Frank R Dillon PhD Center for Research for Substance Use and HIVAIDS Research on Latinos in the United States CSALUD Florida International University Prepared for CSALUD BiAnnual conference April ID: 760500
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Patria Rojas, Ph.D., M.P.H., M.S.W. Frank R. Dillon, Ph.D.Center for Research for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD)Florida International UniversityPrepared for: C-SALUD Bi-Annual conference, April 26, 2011
Adult Latina Drug Use & HIV Risks:Clinical Implications from an Intergenerational Study of Mothers & Daughters
ACKNOWLEDGEMENTS
This study was supported by award number P20MD002288 from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities, or the National Institutes of Health
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Slide2Road Map
Why Study Adult Latina Mother-Daughter
Drug use and HIV/AIDS risk?Overview of Study Methods and SampleMain FindingsQuestions and DiscussionHow do study findings inform clinical services for Latina women in Miami Dade county?Your recommendations for integrating findings with community practice?
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Slide3Background
The
Women’s Study Primary Study of The Latino Minority Drug Abuse Research Program (NIDA R24DA14260, Dr. Mario De La Rosa, PI)Foundation for Ongoing Longitudinal Study - Trajectories of Drug Abuse and HIV Risk among Latina Mother-Daughter Dyads (NINR R01NR012150).
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Slide4Why
Study Adult Latina Mother-Daughter Drug use & HIV/AIDS risk?
HIV/AIDS & Drug Abuse among Latinas in the U.S.Escalating health disparitiesNationally, the rate of infection among Latina women is nearly four times that of non-Latina White women (CDC, 2010). HIV/AIDS is the 3rd leading cause of death among Latina women in Florida age 25 - 44 years (Florida Department of Health-FDOH, 2011).
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Slide5Latino
illicit drug use rates have increased steadily since 2002 [Substance Abuse and Mental Health Services Administration (SAMHSA), 2008].Latina adults also experience disparate negative consequences from drug use disorders (Amaro et al., 2006) Intimate partner violenceIncarcerationHomelessnessMedical problems
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Why
Study Adult Latina Mother-Daughter Drug use
& HIV/AIDS
risk
?
Slide6Adult Latinas in the U.S.
A vulnerable & understudied population in the drug abuse and HIV/AIDS prevention fields (Volkow, 2006).Risk & protective processes determining drug use & HIV risk behaviors of adult Latinas remain relatively unknown (Canino, 2004). The Women’s Study Aims to better understand potential risk & protective processes by studying adult Latina mother-daughter dyads
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Why
Study Adult Latina Mother-Daughter Drug use
& HIV/AIDS
risk
?
Slide7What is Attachment?
Attachment
A consistent emotional bond that an individual experiences toward significant others such as family, friends, and other important people in his or her life (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1969/1982, 1973). Secure attachment to parents, friends, and others in adolescents and adults is associated with psychological adjustment, school achievement, and self-esteem (Armsden & Greenberg, 1987; Buhrmester, 1990; Bukowski, Hoza, Boivin, 1993; Hartup, 1996; Nickerson & Nagle, 2004).
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Slide8The Importance of Latina Mother-Daughter Attachment
Latina Mother-Daughter Attachment
Armsden & Greenberg (1987) conceptualized attachment beyond childhood (across all stages of development) to consist of: Mutual trust of othersCommunication with othersCloseness to othersThe Women’s Study was also guided by the Bogenschneider (1996) ecological risk / protective modelA theoretical perspective that emphasizes family relations as the primary context for human development across the lifespan
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Slide9Supportive
parent-child relations play a powerful positive role in the lives of Latinos (De La Rosa & White, 2001; Gonzalez Castro et al., 2007). E.g., Healthy family cohesion or familismo is associated with Latina/o adult functioning and wellness across the lifespan (Gil, 1996; Gil & Vega, 1996; Vega, Kolody, & Valle, 1986; Rivera et al., 2008). We expected that mother-daughter attachment would be inversely linked to drug abuse and HIV risk behaviors among Latina mothers and their daughters.
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The Importance of Latina Mother-Daughter Attachment
Slide1010
Overview
of Study Methods
and
Sample
Slide11Data collected from drug abusing and non-abusing mother-daughter dyads in Miami-Dade via interviews from 2002-2005.
Criteria for mothers & daughters to be included into community-based study:consenting to be interviewed for at least 2-3 hours18 years old or olderself-identifying as Latinaliving in Miami-Dade County, Fl.
