to the U.S. and maintenance of the Hispanic culture may have on DV within a specific Hispanic subgroup, Cuban-Americans.

DV and Substance Abuse Although alcohol and drug use does not cause DV, research suggests that it is one of the most important risk factors for DV (CDC, 2012b). Cross-sectional data from 7th graders (n = 856) who participated in the 2004 Youth Violence Survey found that alcohol use before age 13 years was significantly associated with both being a victim and perpetrator of physical DV (Swahn, Bossarte, & Sullivent, 2008). The most risky type of

Acculturation, risk behaviors and dating violence

3

Table 2 Multiple logistic regression analyses examining the relationship between acculturation, binge drinking, drug use, sexual risk behaviors and physical dating violence victimization among Cuban-American 9th grade students (N = 82).

Gender Americanism Hispanicism Binge drinking past 30 days Lifetime drug use Drug use past 30 days Sex in past 3 months Condom used during last sex

b

SE

Waldχ2

p

AOR (95% CI)

2.043 − .020 − 2.947 .758 2.495 .307 1.524 2.729

1.296 1.495 1.119 1.337 1.269 2.153 1.404 1.307

2.483 .000 6.935 .322 3.866 .020 1.179 4.358

.115 .989 .008 .571 .286 .049 .278 .037

7.71 0.98 0.05 2.14 8.92 12.12 .21 15.31

(.61, 97.85) (.052, 18.38) (.01, .47) (9.16, 29.34) (.16, 498.98) (1.04, 145.69) (.01, 3.41) (1.18, 198.40)

alcohol consumption among high school adolescents is binge drinking, defined as having five or more standard drinks of alcohol within a couple of hours by the YRBSS (CDC, 2013). Research suggest that binge drinking is relatively common among adolescents with 21.9% of high school students reporting binge drinking on at least 1 day during the past month in 2011 (CDC, 2012b). Miller, Naimi, Brewer, and Everett (2007) examined the relationship between binge drinking and other risk behaviors using YRBSS data from 2003 and found that individuals who reported engaging in binge drinking also showed an increased likelihood of being currently sexually active, smoking, being a victim of DV, and using illicit drugs than both nondrinkers and current drinkers who did not binge (Miller et al., 2007). Furthermore, research has demonstrated a high cooccurrence of using illicit substances and DV perpetration and/or victimization. For example, researchers examining the 1997 YRBSS data from a sample of 5,414 high school students in South Carolina found that victims with a history of severe DV were significantly more likely to use illegal substances, smoke cigarettes, and/or drink alcohol (Coker et al., 2000). Findings from a more recent study conducted in both urban and suburban areas showed that 32.7% of girls who had experienced DV also reported consuming alcohol, 23% reported having used marijuana, and 49.5% reported smoking cigarettes. Among girls who had not experienced DV, on the other hand, 26% reported using alcohol, 10.8% reported marijuana use, and 28.2% reported smoking cigarettes (Ackard, Eisenberg, & Neumark-Sztainer, 2007). Numerous other studies have found a significant association between alcohol and drug use and DV experiences among the general adolescent population, yet relationships for specific racial/ ethnic subgroups have not been thoroughly explored (Foshee, Linder, MacDougall, & Bangdiwala, 2001; Howard, Wang, & Yan, 2007; Vezina & Hebert, 2007). This study will add to the literature by exploring the relationships among binge drinking, drug use and DV, while simultaneously considering the role that acculturation plays on Hispanic adolescent behaviors.

Baseline data from a small randomized controlled trial assessing the feasibility, acceptability and preliminary efficacy of a school-based and ecological intervention aiming to prevent dating violence among Hispanic adolescents were used for this paper (n = 82). Although baseline data were collected from Hispanic adolescents, a parent or caregiver and school personnel as part of the larger study, only baseline data for the Hispanic adolescent are being used for this paper.

DV and Risky Sexual Behaviors

Sample & Setting

The CDC and other public health organizations have highlighted the serious negative health consequences

The sample consisted of 9th grade students recruited from a predominately Hispanic public high school in South Florida

associated with DV and the importance of prevention research in this area (CDC, 2012a,b; World Health Organization, 2012). Such health consequences include not only physical injury, but also sexual health problems. More specifically, results of the 2011 national YRBSS data found a positive relationship between risky sexual behaviors and DV victimization, especially for females (CDC, 2012b). There is also a strong association between sexual partner violence and risk for HIV and other sexually transmitted infections (STIs) for women across the globe (Stockman, Lucea, & Campbell, 2013). One study found that adolescent girls who experienced both physical and sexual DV were three times more likely to have been tested for HIV and other STIs, and more than twice as likely to report an STI diagnosis (Decker, Silverman, & Raj, 2005). Additionally, DV has been associated with a number of risky sexual behaviors, including having multiple sex partners and nonuse of condoms for both males and female adolescents (Howard & Wang, 2003; Silverman et al., 2001). Thus, understanding how sexual health risks configure with acculturation, drug use and DV among adolescents is an important step in the development of culturally specific DV prevention for Hispanics.

