Substance Use & Misuse, 49:1365–1375, 2014 C 2014 Informa Healthcare USA, Inc. Copyright ISSN: 1082-6084 print / 1532-2491 online DOI: 10.3109/10826084.2014.901389
ORIGINAL ARTICLE
Social Stressors and Alcohol Use Among Immigrant Sexual and Gender Minority Latinos in a Nontraditional Settlement State Paul A. Gilbert1 , Krista Perreira2 , Eugenia Eng3 and Scott D. Rhodes4 1
Alcohol Research Group, Public Health Institute, Emeryville, Callifornia, USA; 2 Department of Public Policy, University of North Carolina, Chapel Hill, North Carolina, USA; 3 Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; 4 Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina, USA dividuals. Sexual and gender minority Latinos are often considered a hidden and hard-to-reach population as no population-based sampling frame can be elaborated and for some their potentially stigmatizing characteristics may inhibit recruitment for research studies (Shedlin, Decena, Mangadu, & Martinez, 2011; Zea, Reisen, & Diaz, 2003). While some immigrant Latino men abstain from or consume little alcohol, recent research suggests that a sizeable proportion engages in heavy weekly or heavy episodic drinking (Worby & Organista, 2007). In addition, Latino men’s drinking patterns may differ from other racial/ethnic groups. In their review of alcohol use among US racial/ethnic minorities, Galvan and Caetano (Galvan & Caetano, 2003) found that a greater proportion of Latino men abstained from alcohol than their non-Latino White peers (35% vs. 26%); however, a greater proportion of Latino men reported frequent heavy drink-ing than nonLatino Black or White men (18% versus 15% and 12%, respectively). The same study found that from 1984 to 1995 the proportion of Latino men who reported three or more alcohol-related problems, such as driving while intoxicated, increased from 9% to 16% while the proportions of non-Latino White and Black men reporting alcoholrelated problems decreased. It has been suggested that some Latino men may consume alcohol as a way to cope with the psychological strain associated with their minority status (Laureano & Poliandro, 1991; Neff, 1986). Qualitative research in North Carolina identified alcohol use as a possible coping reaction to migration-related stress (Rhodes et al., 2009). Additionally, some Latino men may use heavy drinking as a strategy to circumvent cultural constraints that otherwise prevent expression of some emotions, such as anger, frustration, or loss (Perez, 2000). Much of the knowledge about Latinos’ alcohol use has been based on samples drawn from traditional Latino
We sought to quantify the association of social stressors with alcohol use among immigrant sexual and gender minority Latinos in North Carolina (n = 190). We modeled any drinking in past year using logistic regression and heavy episodic drinking in past 30 days using Poisson regression. Despite a large proportion of abstainers, there were indications of hazardous drinking. Among current drinkers, 63% reported at least one heavy drinking episode in past 30 days. Ethnic discrimination increased, and social support decreased, odds of any drinking in past year. Social support moderated the associations of English use and ethnic discrimination with heavy episodic drinking. Keywords Hispanic, gay, men who have sex with men (MSM), transgender, southeast US, drinking, binges
INTRODUCTION
Since 1990, the US Latino population has grown rapidly and is now the largest racial/ethnic minority group (Census Bureau, 2011; Ennis, Rios-Vargas, & Albert, 2011). Despite its size, the health status and needs of Latinos are poorly understood due to gaps in national databases, the heterogeneity of immigrant populations, a history of limited funding for Latino research, and relatively few researchers focusing on Latinos (Dovidio, Gluszek, John, Ditlmann, & Lagunes, 2010; North Carolina Institute of Medicine, 2003; Organista, 2007; Rhodes et al., 2007). Additionally, some Latinos may be reluctant to participate in epidemiologic studies because of their immigration status or perceived discrimination. Even less is known about sexual and gender minority Latinos, a sub-group that includes gay- and bisexually identified men, men who have sex with men (MSM) who do not self-identify as gay or bisexual, and gender variant or transgender in-
Address correspondence to Paul A. Gilbert, PhD, MSPH, Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-mail: [email protected]
