Definitions of Culture & Worldview

1. “Race is not a terrible word to me…Maybe because my nature is already mixed. The word race encourages me to remember the influence of eroticism in history. For that is what race memorializes. Within any discussion of race, there lurks the possibility of romance” “I think Brown marks a reunion of peoples, an end to ancient wanderings. Rival cultures and creeds conspire with Spring to create children of a beauty, perhaps of a harmony, previously unknown…The terrorist and the skinhead dream in solitude of purity and the straight line [racial & ethnic purity] because they fear a future that does not isolate them.” Richard Rodriguez; Brown: The Last Discovery of America, 2002

2. Definitions of Culture & Worldview • Culture – a shared system of values, beliefs, and learned patterns of behaviors; knowledge, experience, values, ideas, attitudes, skills, tastes, and techniques passed on from more experienced members; not simply ethnicity or race • Worldview – the way individuals or groups of people look at the universe to form values about their lives and the world around them

3. Elements of Culture • Attitudes and behavior related to literature, art, and other forms of expression • Formal codes related to wellness and sickness • Beliefs about recreation and methods of spending leisure time • Verbal and nonverbal communication • Physical appearance and grooming • Expectations of ceremony, both for special and ordinary occasions • Principles of ethnics • Space requirements of individuals • Attitudes toward being on time or being early • Beliefs regarding those of differing status, with regard to age or wealth • Attitudes related to heroes, traditions, legendary characters, superstitions • Attitudes toward merit and motivation • Beliefs about gender roles • Significance of spirituality

4. Examples of Factors Determining Culture or Worldview • Race/Ethnicity • National Origin • Sexual Orientation • Alcoholism • A Profession

5. Definitions of Acculturation • The modification of the culture of a group or individual as a result of contact with a different culture. • A process in which members of one cultural group adopt the beliefs and behaviors of another group. • Acculturation has been conceptualized as linear and as multidimensional (e.g., ethnic identity, language, nativity). • Acculturation simultaneously evolves in various critical arenas that include experiences that create stressors for individuals and families. • Acculturation has population-level and individual-level effects. • Acculturation factors have been shown to account for considerable within-group variation in Latino adolescent behavior; within-group differences tend to account for more variance in both biological and psychological phenomena than do between-group differences

6. Acculturative Model of Adolescent Substance Use • Context of Exit • Developmental Stage of Child/Adolescent • Family Circumstances Prior to Migration • DRUG USE BEHAVIORS • AOD Use/Abuse • Deviant Peer Associations • School Problems • Family Problems • Family Stress • Loss of “Traditional” Family Values • Family Acculturation Stress • Immigration Experience • Circumstances of Exit • Circumstances of Entrance • Acculturation Stress • Development of Minority Status • Parental Acculturation Stress • Acculturation Process • Social Context • Parental Acculturation • Acculturation of Children • Segmented Assimilation • Assimilation into “Local” Culture

7. Past Month Alcohol Use in a Community Cohort

8. 30-Day Alcohol Use by Time Lived in the U.S.(Gil, Wagner & Vega, J. Comm. Psych., 2000)

9. Past Month Alcohol Use By Level of Acculturation

10. Level of Acculturation By Family Factors

11. Intervention Research with Ethnic Minorities (G.C. Nagayama Hall, JCCP, 2001) Empirically supported therapies are treatments that have been demonstrated to be superior in efficacy to placebo or another treatment “…there is not adequate empirical evidence that any of these empirically supported therapies (ESTs) is effective with ethnic minority populations”

12. Psychotherapy Research with Ethnic Minorities (G.C. Nagayama Hall, JCCP, 2001) Culturally sensitive therapiesare treatments that have been tailored to specific cultural contexts “…there is not adequate empirical support that culturally sensitive psychotherapies (CSTs) are efficacious with ethnic minority populations”

13. Psychotherapy Research with Ethnic Minorities (G.C. Nagayama Hall, JCCP, 2001) “the approaches (EST&CST) need one another for the field of psychotherapy research with ethnic minorities to be advanced”

14. Key Dimensions of Culturally Sensitive Interventions • Socioeconomic Status • Poor vs. rich • Acculturation Status • Hispanic/Latino vs. American, ethnic orientation, ethnic identity • Nativity • Foreign vs. U.S. • Language Preferences • English vs. Spanish • Cultural Beliefs & Practices • Low vs. high distress threshold, time orientation, interpersonal relationships • Acculturation Stress • Perceived discrimination, individual acculturative stress, family acculturative stress • Developmental Status • Younger vs. older • Developmental trajectory in the U.S.

15. Percent Alcohol Use Days at Baseline and Post-Intervention (Gil, Wagner, & Tubman, Addiction, 2004) Note: Baseline and post-intervention measures consisted of use in prior 30 days. Average time from baseline to post-intervention was 10.9 weeks.

16. Percent Marijuana Use Days at Baseline and Post-Intervention Note: Baseline and post-intervention measures consisted of use in prior 30 days. Average time from baseline to post-intervention was 10.9 weeks.

17. Effect of Cultural Variables on Treatment Outcome for U.S.-Born Hispanics (n = 58) STEP/IV ENTERED  R2total R2change Analysis 1 (DV Post # alcohol days) 1. Baseline alcohol days .021* .021* 2. Hispanic ethnic orientation .445** .210*** .191*** Analysis 2 (DV Post # alcohol days) 1. Baseline alcohol days .019 .019 2. Hispanic ethnic pride .427*** .197*** .178*** Analysis 3 (DV Post # of drinks) 1. Baseline # of drinks .016 .016 2. Hispanic ethnic orientation .280* .094* .078* Analysis 4 (DV Post # of drinks) 1. Baseline # of drinks .016 .016 2. Hispanic ethnic pride .354** .142** .126** * p < .05; ** p , .01; *** p < .001.

18. Culturally Sensitive Treatment: Delivery Issues • Intervention programs usually developed for non-Latino populations • Attend to “Surface” issues first: • Accessible location for intervention • Bilingual staffing • Respect and consideration of cultural beliefs and expectations • Attend to “deep” issues later: • Differential levels of acculturation within the family • When using interventions that derive from work with non-Latino populations consider “amenability-to-treatment” elements • Acculturation • Acculturation Stress • Nativity • Problem orientation • Focus on concrete present-oriented factors

19. Questions Regarding Ethnicity • What is required of a interventionist to be able to work with minority populations? • Should we strive to match client-interventionist ethnicity? • In terms of your own ethnic background, how would your family react to the notion of an ATOD prevention program for… • Adults? • Teenagers? • The Elderly?

20. Hot Button Issues • Superstitions/Customs • Death/dying • Religious beliefs • Family role • Patient autonomy • Dietary practices • Physical space/body language