Methods Design

4 with approximately 750 students in the 9th grade. The student population in the school where the study was conducted is predominately Hispanic (97%), and of low socio-economic status with 89% of students qualifying for the free or reducedprice lunch program (National Center for Education Statistics, 2013). The community where the school is located comprises a large Cuban-American population (U.S. Census Bureau, 2013a,b). Students were recruited through presentations made during freshman orientation, the beginning of classes, the distribution of flyers and snowball sampling methods. To be eligible to participate, students had to identify as being Hispanic or Latino, being in the 9th grade, and having a parent or caregiver that was willing to provide consent and participate in the study. All data were collected at the public high school during afterschool hours.

Procedures Approval from the university institutional review board and the school board's research review committee were granted to carry out this study. Research personnel screened parents or caregivers of eligible candidates for eligibility in person or over the phone. If the adolescent and parent met inclusion criteria, they were both scheduled for one of three waves of baseline assessments that were administered as a group. These were organized according to language preference (English or Spanish). The PI, who is bilingual and bicultural, and other members of the research team reviewed the study procedures and informed consent with the Hispanic adolescents and their parent/caregivers. Both parental consent and adolescent assent were obtained. After the informed consent process was complete, Hispanic adolescents were taken to a different room to complete the baseline assessment. This provided a sense of privacy for both the adolescents and the parents. Research personnel provided an overview of the baseline assessment, which consisted of a battery of self-administrated paper and pencil instruments. Research personnel made themselves available to participants to answer any questions they had during the time they completed the assessments. Upon completion of the baseline assessment, research personnel reviewed the forms to ensure completion and provided participants $5 compensation for their time.

Measures Demographic Questions The adolescents were asked to answer questions regarding their age, race, gender, preferred language, country of birth, sexual orientation and current dating status. Bidimensional Acculturation Scale (BAS) The BAS was used to measure acculturation to the U.S. (Americanism) and the maintenance of their culture of origin (Hispanicism; Marin & Gamba, 1996). The scale includes 24 items separated into two subscales; 12 items assessing the

R.M. Gonzalez-Guarda et al. extent to which individuals speak, understand and think in English (e.g., How often do you listen to radio programs in English?) and 12 parallel items that assessed the same for Spanish (e.g., How often do you speak in Spanish to your friends?). This scale has been used extensively across Hispanic subgroups in the U.S., including South Florida (GonzalezGuarda, McCabe, Florom-Smith, Cianelli, & Peragallo, 2011). The mean scores of each sub-scale were used as two separate predictors in this sample. Scores can range from 1 to 4, with mean scores of 2.5 in each sub-scale representing a high level of Americanism and/or Hispanicism. The Americanism and the Hispanicism subscales performed reliably in this sample (α = .96, α = .92, respectively). Youth Risk Behaviors Surveillance System (YRBSS) Questions Fifteen questions taken directly from the YRBSS questionnaire (CDC, 2012b) were used to measure risk behaviors and DV. This included: 1) one item assessing binge drinking in the past 30 days (During the past 30 days, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours?), 2) 11 items assessing lifetime drug use and drug use in the past 30 days for marijuana, cocaine, heroin, methamphetamines, inhalants, ecstasy, steroids, prescription drugs, and injection drugs (e.g., During your life, how many times have you smoked marijuana?), 3) two items assessing the number of sexual partners the adolescent had in the past 3 months and whether a condom was used during their last sexual intercourse, and 4) one item that asked about physical DV victimization (During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?). All risk behavior variables were dichotomized to identifying the following those reporting: 1) reporting binge drinking, 2) using drugs in their lifetime, but not in the past 30 days, 3) using drugs in the past 30 days, 4) having sexual intercourse in the past 3 months, 5) not wearing a condom during their last sexual intercourse, and 6) physical DV victimization in the past 12 months.

Analysis Descriptive statistics and multiple logistic regression were conducted using IBM SPSS Statistic Data Editor. Because this was a sample of Hispanic 9th grade students from one public high school, gender was the only control variable included in the analysis. Gender (male/female), the mean scores for Americanism and Hispanicism, binge drinking (no/yes), lifetime drug use (score), lifetime drug use but not in the past 30 days (no/yes), drug use in the past 30 days (no/ yes), sexual partners in the past 3 months (none/one or more), and condom use during the last act of sexual intercourse (no sex or condom use/no condom use) were regressed on physical DV. Because past year physical DV was assessed, all participants were included in the analysis

Acculturation, risk behaviors and dating violence whether they identified as “currently” dating or not, given that they could have been dating during other periods in the previous year.