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communities (e.g., California, Texas, Florida, and New York) or national samples that mask regional variations; however, nontraditional settlement states have received increasing attention. Recent research in North Carolina found high levels of binge drinking among Latino men (Grzywacz, Quandt, Isom, & Arcury, 2007; Kim-Godwin & Fox, 2009), which was associated with Spanish language use and inversely associated with age and social support (Loury, Jesse, & Wu, 2011; Ornelas, Eng, & Perreira, 2011). These findings suggest a pattern of prevalent risky drinking that is driven by social stressors. As these studies presumed heterosexuality, however, they may not reflect alcohol use among sexual and gender minority Latinos in North Carolina. High levels of alcohol consumption and alcohol-related problems have also been reported for gays and lesbians, often exceeding those found among their heterosexual peers (Drabble, Midanik, & Trocki, 2005; Hughes, 2005; McKirnan & Peterson, 1989a; Stall et al., 2001; Stall & Wiley, 1988). Proposed explanations for the observed disparities have frequently focused on the greater experiences of stigma and discrimination due to minority sexual orientation or internalized negative attitudes about their sexuality (Cabaj, 1996; DiPlacido, 1998; McKirnan & Peterson, 1989b; Meyer, 2003). In other words, gays and lesbians experience stress as a result of their minority sexuality and may turn to alcohol or drugs to cope (Hatzenbuehler, 2009). Although sexual orientation has received far less attention than other types of social stressors, there is increasing support in diverse but predominantly White samples for the proposed association of gay-related stressors with alcohol use (Bux, 1996; Hamilton & Mahalik, 2009; McDermott, Roen, & Scourfield, 2008). Similar to the literature on drinking among Latino men, however, the findings are based on only a small number of studies that have explicitly tested such relationships. To date, very few studies have examined social stressors and alcohol consumption under the joint conditions of Latino ethnicity and minority sexual orientation or gender identity. Nevertheless, a small body of literature has emerged. One of the earliest reports found that immigrant Mexican MSM consumed alcohol at higher levels than their heterosexual immigrant Mexican peers (Tori, 1989) and showed higher levels of stress, which may be attributed to their sexual minority status. Extending these findings, other researchers found that internalized homosexual stigma was positively associated with amount of alcohol consumed (Bruce, Ramirez-Valles, & Campell, 2008) and with sex under the influence of drugs or alcohol (Ramirez-Valles, Kuhns, Campbell, & Diaz, 2010) among gay and bisexual Latino men and transgender Latino individuals in Chicago and San Francisco. To our knowledge, no other studies have measured stressors and alcohol use among sexual and gender minority Latinos. Social support may serve as a compensatory factor. There is substantial evidence of its beneficial effects for a wide variety of health outcomes (Gottlieb & Bergen, 2010; Heaney & Israel, 2008), and the field of public health now recognizes social support as an important de-
terminant of health, particularly as it may interact with other social characteristics such as socio-economic position and social integration (Grundy & Sloggett, 2003; Stansfeld, 2006; Weyers et al., 2008). Social support may buffer some of the disadvantages faced by sexual and gender minority Latinos; however, research to-date has largely been restricted to HIV-related topics (Carlos et al., 2010; Fekete et al., 2009; Wohl et al., 2010; Zea, Reisen, Poppen, Bianchi, & Echeverry, 2005). This reflects the preponderance of research on sexual behavior and relatively scant attention to the relationship between social support and other risky behaviors, including substance use, among this sub-group of Latinos. In this study, we sought to build upon the limited extant literature about alcohol use among immigrant sexual and gender minority Latinos. Drawing upon theory and empirical evidence, we derived a conceptual model to guide the study. The Transactional Model of Stress and Coping (Lazarus & Folkman, 1984) provided the basic structure, focusing on drinking as an active, avoidant coping response to stressors. We drew upon various Minority Stress Models (Clark, Anderson, Clark, & Williams, 1999; Harrell, 2000; Meyer, 1995, 2003) to identify specific sources of stress for the study population, including experiences of discrimination and internalized homonegativity, i.e. internalized negative attitudes about same-sex sexuality. A concurrent qualitative study suggested additional stressors. In individual interviews, age at migration and English language use were identified as key stressors among immigrant sexual and gender minority Latinos in North Carolina (manuscript in preparation). Social Support Theory provided a complementary mechanism to explain the hypothesized association of social stressors with drinking. Based on the Stress Buffering hypothesis (Cohen & Wills, 1985; Ganster & Victor, 1988), we expected that social support would weaken any association between social stressors and alcohol use. Our primary aim was to quantify the association of select social stressors with alcohol use among immigrant sexual and gender minority Latinos in North Carolina, a nontraditional settlement state that has experienced recent, rapid growth of its Latino population (Griffith, 2005; Kochlar, Suro, & Tafoya, 2005). Additionally, we tested whether social support moderated any relationship between social stressors and alcohol use among this sub-group of Latinos. METHODS Sample
