Chapter 5: Racial, Ethnic, and Cultural Considerations

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• To better understand the extent to which race, ethnicity, and culture may (or may not) contribute to substance abuse risk

• To better understand how substance abuse prevention activities can be selected and implemented so that they are most relevant to the youth for whom they are intended

• Definitions
• Migration, acculturation, and substance abuse
• Ethnic/cultural backgrounds

"The cultures from which people hail affect all aspects of mental health and illness, including the types of stresses they confront, whether they seek help, what types of help they seek ... and what types of coping styles and social supports they possess ... Just as health disparities are a cause for public concern, so is our diversity a national asset" (U.S. Department of Health and Human Services, 2001.).

Definitions

• Race

• Scientific evidence has failed to demonstrate a biological basis for race (US DHHS, 2001).

• Likewise, there is no evidence that race predisposes individuals to particular kinds of behavior; race alone is not a good predictor of substance abuse.

• Broader social issues—most often associated with the various legacies of historical oppression and based on notions of race—that have the potential to affect risk and protective factors most likely result in elevated or diminished rates of substance abuse.

• Ethnicity

• Ethnicity relates to the word ethnic, which means belonging to a common group—often linked by race, nationality, and language—with a common cultural heritage and/or derivation.

• Race and ethnicity are dominant elements of culture.

• Culture

• Culture refers to the shared values, traditions, norms, customs, arts, history, folklore, and institutions of a group of people who are unified by race, ethnicity, language, nationality, and/or religion.

• Culture affects the way people respond to messages communicated through various channels and is often interwoven into the way drugs are used in various communities.

View Figure 1: Percentage of Individuals Living Below the Poverty Level According to Race/Ethnicity

• Race, ethnicity, and risk for substance abuse

• There are generally more similarities across racial/ethnic groups than there are differences.

• There are likely more similarities among youth of a particular age who have unique developmental and cultural characteristics than there are differences by race, ethnicity, or the broader societal culture.

• Contextual rather than interpersonal or individual factors may be the key to understanding substance abuse differences, namely:

• Laws and norms favorable to use.
• Availability of drugs.
• Neighborhood poverty and disorganization.



• View Figure 2: Youth Aged 12-17: Percentages of Substance Abuse by Ethnicity

• The importance of understanding culture

• Language and symbols: identify the most effective method of transmitting information

• Body language: recognizing the different meanings associated with gestures

• Substance abuse views: learning and applying to prevention efforts those elements of culture that are discourage substance abuse

• The "majority" culture: understanding the implications of these elements for other ethnic groups

• Youth culture: learning about the elements of culture common to young people

• Practical Points: Reaching Youth of Different Racial/Ethnic/Cultural Backgrounds

• Diversity, multiculturalism, and multiracialism

• A curriculum that is culturally responsive capitalizes on youths' cultural backgrounds rather than attempts to override or negate them. Likewise, such a curriculum is sensitive and responsive to bias in textbooks and other instructional materials, including:

• Invisibility.
• Stereotyping.
• Selectivity and imbalance.
• Unreality.
• Fragmentation and isolation.
• Language bias.



• Working successfully with a multicultural population

• Recognizing common values (all youth want to feel that they belong)

• Recognizing differential power (some groups "belong" more than others)

• Conducting interventions to reduce prejudice and discrimination

• Practical Points: Multicultural Youth

• Working Successfully With Multiracial Youth

• Multiracial youth often have distinct advantages and disadvantages in comparison with their single-race classmates

• Understanding the variety of beliefs, attitudes, and concerns of interracial youths and their families can help prevention leaders develop sensitivity to some of the strengths and needs that these young people may present in the classroom.

Migration, acculturation, and substance abuse

• Migration, levels of assimilation and acculturation, language, and cultural values represent unique considerations for planning culturally targeted interventions.

• Recent immigrants may experience any or all of the following:

• Language and cultural barriers

• Unemployment or underemployment

• Educational, social, and health difficulties

• Pressures of being new, poor, and members of a minority in an unfamiliar community

• Feelings of loss, grief, separation, and isolation as they adjust to a different way of life

• Disruption of family roles and community support

• A variety of emotional and cognitive adjustments associated with education, language, and social factors

Ethnic/cultural backgrounds

• Overview of African-American Youth

• Historical perspectives

• African Americans share major historical experiences that are distinct from the experiences of any other minority group in the United States.

• A major distinction for African Americans is that, in contrast to the voluntary immigration of other minority groups, many of their ancestors were forcibly imported into the United States from the 17th to the 19th centuries and placed into a system under which they were treated as property.