Results Participant Characteristics Participant characteristics are described in Table 1. The majority of students were born outside the U.S. (52.4%), preferred to speak English (74.4%), and were bicultural, scoring high on both the Americanism (M = 3.40, SD = .75) and Hispanicism subscales (M = 2.86, SD = .75). A small proportion of students were currently dating (28.0%), and 14.7% indicated that they had been the victim of physical DV in the past 12 months. Substance abuse and risky sexual behaviors were reported by a large minority of participants.

Relationship Between Acculturation, Risk Behaviors and DV The results of the multiple logistic regression analyses that were conducted are summarized in Table 2. After controlling for gender, Americanism, binge drinking, lifetime drug use, and having sex in the past 3 months did not predict physical DV victimization. Participants that scored high on Hispanicism were at lower odds of reporting physical DV victimization (AOR = 0.53, 95% CI = .01, .47). Participants that reported drug use in the past 30 days (AOR = 12.19, 95% CI = 1.01, 145.69) and not using a condom during their last sexual intercourse (AOR = 15.31, 95% CI = 1.18, 198.40) were at much higher odds of reporting physical DV victimization.

Discussion The purpose of this study is to advance knowledge in the area of DV among Hispanic youth by examining the relationship between acculturation, risk behaviors, and DV victimization within a specific Hispanic subgroup—CubanAmericans. The findings of this study are unique in that no previous studies have simultaneously examined the impact of these factors on DV victimization despite research demonstrating independent association of each of these factors and DV among Hispanic youth. A better understanding of the interrelatedness of risk and protective factors for DV in this population is critical for the development of effective prevention programs aimed at eliminating this health disparity. In this sample, 14.7% reported having been a victim of physical DV in the past 12 months. This is higher than comparable national estimates for Hispanic youth which report a 12-month prevalence of 11.4% and higher than the estimates among Hispanics youth in South Florida (10.5%;

5 CDC, 2012b, 2013). This may be due to certain characteristics that make this community unique. For example, South Florida is home to a large Cuban-American and immigrant population and Spanish is frequently spoken. The county has a high population density and a higher percentage of persons living below the poverty level (21.6%) than the country (14.3%) and county (17.9%) as a whole (U.S. Census Bureau, 2013a,b). Despite the more frequent reporting of DV among the sample, participants of this study were less likely to report binge drinking (14.6% vs. 18.4%) and having sex in the past 3 months (18.5% vs. 26.8%) than the national estimates for Hispanic 9th grade students. More research is needed to explore the role that demographic, cultural, socioenvironmental factors play in increasing or mitigating risk for physical DV and other forms of abuse (i.e., psychological, sexual, stalking), and to identify the pathways in which these may also be associated with other risk behaviors among this population. This sample consisted of a large proportion of students born outside the U.S. (52.4%). Although being an immigrant has been found to be protective against DV among adolescent (Silverman, Decker & Raj, 2007), little is known about the cultural factors associated with this relationship. In this study adolescents who reported higher connectedness to the Hispanic culture were less likely to report DV victimization. Thus, having stronger ties to their culture of origin may serve as a protective factor against DV for Hispanic adolescents. On the other hand, Americanism, or acculturation to the American culture, did not appear to have an impact on DV risk. This is consistent with other research conducted with Hispanic adult women that found that Hispanicism protected against violence, substance abuse, risk for HIV and depression when measured together as an underlying phenomena (i.e., syndemic factor; Gonzalez-Guarda et al., 2011). This study was underpowered to explore the independent effects of immigration and acculturation on risk for physical DV. Country of birth and other characteristics of a population that may be related to their birthplace (e.g., self-esteem) appear to be one of the factors playing a role in risk for intimate partner violence among Hispanic adult women (Gonzalez-Guarda, Vermeesch, Florom-Smith, McCabe, & Peragallo, 2013). More research is needed to tease out the effects of acculturation from other social, cultural and environmental factors that may be associated with immigration and risk for DV within and across Hispanic adolescent sub-groups. The relationship between DV and several measures of substance abuse were also examined in this study. Results indicated that drug use in the past 30 days was associated with an increased risk of DV; however lifetime drug use and binge drinking in the past 30 days were not. The link between illicit drug use and DV victimization is well established in the literature and is conceptualized as a potential precursor to or consequence of DV, as well as a co-occurring behavior (Coker et al., 2000; Howard et al., 2007; Vezina & Hebert, 2007). The lack of association