Data for this study came from an investigation of HIV risk and protective factors among immigrant sexual and gender minority Latinos in North Carolina. A communitybased participatory research (CBPR) partnership guided the parent study and included representatives from public health departments, AIDS service organizations, universities, the local Latino community (including immigrant sexual and gender minority Latinos), and communitybased organizations serving the Latino community. The parent study used respondent-driven sampling (RDS) to
STRESSORS AND ALCOHOL AMONG GAY AND TRANSGENDER LATINOS
recruit participants. RDS is an extension of chain-referral methods that enables researchers to sample populations when no sampling frame can be established (Heckathorn, 1997; Magnani, Sabin, Saidel, & Heckathorn, 2005; Ramirez-Valles, Heckathorn, Vazquez, Diaz, & Campbell, 2005). Initially, the CBPR partnership identified eight seeds, participants chosen to represent the diversity of the local sexual minority Latino community (e.g., by level of “outness” about their sexual orientation, country of origin, gender identity, and HIV status). Nine additional seeds were enrolled during data collection to expedite recruitment in accordance with standard RDS procedures, for a total of 17 seeds. All participants were born outside the US, self-identified as Latino, were age 18 or older, and provided informed consent. Each seed completed a psychosocial and behavioral assessment (described further), received instruction on the study’s recruitment protocol and eligibility criteria, and recruited up to three additional participants from his social network. Each subsequent participant completed an assessment, received instruction on the study’s recruitment protocol and eligibility criteria, and recruited up to three new participants from his social network. Recruitment waves continued until the target sample size (n = 190) was met. All participants were compensated for completing their own assessment ($50) and for each referral that also completed an assessment ($20), a dual incentive process that is a hallmark of RDS methods. The Institutional Review Board (IRB) at Wake Forest University School of Medicine approved the parent study; the Public Health-Nursing IRB at the University of North Carolina at Chapel Hill approved this secondary analysis. Measures
The parent study’s CBPR partnership developed a comprehensive psychosocial and behavioral assessment, using established Spanish-language measures whenever possible and adapting established English-language measures or developing new measures when necessary. Following a committee approach, which is an increasingly preferred translation method (Behling & Law, 2000; Census Advisory Committees, 2004), a group of individuals with complementary skills was convened to translate the English items into Spanish. The group included professional translators (including native Spanish speakers from Mexico and Central America), a translation reviewer, content specialists, and a questionnaire design expert. Multiple group members made independent translations of the assessment, and the full committee met to discuss and reconcile the various versions. The CBPR partnership, which included native Spanish speakers, reviewed and approved the final Spanish translation. Although the parent study focused on HIV-specific outcomes (e.g., condom use, HIV testing), data were available to investigate alcohol use. Current drinking status was assessed by a single item about any alcohol use in the past year (coded 0 = none; 1 = any). Current drinkers were asked to select the most common reason for drinking from a list of seven options (1 = enhance sex; 2 = bored/for fun;
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3 = lose inhibitions; 4 = lonely/depressed; 5 = physical pain; 6 = other; 7 = do not know) and to report the number of heavy episodic drinking episodes in the past 30 days, defined as five or more drinks on a single occasion. Among migration related stressors, language use was measured by the language sub-scale of the Short Acculturation Scale for Hispanics (Marin, Sabogal, Marin, OteroSabogal, & Perez-Stable, 1987). Five items assessed participants’ language use in a variety of situations, such as “what language(s) do you usually speak with your friends?” Participants responded on a five-point bipolar scale (coded 1 = exclusively Spanish to 5 = exclusively English; α = 0.92). Because a majority (59%) of participants spoke exclusively Spanish or more Spanish than English, we modeled language use in terms of English acquisition, with exclusive Spanish speakers serving as the referent group. Participants also reported the number of years they lived in the US, which we used as a proxy for duration of cultural contact. We calculated age at migration by subtracting participants’ self-reported years in the US from self-reported age at time of interview, then created a dichotomous indicator for migration as an adult, (coded 0 = migration at age