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Methods
Slide12P
articipants recruited via snowball sampling method (chain referral; McCracken et al., 1987)Non-drug abusing Latinas:community health fairs, health clinics, radio announcements on local Spanish-language stations, and advertisements on local television channelsDrug abusing Latinas:substance abuse support groups such as Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) meetings and by advertising in a local alternative newspaper, FM radio station, and announcements posted at local drug court program
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Methods
Slide13All measures were
pilot-tested to ensure cultural and linguistic sensitivity to Latino culture and to womenInterviews were conducted in either Spanish (65%) or English (35%) by trained women interviewers using a structured questionnaireThe interview took 2-3 hours to complete, and took place at locations convenient to participants. 69% at home19% at university’s offices12% other places (work, public places)
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Methods
Slide14316 mothers & daughters were interviewed
On average, mothers were 52 years old (range of 33-88), daughters were 28 years old (range of 18-48)Each participant was classified as a non-substance abuser or substance abuser based on the following criteria:Alcohol abuser: at least 4-5 glasses of wine, 3-4 cans/bottles of beer, or 3-4 four-ounce drinks of hard liquor per occasion-during the 12 months prior to assessment (adapted from Naimi et al., 2003)Illicit drug abuser: at least 3 days per week of marijuana use, 2 days per week of cocaine use, one or more occasions of heroin use per week, and/or least 3 ecstasy use occasions per month during the 12 months prior to assessment (adapted from Turner et al., 2001)Abuse of prescribed medication: medicine use without a doctor’s authorization, in larger amounts than prescribed, or for longer periods than prescribed, in the 12 months prior to assessment (adapted from Turner et al., 2001)
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Methods
Slide15Mothers & daughters were classified into 4 types of dyads
Dyad 1: mother-daughter both drug or alcohol abusers (n=40)Dyad 2: mother-abuser and daughter–non-abuser (n=19)Dyad 3: mother-non-abuser and daughter-abuser (n=51)Dyad 4: mother-daughter both non-abusers (n=48)Total Dyads = 158
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Methods
Slide16Top Drugs of Abuse
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Mothers
Daughters
Alcohol Use (59.6%)
Non-medically prescribed sedative use (27.5%)
Marijuana Use (8.1%)
Cocaine Use (6%)
Alcohol Use (79.2%)
Marijuana Use (35.8%)
Cocaine Use (12.8%)
Non-medical prescription drugs (12.2%)
Slide17Differences in Age across Dyads
Slide18Demographics: Nativity
Most mothers were immigrants (84%,
n = 133)Approximately half of daughters (54%, n = 86) were immigrants.
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DAUGHTERS
Slide19Countries of Origin Across Dyads
Slide20Demographics and Drug Abuse
Findings suggest
that age and nativity (acculturation) are related to adult Latina drug abuse.Additional age related findingOn average, the younger a drug abusing mother started using illicit drugs (M = 26.5 years), the younger her daughter reported starting using illicit drugs (M = 18.4 years).
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Slide21Demographics: Personal Income
Personal Income during past year
median = $5,000 to $9,999No significant difference across dyads
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Slide22Demographics: Education Level
Education Level
Median = “post-high school training”No significant difference across dyads
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Slide23Demographics: Employment Status
Current Employment Status
No significant difference across dyads
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51.6
%
Slide24Demographics: Others
Marital Status:
41% of mothers married29% of daughters marriedNo significant difference across dyadsSeparation from MotherApproximately 18% of daughters were separated from mothers during developmentA control variable
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Slide25Main Results
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Main Results
Slide26Mother-Daughter Attachment & Drug Abuse
(De La Rosa et al., 2010)
Slide27Mother-Daughter Attachment & Drug Abuse
(De La Rosa et al., 2010)
IMPLICATIONS
:
Mother-daughter attachment & drug abuse findings emphasize
the need for mother-daughter-based
prevention/treatment
efforts; especially with drug abusing mothers, to reduce
potential intergenerational transmission of drug use disorders among Latina
women
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Slide28Mother-Daughter Attachment & HIV Risk Behaviors
(De La Rosa et al., 2010)
Sex Under the Influence (SUI)61% of daughters engaged in SUI of alcohol during past year28% reported engaged in SUI of illicit drugs during past year
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Slide29Sex under the Influence of Illicit Drugs (SUI-D)
Drug abusing daughters with a drug abusing mother (dyad 1) reported more SUI-D.Daughters who reported less attachment reported more SUI-D.
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Mother-Daughter Attachment & HIV Risk Behaviors
(De La Rosa et al., 2010)
Slide30Sex under the Influence of Alcohol (SUI-A)
Younger daughters reported more SUI-A.Unmarried daughters (81%) reported more SUI-A. Non-abusing daughters with non-abusing mothers (Dyad 4) reported less sex under the influence of alcohol than all other dyads.
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Mother-Daughter Attachment & HIV Risk Behaviors
(De La Rosa et al., 2010)
Slide31IMPLICATIONS
: Attachment and SUI findings emphasize the need for mother-daughter-based prevention/treatment efforts; especially with drug abusing mothers, to reduce HIV risk behaviors among young Latina women.
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Mother-Daughter Attachment & HIV Risk Behaviors
(De La Rosa et al., 2010)
Slide32Age of Sexual Debut (Dillon et al., 2010; Rojas et al., 2010)
Averages among Daughters:
Vaginal Sex = 16 yearsOral Sex = 17 yearsAnal Sex = 22 yearsDaughters reported younger ages of sexual debut when theyspent more time in the U.S. (M= 65% of life) experienced maternal drug abuse during development.The younger daughters started having sex, the more likely they reported Future drug abuse and HIV risk behaviors (greater number of sexual partners, sex under the influence) as adults.IMPLICATIONS: These findings inform HIV/AIDS and drug abuse clinical services with Latina population in Miami-Dade County.
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Slide33Condom Use Among Latinas
133 women engaged in vaginal sex and were told about HIV by their healthcare providers.
75% of the participants used condoms sometimesReasons they did not use condoms in instances:Wanted pregnancyCondoms were not availableThey were in a monogamous relationship and trusted partners.Reasons women used condoms in instances:They were with a new partnerTo prevent STDs and HIVBecause they were available
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Slide34Condom Use Among Latinas
Slide35Reasons for using condoms
all the time
during vaginal sex
Condom Use Among Latinas
Slide36Implications:
Latinas associate condoms with distrust in a relationship or partner.Latinas believe that being in a monogamous relationship means that they are not at risk of acquiring HIV or other STIs.Married or women with a main partner were less likely to use condoms.
Condom Use Among Latinas
Slide37Questions & Discussion
Implications of study findings for clinical services for Latina women in Miami Dade county
?Recommendations for integrating findings with community practice?
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