6 between lifetime drug use and DV in this particular study may be partially explained by the time period of measurement. DV victimization was measured for the past 12 months which coincides with past 30 day drug use but not necessarily lifetime drug use and may have weakened this relationship particularly in instances when this is co-occurring behavior. The lack of a relationship between binge drinking and DV is inconsistent with previous research and indicates an area where further examination is needed. Previous studies have shown that binge drinking is associated with increased risk of experiencing DV in both adolescent and adult populations (Caetano, Cunradi, Schafer & Clark, 2000; Miller et al., 2007). The lack of significant findings in this study may indicate that there is a unique configuration of risk behaviors among Cuban-American adolescents, whereby binge drinking does not contribute to the phenomena of DV. In fact, Caetano and colleagues (2000) have noted that the relationship between binge drinking and intimate partner violence (IPV) among adults differs according to race and ethnicity. For example, in a large population-based sample of married or cohabitating couples, binge drinking did not predict male-to-female IPV, but did predict female-to-male IPV. Further, drinking during IPV was more common among Black couples than Hispanic couples. More research is needed to understand how the relationship between drinking and IPV varies across race, ethnicity, gender and ages, and to elucidate why these differences exist. Lastly, DV was found to be associated with condom use during last sexual encounter but not with having sexual intercourse during the last 3 months. Condom use is generally related to the ability to negotiate their use during sexual encounters. Research with adult and adolescent women has shown that victims of IPV are more likely to report inconsistent condom use and this is often attributed to an imbalance in power within the relationship which does not allow for appropriate condom-use negotiation (Bonacquisti & Geller, 2013; Gielen et al., 2007; Teitelman, Ratcliffe, Morales-Aleman, & Sullivan, 2008). The findings of this study indicate that this dynamic may also be present in Cuban-American adolescent relationships. There are a few limitations to the current study, which should be considered when interpreting the findings. First, this study employed a cross-sectional design. The main limitation of cross-sectional research is its weakness in showing causal relationships. Therefore, in this study, we cannot say that the occurrence of one variable caused the occurrence of another, only that there is some kind of relationship. Further investigation using longitudinal methodology is warranted to better understand the causal relationships between Hispanicism, substance use, and risky sexual behavior with DV victimization. Second, data for this study were collected from a convenience sample of 9th grade students attending a predominately CubanAmerican high school in South Florida; therefore, it is unclear if the findings of this study can be generalized to other sub-group of Hispanic 9th graders attending high schools in different parts of the U.S. or high schools in which Hispanic

R.M. Gonzalez-Guarda et al. students are a minority. Furthermore, students self-selected to participate in this study along with parental consent. As such, this sample may differ in important ways from those who did not participate in the study (e.g., more interest/experience with DV; higher levels of parental support). Finally, the sample of this study was relatively small (n = 82). Therefore, the confidence intervals generated in the analysis were large, and the investigators were limited in regards to the number of theoretically important variables to include in the multivariate logistic regression models. For example, only the relationships between what appears to be the riskiest substance abuse behaviors in the literature (i.e., binge drinking and illicit drug use) and physical DV were explored, leaving out other types of substance abuse (e.g., tobacco use, alcohol use) that could also be associated with DV. Further research is needed to expand upon the potential risk and protective factors for DV among Hispanic adolescents and examine the reach of these study findings to different groups of Hispanic adolescents (e.g. country of birth, geographical area in the U.S.). Despite these limitations, this study extends current knowledge in DV research, highlighting ethnic-specific phenomena that may influence risks among Cuban-American adolescents. More research is needed to identify the factors and pathways that play a role in increasing, or decreasing, risk for DV among Cuban-American and other Hispanic adolescents and how these may or may not differ across racial and ethnic groups. Longitudinal research that untangles the role that acculturation, Hispanicism, other social and environmental associated with the immigration experience, and risk behaviors have on DV over time is particularly needed. This research needs to consider other culturally rooted variables such as familism (importance of family) and ethnic pride that may be confounding the relationship between Hispanicism and DV noted here. This study also has several implications for nurses both in community-based settings and clinical settings. Culturally tailored prevention strategies for DV need to be developed to address the unique needs and strengths of the Hispanic community. These strategies should be comprehensive in that they address DV and interconnected risk behaviors and tap into the protective effect of maintaining traditional cultural values and practices. Screening for DV among Hispanic adolescents is also important. The finding of this study suggests that DV is more common among adolescents who are engaging in other risk behaviors, especially binge drinking, recent drug use and unprotected sex. Therefore, special attention needs to be given to screening and providing care for DV among high risk youth.

Acknowledgments This study was funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars Program (Grant ID# 69341, PI: Gonzalez-Guarda, R.M.). Supplemental support

Acculturation, risk behaviors and dating violence was received from the University of Miami School of Nursing and Health Studies and the Miami Dade County Department of Community Action and Human Services, Coordinated Victim Assistance Center (CVAC). The authors would like to thank the Community Advisory Board for the Partnership for Domestic Violence Prevention at CVAC and the participants of this research study.

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Acculturation, risk behaviors and physical dating violence victimization among Cuban-American adolescents.

The purpose of this study is to describe the relationships among acculturation, risk behaviors, and reported physical dating violence among Cuban-Amer...
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