ORIGINAL ARTICLE
Social Stressors and Alcohol Use Among Immigrant Sexual and Gender Minority Latinos in a Nontraditional Settlement State Paul A. Gilbert1 , Krista Perreira2 , Eugenia Eng3 and Scott D. Rhodes4 1
Alcohol Research Group, Public Health Institute, Emeryville, Callifornia, USA; 2 Department of Public Policy, University of North Carolina, Chapel Hill, North Carolina, USA; 3 Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; 4 Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Winston-Salem, North Carolina, USA dividuals. Sexual and gender minority Latinos are often considered a hidden and hard-to-reach population as no population-based sampling frame can be elaborated and for some their potentially stigmatizing characteristics may inhibit recruitment for research studies (Shedlin, Decena, Mangadu, & Martinez, 2011; Zea, Reisen, & Diaz, 2003). While some immigrant Latino men abstain from or consume little alcohol, recent research suggests that a sizeable proportion engages in heavy weekly or heavy episodic drinking (Worby & Organista, 2007). In addition, Latino men’s drinking patterns may differ from other racial/ethnic groups. In their review of alcohol use among US racial/ethnic minorities, Galvan and Caetano (Galvan & Caetano, 2003) found that a greater proportion of Latino men abstained from alcohol than their non-Latino White peers (35% vs. 26%); however, a greater proportion of Latino men reported frequent heavy drink-ing than nonLatino Black or White men (18% versus 15% and 12%, respectively). The same study found that from 1984 to 1995 the proportion of Latino men who reported three or more alcohol-related problems, such as driving while intoxicated, increased from 9% to 16% while the proportions of non-Latino White and Black men reporting alcoholrelated problems decreased. It has been suggested that some Latino men may consume alcohol as a way to cope with the psychological strain associated with their minority status (Laureano & Poliandro, 1991; Neff, 1986). Qualitative research in North Carolina identified alcohol use as a possible coping reaction to migration-related stress (Rhodes et al., 2009). Additionally, some Latino men may use heavy drinking as a strategy to circumvent cultural constraints that otherwise prevent expression of some emotions, such as anger, frustration, or loss (Perez, 2000). Much of the knowledge about Latinos’ alcohol use has been based on samples drawn from traditional Latino
We sought to quantify the association of social stressors with alcohol use among immigrant sexual and gender minority Latinos in North Carolina (n = 190). We modeled any drinking in past year using logistic regression and heavy episodic drinking in past 30 days using Poisson regression. Despite a large proportion of abstainers, there were indications of hazardous drinking. Among current drinkers, 63% reported at least one heavy drinking episode in past 30 days. Ethnic discrimination increased, and social support decreased, odds of any drinking in past year. Social support moderated the associations of English use and ethnic discrimination with heavy episodic drinking. Keywords Hispanic, gay, men who have sex with men (MSM), transgender, southeast US, drinking, binges
INTRODUCTION
Since 1990, the US Latino population has grown rapidly and is now the largest racial/ethnic minority group (Census Bureau, 2011; Ennis, Rios-Vargas, & Albert, 2011). Despite its size, the health status and needs of Latinos are poorly understood due to gaps in national databases, the heterogeneity of immigrant populations, a history of limited funding for Latino research, and relatively few researchers focusing on Latinos (Dovidio, Gluszek, John, Ditlmann, & Lagunes, 2010; North Carolina Institute of Medicine, 2003; Organista, 2007; Rhodes et al., 2007). Additionally, some Latinos may be reluctant to participate in epidemiologic studies because of their immigration status or perceived discrimination. Even less is known about sexual and gender minority Latinos, a sub-group that includes gay- and bisexually identified men, men who have sex with men (MSM) who do not self-identify as gay or bisexual, and gender variant or transgender in-
Address correspondence to Paul A. Gilbert, PhD, MSPH, Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-mail: [email protected]
1365