• Cultural values and traditions

• Rites of passage
• Cooperative and individual worship/religiosity
• Eldership
• Extended family networks
• Adaptable family roles
• Respect for the collective worth of the community



• Risk factors for drug abuse

• African Americans are more likely than other ethnic groups to:

• Experience homelessness
• Be incarcerated
• Have children in the foster care and child welfare system
• Be exposed to violence
• Experience post-traumatic stress disorder



• Components of ethnic identity interact with other factors to reduce risk or enhance protection against drug use

• Prevalence of drug abuse

• Overall levels of substance abuse among African-American adults have been lower than those among non-Hispanic whites and Hispanics.

• African-American youth are less likely to be involved in substance abuse than non-Hispanic white, American Indian/Alaska Native, or Hispanic/Latino youth until they approach the age of 20 years.

• Religiosity may be one explanation for lower substance abuse rates.

• Practical Points: African-American Youth

• Overview of American Indian/Native Alaskan Youth

• Historical perspectives

• The contemporary problems of substance abuse among many tribes can best be understood in the context of the social, cultural, and tribal diversities and the geopolitical realities of American Indian life.

• Cultural values and traditions

• Anthropologists group American Indian and Alaska Native populations into 10 main "cultural areas."

• California
• Northwest Coast
• Southwest
• Southeastern
• Great Plains
• Eastern Woodlands
• Great Basin and Plateaus
• Subarctic
• Arctic



• Specific values

• A mix of sacred and social events
• Highly respected elders
• Presence of spiritual leaders
• Great variation in beliefs from tribe to tribe
• Coping strategies that draw on traditional sources of strength, including family, the tribe, and the land



• Risk factors for drug abuse

• Many etiological influences on substance abuse among American Indians and Alaska Native youth are the same as for other ethnic groups.

• Relatively high rates of substance abuse are not the result of anything inherent in American Indian tradition.

• American Indian youth face uncertainty and integration problems more than any other population group and suffer more severely from many problems, of which the following have been found to be most important as predictors of substance abuse:

• Lack of integration into either a traditional American Indian or mainstream society

• Lack of clear-cut sanctions against alcohol and other drug abuse

• Peer pressure. Higher levels of alcohol and other drug abuse have been found among more acculturated (to mainstream society) youth than among those who do not perceive themselves as acculturated

• Prevalence of drug abuse

• While prevalence rates vary significantly from tribe to tribe, overall, American Indian and Alaska Native youth show high levels of substance abuse compared with the national average for all youth and that of other racial/ethnic groups.

• Practical Points: American Indian/Alaska Native Youth

• Overview of Asian-American and Pacific Islander Youth

• Historical perspectives

• The mid- to late 1800s brought witnessed the immigration of a quarter of a million Chinese immigrants, primarily for the purpose of working in mines and on railroads.

• Japanese immigrants originally migrated to Hawaii to work on plantations eventually settled in California, where most immigrants worked in agriculture.

• In the early 1880s, and again in the early 1900s, the United States passed legislation aimed at limiting the immigration of various Asian groups, beginning with the Chinese and followed by restrictions on immigration of Japanese, Koreans, and Filipinos.

• Unlike people of Asian origin living in the United States, Pacific Islanders are not primarily immigrants. Their presence in the United States is for the most part a result of the colonization of Hawaii and of the United States taking administrative responsibility for other Pacific territories, such as Guam and American Samoa.

• Cultural values and traditions

• Denial and concerns about the stigma associated with substance abuse may be barriers to parents' involvement in prevention and/or treatment efforts.

• Many Pacific Islander cultures have a holistic world view that is built on a strong interrelationship among the spiritual world, family, community, and universe.

• Most Southeast Asian groups share cultural values that influence parental socialization practices. Children are taught to respect their parents, older siblings, and other adults in positions of authority (e.g., teachers), and individual family members are made aware of their place in the hierarchy.

• In Southeast Asian cultures, individuals strive to attain the Confucian goal of harmony in social relationships and in life in general. They emphasize the family as the most important factor in their childrearing practices.

• Many Asian/Pacific Islander populations, particularly those from the Pacific Islands, have oral traditions for communicating information and messages.

• Historically, under the influence of Chinese Confucianism, East Asians developed complex, literate cultures and cohesive family organizations.

• In Cambodian culture, as well as in other Asian/Pacific Islander cultures, there is tight control of relationships between boys and girls, and marriages are often arranged. This is an issue that leads to highly stressful and painful relations between Asian/Pacific Islander parents and their adolescent children, often resulting in children running away and/or becoming involved with gangs and substance abuse.