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communities (e.g., California, Texas, Florida, and New York) or national samples that mask regional variations; however, nontraditional settlement states have received increasing attention. Recent research in North Carolina found high levels of binge drinking among Latino men (Grzywacz, Quandt, Isom, & Arcury, 2007; Kim-Godwin & Fox, 2009), which was associated with Spanish language use and inversely associated with age and social support (Loury, Jesse, & Wu, 2011; Ornelas, Eng, & Perreira, 2011). These findings suggest a pattern of prevalent risky drinking that is driven by social stressors. As these studies presumed heterosexuality, however, they may not reflect alcohol use among sexual and gender minority Latinos in North Carolina. High levels of alcohol consumption and alcohol-related problems have also been reported for gays and lesbians, often exceeding those found among their heterosexual peers (Drabble, Midanik, & Trocki, 2005; Hughes, 2005; McKirnan & Peterson, 1989a; Stall et al., 2001; Stall & Wiley, 1988). Proposed explanations for the observed disparities have frequently focused on the greater experiences of stigma and discrimination due to minority sexual orientation or internalized negative attitudes about their sexuality (Cabaj, 1996; DiPlacido, 1998; McKirnan & Peterson, 1989b; Meyer, 2003). In other words, gays and lesbians experience stress as a result of their minority sexuality and may turn to alcohol or drugs to cope (Hatzenbuehler, 2009). Although sexual orientation has received far less attention than other types of social stressors, there is increasing support in diverse but predominantly White samples for the proposed association of gay-related stressors with alcohol use (Bux, 1996; Hamilton & Mahalik, 2009; McDermott, Roen, & Scourfield, 2008). Similar to the literature on drinking among Latino men, however, the findings are based on only a small number of studies that have explicitly tested such relationships. To date, very few studies have examined social stressors and alcohol consumption under the joint conditions of Latino ethnicity and minority sexual orientation or gender identity. Nevertheless, a small body of literature has emerged. One of the earliest reports found that immigrant Mexican MSM consumed alcohol at higher levels than their heterosexual immigrant Mexican peers (Tori, 1989) and showed higher levels of stress, which may be attributed to their sexual minority status. Extending these findings, other researchers found that internalized homosexual stigma was positively associated with amount of alcohol consumed (Bruce, Ramirez-Valles, & Campell, 2008) and with sex under the influence of drugs or alcohol (Ramirez-Valles, Kuhns, Campbell, & Diaz, 2010) among gay and bisexual Latino men and transgender Latino individuals in Chicago and San Francisco. To our knowledge, no other studies have measured stressors and alcohol use among sexual and gender minority Latinos. Social support may serve as a compensatory factor. There is substantial evidence of its beneficial effects for a wide variety of health outcomes (Gottlieb & Bergen, 2010; Heaney & Israel, 2008), and the field of public health now recognizes social support as an important de-
terminant of health, particularly as it may interact with other social characteristics such as socio-economic position and social integration (Grundy & Sloggett, 2003; Stansfeld, 2006; Weyers et al., 2008). Social support may buffer some of the disadvantages faced by sexual and gender minority Latinos; however, research to-date has largely been restricted to HIV-related topics (Carlos et al., 2010; Fekete et al., 2009; Wohl et al., 2010; Zea, Reisen, Poppen, Bianchi, & Echeverry, 2005). This reflects the preponderance of research on sexual behavior and relatively scant attention to the relationship between social support and other risky behaviors, including substance use, among this sub-group of Latinos. In this study, we sought to build upon the limited extant literature about alcohol use among immigrant sexual and gender minority Latinos. Drawing upon theory and empirical evidence, we derived a conceptual model to guide the study. The Transactional Model of Stress and Coping (Lazarus & Folkman, 1984) provided the basic structure, focusing on drinking as an active, avoidant coping response to stressors. We drew upon various Minority Stress Models (Clark, Anderson, Clark, & Williams, 1999; Harrell, 2000; Meyer, 1995, 2003) to identify specific sources of stress for the study population, including experiences of discrimination and internalized homonegativity, i.e. internalized negative attitudes about same-sex sexuality. A concurrent qualitative study suggested additional stressors. In individual interviews, age at migration and English language use were identified as key stressors among immigrant sexual and gender minority Latinos in North Carolina (manuscript in preparation). Social Support Theory provided a complementary mechanism to explain the hypothesized association of social stressors with drinking. Based on the Stress Buffering hypothesis (Cohen & Wills, 1985; Ganster & Victor, 1988), we expected that social support would weaken any association between social stressors and alcohol use. Our primary aim was to quantify the association of select social stressors with alcohol use among immigrant sexual and gender minority Latinos in North Carolina, a nontraditional settlement state that has experienced recent, rapid growth of its Latino population (Griffith, 2005; Kochlar, Suro, & Tafoya, 2005). Additionally, we tested whether social support moderated any relationship between social stressors and alcohol use among this sub-group of Latinos. METHODS Sample
Data for this study came from an investigation of HIV risk and protective factors among immigrant sexual and gender minority Latinos in North Carolina. A communitybased participatory research (CBPR) partnership guided the parent study and included representatives from public health departments, AIDS service organizations, universities, the local Latino community (including immigrant sexual and gender minority Latinos), and communitybased organizations serving the Latino community. The parent study used respondent-driven sampling (RDS) to
STRESSORS AND ALCOHOL AMONG GAY AND TRANSGENDER LATINOS
recruit participants. RDS is an extension of chain-referral methods that enables researchers to sample populations when no sampling frame can be established (Heckathorn, 1997; Magnani, Sabin, Saidel, & Heckathorn, 2005; Ramirez-Valles, Heckathorn, Vazquez, Diaz, & Campbell, 2005). Initially, the CBPR partnership identified eight seeds, participants chosen to represent the diversity of the local sexual minority Latino community (e.g., by level of “outness” about their sexual orientation, country of origin, gender identity, and HIV status). Nine additional seeds were enrolled during data collection to expedite recruitment in accordance with standard RDS procedures, for a total of 17 seeds. All participants were born outside the US, self-identified as Latino, were age 18 or older, and provided informed consent. Each seed completed a psychosocial and behavioral assessment (described further), received instruction on the study’s recruitment protocol and eligibility criteria, and recruited up to three additional participants from his social network. Each subsequent participant completed an assessment, received instruction on the study’s recruitment protocol and eligibility criteria, and recruited up to three new participants from his social network. Recruitment waves continued until the target sample size (n = 190) was met. All participants were compensated for completing their own assessment ($50) and for each referral that also completed an assessment ($20), a dual incentive process that is a hallmark of RDS methods. The Institutional Review Board (IRB) at Wake Forest University School of Medicine approved the parent study; the Public Health-Nursing IRB at the University of North Carolina at Chapel Hill approved this secondary analysis. Measures
The parent study’s CBPR partnership developed a comprehensive psychosocial and behavioral assessment, using established Spanish-language measures whenever possible and adapting established English-language measures or developing new measures when necessary. Following a committee approach, which is an increasingly preferred translation method (Behling & Law, 2000; Census Advisory Committees, 2004), a group of individuals with complementary skills was convened to translate the English items into Spanish. The group included professional translators (including native Spanish speakers from Mexico and Central America), a translation reviewer, content specialists, and a questionnaire design expert. Multiple group members made independent translations of the assessment, and the full committee met to discuss and reconcile the various versions. The CBPR partnership, which included native Spanish speakers, reviewed and approved the final Spanish translation. Although the parent study focused on HIV-specific outcomes (e.g., condom use, HIV testing), data were available to investigate alcohol use. Current drinking status was assessed by a single item about any alcohol use in the past year (coded 0 = none; 1 = any). Current drinkers were asked to select the most common reason for drinking from a list of seven options (1 = enhance sex; 2 = bored/for fun;
1367
3 = lose inhibitions; 4 = lonely/depressed; 5 = physical pain; 6 = other; 7 = do not know) and to report the number of heavy episodic drinking episodes in the past 30 days, defined as five or more drinks on a single occasion. Among migration related stressors, language use was measured by the language sub-scale of the Short Acculturation Scale for Hispanics (Marin, Sabogal, Marin, OteroSabogal, & Perez-Stable, 1987). Five items assessed participants’ language use in a variety of situations, such as “what language(s) do you usually speak with your friends?” Participants responded on a five-point bipolar scale (coded 1 = exclusively Spanish to 5 = exclusively English; α = 0.92). Because a majority (59%) of participants spoke exclusively Spanish or more Spanish than English, we modeled language use in terms of English acquisition, with exclusive Spanish speakers serving as the referent group. Participants also reported the number of years they lived in the US, which we used as a proxy for duration of cultural contact. We calculated age at migration by subtracting participants’ self-reported years in the US from self-reported age at time of interview, then created a dichotomous indicator for migration as an adult, (coded 0 = migration at age