• Southeast Asians have a polychronic time framework, versus the monochronic time framework present among Western populations. Polychronic time allows different social interactions to happen at the same time; in contrast, monochronic time demands a linear scheduling of events.

• Asian/Pacific Islander communication relies more on presumptions shared by people, nonverbal signals (e.g., body movement), and the situation in which the interaction occurs.

• Risk factors

• There is less research focused on Asian/Pacific Islander Americans than on other ethnic groups

• There may be a greater tendency in Asian-American/Pacific Islanders to internalize rather than express stress.

• Other risk factors for Asian/Pacific Islander youth include:

• A high immigration rate.
• Problems with language.
• Peer network changes.
• Educational system changes.
• Lack of community support systems.



• Prevalence of drug abuse

• Asian/Pacific Islander youth aged 12- to 17 years report the lowest rates of alcohol, cigarette, and illicit drug use of all racial and ethnic groups.

• Practical Points: Asian/Pacific Islander-American Youth

• Overview of Hispanic/Latino Youth

• Hispanics/Latinos represent a variety of racial and ethnic groups with different histories, occupations, educational levels, social service utilization levels, and degrees of assimilation into mainstream American culture, among other distinctions.

• Historical perspectives

• The experience of Hispanic and Latino groups in the United States has been largely determined by the reason for a given group's migration.

• Cubans, Central Americans, Mexicans, and Puerto Ricans all have distinct historical experiences in the United States.

• Cultural values and traditions

• As with historical experiences, cultural values and traditions may vary according to nation of origin.

• Hispanic/Latino culture has been identified as having a collectivist orientation, in which the needs, goals, values, and expectations of the group are emphasized.

• Collectivism has been associated with high levels of personal interdependence, conformity, readiness to be influenced by others, trust of group members, and mutual empathy. This value orientation stands in stark contrast to the competitive, individualistic, and achievement-oriented U.S. mainstream culture.

• Other traditional Hispanic cultural values include:

• La unidad de familia (the enduring alliance of the family).
• Respeto (the value of rituals and ceremonies and respect to elders).
• Dignidad (individual self-worth).
• Confianza (a close, trusting relationship).
• Caridad (assisting, supporting, and tangibly aiding others in need).



• Risk factors

• Data from a number of studies have suggested that Hispanic/Latino youth are at high risk for use of alcohol and other drugs.

• Some of these studies suggest that parental and sibling alcohol use are the best predictors of alcohol use by young Mexican-American boys (but not girls). Other studies indicate that parents' attitudes and use of licit and illicit drugs play an important role in their children's drug abuse behaviors.

• The processes of migration and acculturation often produce conflicts and strains within the Hispanic/Latino family and increase the risk of substance abuse.

• Some studies have indicated that Hispanic/Latino youth whose parents are more acculturated into American society are at higher risk for using drugs. These studies have shown that foreign-born adolescents who have lived in the United States for over 2 years have higher rates of alcohol and illicit drug abuse than those who have lived here less than 2 years.

• Prevalence of drug abuse

• Hispanic/Latino youth generally report prevalence rates of alcohol, tobacco, and other substance abuse lower than those of American Indian/Alaska Native and non-Hispanic white youth but higher than those of African-American and Asian/Pacific Islander youth (SAMHSA, 2003).

• Practical Points: Hispanic/Latino Youth

• Understanding Non-Hispanic White Youth

• Cultural values and traditions

• Mainstream cultural values are often defined as those of Americans of European origin.

• As such, mainstream American cultural values include:

• Competition.
• Productivity.
• Objectivity.
• A proactive approach to life.



• Other typical non-Hispanic white American beliefs include:

• The concept that man has power over nature.
• The idea that nature itself has laws; everything that happens can be scientifically explained.
• The importance of being the first to "climb the ladder" of success.
• The importance of striving to be the best.



• Risk factors

• Social research has identified many indicators that place youth at risk for problems ranging from hyperactivity to dropping out of school to becoming involved with crime and drug abuse.

• Non-Hispanic white youth share with other racial/ethnic subgroups many of the risk factors for such problems, including drug abuse.

• Prevalence of drug abuse

• Rates of current illicit drug abuse among adolescents aged 12 to 17 years were slightly higher for non-Hispanic whites than for African-Americans and Hispanics/Latinos. With respect to absolute numbers, most current illicit drug abusers are non-Hispanic whites.

• Likewise, non-Hispanic white adolescents have the second highest rate of reported drinking during the past 30 days and the second highest rate of binge drinking, exceeded only by American Indian/Alaska Native youth.

• Practical Points: Non-Hispanic White Youth